recall
int64 0
1
| article_title
stringlengths 5
500
| topic
stringlengths 21
84
| abstract
stringlengths 2
65.8k
|
|---|---|---|---|
0 |
Change in visual perceptual detection distances for low vision travelers as a result of dynamic visual assessment and training
|
Management of Hip Fractures in the Elderly
|
This study evaluated the ability of a dynamic visual assessment and training protocol to improve the ability of 65 persons who were legally blind to detect environmental hazards. Training improved the ability of the majority of subjects to detect hazards, and the assessments identified those who did not need training or would not benefit from it
|
1 |
Wristwatch-distal radial fracture as a marker for osteoporosis investigation: a controlled trial of patient education and a physician alerting system
|
Distal Radius Fractures
|
This article reports a controlled trial to investigate the effectiveness of patient education and a physician alerting system in altering secondary osteoporosis prevention after a low-trauma (fragility) wrist fracture and to record the current rate of osteoporosis investigation following such fractures. Fifty-one women and men aged 50 years or older with a low-trauma wrist fracture were identified (41 women and 10 men; mean age [95% CI], 71.51 [67.31-74.81]). The intervention group received a four-part intervention aimed at both the patient and the family physician in addition to the usual care for the fracture. The control group only received usual care for the fracture. Data were collected for both groups at six weeks and six months.
|
0 |
Advanced techniques in liposuction
|
Panniculectomy & Abdominoplasty CPG
|
Liposuction is a procedure that has been widely used since the 1980s. The introduction of the tumescent technique in 1987 greatly improved the safety of the procedure. Innovative techniques and equip ment modifications have continued to evolve, broadening the scope of application and improving the results that can be obtained. This article discusses several recent advancements in liposuction techniques. Three-Dimensional Tumescent Liposculpture (William R. Cook, Coronado, CA) was developed to view contiguous areas of the body as a unit rather than to simply suction fat from one particular area. Advanced techniques have improved the ability to liposuction difficult areas, such as the arms, calves, medial thighs, and the male breast. A combination of syringe-suction and machine-assisted liposculpture is sometimes used. Tumescent liposculpture has been combined with pulsed CO2 laser surgery to produce a more effective and less invasive treatment for the aging face, neck, and jowls. External ultrasound-assisted liposculpture can produce excellent results.
|
0 |
A noninvasive approach to off-face skin laxity and tightening: A review of the literature
|
Panniculectomy & Abdominoplasty CPG
|
Off-face skin scales tailored to each anatomical site can measure laxity and tightening of the neck, chest, arms, hands, abdomen, buttocks, and medial thighs. Although surgery may be indicated for major weight loss patients, other noninvasive modalities may be considered including: CO2 laser, bipolar radiofrequency, monopolar radiofrequency, microfocused ultrasound, and combination therapies. We provide a review of the literature for each modality and relevance to the off-face anatomical sites.
|
0 |
Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand: A Systematic Review
|
Distal Radius Fractures
|
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.
|
1 |
Local infiltration analgesia in TKA patients reduces length of stay and postoperative pain scores
|
AAHKS (8) Anesthetic Infiltration
|
Numerous postoperative pain protocols exist for patients undergoing total knee arthroplasty (TKA). We compared the length of stay, early range of motion (ROM), and pain scores of a control group with a femoral nerve block to those of a group with femoral nerve block and local infiltration analgesia following TKA. In a consecutive series of patients undergoing primary TKA at a Veteran's Administration hospital, 40 patients (40 TKAs) who had local infiltration analgesia were compared to a historical group of 43 patients (43 TKAs) who had a long-acting femoral nerve block without local infiltration analgesia. Local infiltration analgesia consisted of intraoperative injection of 150 mL of 300 mg ropivacaine, 30 mg ketorolac, and 500 mug epinephrine using 50 mL into each of 3 areas: (1) posterior capsule, (2) medial and lateral capsule, and (3) anterior capsule and subcutaneous tissues. A 17-gauge intra-articular catheter was used to inject an additional 100 mg of ropivacaine on postoperative day 1. The control group had a single-shot femoral nerve block using 150 mg of ropivacaine with epinephrine. Mean length of stay for the local infiltration analgesia group compared to controls was 3.2+/-1.4 days vs 3.8+/-1.6 days, respectively (P=.03). No significant differences existed in average ROM (6 weeks), discharge hematocrit, transfusions, and temperature. Mean pain scores were lower in the local infiltration analgesia group on postoperative day 1 (P=.04), but not on postoperative day 2 or 3. Maximum visual analog scale scores (P<.01) were reduced in the local infiltration analgesia group. Our early experience with local infiltration analgesia demonstrated a significantly reduced length of stay due to decreased postoperative pain.
|
0 |
Examination of the cutoff value of postchemotherapy increase in tumor volume as a predictor of subsequent oncologic events in stage IIB osteosarcoma
|
MSTS 2022 - Metastatic Disease of the Humerus
|
BACKGROUND: Tumor enlargement after chemotherapy is a predictor of a poor histological response, poor survival, and local recurrence. However, the cutoff point of tumor enlargement for predicting subsequent oncologic events has not been determined.
METHODS: We retrospectively reviewed 567 patients who were treated at our institute for stage IIB osteosarcoma. We used receiver operating characteristic (ROC) curve analysis of tumor volume increase for the prediction of subsequent metastasis or local recurrence, and calculated diagnostic indices for different cutoff values.
RESULTS: A tumor volume increase of >15% predicted subsequent metastasis or local recurrence with a sensitivity of 64.7%, a specificity of 81.5%, a positive predictive value of 71.6%, and a negative predictive value of 76.1%. Increases in tumor volumes based on this cutoff value were able to predict subsequent oncologic events in all clinical subgroups, except in cases of rare pathologic subtypes. However, for tumors in the proximal humerus, a cutoff value of 25% had optimal predictive value.
CONCLUSIONS: This study shows that a cutoff value of 15% for tumor volume increase is useful for predicting subsequent metastasis or local recurrence. Our results suggest that tumor enlargement after chemotherapy serves as an easily assessable clinical parameter for risk-adapted therapy.
|
0 |
National clinical guidelines in municipality-based rehabilitation: A cross-sectional survey of knowledge, use, and implementation
|
AMP (Acute Meniscal Pathology)
|
<b>Background</b>: Despite increasing research within physiotherapy, consistent implementation of evidence-based guidelines in everyday physiotherapy practice can present a challenge. <b>Objective</b>: To examine the knowledge, use, and implementation of National Clinical Guidelines (NCG) for knee arthrosis and meniscus pathology in municipality-based rehabilitation in Denmark. <b>Methods</b>: A cross-sectional survey using a web-based questionnaire developed for the present study. Respondents included rehabilitation unit managers, staff in charge of professional development and physiotherapists from municipality-based rehabilitation units in one of the Denmark's five regions. <b>Results</b>: The questionnaire was completed by 61 respondents (75.3%). The responses indicated significantly better knowledge of the NCG for knee arthrosis than of the NCG for meniscus pathology (p = .017). Eighty-two percent (n = 50) replied that their unit had developed local guidelines for knee arthrosis; 74% (n = 45) for meniscus pathology. A total of 72% (n = 44) stated that relevant parts of the knee arthrosis NCG were integrated in local guidelines, whereas only 49% (n = 30) said the same for the meniscus pathology NCG. Respondents replied that implementation depends on factors such as time (46%, n = 28), knowledge (31%, n = 19), and the perceived relevance of the NCG (33%, n = 20) as well as support from local rehabilitation unit managers (23%, n = 14). <b>Conclusion</b>: Differences in the knowledge, use, and implementation of two NCGs among rehabilitation unit managers, staff in charge of professional development, and physiotherapists in municipality-based rehabilitation were identified. It seems that NCGs do not necessarily translate directly into local guidelines.
|
0 |
Patient-specific medial unicompartmental knee arthroplasty has a greater protective effect on articular cartilage in the lateral compartment: A Finite Element Analysis
|
AMP (Acute Meniscal Pathology)
|
OBJECTIVES: Patient-specific (PS) implantation surgical technology has been introduced in recent years and a gradual increase in the associated number of surgical cases has been observed. PS technology uses a patient's own geometry in designing a medical device to provide minimal bone resection with improvement in the prosthetic bone coverage. However, whether PS unicompartmental knee arthroplasty (UKA) provides a better biomechanical effect than standard off-the-shelf prostheses for UKA has not yet been determined, and still remains controversial in both biomechanical and clinical fields. Therefore, the aim of this study was to compare the biomechanical effect between PS and standard off-the-shelf prostheses for UKA.
METHODS: The contact stresses on the polyethylene (PE) insert, articular cartilage and lateral meniscus were evaluated in PS and standard off-the-shelf prostheses for UKA using a validated finite element model. Gait cycle loading was applied to evaluate the biomechanical effect in the PS and standard UKAs.
RESULTS: The contact stresses on the PE insert were similar for both the PS and standard UKAs. Compared with the standard UKA, the PS UKA did not show any biomechanical effect on the medial PE insert. However, the contact stresses on the articular cartilage and the meniscus in the lateral compartment following the PS UKA exhibited closer values to the healthy knee joint compared with the standard UKA.
