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Evaluation of the efficacy and safety of long-term intake of a dietary supplement containing salmon nasal cartilage-derived Proteoglycan on subjects with subjective knee symptoms-an open study
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OAK 3 - Non-arthroplasty tx of OAK
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Proteoglycans, in addition to collagen and hyaluronic acid, are contained in large amounts in connective tissues, such as cartilage and skin, as important components of the extracellular matrix. Recently, a method using acetic acid solution for extracting proteoglycans from salmon nasal cartilage was developed, and it was shown that salmon nasal cartilage-derived proteoglycan (SPG) exerts anti-inflammatory as well as skin-beautifying effects. However, the effects of SPG on the articular cartilage have not yet been investigated. In this study, we evaluated the effects of long-term intake of SPG on arthralgia (both objective findings and subjective symptom) and the serum/urinary levels of cartilage metabolism markers, as also its safety, in 12 subjects (3 male and 9 female, aged 40 to 74 years old; mainly Kellgren-Lawrence (K-L) grade 0-II) suffering from mild knee pain. The study was designed as an open study, and the subjects took one test food capsule daily containing a SPG dose of 10 mg/day for 12 weeks. For the efficacy endpoints, the parameters frequently used for efficacy evaluation in patients with arthritis were selected: the scores on the Japanese Knee Osteoarthritis Measure (JKOM), scores of arthralgia measured on a visual analogue scale (VAS) to evaluate the patients' subjective symptom of knee pain, and scores on the Japanese Orthopaedic Association's Knee Osteoarthritis Therapeutic Response Rating Scale (JOA), a rating scale based on objective findings. In addition, the serum/urinary levels of C2C and CTX-II, both markers of cartilage type II collagen degradation, and of CPII, a marker of cartilage type II collagen synthesis, were measured to evaluate the effect of SPG on cartilage metabolism. Furthermore, the serum type II collagen degradation/synthesis ratios (C2C/CP II ratio and CTX-II/CP II ratio) were used as indicators to evaluate the effect of SPG on type II collagen metabolism. (UMIN000033138) The results revealed significant improvement of the scores on all subscales of the JKOM, the VAS scores for arthralgia under all three conditions examined (pain at rest, pain on walking, and pain on ascending/descending stairs), and the scores on 3 of the 5 subscales of JOA ("pain/walking function," "pain/step up and down function" and "aggregate total symptoms") at 12 weeks as compared with the values at the baseline. Of these subscales, the score for " I. severity of knee pain," an subscale of the JKOM and the VAS scores for pain severity during "walking" and "stair negotiation" began to decrease significantly by 2 weeks after the start of SPG intake, while the scores for the remaining subscales showed significant improvement by 8 weeks of intake. SPG was confirmed to have a persistent rather than a transient effect in improving the pain. Furthermore, of the cartilage metabolism markers, the serum level of C2C, a marker of cartilage type II collagen degradation, as well as that of CP II, a marker of cartilage type II collagen synthesis, were significantly increased at 12 weeks as compared with the values the baseline (P<0.01 for both). Furthermore, the C2C/CPH ratio, which is considered to represent the balance between type II collagen degradation and synthesis, tended to be lower at 12 weeks as compared with that at the baseline (P=0.085), suggesting that the intake of the test food may lead to the relative suppression of cartilage degradation (or relative enhancement of cartilage synthesis). The above results confirm that SPG provides relief from mild knee pain in individuals with mainly K-L grade 0 to II, and can be taken safely. The intake of SPG was not associated with any adverse reactions or abnormal changes of the laboratory test results during the study period.
| 104,077 |
0 |
The Effect of High- and Low-Damping Prosthetic Foot Structures on Knee Loading in the Uninvolved Limb Across Different Walking Speeds
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OAK 3 - Non-arthroplasty tx of OAK
|
Lower limb amputation has been associated with secondary impairments such as knee osteoarthritis in the uninvolved limb. Greater knee loading in the frontal plane has been related to severity and rate of progression in knee osteoarthritis. Reduced push-off work from the involved limb can increase uninvolved limb knee loading. However, little is known about specific effects that prosthetic foot damping may have on uninvolved limb loading. We hypothesized that uninvolved limb peak knee internal abduction moment (IAM) and loading rates would be greater when using a high-damping foot compared with a low-damping foot, across walking speeds. Eight healthy, young subjects walked in a prosthesis simulator boot using the experimental feet. Greater uninvolved limb first peak IAM (+16% in fast speed, P = .002; +11% in slow speed, P = .001) and loading rates (+11% in fast speed, P = .003) were observed when using the high-damping foot compared with low-damping foot. Within each foot, uninvolved limb first peak IAM and loading rates had a trend to increase with increased walking speed. These findings suggest that damping properties of prosthetic feet are related to uninvolved limb peak knee IAM and loading rates.
| 101,296 |
0 |
Repair of osteochondral defects mediated by double-layer scaffolds with natural osteochondral-biomimetic microenvironment and interface
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Osteochondritis Dissecans 2020 Review
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Tissue engineering provides a new approach for the treatment of osteochondral defects. However, the lack of an ideal double-layer scaffold with osteochondral-biomimetic microenvironment and interface similar to native articular tissue greatly limits clinical translation. Our current study developed a double-layer acellular osteochondral matrix (AOM) scaffold with natural osteochondral-biomimetic microenvironment and interface by integrating ultraviolet (UV) laser and decellularization techniques. The laser parameters were optimized to achieve a proper pore depth close to the osteochondral interface, which guaranteed complete decellularization, sufficient space for cell loading, and relative independence of the chondrogenic and osteogenic microenvironments. Gelatin-methacryloyl (GelMA) hydrogel was further used as the cell carrier to significantly enhance the efficiency and homogeneity of cell loading in the AOM scaffold with large pore structure. Additionally, in vitro results demonstrated that the components of the AOM scaffold could efficiently regulate the chondrogenic/osteogenic differentiations of bone marrow stromal cells (BMSCs) by activating the chondrogenic/osteogenic related pathways. Importantly, the AOM scaffolds combined with BMSC-laden GelMA hydrogel successfully realized tissue-specific repair of the osteochondral defects in a knee joint model of rabbit. The current study developed a novel double-layer osteochondral biomimetic scaffold and feasible strategy, providing strong support for the tissue-specific repair of osteochondral defects and its future clinical translation.
| 139,883 |
1 |
Combined prosthetic incisional hernioplasty and panniculectomy - A 5-year single-centre experience
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Panniculectomy & Abdominoplasty CPG
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Background: Ventral incisional hernia patients develop limitation in physical activities as the hernia enlarges, leading to alteration in their lifestyle, quality of life, aesthetic deformities, and occasionally to complications. Cosmetic improvement of the abdomen, an important objective of hernia repair, can be achieved when hernia repair is combined with panniculectomy. The authors undertook this study to review their experience of the integration of hernia repair and panniculectomy to improve the understanding and treatment of this condition. Methods: A retrospective analysis of the records of patients who underwent abdominal hernia repair with panniculectomy from 2005 to 2010 was undertaken. The records were reviewed for patient demographics, hernia etiology, risk factors for recurrence, previous surgeries, previous approach, type of repair, incision approach, complications, length of hospital stay, and duration of follow-up. Surgical management included mesh hernia repair and pannus excision. Results: Of the total 45 patients, mean age was 42.37 years and mean follow-up was 24.4 months. Twelve patients had recurrent hernias. Most of the patients underwent retrorectus underlay mesh repair [39 (86.67 %)], while 6 (13.33 %) underwent onlay mesh technique. Six (13.33 %) patients developed minor skin necrosis, while one (2.22 %) had skin flap necrosis requiring debridement and skin grafting, three (6.67 %) hernias recurred, one (2.22 %) had seroma formation, and one (2.22 %) developed sacral pressure sore. Conclusion: This technique provides both functional and aesthetic benefits and generally meets the needs of the patients. It is safe, with a low risk of postoperative complications. Level of Evidence: Level IV, therapeutic study. © 2012 Springer-Verlag.
| 128,456 |
0 |
Effectiveness of bone cement containing tobramycin. An in vitro susceptibility study of 99 organisms found in infected joint arthroplasty
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
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We used 99 strains of organisms representative of orthopaedic infections to examine the effectiveness of a bone cement containing tobramycin, employing a modified in vitro Kirby-Bauer susceptibility model. The spectrum was broad, including Gram-positive and Gram-negative aerobic organisms, anaerobes and mycobacteria. Simplex P with added tobramycin was effective against most of the strains, including those which are resistant to typical systemic levels of tobramycin. Although direct correlation between in vitro and in vivo results is difficult, the study showed that tobramycin is stable to the exothermic polymerisation of the cement, and that it is released from the surface of the cement at concentrations high enough to inhibit the growth of most organisms which may be encountered after joint arthroplasty
| 20,296 |
0 |
Clinical evaluation of the intraoral fluoride releasing system in radiation-induced xerostomic subjects. Part 2: Phase I study
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
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Radiation-induced xerostomia can result in the rapid onset and progression of dental caries in head and neck cancer patients. Topically applied fluorides have been successfully used to inhibit the formation of dental caries in this population. However, because intensive daily self-application is required, compliance is an issue. The intraoral fluoride-releasing system (IFRS) containing a sodium fluoride core is a newly developed, sustained-release, passive drug delivery system that does not require patient involvement except for periodic replacement, thus reducing the effect of patient compliance on its effectiveness in dental caries prevention. Twenty-two head and neck cancer patients from U. T. M. D. Anderson Cancer Center, with radiation-induced xerostomia, were entered into a pilot study to contrast the daily home use of a 0.4% stannous fluoride-gel-containing tray (control group) to IFRS (study group) with respect to tolerability and adherence, and to obtain information on relative caries preventive efficacy. Participants were stratified on the basis of radiation exposure and randomly assigned to treatment with either IFRS or stannous fluoride gel. Patients in both groups were fitted with two IFRS retainers and also were instructed to use a 1100-ppm fluoride conventional sodium fluoride dentifrice twice daily. The study was conducted as a single-blinded, parallel-cell trial. Pre-existing carious lesions were restored prior to the beginning of the study. The efficacy variable was determined by the mean number of new or recurrent decayed surfaces. Patients were examined for caries 4, 8, 12, 24, 36, and 48 weeks after initiation of treatment. Reports of adverse reactions were based on information volunteered by patients and that were elicited during interviews. At baseline, the resting and stimulated salivary flow rates (g/5min) were significantly greater in the control group than in the study group (p<0.05). Patients in the control group had received significantly more radiation than those in the test group (68Gy vs. 60Gy; p=0.047). No marked differences in follow-up new and recurrent caries were found between the stannous fluoride gel control and IFRS groups during the study period. The rate of new or recurrent carious lesions in the group treated with the fluoride gel was slightly lower than in the IFRS group, based on carious lesions at the baseline examination (Poisson mean number of new or recurrent carious lesions for the control group=0.55 per year vs. 0.83 per year for the study group, p=0.705; odds ratio of the occurrence of any new or recurrent caries during follow-up for control group vs. the study group=0.80; p=0.781). This pilot study revealed that the IFRS was well-tolerated and safe in this study population associated with minimal complications during the duration of this study and was comparable in efficacy to a SnF(2) gel in preventing caries development. The IFRS provided similar rates of control for caries formation to a fluoride-gel-containing tray. The IFRS is designed to release a daily dose of 0.12mg of sodium fluoride, which can be evenly distributed throughout the oral cavity for a single application of 4 months. It would be more convenient than the daily home application of a tray of 0.4% stannous fluoride or 1.1% sodium fluoride gel, and avoids the problem of variable patient compliance
| 17,401 |
0 |
Dabigatran etexilate as second-line therapy in patients with a left ventricular assist device
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DOD - Acute Comp Syndrome CPG
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Introduction: Administration of anticoagulation is mandatory in patients with left ventricular assist devices (LVADs). Vitamin K antagonists require regular monitoring and dosage adjustment. Dabigatran administered in a standard dose twice daily is more convenient and achieves a stable anticoagulant effect, but its effectiveness and safety in patients with LVADs has not been investigated. The objective of the present study was to evaluate whether dabigatran can be used safely as a second-line anticoagulation option in patients with a HeartMate II (HMII) LVAD. Methods: The study population consisted of 7 consecutive patients with end-stage heart failure who underwent HMII implantation and sequentially received acenocoumarol and dabigatran. Occurrence of stroke, systematic embolism, device thrombosis and major or life-threatening bleeding were included in the analysis. An acute decrease in plasma hemoglobin >2 g/dL or a need for transfusion of at least 2 units of packed red blood cells (PRBC) was defined as major bleeding, while an acute decrease in plasma hemoglobin >5 g/dL, fatal, symptomatic intracranial bleed, need for transfusion of at least 4 units PRBC, or association with hypotension requiring the use of intravenous inotropic agents or surgical intervention was defined as life-threatening bleeding. Results: The duration of follow up was 1564 ± 292 days. Patients received acenocoumarol for 855 ± 246 days, followed by dabigatran for 708 ± 368 days. The rates of thromboembolic events were similar under dabigatran and acenocoumarol treatment: strokes, 0.094 vs. 0 /patient-year, p=0.36; systemic embolism, no event in either group; and device thrombosis, 0.053 vs. 0.258 events/patient-year, p=0.19, respectively. Compared to an adjusted acenocoumarol dose, the standard dabigatran dose resulted in similar rates of life-threatening bleeding, but significantly lower rates of major bleeding (0.18 vs. 0.27 bleeds/patient-years, p=0.76, and 0.047 vs. 0.547, p<0.001, for dabigatran and acenocoumarol, respectively). Conclusions: The safe and effective use of dabigatran as a second-line anticoagulation therapy in patients with HMII seems feasible. However, these data must be confirmed in a randomized study.
| 64,383 |
0 |
Single-stage abdominoplasty and mastopexy after weight loss following gastric banding
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Panniculectomy & Abdominoplasty CPG
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Background: With the increasing number of massively obese patients who undergo the implant of a gastric band, there is also a growing demand for a plastic-reconstructive operation of the overstretched skin, now lax after the enormous weight reduction. Methods: From May 2000 to March 2002, 12 abdominoplasties and 12 mastopexies were performed in patients with an average age of 37.3 years (range 33-44 years) as single-stage procedures after an average weight-loss of 67 kg (range 43-111 kg) after gastric banding. A follow-up examination of all patients was carried out an average of 8.4 months (range 1-23 months) after the operation, to review the duration of hospital stay and assess the period of work disablement as well as the patients' satisfaction, which was judged on a scale from 1 (very dissatisfied) to 7 (very satisfied), based on a written questionnaire. Results: The average duration of hospital stay was 7.4 days. There were 5 complications that healed under conservative management. 8 patients suffered an average work disability of 5.4 weeks. 4 patients who were housewives suffered no impairments that affected their ability to carry on with their household duties. The patients' postoperative satisfaction in regard to psyche, appearance, self-confidence and vitality was strongly improved in each case. Conclusions: In comparison to multi-stage procedures, single-stage operations resulted in a reduced duration of hospital stay by 4.1 days and thus in diminished medical costs and in a reduction of work disablement by 3.5 weeks. Patients who underwent single-stage operations were postoperatively more satisfied than those with multi-stage operations.
| 127,219 |
0 |
Profiles of biomarkers of excess alcohol consumption in patients undergoing total hip replacement: Correlation with function
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DoD SSI (Surgical Site Infections)
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Aims. Patients who misuse alcohol may be at increased risk of surgical complications and poorer function following hip replacement. Identification and intervention may lead to harm reduction and improve the outcomes of surgery. The aim of this study was to determine the prevalence of biomarker elevation in patients undergoing hip replacement and to investigate any correlation with functional scores and complications. Methods. We performed a retrospective study that examined the profile of biomarkers of alcohol misuse in 1049 patients undergoing hip replacement. Results. Gamma-glutamyltransferase was elevated in 150 (17.6), and mean corpuscular volume was elevated in 23 (4). At one year general physical health was poorer where there was elevation of GT, and the mental health and hip function was poorer with elevation of MCV. There were no differences in complications. Discussion. Raised biomarkers can alert clinicians to potential problems. They also provide an opportunity to perform further investigation and offer intervention. Future research should focus on the use in orthopaedic practice of validated screening questionnaires and more sensitive biomarkers of alcohol misuse. Conclusion. This study demonstrates a potential substantial proportion of unrecognised alcohol misuse that is associated with poorer functional scores in patients after total hip replacement. Copyright © 2011 Paul J. Jenkins et al.
| 150,144 |
0 |
Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: Comparative study of multiply injured and isolated femoral fractures
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DoD SSI (Surgical Site Infections)
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Background. The aim of this prospective study was to compare the outcomes of distal femoral fractures treated by the Less Invasive Stabilization System (LISS) in multiply injured and isolated fracture cases. Methods. This study comprised 26 patients (16 men, 10 women), who had 27 distal femoral fractures. Patients were divided into two groups; multiple injuries (group I) or isolated distal femoral fracture (group II). The average Injury Severity Score of group I was 26.7. Operations were performed according to biological fixation principles in a submuscular manner. No bone grafting was performed to enhance the healing. The cases were evaluated based on the criteria of Schatzker-Lambert and the modified Hospital for Special Surgery (HSS) scoring system. Results. The mean follow-up period was 25.8 months. Union was achieved in all cases. Two patients in group I required débridement procedures due to deep infection. One of them healed completely but the other did not. The average range of knee motion of groups I and II at the last control were 112.8° and 121.8°, respectively. The mean modified HSS scores were 73.9 and 79.9, respectively. There was no significant difference in the HSS scores or the range of knee motion. The time to full weight bearing was longer in group I owing to the concomitant injuries. Conclusions. We concluded that LISS is a useful method for comminuted supracondylar fractures with multiple trauma patients as the results showed no significant differences when compared with those of patients with isolated femoral fractures. © 2007 The Japanese Orthopaedic Association.
| 147,742 |
0 |
Complications of autologous lymph-node transplantation for limb lymphoedema
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Panniculectomy & Abdominoplasty CPG
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Objective: This study aims to assess potential complications of autologous lymph-node transplantation (ALNT) to treat limb lymphoedema. Design: Prospective, observational study. Method: All limb-lymphoedema patients, followed up in a single lymphology department, who decided to undergo ALNT (January 2004-June 2012) independently of our medical team, were included. Results: Among the 26 patients (22 females, four males) included, 14 had secondary upper-limb lymphoedema after breast-cancer treatment and seven had secondary and five primary lower-limb lymphoedema. Median (interquartile range, IQR) ages at primary lower-limb lymphoedema and secondary lymphoedema onset were 18.5 (13-30) and 47.4 (35-58) years, respectively. Median body mass index (BMI) was 25.9 (22.9-29.3) kg m-2. For all patients, median pre-surgery lymphoedema duration was 37 (24-90) months. Thirty-four ALNs were transplanted into the 26 patients, combined with liposuction in four lower-limb-lymphoedema patients. Ten (38%) patients developed 15 complications: six, chronic lymphoedema (four upper limb, two lower limb), defined as �2-cm difference versus the contralateral side, in the limb on the donor lymph-node-site territory, persisting for a median of 40 months post-ALNT; four, post-surgical lymphocoeles; one testicular hydrocoele requiring surgery; and four with persistent donor-site pain. Median (IQR) pre- and post-surgical lymphoedema volumes, calculated using the formula for a truncated cone, were, respectively, 1023 (633-1375) ml (median: 3 (1-6) months) and 1058 (666-1506) ml (median: 40 (14-72) months; P = 0.73). Conclusion: ALNT may engender severe, chronic complications, particularly persistent iatrogenic lymphoedema. Further investigations are required to evaluate and clearly determine its indications. © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
| 125,087 |
0 |
Impact of recent fracture on health-related quality of life in postmenopausal women
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Management of Hip Fractures in the Elderly
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The effect of fractures other than hip and spine on HRQoL in younger and older women has not been extensively studied. In a cohort of 86,128 postmenopausal women, we found the impact of recent osteoporosis-related fractures on HRQoL to be similar between women < 65 compared with those > or = 65 years of age. The impact of spine, hip, or rib fractures was greater than that of wrist fractures in both age groups. INTRODUCTION: Health-related quality of life (HRQoL) after vertebral and hip fractures has been well studied. Less is known about HRQoL after fractures at other sites. We studied the effect of recent clinical fractures on HRQoL, using Short Form-12 (SF-12). MATERIALS AND METHODS: This study included 86,128 postmenopausal participants in the National Osteoporosis Risk Assessment (NORA) who responded to two follow-up surveys during a 2-year interval. At each survey, they completed the SF-12 HRQoL questionnaire and reported new fractures of the hip, spine, wrist, and rib. The effect of recent fracture on HRQoL was assessed by comparing Physical Component Score (PCS) and Mental Component Score (MCS) means for women with and without new fractures at the second survey. Analyses were by fracture type and by age group (50-64 and 65-99) and were adjusted for PCS and MCS at the first survey. RESULTS: New fractures (320 hip, 445 vertebral, 657 rib, 835 wrist) occurring during the interval between the first and second follow-up surveys were reported by 2257 women. The PCS was poorer in both older and younger women who had fractured the hip, spine, or rib (p < or = 0.001). Wrist fractures had an impact on PCS in women < or = 65 years of age (p < 0.001), but not older women (p > 0.10). These differences in PCS by fracture status were similar to those reported for other chronic diseases such as asthma, chronic obstructive pulmonary disease (COPD), and osteoarthritis. MCS was less consistently changed by fracture status, but younger and older women with vertebral fracture (p < 0.004), older women with hip fracture (p < 0.004), and younger women with rib fracture (p < 0.004) had poorer MCS compared with those who did not fracture within their age cohort. CONCLUSIONS: Recent osteoporosis-related fractures have significant impact on HRQoL as measured by SF-12. The impact of recent fracture on HRQoL was similar for older and younger postmenopausal women. Fracture prevention and postfracture interventions that target the subsequent symptoms are needed for postmenopausal women of any age
| 3,394 |
1 |
Quantitative magnetic-resonance-imaging measures of cartilage predict knee replacement-a case-control study from the osteoarthritis initiative
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Surgical Management of Osteoarthritis of the Knee CPG
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Aim: Knee osteoarthritis is a highly prevalent disease, commonly requiring joint replacement; it substantially reduces quality of life and increases health care utilisation and costs. We aimed to identify whether quantitative measures of articular cartilage structure predict knee replacement, and to establish their utility as outcomes in clinical trials of disease modifying therapy. Methods: A nested case-control study was performed in Osteoarthritis Initiative participants, a multicentre observational cohort of 4796 participants with or at risk of knee osteoarthritis. 127 knees were replaced between baseline and four years follow-up, and one control knee per case matched for baseline radiographic disease stage (Kellgren-Lawrence grade, KLG), gender, and age. Quantitative cartilage measures were obtained from 3 Tesla magnetic resonance images at the exam before knee replacement, and longitudinal change during the prior 12 months when available (n = 110). Results: Cartilage thickness loss in the central and total medial femoro-tibial compartment (primary and secondary outcomes) was significantly greater in case than in control knees (AUC = 0.59/0.58). Differences in cartilage loss were greater at earlier than at later radiographic disease stages (p < 0.01 for interaction with KLG). Cartilage thickness loss in the central tibia was the most predictive longitudinal measure (AUC = 0.64). Cross-sectionally, denuded bone areas in the medial femur distinguished case and control knees most strongly (AUC = 0.66). Conclusions: This study demonstrates the predictive value of quantitative, magnetic resonance imaging-based measures of cartilage for the clinically relevant endpoint of knee replacement, providing support for their utility in clinical trials to evaluate the effectiveness of structure modifying intervention
| 38,238 |
1 |
Effects of thermal therapy on rehabilitation after total knee arthroplasty. A prospective randomized study
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Surgical Management of Osteoarthritis of the Knee CPG
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The role of local heat or cold therapy used in conjunction with exercise in the rehabilitation of total knee arthroplasty patients was investigated. Thirty-six osteoarthritic patients were analyzed. Parameters evaluated were range of motion, swelling about the knee, and pain. All patients received the total condylar knee prosthesis and began range of motion rehabilitation fourteen days after operation. Results showed that temperature alteration does not augment passive range of motion after total knee arthroplasty. It was also shown that cold application decreases swelling as compared with heat. Additionally, the application of cold partially alleviates the discomfort of the rehabilitation process in certain patients
| 37,225 |
0 |
Endoprosthesis as treatment for necrosis and pseudarthrosis after transcervical femoral fractures. A clinical review
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Management of Hip Fractures in the Elderly
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This report concerns 105 patients who developed painful necrosis or pseudarthrosis after nailed transcervical femoral fractures and were treated by Moore's arthroplasty. The mean age at the time of secondary arthroplasty was 68 years, the operation being performed on average 2 years after the fracture and nailing. The mortality within 6 weeks of operation was 3 per cent. Complications not producing late sequelae were seen in 11.4 per cent of cases, and complications producing late sequelae occurred in 5.7 per cent. At the follow-up examination 2 to 8 years after arthroplasty (mean 3.7 years), 37 per cent of the patients were completely free from pain, and the functional result was acceptable in 91 per cent. The remaining 9 per cent had other debilitating illnesses. The results are compared with other reports in the literature
| 12,638 |
0 |
Treatment of cubitus varus using the Ilizarov technique of distraction osteogenesis
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The Treatment of Pediatric Supracondylar Humerus Fractures AUC
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Seven children with a post-traumatic cubitus varus deformity were treated using the Ilizarov technique of distraction osteogenesis. The outcome was rated as excellent in each case and all were satisfied with the cosmetic appearance. No complications had been encountered by the latest follow-up at a mean of 66.7 months. This technique seems reliable for the treatment of such deformities, provided that it achieves full correction by gradual distraction. Nerve palsy and unsightly scars are avoided, and the range of movement of adjacent joints is preserved
| 23,018 |
0 |
Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial
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MSTS 2018 - Femur Mets and MM
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BACKGROUND: Postmastectomy radiotherapy is associated with a lower locoregional recurrence rate and improved disease-free and overall survival when combined with chemotherapy in premenopausal high-risk breast-cancer patients. However, whether the same benefits apply also in postmenopausal women treated with adjuvant tamoxifen for similar high-risk cancer is unclear. In a randomised trial among postmenopausal women who had undergone mastectomy, we compared adjuvant tamoxifen alone with tamoxifen plus postoperative radiotherapy.
METHODS: Between 1982 and 1990, postmenopausal women with high-risk breast cancer (stage II or III) were randomly assigned adjuvant tamoxifen (30 mg daily for 1 year) alone (689) or with postoperative radiotherapy to the chest wall and regional lymph nodes (686). Median follow-up was 123 months. The endpoints were first site of recurrence (locoregional recurrence, distant metastases, or both), and disease-free and overall survival.
FINDINGS: Locoregional recurrence occurred in 52 (8%) of the radiotherapy plus tamoxifen group and 242 (35%) of the tamoxifen only group (p<0.001). In total there were 321 (47%) and 411 (60%) recurrences, respectively. Disease-free survival was 36% in the radiotherapy plus tamoxifen group and 24% in the tamoxifen alone group (p<0.001). Overall survival was also higher in the radiotherapy group (385 vs 434 deaths; survival 45 vs 36% at 10 years, p=0.03).
INTERPRETATION: Postoperative radiotherapy decreased the risk of locoregional recurrence and was associated with improved survival in high-risk postmenopausal breast-cancer patients after mastectomy and limited axillary dissection, with 1 year of adjuvant tamoxifen treatment. Improved survival in high-risk breast cancer can best be achieved by a strategy of both locoregional and systemic tumour control.
| 80,071 |
0 |
Advances in the biology and treatment of bone disease in multiple myeloma
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MSTS 2018 - Femur Mets and MM
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Osteolytic bone disease is pathognomonic of multiple myeloma (MM) and affects more than 80% of patients. Bone disease results in skeletal-related events (SRE) such as vertebral compression fractures, which may cause cord compression, hypercalcemia, pathologic fractures that require radiation or surgical fixation, and severe pain. All of these not only result in a negative impact on quality of life but also adversely impact overall survival. Osteolytic disease is a consequence of increased osteoclast (OC) activation along with osteoblast (OB) inhibition, resulting in altered bone remodeling. OC number and activity are increased in MM via cytokine deregulation within the bone marrow (BM) milieu, whereas negative regulators of OB differentiation suppress bone formation. Bisphosphonates are a well-established treatment of myeloma-related skeletal disease and are the current standard of care. However, complications arising from their long-term use have prompted studies of schedule optimization and alternate strategies. Several novel agents are currently under investigation for their positive effect on bone remodeling via OC inhibition. The identification of negative regulators of OB differentiation has prompted the use of anabolic agents. In addition to restoring bone remodeling, these drugs may inhibit tumor growth in vivo. Future studies will look to combine or sequence all of these agents with the goal of not only alleviating morbidity from bone disease but also capitalizing on the resultant antitumor activity.
| 82,504 |
1 |
Low incidence of ulnar nerve injury with crossed pin placement for pediatric supracondylar humerus fractures using a mini-open technique
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The Treatment of Pediatric Supracondylar Humerus Fractures AUC
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OBJECTIVES: Several recent studies have suggested that medial pinning in pediatric supracondylar humerus fractures leads to increased rates of ulnar nerve injury. The purpose of this study was to determine the risk of iatrogenic ulnar nerve injury in a consecutive series of supracondylar fractures treated using a standardized technique of crossed pin placement. DESIGN: Single cohort retrospective. SETTING: Metropolitan university tertiary care center. PATIENTS AND PARTICIPANTS: Seventy-one consecutive children with Gartland type II or type III supracondylar humerus were treated surgically by 2 pediatric orthopaedic surgeons at 1 institution between 1995 and 2000 using a medial mini-open and cross-pinning technique. Sixty-five patients were available for follow-up (92%). INTERVENTION: Patients were treated with a combination of medial and lateral pins using a mini-incision technique. MAIN OUTCOME MEASUREMENTS: Outcomes analyzed included ulnar nerve injury and clinical and radiographic evidence of healing. RESULTS: The study group consisted of 65 patients, of whom 29 (45%) presented with Gartland type III fractures, and the remaining 36 (55%) presented with a type II fracture. There were no ulnar nerve motor injuries. One patient was noted to have transient sensory changes in the ulnar nerve distribution postoperatively, which resolved by the 1-week follow-up visit. All patients were noted to have normal ulnar motor and sensory nerve function at final follow-up (average 4.5 months). No cases of nonunion, malunion, or infection were identified during the follow-up period. CONCLUSIONS: The rate of iatrogenic ulnar nerve injury with this specific technique of crossed pin placement for extension-type supracondylar humerus fractures was extremely low in this series. A single case of transient ulnar sensory neuropraxia occurred. Our series demonstrates that crossed pin fixation can be performed safely and reliably and is an appropriate treatment option for unstable supracondylar humerus fractures
| 24,722 |
0 |
Complications and reoperations during and after hip arthroscopy: A systematic review of 92 studies and more than 6,000 patients
|
Osteochondritis Dissecans 2020 Review
|
Purpose: To determine the prevalence of complications and reoperations during and after hip arthroscopy. Methods: A systematic review of multiple medical databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. All clinical outcome studies that reported the presence or absence of complications and/or reoperations were eligible for inclusion. Length of follow-up was not an exclusion criterion. Complication and reoperation rates were extracted from each study. Duplicate patient populations within separate distinct publications were analyzed and reported only once. Results: Ninety-two studies (6,134 participants) were included. Most were Level IV evidence studies (88%) with short-term follow-up (mean 2.0 years). Labral tears and femoroacetabular impingement (FAI) were the 2 most common diagnoses treated, and labral treatment and acetabuloplasty/femoral osteochondroplasty were the 2 most common surgical techniques reported. Overall, major and minor complication rates were 0.58% and 7.5%, respectively. Iatrogenic chondrolabral injury and temporary neuropraxia were the 2 most common minor complications. The overall reoperation rate was 6.3%, occurring at a mean of 16 months. Total hip arthroplasty (THA) was the most common reoperation. The conversion rate to THA was 2.9%. Conclusions: The rate of major complications was 0.58% after hip arthroscopy. The reoperation rate was 6.3%, and the most common reason for reoperation was conversion to THA. Minor complications and the reoperation rate are directly related to the learning curve of hip arthroscopy. As surgical indications evolve, patient selection should limit the number of cases that would have been converted to THA. Similarly, the number of minor complications is directly related to technical aspects of the procedure and therefore will decrease with surgeon experience and improvement in instrumentation. Level of Evidence: Level IV, a systematic review of Level I to IV studies. © 2013 by the Arthroscopy Association of North America.
| 138,658 |
0 |
Free medial gastrocnemius myocutaneous flap transfer with neurovascular anastomosis to treat Volkmann's contracture of the forearm
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
Some articles have reported the use of medial gastrocnemius transfer to repair soft-tissue defects caused by trauma and inflammation (Morris, 1978; Feldman et al., 1978; Arnold and Mixter, 1983). However, we have not found any report describing the use of free medial gastrocnemius myocutaneous flap transfer with neurovascular anastomosis to treat Volkmann's contracture of the forearm. Since 1982, 20 cases of Volkmann's contracture of the forearm have been treated by transfer of medial gastrocnemius flap with neurovascular anastomosis. These 20 patients ranged in age from 6-18 years, with a mean of 10 years. There were 18 males and 2 females. All cases resulted from ischaemia of the extrinsic and intrinsic muscles of the forearm and hand. The most common causes were severe supracondylar fractures or, less frequently, fracture-dislocations of the elbow. Six to twenty months after operation, the transplanted muscles exhibited normal electromyographic potentials, good volume and contractile power with satisfactory functional recovery of the forearms. The deformities of the hand and wrist were also corrected. In this paper we describe the anatomy of the donor site and the operative procedure
| 23,633 |
0 |
Total hip replacement
|
Dental Implant Infection
|
Total hip replacement is a valuable new procedure to treat severe noninfectious hip disease in orthopedic surgery. 30 operations in 27 patients were performed at Chung-Shan Medical & Dental College Hospital between July 1977 and August 1980. The low friction athroplasty of Muller type prostesis was used. Satisfactory results in relief of pain and ability to walk were obtained in most patients. No wound infection was experienced in our patients, but 2 cases had postoperative dislocation which was reduced by operation.
| 169,363 |
0 |
Monitoring and management of bone status in patients on chronic glucocorticoid treatment - The Medscheme experience
|
HipFx Supplemental Cost Analysis
|
Objective. Review of administrative databases to gain insight into the investigation, management and sequelae of bone disease in patients on long-term glucocorticoid treatment. Design. Retrospective analysis of 1998 pharmaceutical and clinical claims data for (plus or minus) 2 million lives administered by Medscheme. Data were extracted for members registered with the chronic medication programme as eligible for chronic glucocorticoid treatment. Those identified were subjected to further review for evidence of osteoporosis and/or hip fracture. Subgroup analysis of peri- and postmenopausal women was carried out and compared against a control group. Main outcome measures. Osteoporosis investigation and treatment rates in males and females; frequency of hip fractures; prescribing profiles; role of underlying disease, glucocorticoid route, gender and age in development of osteoporosis. Results. A total of 1 614 subjects (54% females) was registered for chronic glucocorticoid treatment. Osteoporosis was diagnosed in 14.1% of females and 5.9% of males across a broad age range. Hip fractures were recorded for one female and three males. The subgroup analysis showed that osteoporosis was (plus or minus) 1.5 times more common in women receiving glucocorticoids than in peri-and postmenopausal controls, and that there was greater use of vitamin D and calcium supplementation and bisphosphonates in those exposed to glucocorticoids. Multivariate analysis showed overall that female gender, increasing age and oral glucocorticoids were significantly related to osteoporosis. Conclusion. Reference to UK and US data suggests that while local practitioners are aware of the effect of glucocorticoids on bone, the level of awareness is probably suboptimal, especially with regard to male patients
| 52,432 |
0 |
One-staged contralateral or ipsilateral total hip and total knee arthroplasty
|
Surgical Management of Osteoarthritis of the Knee CPG
|
One-staged ipsilateral and contralateral total hip and total knee arthroplasties were compared. A total of 103 patients underwent a 1-staged total knee arthroplasty and total hip arthroplasty between January 1975 and July 1997 (67 contralateral and 36 ipsilateral patients). No prostheses were found to be loose or revised. The contralateral group had a 10.5% hip dislocation rate, and the ipsilateral group had an 8.3% hip dislocation rate. Most of the patients were discharged home (contralateral, 66%; ipsilateral, 56%). There was no significant difference in survival between the contralateral and ipsilateral groups. There was only 1 death within 3 months of the operation. The severity of these patients' deformity may necessitate these procedures be done at 1 operation with consideration of mortality and morbidity risks. Copyright 2002, Elsevier Science (USA). All rights reserved
| 32,676 |
1 |
A prospective, randomised, controlled trial comparing wound dressings used in hip and knee surgery: Aquacel and Tegaderm versus Cutiplast
|
DoD SSI (Surgical Site Infections)
|
INTRODUCTION: Cutiplast (absorbent perforated dressing with adhesive border; Smith & Nephew) is commonly used following orthopaedic operation, but complications of its use have been reported. A prospective, randomised, controlled study was performed to compare the efficacy of Cutiplast versus an Aquacel (hydrofibre dressing; ConvaTec) covered with Tegaderm (vapour-permeable dressing; 3M).