CONCLUSION: The PS UKA provided mechanics closer to those of the normal knee joint. The decreased contact stress on the opposite compartment may reduce the overall risk of progressive osteoarthritis. <b>Cite this article</b>: K-T. Kang, J. Son, D-S. Suh, S. K. Kwon, O-R. Kwon, Y-G. Koh. Patient-specific medial unicompartmental knee arthroplasty has a greater protective effect on articular cartilage in the lateral compartment: A Finite Element Analysis. Bone Joint Res 2018;7:20-27. DOI: 10.1302/2046-3758.71.BJR-2017-0115.R2.
|
0 |
Controlled hypotension in adults undergoing choroidal melanoma resection: comparison between the efficacy of nitroprusside and magnesium sulphate
|
Reconstruction After Skin Cancer
|
METHODSForty adult patients undergoing choroidal melanoma resection and anaesthetized with 2.5 mg kg(-1) propofol, followed by a constant infusion of 120 microg kg(-1) min(-1), and remifentanil 1 microg kg(-1), followed by a continuous infusion of 0.25 microg kg(-1) min(-1), were randomly assigned to two groups to receive either magnesium sulphate or sodium nitroprusside.RESULTSControlled hypotension was achieved at the target systolic pressure of 80 mmHg within 107 +/- 16 and 69 +/- 4.4 s for magnesium sulphate and sodium nitroprusside, respectively. Choroidal blood flow decreased by 24 +/- 0.3% and 22 +/- 3.3% for magnesium sulphate and sodium nitroprusside, respectively. Controlled hypotension was sustained in both groups throughout surgery, and the surgical field rating decreased in a range of 80% in both groups. Sodium nitroprusside decreased pH and increased PaCO2. There were no postoperative complications in any of the groups.CONCLUSIONMagnesium sulphate controlled hypotension, reduced intraoperative pressure and provided good surgical conditions for choroidal melanoma resection with no need for additional use of a potent hypotensive agent in adults.BACKGROUND AND OBJECTIVETo determine whether magnesium sulphate could induce controlled hypotension, reduce choroidal blood flow, provide a 'dry' operative field and could be compared with sodium nitroprusside in the recently raised issue of the use of hypotensive anaesthesia in eye surgery, i.e. for choroidal tumour surgery as the choroid is the most fragile and vascular structure in the eye.
|
1 |
Sequential bilateral total knee arthroplasty under 1 anesthetic in patients (greater-than or equal to)75 years old: Complications and functional outcomes
|
Surgical Management of Osteoarthritis of the Knee CPG
|
The objectives of this study were to determine the perioperative surgical and medical risks associated with sequential bilateral total knee arthroplasty (TKA) in patients (greater-than or equal to)75 years old and to assess their functional status and overall level of satisfaction at follow-up. Study participants were 82 consecutive patients (greater-than or equal to)75 years old who underwent a sequential bilateral TKA and 82 matched patients who underwent a unilateral TKA. There were 46 postoperative complications in the bilateral TKA group compared with 27 in the unilateral TKA group (P = .003). Postoperative cardiovascular complications were significantly greater in the sequential bilateral TKA group and were associated significantly with preoperative cardiovascular comorbidity. The mean Modified Hospital for Special Surgery knee score was rated as good (mean, 63.5 out of 80), and 95% of patients rated their knees as excellent or good at follow-up. Sequential bilateral TKA in patients (greater-than or equal to)75 years old results in high patient satisfaction and good functional status at follow-up; however, there is an increased risk of cardiovascular complications during the postoperative period in bilateral sequential TKA patients when compared with a matched cohort of unilateral TKA patients
|
0 |
Clinical outcome following surgical intervention for periprosthetic hip fractures at a tertiary referral centre
|
DoD SSI (Surgical Site Infections)
|
Complications following surgical intervention for periprosthetic hip fractures are not uncommon. We report the clinical outcome following definitive surgical intervention for this indication at a single tertiary referral centre. All patients admitted between 2003 and 2009 undergoing such treatment were included. Patient demographics, all surgical interventions, complications following definitive fracture treatment, and postoperative mortality were recorded. Radiographs were reviewed to determine the Vancouver classification for each fracture. There were 67 patients (mean age at revision 76.7 years; 61% female). Fractures occurred around primary total hip arthroplasties (43%), revision arthroplasties (34%), and hip hemiarthroplasties (23%). Mean time to fracture from the most recent arthroplasty performed was 7.0 years. Most fractures were Vancouver type B2 (49%). The majority of patients underwent revision total hip arthroplasty (96%), using long-stemmed prostheses or proximal femoral endoprostheses, with cables for fracture fixation. Wound infection and systemic complications were seen in 16% and 13% respectively. One or more further surgical interventions were performed in 12%. There were no deaths in-hospital or at 30-days, with 10 fatalities (15%) at a mean 2-year follow-up. Lower rates of re-intervention and mortality were observed when surgery for acute periprosthetic hip fractures was performed at a tertiary centre. Revision hip arthroplasty with or without fracture fixation proved an effective and safe treatment of periprosthetic hip fractures in a high-risk patient population.
|
0 |
Effects of mouthrinses with chlorhexidine and zinc ions combined with fluoride on the viability and glycolytic activity of dental plaque
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Inhibition of plaque acidogenicity by a mouthrinse with chlorhexidine (CHX) or zinc ions has been ascribed to a prolonged bacteriostasis due to substantive properties of the agents. The present aim was to study the effects of mouthrinses with CHX and Zn ions combined with fluoride on the viability and glycolytic activity of dental plaque in order to assess the bacteriostatic versus possible bactericidal effects. Following 2 d of plaque accumulation, 4 groups of 10 students rinsed with either 12 mM NaF (F), 0.55 mM CHX diacetate+F (F-CHX), 10 mM Zn acetate+F (F-Zn), or with the three agents in combination (F-CHX-Zn). Plaque samples were collected before and 90 min after mouthrinsing. Thereafter, the in vivo plaque pH response to sucrose was monitored in each student using touch microelectrodes. F-CHX and F-CHX-Zn reduced the in vivo pH fall significantly as compared with F, whereas F-Zn exerted a non-significant inhibition. Pooled pre- and post-rinse plaque samples were used to measure the pH fall during fermentation of [14C]-glucose, and the glycolytic profiles were analyzed by HPLC. Bacterial viability was assessed by counting the colony-forming units (CFU). All mouthrinses except F reduced glucose consumption and acid formation and thus the pH fall. F-CHX reduced the CFU equal to the reduction of glucose consumption, indicating that inhibition of plaque acidogenicity was due to a bactericidal rather than a bacteriostatic effect. F and F-Zn did not reduce the CFU, thus F-Zn decreased glucose metabolism without affecting plaque viability. F-CHX-Zn reduced both the CFU and glucose metabolism of surviving plaque microorganisms
|
0 |
Meniscal repair with allograft
|
OAK 3 - Non-arthroplasty tx of OAK
|
INTERVENTION: meniscal allograft CONDITION: meniscal injury PRIMARY OUTCOME: Clinical symptom SECONDARY OUTCOME: Physical findings, Knee score, Images, Blood examination INCLUSION CRITERIA: * It's diagnosed as meniscal injury. * The cartilage of the knee joint degenerated after lateral meniscectmy. * The age when agreeing, is more than 20 years old and less than 65 years old. * Consent is got by a document from the person himself about study participation.
|
0 |
Management of infected tibial intramedullary nailing using an organized treatment protocol
|
DoD SSI (Surgical Site Infections)
|
Twenty cases of osteomyelitis following intramedullary nailing of the tibial shaft fracture were managed with a prospective treatment protocol comprising intramedullary reaming debridement, antibiotic-bead depot, external skeletal fixation, microvascular muscle flap and early cancellous bone grafting. The follow-up period ranged from 25 to 48 months (average, 34.3 months). Pseudomonas aeruginosa (37.5%) and staphylococcus aureus (20.8%) were the organisms most commonly involved. There were 8 united and 12 ununited fractures after reaming debridement surgery. Nineteen infections were initially arrested by one debridement. One infection was arrested by two sequential debridements. All 12 ununited fractures were stabilized by Hoffmann unilateral external fixation until the fracture healed. The time spent in external fixation ranged from 3 to 7 months (average, 5.2 months). Early cancellous bone grafting was successfully accomplished for 9 ununited fractures with major debridement bone loss. The average union time of the 9 fractures with bone grafting was 7.2 months (range, from 6 to 8 months). We believe that this treatment protocol gives a predictable and rapid recovery. The complications were infection recurrence in two cases at the old tibial shaft fracture sites, minor pin tract infection of Hoffmann external fixators in two cases, and stiffness in two ankles and one knee.
|
1 |
Medial and Lateral Meniscal Inside-Out Repairs
|
AMP (Acute Meniscal Pathology)
|
Meniscal tears differ in terms of pattern and location. If left untreated, a meniscal tear can lead to the development of osteoarthritis and increased pain, swelling, and functional limitations. Tears in the vascularized outer two-thirds of the meniscus can often be successfully repaired with use of an inside-out technique. Vertical mattress sutures stabilize the meniscal tear in place, allowing for proper healing. The principal steps in the procedure include (1) assessing the location and pattern of the tear arthroscopically, (2) performing a medial or lateral meniscal repair incision in the proper anatomic location, (3) passing the sutures in a vertical mattress pattern through the torn meniscus, and (4) tying the sutures while verifying sufficient reduction of the tear arthroscopically. Postoperatively, patients remain non-weight-bearing for the course of six weeks. Passive knee flexion from 0degree to 90degree is allowed for the first two weeks. After two weeks, motion is increased as tolerated. At six weeks postoperatively, patients are allowed to progress to weight-bearing as tolerated and initiate the use of a stationary bicycle. They should avoid squatting, sitting cross-legged, and squatting and lifting for four months postoperatively to avoid substantial stress on the healing meniscus. After four months, sports-specific activities are initiated. Patients are expected to return to normal physical activity within four to six months postoperatively.