PATIENTS AND METHODS: Two-hundred patients were randomised to receive one of the two dressings following elective and non-elective surgery of the hip and the knee. We were able to study 183 patients. The condition of the wound and any complications such as skin blistering or signs of infection was noted as was the frequency of dressing changes.
RESULTS: The Aquacel and Tegaderm dressing was 5.8 times more likely to result in a wound with no complications as compared to a Cutiplast dressing (odds ratio, 5.8; 95% CI 2.8-12.5; P < 0.00001).
CONCLUSION: Aquacel covered by Tegaderm is a superior dressing to Cutiplast following surgery to the hip and knee.
| 151,064 |
0 |
All-polyethylene tibial components in obese patients are associated with low failure at midterm followup
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: In the United States, the obese population has increased markedly over the last four decades, and this trend continues. High patient weight places additional stress on TKA components, which may lead to increased polyethylene wear, osteolysis, radiolucencies, and clinical failure. Metal-backed tibial components and all-polyethylene tibial components in the general population have comparable osteolysis and failure, but it is unclear whether these components yield similar osteolysis and failure in obese patients.
QUESTIONS/PURPOSES: We therefore determined the (1) function, (2) occurrence of osteolysis, and (3) complications in a cohort of obese patients receiving all-polyethylene tibial components.
PATIENTS AND METHODS: Between September 17, 1996, and December 19, 2002, we implanted all-polyethylene tibial components in 90 obese patients (125 knees); 24 patients (33 knees) died and 13 patients (17 knees) were lost to followup, leaving 53 patients (59%) with 75 knees. All surgeries were cruciate-retaining, tricompartmental TKAs. We evaluated patients with Knee Society Scores and serial radiographs. Minimum followup was 7 years (mean, 10.4 years; range, 7-14 years).
RESULTS: At latest followup, mean Knee Society Score was 92 points. There were five tibial radiolucencies, all less than 1 mm and characterized as nonprogressive. We observed minimal, nonprogressive osteolysis in one knee. One patient required reoperation after a traumatic event. There were no implant-related failures and no implants at risk of failure.
CONCLUSIONS: At an average 10-year followup, all-polyethylene tibial components were functioning well in this obese group. These findings confirm the effectiveness of all-polyethylene tibial components in obese patients.
| 108,385 |
0 |
Advances in knee arthroplasty for younger patients: traditional knee arthroplasty is prologue, the future for knee arthroplasty is prescient
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Total knee arthroplasty (TKA) was a remarkable development in orthopedic surgery. Joint arthroplasty and arthroscopy were perhaps the greatest innovations in orthopedics in the 20th century and occurred without the advantages of today's technology. Initially, TKA was performed only on elderly patients and those with advanced rheumatoid arthritis because of concerns with long-term wear of polyethylene. Surgeons strongly discouraged this surgery for patients younger than age 60 years because both patients and many orthopedic surgeons believed that knee implants would last only for approximately 10 years, particularly in younger and more active patients. Reports in the late 1980s and early 1990s about accelerated polyethylene wear and osteolysis substantiated the conviction that TKA was contraindicated in younger patients. This led to complacency toward TKA, thus inhibiting technological advances in the procedure to develop implants for younger and more active patients
| 28,980 |
1 |
Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?
|
DOD - Acute Comp Syndrome CPG
|
BACKGROUND: High-energy tibial plateau and tibial plafond fractures have a high complication rate and are frequently treated with a staged approach of spanning external fixation followed by definitive internal fixation after resolution of soft tissue swelling. A theoretical advantage to early spanning external fixation is that earlier fracture stabilization could prevent further soft tissue damage and potentially reduce the occurrence of subsequent infection. However, the relative urgency of applying the external fixator after injury is unknown, and whether delay in this intervention is correlated to subsequent treatment complications has not been examined.
QUESTIONS/PURPOSES: Is delay of more than 12 hours to spanning external fixation of high-energy tibial plateau and plafond fractures associated with increased (1) infection risk; (2) compartment syndrome risk; and (3) time to definitive fixation, length of hospitalization, or risk of secondary surgeries? We further stratified our results based on injury site: plateau and plafond. In practical clinical terms, many of these high-energy C-type articular fractures will arrive at the regional trauma center in the evening and this investigation attempted to explore if these injuries need to be placed in temporizing fixators that evening or if they may be safely addressed in a dedicated trauma room the next morning.
METHODS: We performed a retrospective review of all patients at a Level I university trauma center with high-energy tibial plateau and plafond fractures who underwent staged treatment with a spanning external fixation followed by subsequent definitive internal fixation between 2006 and 2012. Patients who received a fixator within 12 hours of recorded injury time were classified as early external fixation; those who received a fixator greater than 12 hours from injury were classified as delayed external fixation. There were 80 patients (42 plateaus and 38 plafonds) in the early external fixation cohort and 79 patients (45 plateaus and 34 plafonds) in the delayed external fixation cohort. Deep infection rate was 13% in plateau fractures and 18% in plafond fractures. Rates of infection, compartment syndrome, secondary surgeries, time to definitive fixation, and length of hospitalization were recorded.
RESULTS: Controlling for differences in open fracture severity between groups, there was no difference in infection for plafond (early fixation: 12 of 38 [32%]; delayed fixation: seven of 34 [21%]; adjusted relative risk = 1.39 [95% confidence interval {CI}, 0.45-4.31], p = 0.573) and plateau (early fixation: eight of 42 [19%]; delayed fixation: nine of 45 [20%]; adjusted relative risk: 0.93 [95% CI, 0.31-2.78], p = 0.861) groups. For compartment syndrome risk, there was no difference between early and delayed groups for plateau fractures (early fixation: six of 42 [14%]; delayed fixation: three of 45 [7%]; relative risk = 0.47 [0.12-1.75], p = 0.304) and plafond fractures (early fixation: two of 38 [5%]; delayed fixation: three of 34 [9%]; relative risk = 1.67 [0.30-9.44], p = 0.662). There was no difference for length of hospitalization for early (9 +/- 7 days) versus delayed fixation (9 +/- 6 days) (mean difference = 0.24 [95% CI, -2.9 to 3.4], p = 0.878) for patients with plafond fracture. Similarly, there was no difference in length of hospitalization for early (10 +/- 6 days) versus delayed fixation (8 +/- 4 days) (mean difference = 1.6 [95% CI, -3.9 to 0.7], p = 0.170) for patients with plateau fracture. Time to definitive fixation for plateau fractures in the early external fixation group was 8 +/- 6 days compared with 11 +/- 7 days for the delayed external fixation group (mean difference = 2.9 [95% CI, 0.13-5.7], p = 0.040); there was no difference in time to definitive fixation for early (12 +/- 7 days) versus delayed (12 +/- 6 days) for patients with plafond fractures (mean difference = 0.39 [95% CI, -2.7 to 3.4], p = 0.801). There was no difference in risk of secondary surgeries between early external fixation (21 of 38 [55%]) and delayed external fixation (13 if 34 [38%]) for plafond fractures (adjusted relative risk = 0.69 [95% CI, 0.41-1.16], p = 0.165) and no difference between early fixation (24 of 42 [57%]) and delayed fixation (26 of 45 [58%]) for plateau fractures (adjusted relative risk = 1.0 [95% CI, 0.70-1.45], p = 1.00).
CONCLUSIONS: We were unable to detect a difference in infection, compartment syndrome, secondary procedures, or length of hospitalization for patients who undergo early versus delayed external fixation for high-energy tibial plateau or plafond fractures. This may affect decisions for resource use at trauma centers such as whether high-energy periarticular lower extremity fractures need to be spanned on the evening of presentation or whether this procedure may wait until the morning trauma room. Given the high complication rate of these injuries and clinical relevance of this question, this may also need to be examined in a prospective manner.
LEVEL OF EVIDENCE: Level IV, therapeutic study.
| 64,706 |
0 |
The morphology of proximal tibiofibular joint (PTFJ) predicts incident radiographic osteoarthritis: data from Osteoarthritis Initiative
|
OAK 3 - Non-arthroplasty tx of OAK
|
Objective: To determine whether the morphology of proximal tibiofibular joint (PTFJ) is associated with increased risk of incident radiographic osteoarthritis (iROA) over 4 years in the OA Initiative (OAI) study. Methods: A nested matched caseâ??control study design was used to select participants from OAI study. Case knees were defined as those with iROA. Control knees were matched one-to-one by sex, age and radiographic status with case knees. T2-weighted MR images were assessed at P0 (the visit when incident ROA was found on radiograph), P1 (1 year prior to P0) and at OAI baseline. The contacting area of PTFJ (S) and its projection areas onto the horizontal (load-bearing area, SÏ?), sagittal (lateral stress-bolstering area, SÏ?) and coronal plane (posterior stress-bolstering area, SÏ?) were assessed, respectively. Results: 354 case knees and 354 matched control knees were included, with a mean age of 60 and a mean body mass index (BMI) of 28 kg/m2. Baseline PTFJ morphological parameters (S, SÏ? and SÏ?) were significantly associated with iROA over 4 years, and these associations remained unchanged after adjustment for BMI, number of knee bending activities, self-reported knee injury and surgery. S, SÏ? and SÏ? were also significantly associated with iROA at P1 and P0. In subgroup analysed, S, SÏ? and SÏ? were associated with risks of incident joint space narrowing in the medial, but not the lateral tibiofemoral compartment. Conclusion: Greater contacting area, load-bearing area and posterior stress-bolstering area of PTFJ were associated with increased risks of iROA, largely in the medial tibiofemoral compartment.
| 107,370 |
0 |
Metformin inhibits RANKL and sensitizes cancer stem cells to denosumab
|
MSTS 2018 - Femur Mets and MM
|
The increased propensity of BRCA1 mutation carriers to develop aggressive breast tumors with stem-like properties begins to be understood in terms of osteoprotegerin (OPG)-unrestricted cross-talk between RANKL-overproducing progesterone-sensor cells and cancer-initiating RANK<sup>+</sup> responder cells that reside within pre-malignant BRCA1<sup>mut/+</sup> breast epithelial tissue. We recently proposed that, in the absence of hormone influence, cancer-initiating cells might remain responsive to RANKL stimulation, and hence to the therapeutic effects of the anti-RANKL antibody denosumab because genomic instability induced by BRCA1 haploinsufficiency might suffice to cell-autonomously hyperactivate RANKL gene expression. Here we report that the biguanide metformin prevents BRCA1 haploinsufficiency-driven RANKL gene overexpression, thereby disrupting an auto-regulatory feedback control of RANKL-addicted cancer stem cell-like states within BRCA1<sup>mut/-</sup> cell populations. Moreover, metformin treatment elicits a synergistic decline in the breast cancer-initiating cell population and its self-renewal capacity in BRCA1-mutated basal-like breast cancer cells with bone metastasis-initiation capacity that exhibit primary resistance to denosumab in mammosphere assays. The specific targeting of RANKL/RANK signaling with denosumab is expected to revolutionize prevention and treatment strategies currently available for BRCA1 mutation carriers. Our findings provide a rationale for new denosumab/metformin combinatorial strategies to clinically manage RANKL-related breast oncogenesis and metastatic progression.
| 78,065 |
0 |
Risk factors for vascular access-related complications in patients undergoing early invasive strategy
|
DOD - Acute Comp Syndrome CPG
|
Background The knowledge of risk factors related to vascular access complications in patients undergoing early invasive strategy allows the adoption of methods to minimize them. Methods We performed a subanalysis of the ARISE study, aiming to identify predictors of vascular complications in patients randomized to the radial or femoral techniques with the use of vascular closure device (VCD). Results A total of 240 patients with a mean age of 63.0 ± 10.7 years were included, with 30.8% of diabetics. Except for a higher prevalence of women in the radial group, there were no clinical differences between the groups. Percutaneous coronary intervention was performed in 86.7% of the cases. The rate of vascular complications after 30 days was 13.3% in the radial group, due to hematoma > 5 cm (6.7%) and asymptomatic artery occlusion (5.8%), and 12.5% in femoral group, due to hematoma > 5 cm, without significant difference. The following were identified as risk factors for vascular access complications: body mass index (BMI), previous stroke, longer duration of the procedure, and VCD failure. At the stratified analysis, female gender and high or very high-risk CRUSADE score were predictors of complications only for the femoral group. In the multivariate model, the factors that remained significant were BMI and VCD failure. Conclusions The radial and femoral techniques, with the use of VCD, shared variables that were predictors of complications. Risk factors, such as female gender and high-risk CRUSADE score, were attenuated by the use of the radial technique.
| 63,229 |
0 |
Total hip arthroplasty using the miniature Anatomic Medullary Locking stem
|
Management of Hip Fractures in the Elderly
|
We report the outcome of a prospective consecutive series of 52 primary total hip arthroplasties using the miniature porous-coated Anatomic Medullary Locking stem in patients with small anatomic proportions because of hip dysplasia or juvenile chronic arthritis. The mean age of the patients at the time of surgery was 28.7 years (range 14-56 years). The average body weight and height of the patients were 51.8 kg (range 38.5-78.3 kg) and 157.1 cm (range 142.2-183 cm), respectively. The stem was cementless in 40 hips and cemented in 12 hips because of poor bone stock. A cementless acetabular cup with screw was used in all hips. The average followup was 7.1 years (range, 3-15.6 years). The Harris hip scores improved from an average of 31.2 points (range, 3.1-68.8 points)preoperatively to 82.8 points (range, 61.1-96.6 points) at latest followup. Three of 12 (25%) cemented and two of 40 (5%) cementless stem were revised. Four of seven 42-44-mm cups were revised. The miniature Anatomic Medullary Locking cementless femoral stem provides a satisfactory outcome in patients with small anatomic proportions. However, wear and osteolysis with the use of a small cementless polyethylene liner remain challenges
| 7,770 |
0 |
Adaptation of the gait initiation process for stepping on to a new level using a single step
|
Panniculectomy & Abdominoplasty CPG
|
During the gait initiation in level walking, the anticipatory postural adjustments (APA) which precede heel off consist of a forward fall of the whole body and their duration depends on the intended gait velocity related to the step length. The present study examines the adaptation of the gait initiation process for stepping on to a new level. Five subjects performed a single step at natural speed in five experimental conditions. The first condition (C1) was a level walking task whereas the other (stair) conditions required stepping on to a new level (from 8 to 32 cm). The horizontal step length was the same under all conditions. Results showed that the center of mass (CM) forward velocity at the end of the APA, and also until foot contact of the leading limb, decreased from C1 to the stair conditions whereas the peak of forward velocity was similar under all conditions. Moreover, the CM forward displacement up to foot contact was smaller in the stair conditions than in C1. These results suggest the use of a sequential mode of control for the organization of the CM forward dynamics during the stair conditions. This adaptation of the gait initiation process for stepping up is examined mainly from the result that the majority of body lift, which occurred only from the beginning of the double-stance phase, involved a larger CM forward translation than in level walking. As the horizontal step length was the same in all conditions, it can be suggested that the CNS had to reduce the CM forward displacement up to foot contact in the stair conditions, in order to take into account the subsequent greater forward translation.
| 126,879 |
0 |
Primary lymphomas of bone
|
MSTS 2022 - Metastatic Disease of the Humerus
|
Primary lymphomas of bone are uncommon malignancies. The vast majority of them are non-Hodgkin lymphoma (NHL), whereas primary Hodgkin lymphoma (HL) of bone is extremely rare. Patients with primary NHL of bone commonly present with local bone pain, soft tissue swelling, and a mass or a pathological fracture. There is a slight male preponderance, and most patients are over 45-50 years of age. Primary NHL of bone can arise in any part of the skeleton, but long bones (femurs, tibia) are the most common sites of presentation. Comprehensive immunohistochemical studies are required to establish an accurate histological diagnosis of primary NHL of bone. Most cases of primary NHL of bone are classified as diffuse large B-cell lymphomas (DLBCL) in the World Health Organisation (WHO) classification of hematological malignancies. On full staging evaluation, most patients have disease of stage IE or IIE according to the Ann Arbor system. Several studies indicate that patients with primary NHL of bone have a favorable outcome, especially when treated by combined modality therapy. A number of studies reported that clinical stage is the most important prognostic variable in predicting overall survival. Interestingly, the rare occurrence of primary lymphoma of bone is in contrast with the frequency of plasma cell tumors in bone. This could be due to the fact that, during normal B-cell differentiation, the bone marrow is the normal site of homing of plasma cells which are terminally-differentiated, immunoglobulin-secreting post-germinal center B-cells. In this respect, there is circumstancial evidence that primary NHL of bone may represent tumors of post-germinal center B-cells. The present review summarizes data on the histogenesis of primary NHL of bone in view of the recent histogenetic classification of DLBCL on the basis of the B-cell differentiation gene expression profiles (germinal center vs. post-germinal center B-cell differentiation). [References: 115]
| 156,619 |
0 |
Does a single bolus dose of tranexamic acid reduce blood loss and transfusion requirements during hip fracture surgery? A prospective randomized double blind study in 67 patients
|
Management of Hip Fractures in the Elderly
|
Extensive blood loss in total hip surgery is well known and is associated with a high transfusion rate of allogeneic blood. The aim of this study is to assess the effects of intraoperative tranexamic acid on post-operative bleeding and need for allogeneic transfusion during hip fracture surgery. We investigated 67 patients undergoing hip fracture surgery in a prospective, randomized, double-blinded study. 32 patients received tranexamic acid (TA) given in a bolus dose of 15 mg/kg before surgical incision. The remaining, 35 patients were allocated as control group. Postoperative bleeding, transfusions, complications, and hospital stay were recorded. The intraoperative bleeding was significantly lower in the TA group (652 (plus or minus) 228 ml vs. 1108 (plus or minus) 372 ml, P <0.003). Post operative drainage was lower in TA group (296 (plus or minus) 85 ml vs. 375 (plus or minus) 110 ml, P <0.195). There were no differences in coagulation parameters. The rates of transfused patients in TA and control groups were 37 % and 57 %. In TA group, hospital stay was 4.3 (plus or minus) 1.6 days (vs. 5.8 (plus or minus) 1.5 days in control group; P < 0.05). There is one in hospital mortality in control group. We conclude that tranexamic acid significantly reduces blood loss during hip fracture surgery. (copyright) 2007 Tehran University of Medical Sciences. All rights reserved
| 8,954 |
0 |
Gingival crevicular fluid and serum vascular endothelial growth factor: Their relationship in periodontal health, disease and after treatment
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Objectives: The levels of vascular endothelial growth factor (VEGF) in gingival crevicular fluid (GCF) correlate well with clinical parameters of periodontal disease. The present study was designed to assess the relationship between clinical parameters and VEGF levels of the GCF from inflammed gingiva, periodontitis sites and treated periodontitis sites, and to correlate them to the serum VEGF levels. Design: Thirty, gender and age-matched subjects were divided into three groups- health, plaque-induced gingivitis and chronic periodontitis group, based on gingival index score and clinical attachment level. The fourth group consisted of 10 subjects in the periodontitis group, 6-8. weeks after nonsurgical treatment. Total of eighty samples (forty GCF and forty serum samples) were collected and quantified for VEGF using enzyme immunoassay. Results: The highest mean GCF and serum VEGF concentrations were observed in the periodontitis group and lowest in the healthy group. Periodontitis group showed significant reduction in VEGF levels in both GCF and serum samples after treatment. Conclusions: GCF and serum VEGF levels increased progressively with the disease severity and decreased after treatment of periodontal disease. Moreover GCF and serum VEGF levels correlated positively with clinical periodontal parameters. The study indicates the key role of VEGF in periodontal disease as a inflammatory biomarker. (copyright) 2011 Elsevier Ltd
| 19,923 |
1 |
Blade-plate fixation for distal femoral fractures: a case-control study
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: The blade-plate is the earliest of the contemporary internal fixation devices introduced for distal femoral fractures. The recent development of dedicated, fixation devices has considerably limited its use. The objective of this study was to evaluate outcomes after blade-plate fixation and after fixation using other devices.