|
0 |
Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners
|
Management of Hip Fractures in the Elderly
|
OBJECTIVE: To identify nutrients, foods, and dietary patterns associated with stress fracture risk and changes in bone density among young female distance runners.DESIGN AND SETTING: Two-year, prospective cohort study. Observational data were collected in the course of a multicenter randomized trial of the effect of oral contraceptives on bone health.PARTICIPANTS: One hundred and twenty-five female competitive distance runners ages 18-26 years.ASSESSMENT OF RISK FACTORS: Dietary variables were assessed with a food frequency questionnaire.MAIN OUTCOME MEASUREMENTS: Bone mineral density and content (BMD/BMC) of the spine, hip, and total body were measured annually by dual x-ray absorptiometry (DEXA). Stress fractures were recorded on monthly calendars, and had to be confirmed by radiograph, bone scan, or magnetic resonance imaging.RESULTS: Seventeen participants had at least one stress fracture during follow-up. Higher intakes of calcium, skim milk, and dairy products were associated with lower rates of stress fracture. Each additional cup of skim milk consumed per day was associated with a 62% reduction in stress fracture incidence (P < .05); and a dietary pattern of high dairy and low fat intake was associated with a 68% reduction (P < .05). Higher intakes of skim milk, dairy foods, calcium, animal protein, and potassium were associated with significant (P < .05) gains in whole-body BMD and BMC. Higher intakes of calcium, vitamin D, skim milk, dairy foods, potassium, and a dietary pattern of high dairy and low fat were associated with significant gains in hip BMD.CONCLUSIONS: In young female runners, low-fat dairy products and the major nutrients in milk (calcium, vitamin D, and protein) were associated with greater bone gains and a lower stress fracture rate. Potassium intake was also associated with greater gains in hip and whole-body BMD
|
0 |
Complex metabolic and skeletal changes in men taking long-term androgen deprivation therapy
|
Management of Hip Fractures in the Elderly
|
Background: The objective of this study was to assess complex skeletal and metabolic changes in a single cohort of PCa patients taking long-term ADT. Patients and Methods: Ninety-five patients with locally advanced PCa (mean age 73.3 (plus or minus) 6.2 years) were treated with ADT for 24 months. Body mass index (BMI), waist-to-hip ratio (WHR), lipid profile, serum fasting glucose (SFG), and bone mineral density (BMD) of lumbar spine (L1-L4), femoral neck, and total hip BMD were examined at the baseline, and then every 12 months. These measurements were also made to the control group of 88 patients (mean age, 71.9 (plus or minus) 6.7 years). Results: After 12 months of ADT, BMI, WHR, low-density lipoprotein, overall cholesterol, and SFG increased significantly; and total hip BMD and BMD L1-L4 decreased significantly in the study group. After 24 months of ADT, BMI, WHR, and SFG increased significantly. BMD was significantly lower in L1-L4, femoral neck, and total hip. Four patients (4.2%) were diagnosed with new onset diabetes. Overall, the incidence of fractures after 24 months of ADT was 7-fold higher in the study group. Conclusion: ADT leads into unfavorable changes in body composition, unfavorable lipoprotein profile, increase in SFG level and decrease in BMD. The incidence of fractures was 7-fold higher in the study group. (copyright) 2013 Elsevier Inc
|
0 |
Pediatric ptosis as a sign of treatable autonomic dysfunction
|
Upper Eyelid and Brow Surgery
|
Purpose: To report the ophthalmic findings in young patients with dopamine β-hydroxylase deficiency and to assess them in the context of other reports in an attempt to discern if ophthalmic criteria may assist in early detection of this debilitating, yet treatable, disorder. Design: Prospective, observational case series. Methods: An ophthalmic examination, including measuring intraocular and systemic blood pressures while supine, sitting, and standing, and eyelid function and pupillary function testing, was completed on 3 young patients with recently documented dopamine β-hydroxylase deficiency at a single institution. Results: Mean arterial blood pressures were 90.1 ± 18.5 mm Hg supine, 79.1 ± 25.7 mm Hg sitting, and 45.8 ± 11.6 mm Hg standing (P =.021). Mean intraocular pressures in these patients were 15.8 ± 1.0 mm Hg supine, 15.0 ± 3.6 mm Hg sitting, and 7.7 ± 2.3 mm Hg standing (P =.03). Mean palpebral fissure, levator function, and margin reflex distance were 8.2 ± 1.0 mm, 16.0 ± 0 mm, and 2.8 ± 0.6 mm, respectively. Measurable miosis was present in only 1 patient, and pupillary supersensitivity to 2.5% phenylephrine was not observed. Conclusions: The ophthalmologic findings of the patients in this case series documented mild ptosis and striking orthostatic reductions in intraocular pressure and mean arterial blood pressure, as might be expected with a lack of intrinsic sympathetic function. Orthostatic intraocular pressure and mean arterial blood pressure may be a helpful early screening tool for autonomic dysfunction in children undergoing a ptosis evaluation. © 2013 Elsevier Inc. All rights reserved.
|
0 |
Is internal fixation of the intertrochanteric fractures reliable option in patients with cognitive dysfunction?
|
Developmental Dysplasia of the Hip 2020 Review
|
The purpose of this study was to compare the results of hemiarthroplasty with those of treatment internal fixation devices for stable intertrochanteric fractures in patients with moderate and severe cognitive dysfunction. 155 patients were evaluated retrospectively. 54 patients were treated with proximal femoral nail (PFN), 57 with dynamic hip screw (DHS) and 44 were underwent hemiarthroplasty (HA). Activities of daily living (ADL) were evaluated with the Barthel Activity Index (BI) score and the Health Related Quality of Life (HRQoL) with the Euroquol-5D (EQ-5D) test. The BI scores in HA patients were found to be at significantly high compared to the PFN and DHS groups both at the one and two years. A significant difference was also found in the EQ-5D scores in favor of HA group at one year. The most common complications in internal fixation patients were malunion (7/54 for PFN, 9/57 for DHS group), fixation failure (8/54 for PFN, 12/57 for DHS group) and dislocation (10/44), deep infection (8/44) for HA group. The strong predictive variables on ADL in dementia patients were, duration time to surgery and pre-operative MMSE score. In conclusion, HA is the prefered treatment for stable intertrochanteric fractures but that the dislocation (10/44) and infection rates (8/44) are very high in dementia.
|
1 |
Use of anti-granulocyte scintigraphy with 99mTc-labeled monoclonal antibodies for the diagnosis of periprosthetic infection in patients after total joint arthroplasty: a diagnostic meta-analysis
|
PJI DX Updated Search
|
The accurate diagnosis of periprosthetic joint infections (PJI) is crucial for therapy and the prevention of complications. No diagnostic test of PJI is 100% accurate. The aim of this study was to assess the use of anti-granulocyte scintigraphy using 99 mTc-labeled monoclonal antibodies to diagnose PJI after total joint arthroplasty. A systematic search of all relevant studies published through January 2013 was conducted using the MEDLINE, EMBASE, OVID, and ScienceDirect databases. Observational studies that assessed the accuracy of the anti-granulocyte scintigraphy with monoclonal antibodies or antibody fragments labeled with technetium 99 m in diagnosis for PJI and provided data on specificity and sensitivity were identified. Standard methods recommended for meta-analysis of diagnostic accuracy were used. Nineteen studies were eligible for inclusion. The results demonstrated that the area under the summary receiver operator curve was 0.88, and the diagnostic accuracy (Q*) was 0.81. Additionally, the diagnostic odds ratio (DOR) was 18.76 with a corresponding 95% confidence interval of 10.45-33.68. The pooled sensitivity and specificity of the diagnostic method for the diagnosis of PJI were 83% and 79%, respectively, while the pooled positive likelihood ratio (PLR) was 3.56, and the negative likelihood ratio (NLR) was 0.26. Anti-granulocyte scintigraphy using 99 mTc-labeled monoclonal antibodies has a reasonable role in the diagnosis of PJI after total joint arthroplasty. Due to the limitations of the present meta-analysis, additional high-quality original studies are required to confirm the predictive value
|
1 |
Hip fracture time-to-surgery and mortality revisited: mitigating comorbidity confounding by effect of holidays on surgical timing
|
Hip Fx in the Elderly 2019
|
PURPOSE: The association between delayed hip fracture surgery and mortality remains elusive because of strong confounding by comorbidity factors. We designed a study to investigate the effect of small delays in surgery due to holidays.
METHODS: Consecutive hip fractures operated in a high-income, publicly funded healthcare system between 2006 and 2013 were analysed. Age <65 years, pathological fractures, history of previous hip operation and time to surgery >seven days were excluded. Patients were grouped according to number of holidays following admission (HFA) as a surrogate for time to surgery, with difference in mean time to surgery tested for statistical significance and baseline characteristics including age, sex, Charlson comorbidity index (CCI) and fracture and operation types assessed. Survival up to two years was compared.
RESULTS: Thirty-one thousand five hundred and ninety-two patients were included. Patient groups with zero, one, two or three HFA had significantly different mean time to operation of 2.25, 2.47, 2.67 and 2.84 days, respectively (Kruskal-Wallis test p < 0.0001), but baseline characteristics were similar. There was no difference in mortality at six months (p = 0.431) and two years (p = 0.785). Cox's regression analysis identified age, gender and CCI as independent predictors of mortality but not HFA, and the adjusted hazards ratio for each HFA increment was 1.026 [95% confidence interval (CI) 0.999-1.025; p = 0.056] which was not statistically significant.
CONCLUSIONS: We observed no increase in mortality rate in patients having small delays in surgery because of holidays.