HYPOTHESIS: Outcomes after blade-plate fixation are similar to those after condylar screw-plate, distal femoral nail, or locking condylar plate fixation.
MATERIAL AND METHODS: We reviewed outcomes after 62 patients managed with blade-plate fixation and included in a multicentre retrospective study (n=57) or a multicentre prospective study (n=5) and we compared them to outcomes after fixation using condylar screw-plates (n=82), distal femoral nail (n=219), or locking condylar plates (n=301). The four groups were comparable for age, gender distribution, occupational status, prevalence of skin wounds, patient-related factors, type of accident, and type of fracture. The evaluation relied on the clinical International Knee Society (IKS) score and on radiographs.
RESULTS: No significant differences existed across the four groups for operative time, blood transfusion use, complications, need for bone grafting, non-union rate, or IKS score values. The early surgical revision rate for removal of the fixation material was 4% with the blade-plate and 16% with the other three fixation devices (P=0.02). Post-operative fracture deformity was similar in the four groups with, however, a higher proportion of residual malalignment in the screw-fixation group. The final anatomic axis was 3.3+/-1.4degree with the blade-plate versus 2.3+/-3.7degree with the other three fixation devices. The blade-plate group had few patients with axial malalignment, and the degree of malalignment was limited to 3degree of varus and 10degree of valgus at the most, compared to 10degree and 18degree respectively, with the other three fixation devices.
CONCLUSION: Despite the now extremely limited use and teaching of blade-plate fixation, as well as the undeniable technical challenges raised by the implantation of this device, the blade-plate is a simple, strong, and inexpensive fixation method. It remains reliable for the fixation of distal femoral fractures. The disfavour into which the blade-plate is currently falling is not warranted.
LEVEL OF EVIDENCE: III, case-control study.
| 151,993 |
0 |
Safety analysis of 10 clinical trials and for 13 years after first approval of ioflupane (123)I injection (datscan)
|
HipFx Supplemental Cost Analysis
|
Ioflupane is an analog of cocaine that binds reversibly with high affinity to the dopamine transporter (DaT) protein, a marker for presynaptic terminals in dopaminergic nigrostriatal neurons. Ioflupane (123)I Injection is also known as DaTscan or DaTSCAN ((123)I-ioflupane is also called (123)I-2-(beta)-carbomethoxy-3(beta)-(4-iodophenyl)-N-(3-fluoropropyl) nortropane or (123)I-FP-CIT). The diagnostic efficacy of DaTscan has been described elsewhere. Here, we present a comprehensive analysis of the safety of DaT-scan starting from initiation of clinical development through 13 y after the date of first market approval. Safety data in the sponsor's clinical development safety database from 10 completed DaTscan clinical trials were pooled, and postapproval experience was summarized from standardized aggregate safety reports submitted to regulatory agencies. A total of 1,180 clinical trial subjects (92% of 1,284 subjects planned to receive DaTscan in the clinical trials) received DaTscan. Percentages of subjects with adverse events by category were as follows: all (22%), considered at least possibly related to DaTscan by the investigator (4%), any severe (3%), headache (4%), nausea (2%), dizziness (2%), nasopharyngitis (1%), and injection site hematoma (1%). Four percent of subjects had at least 1 serious adverse event; 5 subjects (<1%) had serious adverse events that led to death. All serious adverse events, including those that led to death, were deemed by an expert clinician to be unrelated to DaTscan. An estimated half a million market doses of DaTscan (for single use) were administered from July 2000 through the July 2013 reporting period. In postapproval safety assessment, 1 death was reported 20 d after (and unrelated to) DaTscan administration. Two spontaneously reported serious adverse drug reactions (ADRs) and 32 spontaneously reported non-serious ADRs were submitted, approximately half of which are identified in labeling. Headache (in clinical trials) and injection site pain (postapproval) were the most commonly reported events or reactions. Although adverse events were reported for 1 in 5 clinical trial subjects, most were mild and considered unrelated to DaTscan administration. Severe events were uncommon, and no serious adverse event occurring in more than 1 subject was deemed related to DaTscan administration. In postapproval experience, the frequency of ADRs spontaneously reported was less than 1 per 10,000 doses administered. Comprehensive safety data show that DaTscan was well tolerated. COPYRIGHT (copyright) 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc
| 52,130 |
0 |
Acute renal problems in the critically ill cancer patient
|
MSTS 2018 - Femur Mets and MM
|
Purpose of review This review addresses three major topics relevant for the management of renal problems in the critically ill cancer patient; the assessment of kidney function in patients with cancer, serious water and electrolyte metabolism disturbances and acute kidney injury secondary to hematological and nonhematological malignancies. Recent findings In all cancer patients, renal function (urinalysis for proteinuria or albuminuria and serum creatinine to estimate glomerular filtration rate) should be tested when they first present, at initiation and change of cancer therapy as well as during follow-up. However, the different proposed formulae for estimation of the glomerular filtration rate should be used with caution. Electrolyte abnormalities associated with the refeeding syndrome are common, yet underappreciated, and occur typically in acutely ill, malnourished hospitalized patients who are administered intravenous or enteral nutrition. Currently available data on acute kidney injury and its consequences suggest that acute kidney injury has the potential to substantially alter the outcome of patients with cancer and jeopardize their chances of receiving optimal cancer treatment and a potential cure. Summary The complex management of the numerous renal complications of the critically ill cancer patient needs a multidisciplinary approach in which the nephrologist, intensivist and oncologist all play a pivotal role. © 2008 Wolters Kluwer Health|Lippincott Williams & Wilkins.
| 79,340 |
0 |
High-density association study of 383 candidate genes for volumetric BMD at the femoral neck and lumbar spine among older men
|
Management of Hip Fractures in the Elderly
|
Genetics is a well-established but poorly understood determinant of BMD. Whereas some genetic variants may influence BMD throughout the body, others may be skeletal site specific. We initially screened for associations between 4608 tagging and potentially functional single nucleotide polymorphisms (SNPs) in 383 candidate genes and femoral neck and lumbar spine volumetric BMD (vBMD) measured from QCT scans among 862 community-dwelling white men (greater-than or equal to)65 yr of age in the Osteoporotic Fractures in Men Study (MrOS). The most promising SNP associations (p < 0.01) were validated by genotyping an additional 1156 white men from MrOS. This analysis identified 8 SNPs in 6 genes (APC, DMP1,
| 11,653 |
0 |
Radiographic Diagnosis of Scapholunate Diastasis in Distal Radius Fractures: Implications for Surgical Practice
|
Distal Radius Fractures
|
<b>Background</b> Radiographic diagnosis of scapholunate ligament injury (SLI) in the setting of distal radius fractures (DRFs) is challenging. It remains unclear to what extent radiographic diagnosis of SLI by a radiologist influences surgical decision-making regarding treatment of SLI. <b>Purpose</b> We aimed to (1) identify the number of times that concerns for the possibility of concurrent SLI in the setting of a DRF had been raised by the radiologists, (2) identify how often the radiologist's diagnosis was confirmed by the treating surgeon, and (3) how many of the patients with a radiographic concern for SLI by the radiologist received operative treatment for the SLI. <b>Patients and
| 121,217 |
0 |
Cancer Rehabilitation: Challenges, Approaches, and New Directions
|
MSTS 2018 - Femur Mets and MM
|
Impairments and disability in cancer patients can be caused by the disease process or by its treatment, including the effects of surgery, chemotherapy, and radiation. The prevalence of all cancers, with an estimated 1.4 million new cases in 2006, the development of new treatment options, and improved outcomes have created a constantly growing population of cancer survivors whose function and quality of life have been affected by their diagnoses. This article reviews the theoretical framework, clinical interventions, and research initiatives pertinent to providing rehabilitation services for patients who have been diagnosed with cancer. © 2007 Elsevier Inc. All rights reserved.
| 78,471 |
0 |
Treatment of undisplaced subcapital fractures
|
Management of Hip Fractures in the Elderly
|
A total of 157 patients with undisplaced subcapital fractures was studied with reference to outcome depending on the method of treatment; 135 were treated surgically and 22 were treated conservatively. The main complication of treatment was non-union, with an overall incidence of 5.7%. Conservative treatment resulted in an incidence of non-union which was approximately twice that of patients who were treated surgically. Patients treated surgically, however, had significant postoperative complications in 14.8% of cases. Although conservative treatment has an increased incidence of non-union, it is a safe method of treatment and we feel it still has a place in selected patients
| 13,419 |
1 |
Exercise in the management of knee and hip osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
PURPOSE OF REVIEW: This review focuses on studies published during July 2001 to August 2017 of exercise as an intervention in knee and hip osteoarthritis, including its influence on an array of patient outcomes.
RECENT FINDINGS: Studies continue to illustrate the efficacy of exercise in treating and managing osteoarthritis, with current literature more focused on the knee compared with the hip joint. Both traditional (e.g. strength, aerobic, flexibility) and more nontraditional (e.g. yoga, Tai Chi, aquatic) training modes improve patient outcomes related to joint symptoms, mobility, quality of life, psychological health, musculoskeletal properties, body composition, sleep, and fatigue. Exercise that is adequately dosed (e.g. frequency, intensity) and progressive in nature demonstrated the greatest improvements in patient outcomes. Supervised, partially supervised, and nonsupervised interventions can be successful in the treatment of osteoarthritis, but patient preference regarding level of supervision and mode of exercise may be key predictors in exercise adherence and degree of outcome improvement. A topic of increasing interest in osteoarthritis is the supplementary role of behavior training in exercise interventions.
SUMMARY: Osteoarthritis is a complex, multifactorial disease that can be successfully managed and treated through exercise, with minimal risk for negative consequences. However, to have greatest impact, appropriate exercise prescription is needed. Efforts to achieve correct exercise doses and mitigate patient nonadherence are needed to lessen the lifelong burden of osteoarthritis.
| 116,075 |
0 |
Clinical and histopathologic review of 18 explanted porous polyethylene orbital implants
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
PURPOSE: To review the clinical and histopathologic features of porous polyethylene (PP) orbital implants requiring explantation. DESIGN: Case series. PARTICIPANTS: Eighteen explanted PP orbital implants of 18 patients were studied. METHODS: The charts and histopathologic findings were reviewed for all patients requiring explantation of PP orbital implants between 1997 and 2006 by 2 oculoplastic surgeons at the University of British Columbia. MAIN OUTCOME MEASURES: Clinical data obtained included patient demographics, the nature of the primary surgery, and the clinical presentation leading to eventual implant removal. The histopathologic data observed included the presence of anterior exposure, area of fibrovascular ingrowth, type of inflammation, and presence and type of bacterial colonies. RESULTS: Nine (50%) of the 18 patients studied were referred from other surgeons. The balance represented 3.2% of all PP implants placed by the 2 surgeons. The procedures for the primary surgery were 12 enucleations (67%), 5 eviscerations (28%), and 1 secondary implant (5%). Clinical findings included anterior implant exposure and discharge in all cases. Histopathologic analysis was performed in all of the implants and showed less than 50% fibrovascular ingrowth in 16 implants (89%) and predominantly acute or mixed inflammation in 15 (83%). Foreign body giant cells were seen adjacent to the implant material in all cases. Bacterial colonies on gram stain were identified in 12 specimens (67%); overall, gram-positive cocci in clusters or chains were found in 10 implants (56%), and gram-negative bacteria were found in 1 (5.5%). Thirteen patients (72%) lived in locations distant from Vancouver, the surgical center. CONCLUSIONS: This article presents the largest review of explanted porous polyethylene orbital spheres. The findings suggest that anterior exposure allows bacterial colonization and the development of a heavy inflammatory infiltrate. Poor tissue ingrowth may limit the penetration of topical or systemic antibiotic therapy, leading to the necessity for explantation. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article
| 17,496 |
0 |
A review of upper limb injuries in bear maul victims: Consistent pattern and inverse relation in severity with facial and scalp injuries
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
PURPOSE: Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year. METHODS: Twenty-one consecutive patients over a period of 1 year reported to our department for orthopaedic management of bear maul injuries. All the patients were referred either from peripheral hospitals or from other surgical departments of our hospital. RESULTS: All the patients had facial/scalp injuries of variable severity. In all the patients the severity of limb and facial trauma was inversely proportional to each other. Pattern of upper limb trauma in most of the patients was similar. Fifteen patients had either fractures of distal humerus or mid shaft/proximal forearm bone fracture. Two had distal forearm bone fracture, 2 had carpal/metacarpal fractures and 1 had clavicle fracture. Only 1 had lower limb fracture. Thirteen out of 21 patients had associated neurovascular injury of the involved limb. The characteristic feature was extensive soft tissue involvement of the affected limb. CONCLUSION: Upper limb injuries in bear maul patients usually have similar pattern. The severity of upper limb and facial/scalp trauma is inversely proportional to each other. Multistage orthopaedic surgeries are needed for such complex limb injuries.
| 143,188 |
0 |
Variability of steroid receptors in multiple biopsies of breast cancer: effect of systemic therapy
|
MSTS 2018 - Femur Mets and MM
|
Estrogen receptor (ER) was measured on two or more specimens taken from each of 53 patients with carcinoma of the breast (18 also had progesterone receptor analyzed). Among the 35 patients who had no interval therapy, 27 patients had repeated tests within one month, and only two had reversal of ER results. Among the eight patients who had ER tests 9-36 months apart, four of five ER + lesions (7 + fmol/mg cytosol protein) had ER - metastasis. Among the 18 patients who received systemic therapy, three of ten ER + became ER -, while two of ten ER - became ER +. Our data and reports in the literature are summarized, showing that about 20% of receptor studies among multiple samples are different even when patients received no interval therapy. In asynchronous studies, it is more likely to have ER positive change to negative than vice versa (31% vs 12%). Interval chemotherapy or endocrine therapy tends to increase the occurrence of ER negative relapse among patients with ER positive tumors.
| 79,367 |
0 |
Calcitonin receptor polymorphism is associated with a decreased fracture risk in post-menopausal women
|
Management of Hip Fractures in the Elderly
|
High bone resorption by the osteoclast results in osteoporosis, a disease affecting 40% of women after the menopause. Calcitonin, used to treat osteoporosis, inhibits bone resorption via receptors located on the osteoclasts. Two alleles of the calcitonin receptor gene ( CTR ) exist: a base mutation T-->C in the third intracellular C-terminal domain changes a proline (CCG) at position 447 to a leucine (CTG). We therefore studied the distribution of these alleles in a cohort of 215 post-menopausal Caucasian women suffering or not from osteoporotic fractures. The region of interest within the point mutation was amplified by PCR and screened for single strand conformation polymorphism. This work was followed by DNA sequencing of the fragments amplified. We found that bone mineral density (BMD) at the femoral neck was significantly higher in heterozygous subjects with the Rr genotype compared with the homozygous leucine (RR) and homozygous proline (rr) genotypes. Also, a decreased fracture risk was observed in heterozygote subjects. In conclusion, our results suggest that polymorphism of CTR could be associated with osteoporotic fractures and BMD in a population of post-menopausal women. CTR heterozygotes could produce both alleles of the receptor. The heterozygous advantage effect of Rr subjects could explain their protection against osteoporosis: higher bone density and decreased fracture risk. Establishing the genotype of the CTR gene in post-menopausal women could be of value in evaluating their risk of developing fractures
| 10,450 |
0 |
Osteonecrosis of the jaw associated with bisphosphonate use: Presentation of seven cases and literature review
|
MSTS 2018 - Femur Mets and MM
|
PROBLEM ADDRESSED: Bisphosphonates, pyrophosphate analogs, are strong osteoclast inhibitors that are used for osteoporosis and in the treatment of solid tumors with bony metastasis. There are growing reports of osteonecrosis associated with the nitrogen containing bisphosphonates, Pamindronate and Zolendronic acid therapy. Theses cases have been most commonly seen and treated by oral surgeons. An untreated maxillary osteonecrosis can lead to pansinusitis, involving the otolaryngologist in these patients' care. To the authors' knowledge, this is the first case series reported in the otolaryngology literature. PATIENTS AND METHODS: A retrospective chart review was conducted on patients presenting to the Mount Sinai Hospital Center and at Elmhurst General Hospital between October 2003 and November 2004 with a history of refractory osteomyelitis of the jaws and chronic bisphosphonate therapy. RESULTS: Seven patients were identified with both of these conditions. These patients presented with nonhealing ulcers of the mandible or maxilla. Four of the patients were on bisphosphonate therapy, and the other three had been treated with bisphosphonates. Three of the patients required extensive operations to remove the involved bone. One patient required endoscopic sinus surgery. CONCLUSIONS: Increasing reports of bisphosphonate associated osteomyelitis and the difficulty in treating these patients requires further investigation to identify the subset of patients who are at increased risk for this process. The optimal and safe duration of treatment with bisphosphonates needs to be determined. © The American Laryngological, Rhinological & Otological Society, Inc.
| 80,998 |
1 |
Is routine antibiotic prophylaxis cost effective for total joint replacement patients?