|
0 |
Three-year follow-up of the use of transdermal 17beta-estradiol matrix patches for the prevention of bone loss in early postmenopausal women
|
Management of Hip Fractures in the Elderly
|
OBJECTIVE: A total of 325 of 569 postmenopausal women who were initially recruited into two 2-year, double-blind, placebo-controlled, dose-ranging studies of a matrix transdermal formulation of 17beta-estradiol (Menorest) participated in open-label extensions for a third year.STUDY DESIGN: Those patients originally randomly assigned to receive 17beta-estradiol continued active treatment with dosages of 25, 50, 75, or 100 microg/d, whereas those originally randomly assigned to receive a placebo patch were switched to an active patch of identical size that delivered 17beta-estradiol at 25, 50, 75, or 100 microg/d. Follow-up was conducted, and bone density and other parameters were compared.RESULTS: Overall, gains in bone mass were maintained in patients who received 3 years of active treatment. In patients originally randomly assigned to receive placebo, initial losses in bone mass during the first 2 years were reversed and replaced with marked increases after the switch to active treatment. All patients who had initially received placebo showed significant, dose-related, clinically relevant increases (2.77% +/- 0.99%; P =.0048; to 7.36% +/- 0.74%; P =.0001) in lumbar spine bone mineral density relative to the end of the second year of the original study; smaller final-year increases were noted among the patients who had been actively treated for all 3 years. Similar trends were reported for femoral, trochanter, and total hip bone mineral densities. Mean total body bone mineral density either increased or remained unchanged in all dosage groups. These results were accompanied by parallel changes in levels of serum and urinary markers of bone turnover, with all markers approaching or returning to premenopausal levels by month 36. The high tolerability of this formulation during years 1 and 2 was maintained during year 3; 5.5% of patients withdrew from treatment because of adverse events in the final year.CONCLUSION: The Menorest formulation of transdermal 17beta-estradiol maintained bone mineral density gains in postmenopausal women and was well tolerated through a 3-year treatment period. It was also effective in reversing the initial bone loss associated with late commencement of therapy
|
0 |
Prevalence of completely edentulous patients opting for implant supported prosthesis
|
Dental Implant Infection
|
A completely edentulous patient faces many problems like difficulty in chewing, drooping corners of the mouth, unaesthetic appearance etc. Hence, it is important to restore the patient's mouth. There are a variety of treatment options for completely edentulous patients ranging from complete denture to implant supported prostheses. The aim of this study is to check the prevalence of completely edentulous patients opting for implant supported prostheses and the correlation between types of prosthesis and various parameters. The subjects for this retrospective study were selected from June 2019 to May 2020. The prostheses were divided into four groups: Group 1: Complete denture treatment, Group 2: FP1 prosthesis, Group 3: Hybrid denture and Group 4: Implant supported overdenture. Frequencies of the prostheses were checked and Chi-square test was used to check the association of the treatment options with age and gender. It was observed that complete denture had the maximum prevalence, followed by an equal prevalence of FP1 prosthesis and hybrid denture and the least prevalence was of implant supported prosthesis. When the association was checked with types of prosthesis and age, it was observed that complete denture was mostly seen in elderly patients, whereas implant supported fixed prosthesis was mostly seen in middle aged patients. When the association was checked with types of prosthesis and gender, it was observed that complete denture was mostly seen in males, whereas implant supported fixed prosthesis had equal prevalence. It can be concluded that very few patients opted for implant supported prostheses with further studies required.
|
0 |
Comorbidities associated with end-stage knee osteoarthritis explain differences in the probability of major complications within 30 days of joint arthroplasty when compared to patients with hip osteoarthritis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Purpose: Differences in the incidence of several major early postoperative complications have been reported following hip and knee arthroplasty procedures for osteoarthritis (OA). However, given the postulated different pathogenesis and comorbidities associated with OA of these joints, the relative contributions of these comorbidities to the observed complications, as compared to the surgical procedure itself, are unclear. Thus, the purpose of the present study was to investigate whether comorbidities known to be associated with endstage knee OA explained differences in the risk of major complications within 30 days of arthroplasty surgery between patients undergoing surgery for knee and hip OA. Methods: All patients who underwent primary total knee (TKA) or hip arthroplasty (THA) for a diagnosis of OAwere extracted from the 2010 to 2012 American College of Surgeons National Surgical Quality Improvement Project databases. Combined, these databases include preoperative risk factor and 30 day postoperative morbidity data from 374 clinical sites in North America, abstracted by trained reviewers. The study cohort encompassed 54,022 cases, including 33,906 of knee OA and 20,116 of hip OA. Patient data extracted included age, gender, and body mass index (BMI) stratified by World Health Organization (WHO) class. In a previous study, the following comorbidities were identified to be independently associated with end-stage knee OA: hypertension requiring medication, diabetes, and higher grade of obesity. Additionally, other variables known to be associated with the risk of one or more complications of interest were extracted, including smoking status within one year of surgery, chronic systemic steroid use within 30 days of surgery, and length of surgery. The specific major complications evaluated were any surgical site infection (SSI), pulmonary embolism (PE), myocardial infarction (MI) and deep vein thrombosis (DVT). Descriptive statistics were obtained. Logistic regression analyses were performed to assess the odds of developing any major complication, as well each major complication individually, between patients with endstage knee and hip OA undergoing surgery adjusting for demographics and identified comorbidities. Results: Significantly greater odds of developing a major complication were observed in patients with knee OA as compared to those with hip OA when controlled for age and gender alone (OR: 1.22; 95%CI [1.08- 1.37]). However, after controlling for associated comorbidities and other risk factors, knee arthroplasty itself was not associated with significantly different odds of experiencing a major complication (1.13; 95% CI [0.99-1.27]). Increasing obesity was associated with increased odds of SSI (grade III vs normal OR 2.40; 95% CI [1.66-3.47]) and PE (OR 2.51; 95%CI [1.32-4.79]). Diabetes was associated with increased odds of SSI (OR 1.46; 95%CI [1.18-1.80]) and MI (OR 1.98; 95% CI [1.36-2.88]). Hypertensionwas associated with increased odds of MI (OR 2.33; 95% CI [1.44-3.76]). None of the studied comorbidities were found to independently predict differences in the odds of DVT. Conclusions: The results of the present study suggest that the relative probabilities of developing early post-operative major complications following knee and hip arthroplasty for OA are significantly influenced by patients' comorbidities. Given the increased prevalence of important predictors such as obesity, diabetes and hypertension among patients with end-stage knee OA, some of the probability of developing complications following knee arthroplasty may be incorrectly attributed to the procedure itself, rather than to differences in patient characteristics when compared to those undergoing hip arthroplasty
|
0 |
Inhibition of lung metastasis by synthetic and recombinant fragments of human fibronectin with functional domains
|
Reconstruction After Skin Cancer
|
We have investigated the antimetastatic effect of synthetic or recombinant peptides containing the functional domains of fibronectin on experimental and spontaneous lung metastases of murine tumor cells. CS1 peptide which is present within type III homology connecting segment (IIICS) as well as C-274 (cell-binding domain) were able to inhibit experimental lung metastasis when co-injected intravenously (iv) with B16-BL6 melanoma cells, while H-271 (heparin-binding domain) could not. In the spontaneous metastasis model, multiple iv administrations of CS1 or C-274 after surgical excision of primary tumors caused a significant reduction of metastatic colonies in the lung. Both CS1 and C-274 significantly inhibited cell adhesion and migration to fibronectin-coated substrates when added freely in solution. CS1 peptide also inhibited the cell adhesion and migration to laminin-coated substrates, but C-274 did not. H-271 did not have any inhibitory effect on cell adhesion or migration to either of the substrates. Similarly, CS1 inhibited tumor invasion to both Matrigel/fibronectin- and Matrigel/laminin-coated filters, whereas C-274 inhibited the invasion to only Matrigel/fibronectin-coated filter. These results indicate that CS1 peptide of fibronectin, lacking the Arg-Gly-Asp-containing domain, actively inhibits tumor metastases in spontaneous and experimental metastasis models. The use of such a peptide might offer a promising therapeutic approach for combatting or preventing cancer metastasis.
|
0 |
A physiological approach in stabilization and consolidation of unstable femoral neck fracture in osteoporotic elderly patients: A retrospective review
|
Management of Hip Fractures in the Elderly
|
A retrospective review was performed on 46 unstable femoral neck fractures in osteoporotic elderly patients. They were treated with internal fixation using a nail-plate associated with filling of the metaphysis with a biomaterial - natural coral - which undergoes bone incorporation. From 1992 to 1996, the increased knowledge for use of natural coral in the surgical procedures allowed a progressively decrease in the mean time to weight bearing, starting from 26.3 days (1992) to 11.2 days (1996). Primary stabilization at the fracture site was obtained in 42 patients (91.3%), clinically evidenced by the absence of pain from unlimited weight bearing. Only four mild impactions were reported. Consolidation was observed in all cases but one. Among them, more than half of the patients (53.3%) had a time to consolidation equal or lower than to 45 days; 70% healed in 2 months. Biocompatibility of the coral was perfect. Full bioresorbability was observed-partially in five cases, in all other cases from 3 to 18 months. The biomaterial was filled with bone marrow. It acts "as if" it was a real autologous graft. A mechanically perfectly stabilized fracture site, a large amount of biomaterial, a spheric shape, 4 mm diameter, injected with bone marrow, filled in a good environment, are the best conditions to obtain good result with an easily reproducive system
|
0 |
Common variants in the GDF5-UQCC region are associated with variation in human height
|
SR for PM on OA of All Extremities
|
Identifying genetic variants that influence human height will advance our understanding of skeletal growth and development. Several rare genetic variants have been convincingly and reproducibly associated with height in mendelian syndromes, and common variants in the transcription factor gene HMGA2 are associated with variation in height in the general population. Here we report genome-wide association analyses, using genotyped and imputed markers, of 6,669 individuals from Finland and Sardinia, and follow-up analyses in an additional 28,801 individuals. We show that common variants in the osteoarthritis-associated locus GDF5-UQCC contribute to variation in height with an estimated additive effect of 0.44 cm (overall P < 10(-15)). Our results indicate that there may be a link between the genetic basis of height and osteoarthritis, potentially mediated through alterations in bone growth and development
|
0 |
Concurrent Use of Opioids with Other Central Nervous System-Active Medications among Older Adults
|
Hip Fx in the Elderly 2019
|
The primary objective was to determine the prevalence and characteristics of older adults concurrently using opioids and other central nervous system (CNS)-active medications, and the specialties of providers who ordered the medications. A secondary objective was to document medication-related adverse effects associated with such concurrent drug use. Study populations were identified as older adults aged =65 years with 1 year continuous medical and drug plan enrollment during 2017 and opioid use of =2 prescriptions for =15 days' supply. CNS-active medications included benzodiazepines, non-benzodiazepine hypnotics, muscle relaxants, antipsychotics, and gabapentinoids. Provider specialties were identified from the National Provider Identification database. Characteristics associated with opioids only, opioids plus 1, and opioids plus =2 additional CNS-active medications were determined using multinomial logistic regression. Outcome measures during 2017 included injurious falls/fractures and =3 emergency room (ER) visits. Among eligible insureds (N = 209,947), 57% used opioids only, 28% used opioids plus 1 additional CNS medication, and 15% used =2 additional medications. About 60% of opioids and other concurrent CNS medications were prescribed by the same provider, generally a primary care provider. Benzodiazepines and gabapentinoids were most often used concurrently with opioids. Health status, insomnia, anxiety, depression, and low back pain had the strongest associations with concurrent medication use. Overall, concurrent use with =2 CNS medications increased the likelihood of injurious falls/fractures or =3 ER visits in this population by about 18% and 21%, respectively. Both patients and providers may benefit from an awareness of adverse outcomes associated with concurrent opioid and other CNS-active medication use.