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Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
The routine use of amoxicillin antibiotic prophylaxis prior to dental procedures for patients with total joint prostheses in place remains controversial. This analysis shows that the practice may not be cost-effective for patients in whom the risk of infection with dental work is low. However, specific data quantifying the risk and the impact prophylactic antibiotics can have is needed. Patients and physicians will need to continue to consider their use on an individual basis and should consider the risk of infection as well as the risk of adverse drug reaction when making treatment decisions
| 22,631 |
0 |
UK DRAFFT: A randomised controlled triaof percutaneous fixation with kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius
|
Distal Radius Fractures
|
Background: In high-income countries, 6% of all women will have sustained a fracture of the wrist (distal radius) by the age of 80 years and 9% by the age of 90 years. Advances in orthopaedic surgery have improved the outcome for patients: many such fractures can be treated in a plaster cast alone, but others require surgical fixation to hold the bone in place while they heal. The existing evidence suggests that modern locking-plate fixation provides improved functional outcomes, but costs more than traditional wire fixation. Methods: In this multicentre trial, we randomly assigned 461 adult patients having surgery for an acute dorsally displaced fracture of the distal radius to either percutaneous Kirschner-wire fixation or locking-plate fixation. The primary outcome measure was the Patient-Rated Wrist Evaluation © (PRWE) questionnaire at 12 months after the fracture. In this surgical trial, neither the patients nor the surgeons could be blind to the intervention. We also collected information on complications and combined costs and quality-adjusted life-years (QALYs) to assess cost-effectiveness. Results: The baseline characteristics of the two groups were well balanced and over 90% of patients completed follow-up. Both groups of patients recovered wrist function by 12 months. There was no clinically relevant difference in the PRWE questionnaire score at 3 months, 6 months or 12 months [difference at 12 months: â??1.3; 95% confidence interval (CI) â??4.5 to 1.8; p = 0.398]. There was no difference in the number of complications in each group and small differences in QALY gains (0.008; 95% CI â??0.001 to 0.018); Kirschner-wire fixation represents a cost-saving intervention (â??£727; 95% CI â??£588 to â??£865), particularly in younger patients. Conclusions: Contrary to the existing literature, and against the increasing use of locking-plate fixation, this trial shows that there is no difference between Kirschner wires and volar locking plates for patients with dorsally displaced fractures of the distal radius. A Kirschner-wire fixation is less expensive and quicker to perform. Trial registration: Current Controlled Trials ISRCTN31379280. Funding: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 17. See the NIHR Journals Library website for further project information.
| 120,616 |
0 |
A review of analgesia for knee surgery
|
Surgical Management of Osteoarthritis of the Knee CPG
|
This review demonstrates that there are inadequate data to draft a protocol in pain management after knee surgery. The review is intended to provide a stimulus for those who manage their orthopedic patients in a particular manner to test their pain management strategy in a random, prospective, controlled manner. They should aim to provide a data base that will assist in solving the knee surgery conundrums which inhibit identification of the most efficacious delivery of analgesia
| 27,819 |
0 |
Association of Patient-reported Outcomes With Clinical Outcomes After Distal Humerus Fracture Treatment
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
In this study, we assessed the patient-reported outcomes of distal humerus fracture treatment using Patient-Reported Outcomes Measurement Information System (PROMIS) or QuickDASH (Disabilities of the Arm, Shoulder, and Hand) scores and the association between patient-reported outcomes and clinical outcomes. METHODS: We performed a retrospective cohort study of 76 adult patients who sustained an acute distal humerus fracture between 2016 and 2018; 53 patients completed at least one patient-reported outcome measure used to assess physical function (PF) during their routine follow-up care (69.7% response rate). The average time to follow-up patient-reported outcome measure was 10.3 months. Patients completed the PROMIS PF 10a, PROMIS upper extremity (UE) 16a, and/or QuickDASH based on the treating institution/service. In addition, the PROMIS Global (Mental) subscale score was used as a measure of self-rated mental health. To assess clinical outcomes, we measured radiographic union, range of motion, and postoperative complications. RESULTS: Most fractures were intra-articular (67.9%), and 84.9% were treated surgically. After treatment, 98.1% of fractures united radiographically. By the final follow-up, the average arc of motion was 18° to 122°. Average (±SD) PROMIS PF and UE scores were 41.7 ± 11.1 and 40.8 ± 12.4, respectively. The average QuickDASH score was 39.4 ± 26.5. The arc of flexion-extension and PROMIS Global (Mental) score were independently associated with PROMIS PF and PROMIS UE scores. CONCLUSIONS: We found that clinical factors (the arc of flexion-extension) and patient psychological factors (PROMIS Global [Mental] score) were independently associated with PROMIS measures of PF after distal humerus fracture treatment. These data can be used to contextualize patient outcomes and guide patient expectations.
| 142,074 |
0 |
Relationship between functional status and the capacity to regulate behavior among elderly persons following hip fracture
|
Management of Hip Fractures in the Elderly
|
Objective: To assess the relationship between behavioral self-regulation and functional status among older rehabilitation inpatients. Study Design: Prospective outcome study. Setting: Fourteen inpatient rehabilitation units and skilled nursing facilities. Participants: Two hundred twelve older adults following hip fracture or replacement. Measures: Mini Mental State Exam (MMSE), Geriatric Depression Scale, Behavioral Dyscontrol Scale (BDS), and nurse-rated functioning on activities of daily living (ADLs) and the Barthel Index. Results: Risk-adjusted analyses found the BDS to be strongly associated with all 11 ADLs and the Barthel Index. The MMSE made an additional contribution to 4 models. Conclusion: The results suggest that the ability to use intentions to guide purposeful behavior is an important contributor to functioning among older adults, affecting rehabilitation potential
| 3,599 |
0 |
Prevalence of pin tract infection: the role of combined silver sulphadiazine and chlorhexidine dressing
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
OBJECTIVE: Infection at the pin tract is a common complication of external fixation. This study was done to compare the rate of pin site infection following combined 1% silver sulphadiazine and 5 % chlorbexidine dressing with 5% chlorhexidine dressing alone. METHOD: This was a prospective controlled study which compared the results of pin site dressing using a combination of chlorhexidine and silver sulphadiazine cream (Study group) with dressing using chlorhexidine alone. Eligible patients had external fixation in the treatment of open fractures or orthopaedic conditions. Pin-tract infection was deemed to be present iferythema, cellulitis or purulent discharge occurred around a pin site. We did not distinguish between deep and superficial infection. RESULTS: The study group had one hundred and seventy pin sites while the control group had one hundred and sixty-four pin sites. Thirty-eight patients, in whom thirty-seven uniplanar external fixators and one Ilizarov ring fixator were used, made up both groups. Three patients (7.9%) had pin tract infection in the study group while nine patients (23.7%) had pin tract infection in the control group. CONCLUSION: There was a significantly lower prevalence of pin-tract infection amongst patients whose external fixation pins were dressed with 1% silver sulphadiazine and 5% chlorhexidine than in those dressed with chlorhexidine alone (P = 0.03). Therefore, we advocate the use of a combination of silver sulphadiazine and chlorhexidine for pin site dressing
| 19,668 |
0 |
Osteochondral Repair and Electromechanical Evaluation of Custom 3D Scaffold Microstructured by Direct Laser Writing Lithography
|
Osteochondritis Dissecans 2020 Review
|
OBJECTIVE: The objective of this study was to assess a novel 3D microstructured scaffold seeded with allogeneic chondrocytes (cells) in a rabbit osteochondral defect model. DESIGN: Direct laser writing lithography in pre-polymers was employed to fabricate custom silicon-zirconium containing hybrid organic-inorganic (HOI) polymer SZ2080 scaffolds of a predefined morphology. Hexagon-pored HOI scaffolds were seeded with chondrocytes (cells), and tissue-engineered cartilage biocompatibility, potency, efficacy, and shelf-life in vitro was assessed by morphological, ELISA (enzyme-linked immunosorbent assay) and PCR (polymerase chain reaction) analysis. Osteochondral defect was created in the weight-bearing area of medial femoral condyle for in vivo study. Polymerized fibrin was added to every defect of 5 experimental groups. Cartilage repair was analyzed after 6 months using macroscopical (Oswestry Arthroscopy Score [OAS]), histological, and electromechanical quantitative potential (QP) scores. Collagen scaffold (CS) was used as a positive comparator for in vitro and in vivo studies. RESULTS: Type II collagen gene upregulation and protein secretion was maintained up to 8 days in seeded HOI. In vivo analysis revealed improvement in all scaffold treatment groups. For the first time, electromechanical properties of a cellular-based scaffold were analyzed in a preclinical study. Cell addition did not enhance OAS but improved histological and QP scores in HOI groups. CONCLUSIONS: HOI material is biocompatible for up to 8 days in vitro and is supportive of cartilage formation at 6 months in vivo. Electromechanical measurement offers a reliable quality assessment of repaired cartilage.
| 138,756 |
0 |
Surface repair of the femoral head using press-osteochondral autograft transfer
|
Osteochondritis Dissecans 2020 Review
|
AIMS: Hyaline cartilage has a low capacity for regeneration. Untreated osteochondral lesions of the femoral head can lead to progressive and symptomatic osteoarthritis of the hip. The purpose of this study is to analyze the clinical and radiological long-term outcome of patients treated with osteochondral autograft transfer. To our knowledge, this study represents a series of osteochondral autograft transfer of the hip with the longest follow-up. METHODS: We retrospectively evaluated 11 hips in 11 patients who underwent osteochondral autograft transfer in our institution between 1996 and 2012. The mean age at the time of surgery was 28.6 years (8 to 45). Outcome measurement included standardized scores and conventional radiographs. Kaplan-Meier survival curve was used to determine the failure of the procedures, with conversion to total hip arthroplasty (THA) defined as the endpoint. RESULTS: The mean follow-up of patients treated with osteochondral autograft transfer was 18.5 years (9.3 to 24.7). Six patients developed osteoarthritis and had a THA at a mean of 10.3 years (1.1 to 17.3). The cumulative survivorship of the native hips was 91% (95% confidence interval (CI) 74 to 100) at five years, 62% (95% CI 33 to 92) at ten years, and 37% (95% CI 6 to 70) at 20 years. CONCLUSION: This is the first study analyzing the long-term results of osteochondral autograft transfer of the femoral head. Although most patients underwent conversion to THA in the long term, over half of them survived more than ten years. Osteochondral autograft transfer could be a time-saving procedure for young patients with devastating hip conditions who have virtually no other surgical options. A larger series or a similar matched cohort would be necessary to confirm these results which, in view of the heterogeneity of our series, seems difficult to achieve.
| 140,031 |
0 |
CCR9/CCL25 expression in non-small cell lung cancer correlates with aggressive disease and mediates key steps of metastasis
|
MSTS 2018 - Femur Mets and MM
|
Poor clinical outcome of lung cancer (LuCa) is primarily due to lack of knowledge about specific molecules involved in its progression and metastasis. In this study, we for the first time show the clinical and biological significance of CC chemokine receptor-9 (CCR9) in non-small cell lung cancer (NSCLC). Expression of CCR9 and CCL25, the only natural ligand of CCR9, was significantly higher (p<0.0001) in NSCLC tissues and serum respectively, compared to their respective controls. Interestingly, expression of both CCR9 and CCL25 was significantly higher in adenocarcinomas (ACs) compared to squamous cell carcinomas (SCCs) (p = 0.04, and p< 0.0001). Similar to tissues, AC and SCC cell lines were positive for CCR9 expression. Despite of marginal difference in CCR9 expression, AC cells showed higher migratory and invasive potential in response to CCL25, compared to SCC cells. This differential biological response of AC cells was primarily due to differential expression of matrix metalloproteinases and tissue inhibitor of metalloproteinases under the influence of CCL25. Our results suggest CCR9 as a potential target for developing new treatment modality for NSCLC. Additionally, differential serum CCL25 level in ACs and SCCs, two NSCLC subtypes, suggest its potential as a non-invasive diagnostic/prognostic biomarker.
| 78,676 |
0 |
Versatility of an extended posterior approach for the treatment of acetabular fractures with reference to the superior gluteal neurovascular bundle
|
DoD SSI (Surgical Site Infections)
|
Summary: The superior gluteal neurovascular bundle is at risk of injury in certain types of acetabular fractures and the associated surgery. This article describes the versatility of an extended posterior approach, previously described for complex revision total hip replacement (the Adelaide approach) and for the treatment of acetabular fractures that allows a wide exposure of the ilium through identification, protection, and mobilization of the superior gluteal neurovascular bundle.
| 149,119 |
0 |
Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND: The management of soft tissue balance during surgery is essential for the success of total knee arthroplasty (TKA) but remains difficult, leaving it much to the surgeon's feel. Previous assessments for soft tissue balance have been performed under unphysiological joint conditions, with patellar eversion and without the prosthesis only at extension and 90 deg of flexion. We therefore developed a new tensor for TKA procedures, enabling soft tissue balance assessment throughout the range of motion while reproducing postoperative joint alignment with the patellofemoral (PF) joint reduced and the tibiofemoral joint aligned. Our purpose in the present study was to clarify joint gap kinematics using the tensor with the CT-free computer assisted navigation system. METHOD OF APPROACH: Joint gap kinematics, defined as joint gap change during knee motion, was evaluated during 30 consecutive, primary posterior-stabilized (PS) TKA with the navigation system in 30 osteoarthritic patients. Measurements were performed using a newly developed tensor, which enabled the measurement of the joint gap throughout the range of motion, including the joint conditions relevant after TKA with PF joint reduced and trial femoral component in place. Joint gap was assessed by the tensor at full extension, 5 deg, 10 deg, 15 deg, 30 deg, 45 deg, 60 deg, 90 deg, and 135 deg of flexion with the patella both everted and reduced. The navigation system was used to obtain the accuracy of implantations and to measure an accurate flexion angle of the knee during the intraoperative joint gap measurement. RESULTS: Results showed that the joint gap varied depending on the knee flexion angle. Joint gap showed an accelerated decrease during full knee extension. With the PF joint everted, the joint gap increased throughout knee flexion. In contrast, the joint gap with the PF joint reduced increased with knee flexion but decreased after 60 deg of flexion. CONCLUSIONS: We clarified the characteristics of joint gap kinematics in PS TKA under physiological and reproducible joint conditions. Our findings can provide useful information for prosthetic design and selection and allow evaluation of surgical technique throughout the range of knee motion that may lead to consistent clinical outcomes after TKA
| 30,604 |
0 |
Efficacy of a multiple diode laser system for body contouring
|
Panniculectomy & Abdominoplasty CPG
|
Background and Objectives Low-level laser therapy (LLLT) has been shown to induce cellular reactions in nonphotosynthetic cells however skepticism remains regarding efficacy at the clinical level. The purpose of this study was to evaluate the efficacy of LLLT independent of liposuction. Additionally, a weight loss supplement (Curva�, Santa Barbra Medical Innovations, Santa Barbra, CA) was evaluated. This clinical trial evaluates the effectiveness of the Erchonia EML Laser (Zerona� System, Santa Barbra Medical Innovations) for non-invasive fat reduction and body contouring in a split-body clinical evaluation. Materials and Methods Five subjects were enrolled and completed the study. Subjects had a body mass index (BMI) of less than or equal to 29 kg/m2 and satisfied the set inclusion criteria. Participants were randomly assigned to receive low-level laser treatments on one side of the body three times per week for 2 weeks. One group took the weight loss supplement and was also treated with the laser. Subject satisfaction questionnaires, physician blinded photo evaluation, circumference measurements and ultrasound measurements were utilized to evaluate efficacy. Results Circumference measurements revealed no statistically significant reduction at either 7 days or 1 month post-treatment. One month following treatment the greatest circumference reduction overall was 0.5 ± 0.3 inches. Ultrasound measurements also did not reveal statistically significant reduction in fat layer thickness (P > 0.5). Evaluation by three blinded dermatologists resulted in average correct photo identification of 51.1%. Results reflect little clinical difference between post-treatment and baseline images. Three subjects recording a "dissatisfied" rating on satisfaction questionnaires and all subjects reported the effects of the treatment were less than expected. Subjects who took the weight loss supplement had no greater circumference reduction or identifiable clinical outcome. Conclusions This small study demonstrates to the authors that there needs to be more evidence to show clinical circumferential reduction before LLLT can be recommended as an effective therapeutic option. © 2011 Wiley-Liss, Inc.