|
0 |
Radiographic Healing and Functional Outcomes of Untreated Ulnar Styloid Fractures Following Volar Plate Fixation of Distal Radius Fractures: A Prospective Analysis
|
Distal Radius Fractures
|
Background: Ulnar styloid fractures (USFs) are common concomitant injuries associated with distal radius fractures (DRFs). Recent studies have found conflicting evidence on whether these fractures treated or untreated effect pain and functional outcomes. The purpose of this study was to prospectively evaluate pain and function outcomes of consecutively untreated USFs in surgically repaired DRFs. The study hypothesis was that there would be no difference in outcomes whether an USF is present or not, with all cases left untreated. Methods: A prospective study at a single institution of consecutive DRF treated surgically with volar locked plating was undertaken. No patients underwent fixation of an USF if present. There were no treated USF that were excluded. Patients with associated ulnar neck and shaft fractures were excluded. Functional outcome measures were analyzed using the Quick Disabilities of the Arm, Shoulder, and Hand score (QDASH) and the Patient-Rated Wrist Evaluation (PRWE) scores. Outcome measures were collected at 3 months and 1 year postoperatively. Results: There was an incidence of 52.2% (n = 70/134) USF associated with surgically treated DRF. By location, there were 52.9% (n = 37/70) ulnar styloid tip fractures and 46.1% (33/70) ulnar styloid base. There were 75.7% of USF (53/70) still not healed by 1-year follow-up. When comparing patients with a DRF without an USF versus DRF with an associated USF at 12 months, there was no statistical difference in the QDASH score (6.7 vs 8.4, P = .47) or the PRWE total score (4.8 vs 7.5, P = .24). Similarly, subgroup analysis showed no statistical difference in QDASH or PRWE scores at final follow-up in united USF versus nonunited USF subjects (QDASH 14.2 vs 6.8, P = .112; PRWE 14.8 vs 5.4, P = .185). Conclusions: USFs are a common concomitant injury occurring in nearly half of DRFs treated surgically. Our prospective cohort analysis showed that neither the presence, type, nor bony union status of a concomitant USF has any significant effect on patient outcomes or reoperations at 1-year postoperatively. Our study confirms our hypothesis that USF of the tip and base should be left untreated.
|
0 |
Bisphosphonate complications including osteonecrosis of the jaw
|
MSTS 2018 - Femur Mets and MM
|
Bisphosphonate therapy has been incorporated in the standard management of patients with multiple myeloma-related bony disease. Although their efficacy in reducing skeletal related events is important in the supportive management of the myeloma patient, post-marketing experience with this class of agents, particularly the more potent intravenous agents pamidronate and zoledronic acid, have raised cautionary notes regarding the potential side effects of these agents. The focus of this session is to review the risk factors, incidence, prevention strategies and management of bisphosphonate-related osteonecrosis of the jaw. In addition, pathophysiology, incidence and monitoring for renal dysfunction during chronic therapy with these agents are reviewed. [References: 30]
|
0 |
Blood Flow Restriction Exercise Study
|
OAK 3 - Non-arthroplasty tx of OAK
|
This pilot study will investigate the effects of blood flow restriction (BFR) exercise for up to 4â?6 weeks prior to total knee arthroplasty (TKA) surgery in older patients to measure clinical outcomes such as strength, lower extremity function, and pain.
|
0 |
The importance of correct patient positioning in theatres and implications of mal-positioning
|
DOD - Acute Comp Syndrome CPG
|
Patient positioning in theatre pertains to how a patient is transferred and positioned for a specific procedure. Patient safety is a central focus of care within the NHS and every healthcare practitioner must ensure that patients are protected from harm where possible. Mal-positioning of the patient has important implications in terms of associated problems of pressure sores, nerve compressions, deep vein thrombosis and compartment syndrome, and should be avoided.
|
0 |
A reliable, valid and responsive questionnaire to score the impact of knee complaints on work following total knee arthroplasty: the WORQ
|
Surgical Management of Osteoarthritis of the Knee CPG
|
The Work, Osteoarthritis or joint-Replacement Questionnaire (WORQ) was developed to assess physical difficulty experienced in work before or following total knee arthroplasty (TKA). Thirteen questions were designed. The WORQ was tested for internal consistency by factor analysis, internal reliability (Crohnbach's alpha), and construct validity. A test-retest reproducibility was performed for analyzing standard error of measurement (SEM agreement), reliability (ICC) and smallest detectable change (SDC) in individuals and groups. Lastly responsiveness (standardized response means [SRM]), floor and ceiling effects and interpretability (minimal important change [MIC]) were analyzed. It is shown that the WORQ is a reliable, valid and responsive questionnaire that can be used to evaluate the impact of knee complaints following TKA on patients' ability to work
|
0 |
Pain management in patients who undergo outpatient arthroscopic surgery of the knee
|
AAHKS (2) Corticosteroids
|
Arthroscopy of the knee joint produces an initial afferent barrage of pain signals that have the capacity to initiate prolonged changes in the nervous system leading to the amplification and prolongation of postoperative pain. Preemptive analgesia involves the administration of analgesics prior to painful stimuli to prevent the amplification of postoperative pain. It is currently recommended that multimodal analgesic regimens be utilized in the management of postoperative pain. Intra-articular bupivacaine and morphine are effective analgesics for arthroscopic knee surgery. Intra-articular ketorolac, corticosteroids, and clonidine may also have a role in reducing pain following arthroscopic knee surgery. Nonsteroidal anti-inflammatory drugs play an important role in the management of postoperative orthopaedic pain, and the newer cyclooxygenase-2-specific nonsteroidal anti-inflammatory drugs may have additional advantages with respect to safety. Preemptive and multimodal analgesic techniques should be utilized in the management of patients undergoing anterior cruciate reconstruction.
|
0 |
Determinants of return to work after carpal tunnel release
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
PURPOSE: The determinants of time to return to work-a common measure of treatment effectiveness-are incompletely defined. Our primary hypothesis was that employment circumstances are the strongest determinant of earlier return to work. Our secondary hypothesis was that return to work in patients with desk-based jobs is predicted by patient expectations and other psychosocial factors. METHODS: We enrolled 65 employed patients with limited incision open carpal tunnel release in a prospective cohort study. Patients completed validated measures of depression, coping strategies, pain anxiety, and job burnout. Heavy lifting was not allowed for 1 month after surgery. Return to modified and full work duty was recorded in days. Although not specifically an exclusion criterion, none of the patients had a workers' compensation claim or other source of secondary gain. RESULTS: Patients returned to modified duty an average of 11.8 days and full duty at an average of 18.9 days after surgery. Predictors of earlier return to modified duty in multivariate analyses included desk-based work and both the number of days patients expected to take off and the numbers of days they wanted to take off for the entire cohort, with an additional influence from catastrophic thinking in desk-based workers. Predictors of earlier return to full duty in multivariate analyses included desk-based work and number of days patients expected to take off before for the entire cohort, fewer days off desired in non-desk-based workers, fewer days off desired and change in work role in desk-based workers, and lower pain anxiety in part-time workers. CONCLUSIONS: The most important determinant of return to full duty work after limited incision open carpal tunnel release is job type, but psychological factors such as patient expectations, catastrophic thinking, and anxiety in response to pain also have a role. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II
|
0 |
Assessment of osteoarthritis candidate genes in a meta-analysis of nine genome-wide association studies
|
SR for PM on OA of All Extremities
|
OBJECTIVE: To assess candidate genes for association with osteoarthritis (OA) and identify promising genetic factors and, secondarily, to assess the candidate gene approach in OA. METHODS: A total of 199 candidate genes for association with OA were identified using Human Genome Epidemiology (HuGE) Navigator. All of their single-nucleotide polymorphisms (SNPs) with an allele frequency of >5% were assessed by fixed-effects meta-analysis of 9 genome-wide association studies (GWAS) that included 5,636 patients with knee OA and 16,972 control subjects and 4,349 patients with hip OA and 17,836 control subjects of European ancestry. An additional 5,921 individuals were genotyped for significantly associated SNPs in the meta-analysis. After correction for the number of independent tests, P values less than 1.58 x 10(-5) were considered significant. RESULTS: SNPs at only 2 of the 199 candidate genes (COL11A1 and VEGF) were associated with OA in the meta-analysis. Two SNPs in COL11A1 showed association with hip OA in the combined analysis: rs4907986 (P = 1.29 x 10(-5) , odds ratio [OR] 1.12, 95% confidence interval [95% CI] 1.06-1.17) and rs1241164 (P = 1.47 x 10(-5) , OR 0.82, 95% CI 0.74-0.89). The sex-stratified analysis also showed association of COL11A1 SNP rs4908291 in women (P = 1.29 x 10(-5) , OR 0.87, 95% CI 0.82-0.92); this SNP showed linkage disequilibrium with rs4907986. A single SNP of VEGF, rs833058, showed association with hip OA in men (P = 1.35 x 10(-5) , OR 0.85, 95% CI 0.79-0.91). After additional samples were genotyped, association at one of the COL11A1 signals was reinforced, whereas association at VEGF was slightly weakened. CONCLUSION: Two candidate genes, COL11A1 and VEGF, were significantly associated with OA in this focused meta-analysis. The remaining candidate genes were not associated
|
0 |
Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus
|
PRP (Platelet-Rich Plasma)
|
PURPOSE: The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientific evidence and the clinical experience of knee experts.
METHODS: Three groups of surgeons and scientists elaborated and ratified the so-called formal consensus process to define the recommendations for the management of traumatic meniscus tears. A traumatic meniscus tear was defined as a tear with an acute onset of symptoms caused by a sufficient trauma. The expert groups included a steering group of eight European surgeons and scientists, a rating group of another nineteen European surgeons, and a peer review group. The steering group prepared twenty-seven question and answer sets based on the scientific literature. The quality of the answers received grades of A (a high level of scientific support), B (scientific presumption), C (a low level of scientific support) or D (expert opinion). These question and answer sets were then submitted to and evaluated by the rating group. All answers were scored from 1 (= totally inappropriate) to 9 (= totally appropriate) points. Thereafter, the comments of the members of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the finalized question and answer sets were submitted for final review by the peer review group composed of representatives of the ESSKA-affiliated national societies. Eighteen representatives replied.