| 124,644 |
0 |
Blunt Vascular Trauma in the Extremity: Diagnosis, Management, and Outcome
|
DOD - Acute Comp Syndrome CPG
|
Background: Blunt vascular trauma in an extremity is an uncommon diagnosis. Considering the complexity of these injuries, it is worthwhile to determine how select factors affect the outcome of the limb and the patient. The objectives of this study were to review the diagnosis, management, and outcomes of patients who sustained blunt vascular injuries in the extremities and relate factors in their treatment to the outcome of the injured extremity. Methods. A retrospective review of data on adult and pediatric patients who had a diagnosis of blunt vascular injury in an extremity and underwent some attempt at restoration of vascular flow was conducted. Results: From January 1995 to December 2002, 62 patients (80.3% male; mean age, 33.2 ± 15.8 years) sustained blunt trauma (mean Injury Severity Score, 14.6 ± 8.4), with 93 vascular injuries in 65 extremities (16 upper and 49 lower). Hard signs of vascular injury occurred in 41 (66%) patients. An associated fracture and/or dislocation was present in 59 patients (95%). Preoperative arteriograms were obtained in 20 patients (17 occlusions, 2 embolizations, and 1 untreated). Vessel injuries were as follows: 16 upper (brachial artery, 50%) and 63 lower (tibial/peroneal/popliteal, 84%), with ligation being the most common treatment in the latter. Intravascular shunts were used to restore blood flow in 18 vessels (13 arteries and 5 veins) in 13 patients. Delays in diagnosis or treatment occurred in six patients, mostly because of errors in management/judgment. Delayed or late fasciotomies were performed in six patients, and five developed rhabdomyolysis. Six patients died. The age (p = 0.0006), Injury Severity Score (p = 0.0007), and Mangled Extremity Severity Score (p = 0.0009) were significantly different for the survivors compared with the nonsurvivors. Conclusion: Blunt vascular injuries in the lower extremities occur most commonly in the anteroposterior tibial arteries; injured arteries in the proximal upper and lower extremity require resection with interposition grafting, whereas those in the forearm or calf are usually ligated; the amputation rate in 65 injured extremities with blunt vascular trauma was 18.%, which is at least three times that for those who sustain penetrating injury; and delays in diagnosis and treatment are uncommon in these patients with multiple injuries.
| 63,890 |
0 |
Medication-related osteonecrosis of the jaw in oncological patients with skeletal metastases: conservative treatment is effective up to stage 2
|
MSTS 2018 - Femur Mets and MM
|
There is currently no widespread strategy for treating medication-related osteonecrosis of the jaw (MRONJ), so our aim was to evaluate retrospectively the outcome of a minimally invasive treatment protocol for patients with both MRONJ and cancer. We designed a retrospective cohort study of patients with cancer who had been diagnosed with MRONJ after treatment with denosumab or bisphosphonates given intravenously. Primary outcome measures were improvement in the clinical stage of MRONJ and the time course to its resolution. Secondary outcome measures included the incidence of risk factors and patterns of treatment. Seventy-nine patients with 109 lesions were enrolled, and their characteristics, presentation of the lesions, complications, and relations to previous oral interventions were recorded. Treatment depended on the stage of disease, and included conservative medical, and minimally-invasive surgical, procedures. There was complete healing and resolution of disease in 38/57 stage 1 lesions, 30/47 stage 2 lesions, and 3/5 stage 3 lesions. The symptoms improved in 16/47 stage 2 lesions, and 2/5 stage 3 lesions. Fifteen of the stage 1 lesions, and one of the stage 2 lesions, failed to respond. Despite the possibility of an aggressive approach to the treatment of MRONJ, conservative treatment remains the first line of defence as regression is obvious, with evidence of no evolution to a higher stage. In our experience surgical intervention is recommended in persistent stage 3 MRONJ that has failed to respond to conservative treatment.
| 83,462 |
0 |
Giant medial parameniscal cyst in an osteoarthritic knee
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Medial parameniscal cysts of the knee are typically 0.3 to 9 mm in diameter. Few cases of unusually large medial parameniscal cysts have been reported. We describe the treatment of a patient with osteoarthritis of the knee who presented with an extraordinarily large, ipsilateral, medial parameniscal cyst, 10 cm in diameter. We believe this to be the largest medial parameniscal cyst reported in the English literature. Based on the patient's severe tricompartmental arthritis and associated symptoms, total knee arthroplasty (TKA) was indicated with simultaneous excision of the parameniscal cyst. Perioperativley, the cyst was found to have penetrated beyond the menisco-capsular attachments that were adjacent to a degenerative posterior horn horizontal medial meniscal tear. Following excision of the cyst, the mass was measured with surgical tape to be 10x10x5 cm. After complete excision of the parameniscal cyst, TKA was performed. Histological examination confirmed a benign parameniscal synovial cyst. At 2-year follow-up, the patient was ambulating unassisted without difficulty. The wound had completely healed with no evidence of recurrence of the cyst. The patient's range of motion was 0 degrees to 110 degrees with no signs of instability. Our patient's pathology was most significant for the heretofore unseen large size of the paramensical cyst. Open excision of this giant parameniscal cyst followed by TKA was effective in treating the patient's degenerative joint disease and extraordinarily large, painful soft tissue mass
| 29,329 |
1 |
Cigarette smoking and knee osteoarthritis in the elderly: Data from the Korean National Health and Nutritional Examination Survey
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OAK 3 - Non-arthroplasty tx of OAK
|
Background: The relationship between smoking and osteoarthritis (OA) has not been investigated in a large-scale study. The aim of this study was to examine the relationship between smoking and knee OA in the elderly. Methods: This study included 5117 subjects aged >60 years who responded to questionnaires on their history of smoking and knee OA diagnosed by a physician taken from the Korean National Health and Nutritional Examination Survey (KNHANES-VI) 2013â??2015. We classified all 5117 subjects into 2 groups (the OA group and non-OA group) and compared the demographics and characteristics between the 2 groups. A multivariate logistic regression analysis was conducted to investigate the possible association between knee OA and smoking. Results: The prevalence of current smoking in the OA group (5.1%) was significantly lower than in the non-OA group (14.6%; p < 0.001). Furthermore, the proportion of moderate smokers who smoked >10 cigarettes per day or heavy smokers who smoked >20 cigarettes per day was significantly higher in the non-OA group. In the multivariate analysis, current smoking history was a preventative factor for the prevalence of OA in a multivariate model that included age, sex, body mass index, waist circumference (OR: 0.752, 95% CI: 0.571â??0.989, p = 0.042). Conclusions: This large-scale national study highlights an inverse association between smoking and the prevalence of knee OA in the general Korean elder adult population, primarily in males. Further investigation of this relationship between smoking and knee OA is needed to determine smoking's specific mechanism of protection against knee OA.
| 115,268 |
0 |
A HIF-regulated VHL-PTP1B-Src signaling axis identifies a therapeutic target in renal cell carcinoma
|
MSTS 2018 - Femur Mets and MM
|
Metastatic renal cell carcinoma (RCC) is a molecularly heterogeneous disease that is intrinsically resistant to chemotherapy and radiotherapy. Although therapies targeted to the molecules vascular endothelial growth factor and mammalian target of rapamycin have shown clinical effectiveness, their effects are variable and short-lived, underscoring the need for improved treatment strategies for RCC. Here, we used quantitative phosphoproteomics and immunohistochemical profiling of 346 RCC specimens and determined that Src kinase signaling is elevated in RCC cells that retain wild-type von Hippel-Lindau (VHL) protein expression. RCC cell lines and xenografts with wild-type VHL exhibited sensitivity to the Src inhibitor dasatinib, in contrast to cell lines that lacked the VHL protein, which were resistant. Forced expression of hypoxia-inducible factor (HIF) in RCC cells with wild-type VHL diminished Src signaling output by repressing transcription of the Src activator protein tyrosine phosphatase 1B (PTP1B), conferring resistance to dasatinib. Our results suggest that a HIF-regulated VHL-PTP1B-Src signaling pathway determines the sensitivity of RCC to Src inhibitors and that stratification of RCC patients with antibody-based profiling may identify patients likely to respond to Src inhibitors in RCC clinical trials.
| 82,497 |
0 |
Zoledronic acid: an advance in tumour bone disease therapy and a new hope for osteoporosis
|
MSTS 2018 - Femur Mets and MM
|
The two main therapeutic applications of bisphosphonates are tumour bone disease and osteoporosis. They constitute the standard treatment for cancer hypercalcaemia, and placebo-controlled trials have shown that the prolonged administration of bisphosphonates, such as pamidronate or clodronate, can reduce the frequency of complications from tumour bone disease due to metastatic breast cancer or myeloma by a quarter to one-half. The results obtained with the intravenous route appear to be more impressive and more rapidly obtained than with oral compounds. Both agents can reduce the risk of vertebral, wrist and hip fractures by 30 - 50%, whereas other antiresorptive agents, such as raloxifene (Eli Lilly & Co.) or calcitonin (Unigene Laboratories Inc.), have only been demonstrated to reduce the incidence of vertebral fractures. The short infusion time (4 mg over 15 min) offers a convenient therapy and constitutes the most evident advantage of zoledronic acid, which will improve patients' quality of life. Zoledronic acid has the potential to change the treatment of osteoporosis dramatically. [References: 87]
| 82,758 |
0 |
Poor prognosis for infectious complications of surgery for ankle and hindfoot fracture and dislocation. A 34-case series
|
DoD SSI (Surgical Site Infections)
|
INTRODUCTION: Ankle and hindfoot fractures are associated with high rates of complications, and of infection in particular, for which rates of 1% to 48% are reported.
HYPOTHESIS: Treatment of bone and joint infection (BJI) secondary to surgery for ankle or hindfoot fracture is at high risk of failure. We analyzed results of treatment of BJI in this context.
MATERIAL AND METHODS: 33 patients (34 cases) were treated for ankle or hindfoot BJI between 2010 and 2015. Cure was defined by absence of fistula and of local or general inflammatory signs and by normal C-reactive protein level, at a minimum 2 years' follow-up. Fusion without infection was counted as success; recurrent infection and amputation were counted as failure. Mean age at trauma was 52 years (range, 16-85 years). Median time to diagnosis of BJI was 44 days (range, 2-830 days).
RESULTS: Mean follow-up was 20 months (range, 3-59 months). Twenty-two patients were cured (65%). Seven cases required joint fusion (21%). The failure rate was 15%, including 5 transtibial amputations. Skin cover flap was required for 15 patients (44%), at a median 33 days (range, 0-167 days).
DISCUSSION: Despite its retrospective design and small numbers, the present study confirmed the poor prognosis of BJI following surgery for ankle and/or hindfoot fracture. Patients need to be informed of this.
TYPE OF STUDY AND LEVEL OF EVIDENCE: IV, retrospective observational.
| 147,871 |
0 |
A Web-Based Platform for Patients With Osteoarthritis of the Hip and Knee: A Pilot Study
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Chronic conditions are the leading cause of disability throughout the world and the most expensive problem facing the health care systems. One such chronic condition is osteoarthritis (OA), a frequent cause of major disability.
OBJECTIVE: To describe the effect on joint pain for the first users of a newly developed Web-based osteoarthritis self-managing program, Joint Academy, and to examine whether these patients would recommend other OA patients to use the program.
METHODS: Patients with clinically established knee or hip OA according to national and international guidelines were recruited from an online advertisement. A trained physiotherapist screened the eligible patients by scrutinizing their answers to a standardized questionnaire. The 6-week program consisted of eight 2- to 5-minute videos with lectures about OA, effects of physical activity, self-management, and coping strategies. In addition, exercises to improve lower extremity physical function were introduced in daily video activities. During the course of the program, communication between physiotherapist and patients was based on an asynchronous chat. After 6 weeks, patients were able to continue without support from the physiotherapist. Patients reported their current pain weekly by using a numeric rating scale (range 0-10; 0=no pain, 10=worst possible pain) as long as they were in the program. In addition, after 6 weeks patients answered the question "What is the probability that you would recommend Joint Academy to a friend?"
RESULTS: The eligible cohort consisted of 53 individuals (39 women; body mass index: mean 27, SD 5; age: mean 57, SD 14 years). With the continued use of the program, patients reported a constant change in pain score from mean 5.1 (SD 2.1) at baseline to mean 3.6 (SD 2.0) at week 12. Six patients participated for 30 weeks (mean 3.2, SD 2.1). Overall, the patients would highly recommend Joint Academy to other OA patients, suggesting that the platform may be useful for at least some in the vast OA population.
CONCLUSIONS: Joint Academy, a Web-based platform for OA therapy, has the potential to successfully deliver individualized online treatment to many patients with OA that presently lack access to treatment.
| 102,466 |
0 |
Biomechanical comparison of fixed- and mobile-bearing for unicomparmental knee arthroplasty using finite element analysis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Unicomparmental knee arthroplasty (UKA) is a popular alternative to total knee arthroplasty (TKA) and high tibial osteotomy for unicompartmental knee conditions, especially in young patients. However, failure of UKA occurs due to either progressive osteoarthritis (OA) in the other compartment or wear on the polyethylene (PE) insert. This study used finite element (FE) analysis to investigate the effects of PE insert contact pressure and stress in opposite compartments for fixed- and mobile-bearing UKA. Analysis was performed using high kinematics displacement and rotation inputs, which were based on the kinematics of the natural knee. ISO standards were used for axial load and flexion. The mobile-bearing PE insert had lower contact pressure than the fixed-bearing PE insert. With the mobile-bearing UKA, lower stress on the opposite compartment reduces the overall risk of progressive OA in the knee. The fixed-bearing UKA increases the overall risk of progressive OA in the knee due to higher stress on the opposite compartment. However, the PE insert of mobile-bearing showed pronounced backside stress at the inferior surface. (c) 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
| 35,524 |
0 |
The management of the soft tissues in pilon fractures
|
DoD SSI (Surgical Site Infections)
|
Fourteen patients with 15 pilon fractures were reviewed retrospectively to analyze cases treated by open reduction and internal fixation through both anteromedial and lateral incisions. The protocol for this procedure involved objective soft-tissue evaluation, anteromedial wound closure, judicious use of primary skin grafting, and delayed primary or secondary closure for the lateral wound. Eleven fractures were treated according to the established principles of the Association for the Study on Internal Fixation (AO/ASIF). The type and incidence of wound complications were recorded. Most injuries reviewed were of the high-energy or Type III fracture as defined by Reudi and Allgower. There was only one patient with a wound complication. This technique minimized the potential for wound complication and disastrous disability.
| 147,980 |
0 |
The nature of the characteristic cementum-like matrix deposits in the walls of simple bone cysts
|
MSTS 2022 - Metastatic Disease of the Humerus
|
AIMS: Simple bone cysts (SBC) are benign tumour-like lesions, generally occurring in the metaphyses of long bones before skeletal maturity. Remarkably, in 10-70% of cases, a peculiar, amorphous and hypocellular matrix is found in the walls of SBCs which is usually regarded to consist of (calcified) fibrin clots in the literature. Because these deposits are strongly fuchsinophilic in routine van Gieson stains, the aim of this study was to investigate a series of SBCs using immunohistochemistry and electron microscopy.
METHODS AND RESULTS: A comprehensive panel of antibodies against fibrin as well as collageneous and non-collageneous proteins of bone was used, and detected substantial amounts of collagen and decorin as the main components of the investigated matrix. Electron microscopy clearly underlined the immunohistochemical results and also showed abundant fibrils with a periodic banding characteristic of collagen. Adjacent to and in between these collagen deposits runx-2- and osterix-expressing cells were detectable, most probably representing immature osteoprogenitor cells.
CONCLUSIONS: Although still stated in the literature and most current textbooks, we were not able to detect any evidence of fibrin as a component of the respective matrix deposits that seem to consist predominantly of collagen and decorin.
| 153,773 |
0 |
SOCS1 Regulates Apoptosis and Inflammation by Inhibiting IL-4 Signaling in IL-1beta-Stimulated Human Osteoarthritic Chondrocytes
|
OAK 3 - Non-arthroplasty tx of OAK
|
Recently, Suppressor of Cytokine Signaling 1 (SOCS1) was identified as a potential therapeutic target for osteoarthritis (OA) treatment. However, the mechanisms and signaling pathways of SOCS1 in the regulation of OA development are unclear. The purpose of the current study was to investigate whether interleukin- (IL-) 4 was involved in regulatory mechanism of SOCS1 in human osteoarthritic chondrocytes. First, IL-1beta was used to stimulate human osteoarthritic chondrocytes isolated from the articular cartilage of OA patients undergoing total knee replacement. The protein and mRNA expression levels of SOCS1 were upregulated in IL-1beta-stimulated human osteoarthritic chondrocytes compared with control cells. The knockdown of SOCS1 increased cell viability and inhibited cell apoptosis. It was also found that IL-4 expression was increased by SOCS1 silencing. Additionally, knockdown of IL-4 reduced cell viability and increased cell apoptosis of osteoarthritic chondrocytes transfected with SOCS1 siRNA. Moreover, the decreased expression of inflammatory factors induced by SOCS1 was enhanced by IL-4 knockdown. In conclusion, IL-4 signaling plays a crucial role in the regulatory functions of SOCS1 in apoptosis and inflammation in human osteoarthritic chondrocytes. These findings provide a potential therapeutic target for the clinical treatment of OA.
| 108,094 |
0 |
The IPSO study: ibuprofen, paracetamol study in osteoarthritis. A randomised comparative clinical study comparing the efficacy and safety of ibuprofen and paracetamol analgesic treatment of osteoarthritis of the knee or hip
|
OAK 3 - Non-arthroplasty tx of OAK
|
OBJECTIVE: To compare the analgesic efficacy of single and multiple doses of ibuprofen with that of paracetamol in patients with knee or hip osteoarthritis (IPSO study). METHOD: 222 patients were randomised in a double blind, multicentre studyâ?156 (70%) had a painful knee joint and 66 (30%) a painful hip joint. The main efficacy criterion was pain intensity assessment after a single dose (ibuprofen 400 mg, paracetamol 1000 mg). Functional disability assessment and patient global assessment were carried out over 14 days. RESULTS: The sum of the pain intensity difference over 6 hours after the first administration was significantly higher (p = 0.046) in the ibuprofen group than in the paracetamol group. Over 14 days pain intensity decreased from the first day and was significantly lower in the ibuprofen group than in the paracetamol group (p<0.05). The functional disability of the patient was assessed using the WOMAC; the ibuprofen group improved significantly over 2 weeks compared with the paracetamol group for each of the subscales: stiffness (p<0.002), pain (p<0.001), physical function (p<0.002). The drugs were equally safe. CONCLUSION: The IPSO study shows that for the treatment of osteoarthritic pain, ibuprofen 400 mg at a single and multiple dose (1200 mg/day) for 14 days is more effective than paracetamol, either as a single dose of 1000 mg or a multiple dose (3000 mg/day). Because ibuprofen and paracetamol have similar tolerability, this study indicates that the efficacy/tolerability ratio of ibuprofen is better than that of paracetamol in this indication over 14 days.
| 113,578 |
0 |
HIV and dyslipidaemia
|
Panniculectomy & Abdominoplasty CPG
|
Patients with HIV have decreased mortality with new and effective antiretroviral therapy. We are increasingly seeing patients with HIV and dyslipidaemia and there are still many unanswered questions regarding cardiovascular risk assessment and management of patients with HIV associated dyslipidaemia. This article hopes to simplify and present what is currently known on the subject.