RESULTS: The review of the literature revealed a rather low scientific quality of studies examining the treatment of traumatic meniscus tears. Of the 27 questions, only one question received a grade of A (a high level of scientific support), and another received a grade of B (scientific presumption). The remaining questions received grades of C and D. The mean rating of all questions by the rating group was 8.2 (95% confidence interval 8.1-8.4). A general agreement that MRI should be performed on a systematic basis was not achieved. However, MRI was recommended when arthroscopy would be considered to identify concomitant pathologies. In this case, the indication for MRI should be determined by a musculoskeletal specialist. Based on our data, stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears. When repair is required, surgery should be performed as early as possible. Evidence that biological enhancement such as needling or the application of platelet-rich plasma would improve healing was not identified. Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair.
DISCUSSION: The consensus was generated to present the best possible recommendations for the treatment of traumatic meniscus tears and provides some groundwork for a clinical decision-making process regarding the treatment of meniscus tears. Preservation of the meniscus should be the first line of treatment when possible, because the clinical and radiological long-term outcomes are worse after partial meniscectomy than after meniscus preservation. The consensus clearly states that numerous meniscus tears that were considered irreparable should be repaired, e.g., older tears, tears in obese patients, long tears, etc. LEVEL OF EVIDENCE: II.
|
0 |
Development of a Comprehensive Falls Prevention Model in a Long-Term Care Facility
|
DoD PRF (Psychosocial RF)
|
This article discusses the development of a comprehensive falls prevention and injury reduction model in a large long-term care facility. The model, appropriately named the S.A.F.E. program, was adopted from another Veterans Administration medical center and significantly revised to meet the specific needs of our patient population. The importance of carefully selecting a fall risk screening tool to identify those residents that have a high probability of falling is discussed. Intrinsic and extrinsic risk factors are briefly reviewed based on the current literature. High-risk residents should be referred to the appropriate discipline for in-depth assessment. Evidenced-based interventions that address these risk factors are discussed. Interventions are preventative or reactive in nature and specifically designed to prevent falls or to reduce the degree of injury respectively. The value of continuous quality improvement measures is reviewed. A clinical falls algorithm is discussed along with the S.A.F.E. model that outlines the steps staff should follow to improve resident safety as it relates to falls. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
|
0 |
Compartment pressure curves predict surgical outcome in chronic deep posterior compartment syndrome
|
DOD - Acute Comp Syndrome CPG
|
BACKGROUND: Results of surgery for chronic exertional compartment syndrome (CECS) of the lower leg deep posterior compartment are inferior compared with other types of CECS. Factors predicting success after surgery are unknown.
PURPOSE: To study the prognostic value of preoperative compartmental pressure curves in patients receiving surgery for deep posterior compartment CECS.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: Intracompartmental pressures (ICPs) of patients with deep posterior lower leg CECS were obtained at 4 time points (ie, before, immediately after, and 1 and 5 minutes after a standard exercise challenge test). Area under the 4-point pressure curve was calculated. Patients received a questionnaire investigating residual symptoms after surgery.
RESULTS: A complete data set was available for 52 patients (men, n = 23; age, 33 +/- 14 years). They rated their 3-month postoperative clinical outcome as excellent (14%), good (38%), fair (35%), or poor (13%). Outcome at 3 months was related to the area under the preoperative 4-point pressure curve (excellent, 127 +/- 28; good, 113 +/- 25; fair, 100 +/- 22; and poor, 88 +/- 15; P = .005; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08). At the long-term follow-up (39 +/- 24 months), all 5 cardinal symptoms (pain, tight feeling, cramps, weakness, and diminished sensibility) were greatly attenuated (P < .001) in the successfully operated group. Long-term success was 48%. Delay in diagnosis was related to poor outcome (P = .04). Correlations between pressures/area under the 4-point pressure curve and long-term outcome were not significant, however.
CONCLUSION: Preoperative measured intracompartmental pressures obtained in rest and after a standard exercise test may predict success of surgery for deep posterior compartment CECS of the lower limb. Further standardizing of preoperative pressure protocols may confirm that compartmental pressure analysis has diagnostic as well as predictive properties.
|
0 |
Oncoplastic surgery in a Japanese patient with breast cancer in the lower inner quadrant area: partial mastectomy using horizontal reduction mammoplasty
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
We report the results of oncoplastic surgery in a Japanese patient with early breast cancer. Her breasts were ptotic, and her lesion was considered to be suitable for breast-conserving surgery. Oncoplastic surgery involving partial resection of the gland and a horizontal-type mammoplasty was performed. The technique was easy to perform, and the cosmetic outcome was excellent.
|
0 |
[Postoperative delirium after general anesthesia vs. spinal anesthesia in geriatric patients]
|
Management of Hip Fractures in the Elderly
|
BACKGROUND: Influence of the type of anesthesia on postoperative delirium was examined in geriatric patients with femoral neck fracture.METHODS: Forty patients aged 70 or more were randomly allocated to receive either general anesthesia (sevoflurane, nitrous oxide in oxygen, G group, n = 21) or spinal anesthesia (0.5% bupivacaine, S group, n = 19). G group received the oxygen therapy during the 12-hour postoperative period. Postoperative assessments included the rate of postoperative delirium during the 4-day postoperative period, oxygen saturation during the 18-hour postoperative period, the value of hemoglobin at 1 postoperative day and the number of analgesics requirements during the 4-day postoperative period.RESULTS: The rate of postoperative delirium was similar between the two groups during the 4-day postoperative period. However, that of S group tended to be higher during the 1-day postoperative period. Postoperative analgesic effect and the value of hemoglobin at 1 postoperative day were similar between the two groups. Oxygen saturation was similar between the two groups except 6 hours after the operation.CONCLUSIONS: The type of anesthesia, general or spinal, does not affect the postoperative delirium in geriatric patients with femoral neck fracture
|
0 |
Nanomaterials and synergistic low-intensity direct current (LIDC) stimulation technology for orthopedic implantable medical devices
|
DoD SSI (Surgical Site Infections)
|
Nanomaterials play a significant role in biomedical research and applications because of their unique biological, mechanical, and electrical properties. In recent years, they have been utilized to improve the functionality and reliability of a wide range of implantable medical devices ranging from well-established orthopedic residual hardware devices (e.g., hip implants) that can repair defects in skeletal systems to emerging tissue engineering scaffolds that can repair or replace organ functions. This review summarizes the applications and efficacies of these nanomaterials that include synthetic or naturally occurring metals, polymers, ceramics, and composites in orthopedic implants, the largest market segment of implantable medical devices. The importance of synergistic engineering techniques that can augment or enhance the performance of nanomaterial applications in orthopedic implants is also discussed, the focus being on a low-intensity direct electric current (LIDC) stimulation technology to promote the long-term antibacterial efficacy of oligodynamic metal-based surfaces by ionization, while potentially accelerating tissue growth and osseointegration. While many nanomaterials have clearly demonstrated their ability to provide more effective implantable medical surfaces, further decisive investigations are necessary before they can translate into medically safe and commercially viable clinical applications. The article concludes with a discussion about some of the critical impending issues with the application of nanomaterials-based technologies in implantable medical devices, and potential directions to address these. © 2013 Wiley Periodicals, Inc.
|
0 |
Treatment outcomes of patients with spinal metastases derived from hepatocellular carcinoma
|
MSTS 2018 - Femur Mets and MM
|
BACKGROUND: The prognosis of hepatocellular carcinoma (HCC) used to be poor, but it has recently improved, which has meant that clinicians have greater opportunity to treat spinal metastases and the associated epidural spinal cord compression. However, there have been few systematic functional studies about HCC-derived spinal metastases. The treatment outcomes of surgical treatment for HCC-derived metastatic spinal tumors were investigated.
METHODS: The post-treatment survival period and pain, paralysis, and disturbance of activities of daily living (ADL) were investigated in 60 patients (surgery 25, conservative treatment 35).
RESULTS: The mean post-treatment survival period was 7.4 +/- 8.2 months (range 0.3-36 months). Univariate analysis indicated that the following factors influenced survival: the patient's general condition, presence/absence of major internal organ metastasis, serum albumin level, Child-Pugh classification, surgical treatment for spinal metastasis, and bone-modifying agent treatment. In the multivariate analysis of these 6 items, 3 significant factors were extracted: the patient's general condition, the serum albumin level, and bone-modifying agent treatment. Pain significantly improved in both groups (p < 0.001). Paralysis did not change significantly in the surgical group (p = 0.575), but it was significantly aggravated in the conservative treatment group (p = 0.047). The ADL abilities of the surgical group improved significantly (p < 0.001).
CONCLUSION: Most patients exhibited poor survival. In the conservative treatment group, paralysis was significantly aggravated, and little improvement was seen in the patients' ADL abilities. In the surgical group, the patients' ADL abilities improved significantly, but their paralysis did not. Therefore, surgery should be actively performed for HCC-derived spinal metastasis whenever it is indicated.
|
0 |
MOntelukast as a potential CHondroprotective treatment following Anterior cruciate ligament reconstruction (MOCHA Trial): study protocol for a double-blind, randomized, placebo-controlled clinical trial
|
AMP (Acute Meniscal Pathology)
|
Background: After anterior cruciate ligament (ACL) reconstruction, patient-reported outcomes are improved 10 years post-surgery; however, cytokine concentrations remain elevated years after surgery with over 80% of those with combined ACL and meniscus injuries having posttraumatic osteoarthritis (PTOA) within 10–15 years. The purpose of this multicenter, randomized, placebo-controlled trial is to assess whether a 6-month course of oral montelukast after ACL reconstruction reduces systemic markers of inflammation and biochemical and imaging biomarkers of cartilage degradation. Methods: We will enroll 30 individuals undergoing primary ACL reconstruction to participate in this IRB-approved multicenter clinical trial. This trial will target those at greatest risk of a more rapid PTOA onset (age range 25–50 with concomitant meniscus injury). Patients will be randomly assigned to a group instructed to take 10 mg of montelukast daily for 6 months following ACL reconstruction or placebo. Patients will be assessed prior to surgery and 1, 6, and 12 months following surgery. To determine if montelukast alters systemic inflammation following surgery, we will compare systemic concentrations of prostaglandin E2, monocyte chemoattractant protein-1, and pro-inflammatory cytokines between groups. We will also compare degradative changes on magnetic resonance imaging (MRI) collected 1 and 12 months following surgery between groups with reductions in early biomarkers of cartilage degradation assessed with urinary biomarkers of type II collagen breakdown and bony remodeling. Discussion: There is a complex interplay between the pro-inflammatory intra-articular environment, underlying bone remodeling, and progressive cartilage degradation. PTOA affects multiple tissues and appears to be more similar to rheumatoid arthritis than osteoarthritis with respect to inflammation. There is currently no treatment to delay or prevent PTOA after ACL injury. Since there is a larger and more persistent inflammatory response after ACL reconstruction than the initial insult of injury, treatment may need to be initiated after surgery, sustained over a period of time, and target multiple mechanisms in order to successfully alter the disease process. This study will assess whether a 6-month postoperative course of oral montelukast affects multiple PTOA mechanisms. Because montelukast administration can be safely sustained for long durations and offers a low-cost treatment option, should it be proven effective in the current trial, these results can be immediately incorporated into clinical practice. Trial registration: ClinicalTrials.govNCT04572256. Registered on October 1, 2020.
|
0 |
Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process
|
AAHKS (8) Anesthetic Infiltration
|
Traditional non-steroidal anti-inflammatory drugs (NSAID) and selective cyclooxygenase-2 (COX-2) inhibitors are widely used in the treatment of pain, including bone fracture pain and orthopaedic post-operative pain. The gastrointestinal and cardiovascular adverse effects of NSAIDs are acknowledged, but their effects on bone are less widely known. Prostaglandins play an important role in the regulation of osteoblast and osteoclast functions, and inhibition of prostaglandin production retards bone formation. Therefore, NSAIDs could be expected to have significant consequences in divergent clinical situations where bone formation or remodelling is a contributing factor. The present survey reviews current experimental and clinical evidence related to two of those conditions (i.e. on ectopic bone formation and on bone fracture healing). NSAIDs are used clinically to prevent ectopic bone formation (also known as heterotopic ossification) (e.g. after total hip arthroplasty or trauma). The efficacy of NSAIDs in the avoidance of heterotopic ossification has been documented in controlled clinical trials, but the inherent risks (e.g. on healing processes and on loosening of prostheses) need further studies. At the same time, NSAIDs are widely used in the treatment of fracture pain, and their inhibitory effects on the ongoing bone healing process have raised concerns. Results of fracture healing studies in animals treated with NSAIDs or in mice lacking COX-2 gene show that inhibition or deficiency of COX-2 impairs the bone healing process. The limited clinical data also support the assumption that inhibition of COX-2 by non-selective or COX-2-selective NSAIDs delays fracture healing. However, the clinical significance of the effect in various patient groups needs to be carefully assessed and further investigations are needed to characterize the patients at the highest risk for NSAID-induced delayed fracture healing and its complications. In the meantime, use of NSAIDs in fracture patients should be cautious, keeping in mind the benefits of pain relief and inhibition of ectopic bone formation on one hand, and the risks of non-union and retarded union on the other hand. [References: 56]
|
0 |
Can martial arts techniques reduce fall severity? An in vivo study of femoral loading configurations in sideways falls
|
Management of Hip Fractures in the Elderly
|
Sideways falls onto the hip are a major cause of femoral fractures in the elderly. Martial arts (MA) fall techniques decrease hip impact forces in sideways falls. The femoral fracture risk, however, also depends on the femoral loading configuration (direction and point of application of the force). The purpose of this study was to determine the effect of fall techniques, landing surface and fall height on the impact force and the loading configuration in sideways falls. Twelve experienced judokas performed sideways MA and Block ('natural') falls on a force plate, both with and without a judo mat on top. Kinematic and force data were analysed to determine the hip impact force and the loading configuration. In falls from a kneeling position, the MA technique reduced the impact force by 27%, but did not change the loading configuration. The use of the mat did not change the loading configuration. Falling from a standing changed the force direction. In all conditions, the point of application was distal and posterior to the greater trochanter, but it was less distal and more posterior in falls from standing than from kneeling position. The present decrease in hip impact force with an unchanged loading configuration indicates the potential protective effect of the MA technique on the femoral fracture risk. The change in loading configuration with an increased fall height warrant further studies to examine the effect of MA techniques on fall severity under more natural fall circumstances
|
1 |
Recent advances in hyaluronic acid based therapy for osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
Osteoarthritis is a debilitating disease that has increased in prevalence across the world due to the aging population. Currently, physicians use a plethora of treatment strategies to try and slow down the progression of the disease, but none have been shown to ubiquitously treat and cure the disease. One of the strategies uses the high molecular weight molecule hyaluronic acid as either an injectable or oral supplement for treatment. Hyaluronic acid (HA) is a relatively new treatment that has shown varied results through several clinical trials. It can be used as a scaffold for engineering new treatments and several new preparations have just been added to the market. A comprehensive search was conducted through several search databases according our inclusion and exclusion criteria. This review included 44 prospective clinical trial investigating the feasibility and efficacy of HA injection for knee, hip, and ankle osteoarthritis. This review will take a closer look at hyaluronic acid and its properties, as well clinical effectiveness and future options.
|
0 |
Postpartum rubella immunization: association with development of prolonged arthritis, neurological sequelae, and chronic rubella viremia
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Six women developed chronic long-term arthropathy after postpartum immunization against rubella. All individuals developed acute polyarticular arthritis within 12 days to three weeks postimmunization and have had continuing chronic or recurrent arthralgia or arthritis for two to seven years after vaccination. Acute neurological manifestations, consisting of carpal tunnel syndrome or multiple paresthesiae, developed postvaccination in three women. Two have developed continuing active or chronic recurrent episodes of blurred vision, paresthesiae, and painful limb syndromes together with recurrent joint symptoms. Chronic rubella viremia has been detected in peripheral blood mononuclear cell (MNC) populations in five of the six women up to six years after vaccination. In addition rubella virus was isolated from breast milk MNCs in one individual at nine months postvaccination and from peripheral blood MNCs in two of four breast-fed infants studied at 12-18 months of age. Immune responses to rubella virus studied at sequential intervals after vaccination correlated with development of rheumatologic and neurological manifestations
|
1 |
Hospital stay and blood transfusion in elderly patients with hip fractures
|
Hip Fx in the Elderly 2019
|
Neck of femur (NOF) fractures in elderly patients are the most frequent condition which an orthopaedic surgeon confronts nowadays. The incidence of these fractures is increasing as the population continues to age. These patients absorb the majority of the resources in the hospitals, as their healthcare demands are increased. This study included all patients who were admitted to our hospital between January and October 2015 following a neck of femur fracture. A total of 336 patients were included (72.3% female). We gathered demographic and hospitalisation data from patients' files. Haemoglobin (Hb) levels at admission and transfusion data were also collected. Male patients appeared to have a relatively higher risk of mortality than females (p=0.01). Patients with high ASA grade (IV) had a higher mortality rate (p=0.01). Age, delay of surgery, type of surgery, AMTS and Hb at admission and type of fracture on the other hand did not have a significant impact on mortality (p>0.05). Patients who needed transfusion during their hospitalisation had significantly lower Hb at admission (p=0.044). More specifically, patients who had Hb<110 at admission were more likely to need transfusion (p<0.001). Hospitalisation of patients who needed transfusion was significantly prolonged. In our effort to deliver the best services to our patients, this study considers transfusing the elderly patients with low Hb at admission (Hb<110) pre-operatively, with a view to increasing their reserves for the operation and potentially speeding up the rehabilitation process and decreasing their hospitalisation time.
|
0 |
Up to seven years' follow-up of short cemented stems in complex primary total knee arthroplasty: A prospective study
|
Dental Implant Infection
|
BACKGROUND: Although primary total knee arthroplasty (TKA) shows good clinical, functional and radiological results, it can be complicated by certain conditions or pathologies. The main objective of this study was to evaluate the global performance of short cemented metaphyseal stem components in patients undergoing complex primary TKA., METHODS: This is a single-surgeon prospective case series of 91 patients who underwent complex primary TKA requiring short stem fixation between January 2009 and October 2014. Knee Society Scores, physical examinations, and radiological assessments were performed pre- and postoperatively at six weeks, three months, six months, 12months, and annually thereafter., RESULTS: There were 40 females (46 TKAs) and 40 males (45 TKAs) in the study cohort. The left knee accounted for 52.7% of the surgeries. The average body-mass index (BMI) was 31.8kg/m2. Knee Society Scores obtained at the latest follow-up showed 96.4% and 95.5% good-to-excellent results respectively for the Knee and Function sub-scores. Radiological assessment showed that all Knee Society roentgenographic scores were below 10, without any evidence of impending or possible failure. Only one revision was required in this cohort for a patient suffering a deep chronic infection. At seven years, the Kaplan-Meier survivorship analysis revealed a 100% survivorship for aseptic loosening and a 98.9% survivorship for infection and revision of the components for any reason., CONCLUSION: This study demonstrated that TKA with short cemented stems resulted in good functional, clinical, and radiological outcomes for up to seven years for patients requiring complex TKA. Copyright © 2017 Elsevier B.V. All rights reserved.