| 123,955 |
0 |
Patterns of chemotherapy, toxicity, and short-term outcomes for older women receiving adjuvant trastuzumab-based therapy
|
HipFx Supplemental Cost Analysis
|
Limited data are available regarding patterns of chemotherapy receipt and treatment-related toxicities for older women receiving adjuvant trastuzumab-based therapy. We used surveillance, epidemiology and end results (SEER)-Medicare data to identify patients (less-than or equal to)66 years with stage I-III breast cancer treated during 2005-2009, who received trastuzumab-based therapy. We examined patterns of chemotherapy receipt, and using multivariable logistic regression, we examined associations of age and comorbidity with non-standard chemotherapy. In propensity-weighted cohorts of women receiving standard and non-standard trastuzumab-based therapy, we also examined rates of (1) hospital events during the first 6 months of chemotherapy and (2) short-term survival. Among 2,106 women, 29.7 % were aged (greater-than or equal to)76 and 66 % had a comorbidity score = 0. Overall, 31.3 % of women received non-standard chemotherapy. Compared to patients aged 66-70, older patients more often received non-standard chemotherapy [adjusted odds ratio (OR) = 4.1, 95 % confidence interval (CI) = 3.40-4.92 (ages 76-80); OR = 15.3, 95 %CI = 9.92-23.67 (age (less-than or equal to) 80)]. However, comorbidity was not associated with receipt of non-standard chemotherapy. After propensity score adjustment, hospitalizations were more frequent in the standard (vs. non-standard) group (adjusted OR = 1.7, 95 % CI = 1.29-2.24). With a median follow-up of 2.8 years, 276 deaths occurred; the adjusted hazard ratio (HR) for death was lower in standard versus non-standard treated women (HR = 0.69, 95 % CI = 0.52-0.91). Among a population-based cohort of older women receiving trastuzumab, nearly one-third received non-standard chemotherapy, with the highest rates among the oldest women. Non-standard chemotherapy was associated with fewer toxicity-related hospitalizations but worse survival. Further exploration of treatment toxicities and outcomes for older women with HER2-positive breast cancer is warranted. (copyright) 2014 Springer Science+Business Media New York
| 52,293 |
0 |
Relationships Between Tibiofemoral Contact Forces and Cartilage Morphology at 2 to 3 Years After Single-Bundle Hamstring Anterior Cruciate Ligament Reconstruction and in Healthy Knees
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Prevention of knee osteoarthritis (OA) following anterior cruciate ligament (ACL) rupture and reconstruction is vital. Risk of postreconstruction knee OA is markedly increased by concurrent meniscal injury. It is unclear whether reconstruction results in normal relationships between tibiofemoral contact forces and cartilage morphology and whether meniscal injury modulates these relationships.
HYPOTHESES: Since patients with isolated reconstructions (ie, without meniscal injury) are at lower risk for knee OA, we predicted that relationships between tibiofemoral contact forces and cartilage morphology would be similar to those of normal, healthy knees 2 to 3 years postreconstruction. In knees with meniscal injuries, these relationships would be similar to those reported in patients with knee OA, reflecting early degenerative changes.
STUDY DESIGN: Cross-sectional study; Level of evidence, 3.
METHODS: Three groups were examined: (1) 62 patients who received single-bundle hamstring reconstruction with an intact, uninjured meniscus (mean age, 29.8 +/- 6.4 years; mean weight, 74.9 +/- 13.3 kg); (2) 38 patients with similar reconstruction with additional meniscal injury (ie, tear, repair) or partial resection (mean age, 30.6 +/- 6.6 years; mean weight, 83.3 +/- 14.3 kg); and (3) 30 ligament-normal, healthy individuals (mean age, 28.3 +/- 5.2 years; mean weight, 74.9 +/- 14.9 kg) serving as controls. All patients underwent magnetic resonance imaging to measure the medial and lateral tibial articular cartilage morphology (volumes and thicknesses). An electromyography-driven neuromusculoskeletal model determined medial and lateral tibiofemoral contact forces during walking. General linear models were used to assess relationships between tibiofemoral contact forces and cartilage morphology.
RESULTS: In control knees, cartilage was thicker compared with that of isolated and meniscal-injured ACL-reconstructed knees, while greater contact forces were related to both greater tibial cartilage volumes (medial: R<sup>2</sup> = 0.43, beta = 0.62, P = .000; lateral: R<sup>2</sup> = 0.19, beta = 0.46, P = .03) and medial thicknesses (R<sup>2</sup> = 0.24, beta = 0.48, P = .01). In the overall group of ACL-reconstructed knees, greater contact forces were related to greater lateral cartilage volumes (R<sup>2</sup> = 0.08, beta = 0.28, P = .01). In ACL-reconstructed knees with lateral meniscal injury, greater lateral contact forces were related to greater lateral cartilage volumes (R<sup>2</sup> = 0.41, beta = 0.64, P = .001) and thicknesses (R<sup>2</sup> = 0.20, beta = 0.46, P = .04).
CONCLUSION: At 2 to 3 years postsurgery, ACL-reconstructed knees had thinner cartilage compared with healthy knees, and there were no positive relationships between medial contact forces and cartilage morphology. In lateral meniscal-injured reconstructed knees, greater contact forces were related to greater lateral cartilage volumes and thicknesses, although it was unclear whether this was an adaptive response or associated with degeneration. Future clinical studies may seek to establish whether cartilage morphology can be modified through rehabilitation programs targeting contact forces directly in addition to the current rehabilitation foci of restoring passive and dynamic knee range of motion, knee strength, and functional performance.
| 103,091 |
1 |
Postoperative analgesic effect of locally infiltrated levobupivacaine in fleur-de-Lys abdominoplasty
|
Panniculectomy & Abdominoplasty CPG
|
BACKGROUND: This prospective double-blind study compared the analgesic properties of locally infiltrated levobupivacaine with those of ropivacaine in fleur-de-lys abdominoplasty. METHODS: A total of 46 patients subjected to fleur-de-lis abdominoplasty under general anesthesia were included. The patients were randomly assigned to receive local infiltration of the peri-incisional and dissected area with the following solutions: group A (placebo group, n = 15) received 100 ml of saline 0.9%, group B (n = 15) received 50 ml of ropivacaine 0.75% in 50 ml of saline 0.9%, and group C (n = 16) received 60 ml of levobupivacaine 0.25% in 40 ml of saline 0.9%. The anesthetic technique was standardized for all the groups. The patients were asked to assess their pain at rest on a visual analog scale (VAS) at 2 h, 4 h, and 24 h postoperatively. Data were analyzed by mixed analysis of variance (ANOVA), simple ANOVA, and repeated measures ANOVA, followed by Tukey's test. RESULTS: Groups B and C did not differ significantly in their VAS scores at 2 h postoperatively, but group C experienced significantly less pain (p < 0.001) than either the control group or the B group at 4 h and 24 h postoperatively. Group B also registered significantly lower VAS scores (p < 0.001) than the placebo group at 4 h postoperatively. CONCLUSIONS: It is concluded that for mini abdominoplasty, adequate analgesia is achieved for at least 4 h postoperatively by local tissue infiltration with either ropivacaine or levobupivacaine. However, in terms of intensity and duration of analgesia, levobupivacaine was found to be more effective than ropivacaine in reducing postoperative pain associated with mini abdominoplasty.
| 128,486 |
0 |
A Study Evaluating the Efficacy of a Single Injection Autologous Adipose Derived Mesenchymal Stromal Cells in Patients With Knee Osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
ASCs will be administered via intraâ?articular use into the knee joint affected by OA where they are expected to exert their therapeutic effects. The objective of this clinical trial is to generate efficacy and tolerability profiles of single injections of 2 dosages of autologous ASCs versus standard of care (placebo), when administered locally into a knee joint affected by OA after in vitro cell expansion. The potential of ASC to lead to a diseaseâ?modifying therapeutic option for the treatment of this chronic and debilitating disease will be assessed by MRI after 1 and 2 years. This will be a phase IIb, multiâ?centre, prospective, randomized, doubleâ?blind study, comparing cultureâ?expanded autologous ASC with placebo.
| 106,646 |
0 |
Differential expression of interleukin-8 and intercellular adhesion molecule-1 by human gingival epithelial cells in response to Actinobacillus actinomycetemcomitans or Porphyromonas gingivalis infection
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Little is known regarding the molecules expressed by gingival epithelial cells that are involved in initiating and maintaining inflammation following the interaction with periodontal pathogens. Thus, we investigated the effect of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis infection on the expression of neutrophil chemoattractant interleukin 8 (IL-8) and the adhesion molecule intercellular adhesion molecule-1 by gingival epithelial cells. The data revealed that both IL-8 and intercellular adhesion molecule-1 expression increased after infection with A. actinomycetemcomitans (IL-8: 2- to 7-fold; intercellular adhesion molecule-1: 2.5- to 3.7-fold). IL-8 secretion reached a maximal level 6 h after the infection and the expression subsequently decreased to basal level. The increased cell surface intercellular adhesion molecule-1 expression started at 4 h after infection and reached a maximal level 14 h after the infection. In contrast, the expression of both molecules rapidly decreased 2 h after challenge with P. gingivalis. This opposite influence of A. actinomycetemcomitans and P. gingivalis infection on the expression of IL-8 and intercellular adhesion molecule-1 by gingival epithelial cells suggests that A. actinomycetemcomitans infection may initiate the recruitment of neutrophils, whereas the P. gingivalis infection may retard this process and therefore demonstrate a distinct perspective of virulence
| 18,481 |
0 |
Intra-Articular Calcaneal Fractures: A Literature Review of Atraumatic Incisional Considerations
|
DoD SSI (Surgical Site Infections)
|
When calcaneal fractures occur, the treating physician is faced with many decisions that are required to bring about a good clinical outcome. From a surgical perspective, decisions must be made regarding whether or not fixation is necessary, and if so, what will be used. Implicit in that thought process is planning of the surgical approach. This article shows that there are numerous considerations, including the level of edema, condition of the soft tissue envelope, posttrauma time, and circulation. These factors should play a significant role in planning the surgical incision, and may dictate the repair options available to the surgeon.
| 147,917 |
0 |
Altered chemokine receptor expression in papillary thyroid cancer
|
MSTS 2018 - Femur Mets and MM
|
BACKGROUND: Papillary thyroid cancer (PTC), the most prevalent type of differentiated thyroid carcinoma, displays a strikingly high frequency of lymph node metastasis (LNM). Recent data suggest that chemokines can play an important role in promoting tumor progression and metastatic migration of tumor cells. Here we have evaluated whether PTC tissues express a different pattern of chemokine receptors and if the expression of these receptors correlates with LNM.
METHODS: We assessed by immunohistochemistry and flow cytometry the expression of the chemokine receptors CCR3, CCR7, and CXCR4 in tumor and nonmalignant thyroid tissues from patients suffering from PTC. Expression of these receptors in PTC was correlated with the clinical pathological condition of PTC.
RESULTS: Our data show a significant enhancement of CCR3 (2.5 times higher, p = 0.038) and CXCR4 (1.7 times higher, p = 0.02) expression in PTC tissues as determined by immunohistochemical staining, and of CCR3 (3.5 times higher, p < 0.002) in the plasma membrane as determined by flow cytometric analyses, compared to controls. In addition, while CCR3 (100%) and CXCR4 (90%) were present in both tumor and control thyroid tissues, expression of CCR7 was scarcely detected in PTC cells (5-10%) and not found in control cells. CXCR4 expression correlated with the classical variant of PTC (p < 0.035) and extranodal extension (p < 0.010) in patients with LNM.
CONCLUSIONS: Our data support the notion that CCR3, CCR7, and CXCR4 are increasingly expressed in tumor cells from PTC and that CXCR4 expression in PTC could be a potential marker for enhanced tumor aggressiveness.
| 78,609 |
0 |
Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women
|
Management of Hip Fractures in the Elderly
|
Degenerative diseases of lumbar spine commonly noted in elderly people may affect their lumbar spine bone mineral density (BMD). The aim of this study is to determine whether the degree of degenerative spinal diseases is correlated with lumbar spine and femoral neck BMD. This study included 630 women age 60 years or over (mean age 73.3 +/- 6.9 years) visiting the Osteoporosis Outpatient Clinic at the Tokyo Metropolitan Geriatric Medical Center. Subjects underwent anteroposterior and lateral X-rays of the lumbar spine. The score of degenerative spinal diseases for each subject was calculated according to the scores for the Kellgren-Lawrence method, osteophyte formation, bone sclerosis, disk space narrowing, and spondylolisthesis involving L1-L2 through L4-L5 interspaces. Moreover, the number of vertebral fractures at L2 through L4 was recorded. The BMD of the second to fourth lumbar spine from anteroposterior projections and femoral neck were measured using an Expert-5000 (GE Lunar, Madison, WI USA). Most subjects had degenerative diseases of the lumbar spine. Scores for the Kellgren-Lawrence method, osteophyte formation, bone sclerosis, disk space narrowing, and spondylolisthesis were positively correlated with lumbar spine BMD, while they were not correlated with femoral neck BMD. Multiple regression analysis indicated that the scores for osteophyte formation, bone sclerosis, and disk space narrowing were independently correlated with lumbar spine BMD. Thus, in this study, the scores for degenerative spinal diseases were correlated with lumbar spine BMD, while they were not correlated with femoral neck BMD. This discrepancy indicates that degenerative spinal diseases are associated with increased lumbar spine BMD measurements. Femoral neck BMD therefore may be more appropriate than lumbar spine BMD in evaluating osteoporosis in elderly women
| 6,840 |
0 |
Two trials of diflunisal in osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
Two doubleâ?blind interâ?group trials were carried out in which diflunisal was compared for 12 weeks against aspirin in 30 patients with osteoarthritis of knees or hips, and against naproxen for 8 weeks in 20 patients with osteoarthritic knees. Diflunisal appeared to be somewhat better than aspirin in terms of both effectiveness and tolerance, whilst it was similar in both repects to naproxen.
| 106,965 |
0 |
The second lumbrical-interossei latency difference in carpal tunnel syndrome: Is it a mandatory or a dispensable test?
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
Objective: To assess the value of the 2L-INT latency difference in the electrodiagnosis of the carpal tunnel syndrome (CTS) and evaluate its sensitivity in comparison to other routine median motor and sensory studies. Methods: The study was conducted on 100 hands with symptoms and signs suggestive of CTS and 100 non-CTS hands as the control group. All were subjected to routine median motor nerve conduction study with stimulation at midpalm, wrist and elbow, median-versus-radial sensory comparison study and Second lumbrical-versus-interosseus (2L-INT) motor comparison study. Results: The results showed that the most sensitive tests were the median-radial sensory test and the 2LINT test and that both were correlated suggesting that the motor fibers of the median nerve can be compressed as early as sensory fibers. Conclusion: The 2L-INT test is as sensitive and important as the median-radial sensory test. Significance: We recommend the routine use of the 2L-INT test in clinically suspected cases of CTS especially in cases where routine median motor studies are normal together with the median-radial sensory test even if the sensory studies are normal. © 2012.
| 140,554 |
0 |
Nuclear factor-kappaB activation by type II collagen peptide in articular chondrocytes: its inhibition by hyaluronan via the receptors
|
OAK 3 - Non-arthroplasty tx of OAK
|
OBJECTIVE: This study aimed to examine nuclear factor-kappaB (NF-kappaB) activation by a synthetic peptide from type II collagen fragment (CB12-II) and its inhibition by hyaluronan (HA) via its receptors, CD44, and intercellular adhesion molecule-1 (ICAM-1) in chondrocytes.
METHODS: Osteoarthritic cartilage explants or chondrocytes in monolayer were cultured with CB12-II. Secreted levels of matrix metalloproteinase (MMP)-13 in conditioned media and NF-kappaB activation in chondrocytes were determined by immunoblotting and enzyme-linked immunosorbent assay (ELISA). Cultures were pretreated with HA to evaluate the inhibitory effect on CB12-II action, and the role of HA receptors in HA effect was investigated using antibodies to CD44 and ICAM-1.
RESULTS: CB12-II stimulated phosphorylation and nuclear translocation of NF-kappaB, leading to increased MMP-13 production. HA suppressed NF-kappaB activation and MMP-13 induction by CB12-II. The individual antibody to CD44 or ICAM-1 partially reversed HA effect on CB12-II action, and both antibodies in combination completely blocked the HA effect.
CONCLUSIONS: This study clearly demonstrates that CB12-II activates NF-kappaB for MMP-13 induction and that HA inhibits CB12-II action through interaction with CD44 and ICAM-1 in chondrocytes. HA administration into osteoarthritic joints could suppress the catabolic action of matrix degradation products such as CB12-II as a potent NF-kappaB inhibitor.
| 100,999 |
0 |
Rationale and options for choosing an optimal closure technique for primary midsagittal osteochondrotomy of the sternum. Part 3: Technical decision making based on the practice of patient- appropriate medicine
|
DoD SSI (Surgical Site Infections)
|
The topographic anatomy of the sternum is similar in a healthy population. However, in a clinical subset of patients with comorbidities such as diabetes mellitus, chronic obstructive pulmonary disease, high body mass index, chronic renal disease, or age-related osteoporosis, there are significant changes in the normal physiology that may influence overall patient outcome following trans-sternal intrathoracic surgery. These changes can create technical difficulties in reconstructing the bisected sternum and adversely affect the biomechanics of the thoracic wall, forcing difficult surgical choices with regard to implant options and increasing the cost of an otherwise routine cardiac surgery. A thorough preoperative surgical and technical planning is essential to avert perioperative complications such as failure of wound healing, non-union of the sternum, and life-threatening mediastinitis. Patient expectations need to be explored and the patients should be well informed so that they can make knowledgeable choices regarding their illness and surgical interventions. They should also be given a probable prognosis to provide psychological support. Within the realm of clinical methodology, the concept of patient-appropriate medicine is introduced to direct attending team to become aware of overall health of its patient. The inclusion of a clinical biomechanical engineer as a surgical team member is recommended to perform patient-specific finite element analysis to select an optimal implant to fix the sternum. To help assess the overall benefit-risk profile objectively, an absolute therapeutic index has been proposed.
| 147,262 |
0 |
Predicting the longer term outcomes of total knee arthroplasty
|
Surgical Management of Osteoarthritis of the Knee CPG
|
We asked the question of what are the patient level predictors (age, gender, body mass index, education, ethnicity, mental health, and comorbidity) for a sustained functional benefit at a minimum of 1 year follow-up after total knee arthroplasty(TKA). Five hundred fifty-one consecutive patients were reviewed from our joint registry between the years of 1998 and 2005. Baseline demographic data and the outcome scores of the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Short-Form 36 (SF36) scores were extracted from the database. Longitudinal regression modeling was performed to identify the predictive factors of interest. We had 27% of data points missing. The mean follow-up in our cohort was 3.0 years (range 1-8 years) and there were no revisions performed during this time. Clinical outcome scores were found to be relatively constant for 3-4 years after surgery and then demonstrated a gradual decline after that. Older age, year of follow-up, greater comorbidity, and a poorer mental health state at time of surgery were identified as negative prognostic factors for a sustained functional outcome following TKR (P<0.05). Knowledge of these factors that predict outcomes should be used in setting appropriate patient expectations of surgery
| 35,883 |
0 |
ASU (piascled ine) in treatment of osteoarthritis - New findings about possible effects on structural progression
|
OAK 3 - Non-arthroplasty tx of OAK
|
The author introduces his report with epidemiological data on the impact of large joint osteoarthritis (OA). He then briefly describes the pathogenesis of OA emphasising the fundamental role of articular hyaline cartilage degeneration. The extract from avocado and soy (ASU) Piascledine exhibits antiâ?inflammatory action, inhibits destructive mediators (e.g. ILâ?1, metaloproteinases) in the cartilage at the level of chondrocytes, and stimulates anabolic mediators (e.g. TGFâ?β). The anticatabolic effect of Piascledine is manifested at the level of osteoblasts. There have been a number of symptomatic studies of ASU but only four of these satisfy highâ?quality criteria, and were included in a new metaâ?analysis published in 2007. Data from a total of 664 patients were analysed. The extent of the effect of ASU on pain compared to placebo was 0.39, and 0.45 when Lequesne index was used for assessment, a value consistent with clinically significant, moderate effect. A randomized, prospective controlled study in patients with symptomatic coxarthrosis confirmed equal symptomatic efficacy of ASU and chondroitin sulphate. This study, focusing on structureâ?modifying effect in hip joint OA over a period of 3 years, evaluated the structural progression of OA based on chondrometry as described by Lequesne. Progression was recorded in a smaller number of patients in the ASU group compared to placebo (40 % vs. 50 %; p = 0.0039). Piascledine is characterized by high safety â? excellent tolerance in clinical studies have been reported by more that 90 % of patients. Practically no serious adverse effects have been observed. The overall efficacy/safety ratio is thus favourable, and Piascledine can be recommended even according to the principles of evidenceâ?based medicine, especially for the therapy of symptomatic (painful) gonarthrosis and coxarthrosis.
| 107,225 |
1 |
Post-operative blood loss in total knee arthroplasty: knee flexion versus pharmacological techniques
|
Surgical Management of Osteoarthritis of the Knee CPG
|
PURPOSE: To compare the blood loss and the blood transfusion between a control group and a group of patients following either a local administration of tranexamic acid or a mechanical post-operative knee flexion, a controlled randomized study was performed. METHODS: Sixty patients affected by primary knee osteoarthritis and candidates to receive a primary unilateral total knee arthroplasty were enrolled in a prospective, randomized, controlled study. Exclusion criteria were the following: tranexamic acid allergy, the use of pharmacological anticoagulant therapy, previous knee surgery and renal failure. For each patient, the following parameters were investigated: the blood loss volume, the haemoglobin and haematocrit concentrations and the blood transfusion needs. RESULTS: Compared to the control group, the administration of systemic tranexamic acid significantly reduces (p < 0.05) both the blood loss (average reduction 39.8 %) and the blood transfusion needs (64 %). Furthermore, the tranexamic acid group shows a significant reduction (p < 0.05) compared to the knee flexion group of the blood loss (average reduction 31.8 %) and the transfusion needs (65 %). However, even if the knee flexion technique slightly reduces the blood loss (average reduction 11.6 %) compared to the control group, this difference is not statistically significant (n.s.). Moreover, this treatment did not reduce the transfusion needs compared to the control group (n.s.). Incidence of complications was not influenced by any of the treatments. CONCLUSIONS: The use of tranexamic acid compared to knee flexion and to control group significantly reduces blood loss and transfusion needs, without wound complications or symptomatic deep vein thrombosis. LEVEL OF EVIDENCE: Prospective therapeutic study, Level I
| 37,336 |
1 |
Effect of upper eyelid surgery on corneal topography
|
Upper Eyelid and Brow Surgery
|
OBJECTIVE: To compare the effects of different upper eyelid procedures on corneal topography. METHODS: Eighty-two eyes of 43 patients with various degrees of dermatochalasis or ptosis underwent computed corneal topography before surgery and at 3 months after surgery. Patients were divided into groups depending on the extent of surgery. In addition, the thickness of the central cornea was correlated with the change in astigmatism. RESULTS: There were mean changes in total astigmatism of 0.25 diopter (D) after ptosis surgery (P = .02) and 0.21 D after blepharoplasty with reduction of large fat pads (P = .04) compared with 0.09 D in patients after skin-only blepharoplasty. In addition, there was a correlation between corneal thickness and change in astigmatism of more than 0.2 cylinders after ptosis surgery (P < .05). Postoperative astigmatic axis changes were not systematic. CONCLUSIONS: We found a statistically significant correlation between the severity of upper eyelid abnormality and topographical corneal changes after surgery. These findings emphasize the importance of advising patients, especially those with ptosis and severe dermatochalasis, that upper eyelid repositioning procedures may induce vision changes.
| 68,503 |
0 |
Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
BACKGROUND: The ORACLE II trial compared the use of erythromycin and/or amoxicillin-clavulanate (co-amoxiclav) with that of placebo for women in spontaneous preterm labour and intact membranes, without overt signs of clinical infection, by use of a factorial randomised design. The aim of the present study--the ORACLE Children Study II--was to determine the long-term effects on children after exposure to antibiotics in this clinical situation. METHODS: We assessed children at age 7 years born to the 4221 women who had completed the ORACLE II study and who were eligible for follow-up with a structured parental questionnaire to assess the child's health status. Functional impairment was defined as the presence of any level of functional impairment (severe, moderate, or mild) derived from the mark III Multi-Attribute Health Status classification system. Educational outcomes were assessed with national curriculum test results for children resident in England. FINDINGS: Outcome was determined for 3196 (71%) eligible children. Overall, a greater proportion of children whose mothers had been prescribed erythromycin, with or without co-amoxiclav, had any functional impairment than did those whose mothers had received no erythromycin (658 [42.3%] of 1554 children vs 574 [38.3%] of 1498; odds ratio 1.18, 95% CI 1.02-1.37). Co-amoxiclav (with or without erythromycin) had no effect on the proportion of children with any functional impairment, compared with receipt of no co-amoxiclav (624 [40.7%] of 1523 vs 608 [40.0%] of 1520; 1.03, 0.89-1.19). No effects were seen with either antibiotic on the number of deaths, other medical conditions, behavioural patterns, or educational attainment. However, more children whose mothers had received erythromycin or co-amoxiclav developed cerebral palsy than did those born to mothers who received no erythromycin or no co-amoxiclav, respectively (erythromycin: 53 [3.3%] of 1611 vs 27 [1.7%] of 1562, 1.93, 1.21-3.09; co-amoxiclav: 50 [3.2%] of 1587 vs 30 [1.9%] of 1586, 1.69, 1.07-2.67). The number needed to harm with erythromycin was 64 (95% CI 37-209) and with co-amoxiclav 79 (42-591). INTERPRETATION: The prescription of erythromycin for women in spontaneous preterm labour with intact membranes was associated with an increase in functional impairment among their children at 7 years of age. The risk of cerebral palsy was increased by either antibiotic, although the overall risk of this condition was low. FUNDING: UK Medical Research Council
| 18,737 |
0 |
Prevalence and prediction of osteopenia in chronic liver disease
|
Management of Hip Fractures in the Elderly
|
To obtain information on the prevalence and clinical and laboratory correlates of osteopenia in patients with chronic liver disease, we measured bone densities and 30 selected laboratory variables in 133 subjects (70 men, 63 women) with liver disease. Thirty-two had alcoholic liver disease, 18 had primary biliary cirrhosis, 16 had primary sclerosing cholangitis, 48 had other forms of cirrhosis (cryptogenic, posthepatic) and 19 had chronic hepatitis or fibrosis without cirrhosis. Bone densities of the lumbar spine and three sites of the proximal femur (neck, Ward's triangle, greater trochanter) were estimated by dual-photon absorptiometry. Bone densities at all sites were significantly correlated to one another (r = 0.4 to 0.9; 95% confidence intervals = 0.24-0.54 to 0.81-0.90; p < 0.0001 for all). Compared with an age- and gender-matched reference group, patients with liver disease had highly significant decreases in bone densities (>2 standard deviations below control values; p < 0.0008 at all sites). Decreases were particularly marked (24% to 42%) at Ward's triangle, the site of the femoral neck particularly prone to fracture. The prevalence of decreased bone densities ranged from 10% to 56%, depending on the site studied and the nature of the liver disease. Among 30 laboratory variables studied, there were significant (p < 0.05) correlations with bone densities at more than one site for urinary creatinine (r = 0.21, 0.25), urinary calcium (r = -0.18, -0.23), serum total alkaline phosphatase (r = -0.18, -0.27) and the liver-1 isozyme of serum alkaline phosphatase (r = -0.19, -0.26). We conclude that osteopenia is prevalent in patients with chronic liver disease, particularly in those with reduced skeletal muscle mass (reflected in lower creatinine excretions) and higher serum alkaline phosphatases. However, because correlations are relatively low between laboratory variables and bone densities, the laboratory variables tested are not useful to predict which patients with chronic liver disease have osteopenia. Thus the way to determine the presence and severity of osteopenia in these patients is to measure bone density
| 3,257 |
0 |
Vitamin D and muscle function
|
Management of Hip Fractures in the Elderly
|
The aim of this review is to summarize current knowledge on the relation between vitamin D and muscle function. Molecular mechanisms of vitamin D action on muscle tissue have been known for many years and include genomic and non-genomic effects. Genomic effects are initiated by binding of 1,25-dihydroxyvitamin D3 (1,25(OH)2D) to its nuclear receptor, which results in changes in gene transcription of messenger RNA and subsequent protein synthesis. Non-genomic effects of vitamin D are rapid and mediated through a membrane-bound vitamin D receptor (VDR). Genetic variations in the VDR and the importance of VDR polymorphisms in the development of osteoporosis are still a matter of controversy and debate. Most recently, VDR polymorphisms have been described to affect muscle function. The skin has an enormous capacity for vitamin D production and supplies the body with 80-100% of its requirements of vitamin D. Age, latitude, time of day, season of the year and pigmentation can dramatically affect the production of vitamin D in the skin. Hypovitaminosis D is a common feature in elderly people living in northern latitudes and skin coverage has been established as an important factor leading to vitamin D deficiency. A serum 25-hydroxyvitamin D level below 50 nmol/l has been associated with increased body sway and a level below 30 nmol/l with decreased muscle strength. Changes in gait, difficulties in rising from a chair, inability to ascend stairs and diffuse muscle pain are the main clinical symptoms in osteomalacic myopathy. Calcium and vitamin D supplements together might improve neuromuscular function in elderly persons who are deficient in calcium and vitamin D. Thus 800 IU of cholecalciferol in combination with mg of elemental calcium reduces hip fractures and other non-vertebral fractures and should generally be recommended in individuals who are deficient in calcium and vitamin D. Given the strong interdependency of vitamin D deficiency, low serum calcium and high levels of parathyroid hormone, however, it is difficult to identify exact mechanisms of action
| 8,433 |
0 |
Prognostic factors in patients with metastatic breast cancer at the time of diagnosis
|
MSTS 2022 - Metastatic Disease of the Humerus
|
Approximately 90% of breast cancer mortality is due to metastases that are resistant to adjuvant therapies. Thus, assessment of factors associated with clinical outcomes in patients with advanced breast cancer is of significant importance. Despite the recent improvement in early detection, between 5 and 10% of breast cancer patients are diagnosed with metastasis at initial presentation or, rarely, before the primary breast cancer has been identified. These patients typically have poorer survival outcomes compared to those who develop distant metastasis subsequently. Yet, the prognostic relevance in these patients has not been intensively explored. In this study, we analyzed breast cancer patients with distant metastasis at the time of diagnosis between 1997 and 2010 (n=194) to identify the clinicopathological factors significant for overall survival. By univariate analysis, race, estrogen receptor (ER) and progesterone receptor status were significantly associated with overall survival, while race and ER remained independent factors in multivariate analysis. Being Caucasian and overexpressing of ER both showed a significantly decreased hazard of death (P=0.015 and 0.017, respectively). Reflecting these findings, the overall survival differed significantly between breast subtypes, with the luminal subtype and triple negative disease being associated with the longest and worst survival, respectively. Further, multi-organ involvement was associated with a worse prognosis than those with single organ metastasis, whereas no significant difference in survival was found between the different anatomic sites (bone, viscera and brain). Our findings suggest that it is predominantly the intrinsic nature of the tumor along with the genetic makeup of the patient that predicts the prognostic outcome in those patients with advanced disease at presentation.
| 154,346 |
0 |
Neural correlates of the attentional blink
|
Upper Eyelid and Brow Surgery
|
Attending to a visual event can lead to functional blindness for other events in the visual field. This limit in our attentional capacities is exemplified by the attentional blink (AB), which refers to the transient but severe impairment in perceiving the second of two temporally neighboring targets. Using functional magnetic resonance imaging (fMRI), we observed predominantly right intraparietal and frontal cortex activations associated with the AB. We further demonstrate that an AB can be elicited by both temporal and spatial distractor interference on an attended target and that both of these interference mechanisms activate the same neural circuit. These results suggest that a (right) parietofrontal network previously implicated in attentional control and enhancement is also a locus of capacity-limited processing of visual information.
| 66,108 |
0 |
Hybrid revision total hip arthroplasty: a 7-year follow-up study
|
Management of Hip Fractures in the Elderly
|
The hybrid method for fixation of total hip arthroplasty (THA) has shown excellent results during the first decade in primary operations. To investigate its role in revision surgery, data on 48 revision THAs in 45 patients that met the inclusion criteria were gathered prospectively, using HGP cementless acetabular components and precoated cemented femoral components inserted with so-called second generation femoral cementing technique in each case. For the 48 hips during an average follow-up period of 7.4 years, no acetabular components was loose or had pelvic lysis. One acetabular component was revised for recurrent dislocation; 1 of 48 femoral components was revised for aseptic loosening and 1 for periprosthetic fracture. Three additional femoral stems (6%) were loose. In this small series, the hybrid concept for revision of failed nonseptic THAs has shown excellent results
| 834 |
0 |
3D gait analysis with and without an orthopedic walking boot
|
OAK 3 - Non-arthroplasty tx of OAK
|
INTRODUCTION: Orthopedic walking boots have been widely used in place of traditional fiberglass casts for a variety of orthopedic injuries and post-surgical interventions. These walking boots create a leg length discrepancy (LLD). LLD has been shown to alter the kinematics and kinetics of gait and are associated with lumbar and lower limb conditions such as: foot over pronation, low back pain, scoliosis, and osteoarthritis of the hip and knee joints. Past gait analyses research with orthopedic boots is limited to findings on the ipsilateral limb. Thus, the purpose of the study was to examine bilateral gait kinematics & kinetics with and without a walking boot.
METHODS: Forty healthy participants (m=20, f=20, age 20.7+/-1.8 yrs., ht. 171.6+/-9.5cm, wt. 73.2+/-11.0kg, BMI 24.8+/-3.2) volunteered. An eight camera Vicon Motion Capture System with PIG model and two AMTI force plates were utilized to record the walking trial conditions: (1) bilateral tennis shoes (2) boot on right foot, tennis shoe on left foot (3) boot on right foot, barefoot on left foot. Data were processed in Nexus 2.2.3 and exported to Visual 3D for analysis.
RESULTS: When wearing the boot, there were significant differences in most joint angles and moments, with larger effects on long limb.
CONCLUSION: The walking boot alters the gait in the same way as those with existing LLD, putting them at risk for development of secondary knee, hip, and low back pain during treatment protocol.
| 102,956 |
0 |
Cementless total knee arthroplasty in juvenile onset rheumatoid arthritis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Twenty-two total knee arthroplasties with at least one cementless component were performed in 14 patients with juvenile rheumatoid arthritis (JRA) from 1985 to 1989. All 22 femoral components and ten tibial components were implanted cementless. The mean age at operation was 26 years. All 14 patients were available for follow-up evaluation at an average of 3.9 years (range, two to 6.2 years). Using The Knee Society's scoring system, the knee score improved from an average of 18 points (range, 0-47 points) preoperatively to 92 points (range, 58-100 points) at follow-up evaluation. The functional score improved from 28 points (range, 0-55 points) to 76 points (range, 40-100 points). Nonprogressive radiolucencies of less than 1 mm were observed in two knees. One reoperation was performed for failure of a metal-backed patellar component. Knee arthroplasty with cementless components in selected JRA patients can give results comparable with a fully cemented knee at the two- to six-year follow-up evaluation
| 33,707 |
1 |
Function after primary hemiarthroplasty and secondary total hip arthroplasty in femoral neck fracture
|
Management of Hip Fractures in the Elderly
|
Four to 12 years after primary treatment of femoral neck fracture with hemiarthroplasty in a group of Finnish patients and secondary total hip arthroplasty as a salvage procedure for healing complication after primary osteosynthesis in a group of Swedish patients, function was classified and the Nottingham Health Profile questionnaire was applied. The two groups were comparable with regard to age, sex, and social status. The patients with secondary total hip arthroplasty used walking aids to a lesser extent than the patients with hemiarthroplasty and experienced less problems in several aspects of life. Walking ability was considered unchanged, compared to prefracture, to a larger extent in the secondary total hip arthroplasty group. Thus, secondary total hip arthroplasty in patients with healing complication following primary osteosynthesis gives better long-term functional capacity than that obtained with a primary hemiarthroplasty
| 14,591 |
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