|
0 |
Diabetic foot ulcers: pathogenesis and management
|
DoD LSA (Limb Salvage vs Amputation)
|
Foot ulcers are a significant complication of diabetes mellitus and often precede lower-extremity amputation. The most frequent underlying etiologies are neuropathy, trauma, deformity, high plantar pressures, and peripheral arterial disease. Thorough and systematic evaluation and categorization of foot ulcers help guide appropriate treatment. The Wagner and University of Texas systems are the ones most frequently used for classification of foot ulcers, and the stage is indicative of prognosis. Pressure relief using total contact casts, removable cast walkers, or "half shoes" is the mainstay of initial treatment. Sharp debridement and management of underlying infection and ischemia are also critical in the care of foot ulcers. Prompt and aggressive treatment of diabetic foot ulcers can often prevent exacerbation of the problem and eliminate the potential for amputation. The aim of therapy should be early intervention to allow prompt healing of the lesion and prevent recurrence once it is healed. Multidisciplinary management programs that focus on prevention, education, regular foot examinations, aggressive intervention, and optimal use of therapeutic footwear have demonstrated significant reductions in the incidence of lower-extremity amputations.
|
0 |
Orthopaedic enhanced recovery programme for elective hip and knee arthroplasty â?? Could a regional programme be beneficial
|
AAHKS (4) Acetaminophen
|
Introduction Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital. Objectives The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis. Methods A prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit. A multidisciplinary approach to devising an ERP was undertaken between anaesthetists, surgeons and physiotherapists. Domains included optimising pre-operative nutrition, anaesthetic pre-meds, standardised anaesthetic technique, standardised intraoperative technique and use of locally infiltrated anaesthetic (LIA), as well as a post operative pain regimen. The multidisciplinary team (MDT) involved physiotherapy for the patient on day 0. Demographic data, day 1 and day 2 post operative subjective pain scores using an analogue scale were recorded. Data was collated and analysed using appropriate statistical methods. A p-value of <0.05 was considered significant. Results A total of 40 patients (25 total hip replacements and 15 total knee replacements) were included. All conformed to the ERP. Reductions in patient reported pain scores were observed. Specifically, in total hip arthroplasty (THA), day 1 scores were not significantly improved (p=0.25), however day 2 scores improved significantly (p=0.02). For total knee arthroplasty (TKA), both day 1 and day 2 scores improved significantly (p=0.02 & p < 0.001, respectively) Analgesic requirements were not significantly different between hip and knee replacements. Early mobilization occurred in 95% of patients. Length of stay was reduced significantly in hip (1.8 days, p=0.003) and knee (1.9 days(p < 0.001) replacements following ERP. Cost analysis demonstrated a potential annual saving of approximately £ 200,000 for the study unit if ERP was applied to all elective hip and knee arthroplasty procedures. Conclusions The study demonstrates that a tailored, MDT orientated ERP can be beneficial in elective hip and knee arthroplasty. Reductions in pain scores, early ambulation and facilitated early discharge are beneficial to the patient, and cost effective for the unit. The implementation across the region may result in further cost savings.
|
0 |
Research in Osteochondritis Dissecans of the Knee: 2016 Update
|
Osteochondritis Dissecans 2020 Review
|
Osteochondritis dissecans (OCD) of the knee remains a relatively common and poorly understood pediatric and adolescent knee condition. Both conservative and surgical treatments have major impact on the lives of young active, athletic patients with knee OCD. OCD has been recently redefined as a "focal, idiopathic alteration of subchondral bone with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis." The 2011 American Academy of Orthopedic Surgeons Clinical Practice Guidelines found limited evidence for all aspects of the treatment of knee OCD. The multicenter study group Research in Osteochondritis dissecans of the Knee (ROCK) was formed to advance the understanding and treatment of this condition. This article will review our current understanding of the pathophysiology, treatment options, and outcomes of OCD of the knee, with a focus on the past, present, and future research including the work of the ROCK study group.
|
0 |
Assessment of neurophysiologic changes and disease activity in patients with chronic rheumatoid arthritis
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Objective: The involvement of the peripheral nervous system is not uncommon in rheumatoid arthritis (RA); the most common disorders are multiple mononeuritis, sensor motor neuropathy, and entrapment neuropathy. Several auto-antibodies are associated with the disease, but of the most important are the anti-cyclic citrullinated peptide (anti-CCP) antibodies. However, little is known, about the role of high sensitive C-reactive protein (Hs-CRP) in relation to disease activity in RA. The objectives were to look for the frequency of peripheral nerves involvement in chronic rheumatoid arthritis patients and to investigate the correlations between clinical, hematological, serological, and neurophysiologic findings. Methods: This study involved 48 patients with rheumatoid arthritis and 30 apparently healthy subjects as controls. Neurophysiologic assessment was performed for each patient and control subjects and the ELISA method was used for the quantitative measurement of serum anti-CCP antibodies and Hs-CRP concentrations by using special kits. Results: The mean duration of the disease was 6.76(plus or minus)0.795 years, the mean DAS28 for RA patients was 5.22(plus or minus)0.131, and the mean HAQ score was 1.00(plus or minus)0.06. Thirty-three (68.8%) of 48 cases with RA exhibited an electrophysiological evidence of neuropathy(ies): 14 (29.2%) patients with carpal tunnel syndrome (CTS), 9 (18.8%) patients with polyneuropathy, while 5 (10.4%) patients showed mononeuritis multiplex. There were highly significant increases in the mean values of serum anti-CCP antibody concentration (22.61 (plus or minus) 2.34 Vs 5.47 (plus or minus) 0.42 U/ml, P<0.001), serum Hs-CRP concentration (10.05 (plus or minus) 0.64 Vs 2.81 (plus or minus) 0.22 mg/l, P<0.001), and ESR (41.85(plus or minus)2.7 Vs 11.73(plus or minus)1.3 mm/hr, P<0.001) in the RA group compared to the control group. In patients with RA, significant negative correlations were observed between anti-CCP antibody concentration and sural nerve velocity (r =-0.233, P < 0.05) while significant positive correlation was found between anti-CCP antibody concentration with sural latency (r=0.231, P<0.05). The serum Hs-CRP level significantly positively correlated with the Stanford disability index (r=0.324, P<0.05), number of tender joint (r=0.296, P<0.05), and ESR (r=0.436, p<0.01). Conclusions: The commonest neurophysiologic abnormalities were carpal tunnel syndrome (CTS), followed by polyneuropathy. Serum anti-CCP antibodies concentration, serum Hs-CRP concentration, and disability index (DI) are significantly correlated with neuropathy and occurrence of neuropathy depends on the activity and/ or severity of rheumatoid arthritis. (copyright) 2013 DAR Publishers? University of Jordan. All Rights Reserved
|
0 |
Ergonomics: a case study in preventing repetitive motion injuries
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Dental Services Group has designed and implemented a system for its dental laboratories to mitigate cumulative trauma injuries, such as carpal tunnel syndrome and tendinitis. In the dental laboratory, these injuries result from repetitive motions such as waxing, sandblasting, grinding and polishing. This article describes purchasing guidelines for ergonomically designed laboratory equipment and offers resources for implementing workplace safety programs
|
0 |
Accelerating 3D-T1? mapping of cartilage using compressed sensing with different sparse and low rank models
|
AMP (Acute Meniscal Pathology)
|
Purpose: To evaluate the feasibility of using compressed sensing (CS) to accelerate 3D-T1? mapping of cartilage and to reduce total scan times without degrading the estimation of T1? relaxation times. Methods: Fully sampled 3D-T1? datasets were retrospectively undersampled by factors 2-10. CS reconstruction using 12 different sparsifying transforms were compared, including finite differences, temporal and spatial wavelets, learned transforms using principal component analysis (PCA) and K-means singular value decomposition (K-SVD), explicit exponential models, low rank and low rank plus sparse models. Spatial filtering prior to T1? parameter estimation was also tested. Synthetic phantom (n = 6) and in vivo human knee cartilage datasets (n = 7) were included. Results: Most CS methods performed satisfactorily for an acceleration factor (AF) of 2, with relative T1? error lower than 4.5%. Some sparsifying transforms, such as spatiotemporal finite difference (STFD), exponential dictionaries (EXP) and low rank combined with spatial finite difference (L+S SFD) significantly improved this performance, reaching average relative T1? error below 6.5% on T1? relaxation times with AF up to 10, when spatial filtering was used before T1? fitting, at the expense of smoothing the T1? maps. The STFD achieved 5.1% error at AF = 10 with spatial filtering prior to T1? fitting. Conclusion: Accelerating 3D-T1? mapping of cartilage with CS is feasible up to AF of 10 when using STFD, EXP or L+S SFD regularizers. These three best CS methods performed satisfactorily on synthetic phantom and in vivo knee cartilage for AFs up to 10, with T1? error of 6.5%.
|
0 |
Chondrocytes extract from patients with osteoarthritis induces chondrogenesis in infrapatellar fat pad-derived stem cells
|
OAK 3 - Non-arthroplasty tx of OAK
|
OBJECTIVE: Infrapatellar fat pad of patients with osteoarthritis (OA) contains multipotent and highly clonogenic adipose-derived stem cells that can be isolated by low invasive methods. Moreover, nuclear and cytoplasmic cellular extracts have been showed to be effective in induction of cell differentiation and reprogramming. The aim of this study was to induce chondrogenic differentiation of autologous mesenchymal stem cells (MSCs) obtained from infrapatellar fat pad (IFPSCs) of patients with OA using cellular extracts-based transdifferentiation method.
DESIGN: IFPSCs and chondrocytes were isolated and characterized by flow cytometry. IFPSCs were permeabilized with Streptolysin O and then exposed to a cell extract obtained from chondrocytes. Then, IFPSCs were cultured for 2 weeks and chondrogenesis was evaluated by morphologic and ultrastructural observations, immunologic detection, gene expression analysis and growth on 3-D poly (dl-lactic-co-glycolic acid) (PLGA) scaffolds.
RESULTS: After isolation, both chondrocytes and IFPSCs displayed similar expression of MSCs surface makers. Collagen II was highly expressed in chondrocytes and showed a basal expression in IFPSCs. Cells exposed to chondrocyte extracts acquired a characteristic morphological and ultrastructural chondrocyte phenotype that was confirmed by the increased proteoglycan formation and enhanced collagen II immunostaining. Moreover, chondrocyte extracts induced an increase in mRNA expression of chondrogenic genes such as Sox9, L-Sox5, Sox6 and Col2a1. Interestingly, chondrocytes, IFPSCs and transdifferentiated IFPSCs were able to grow, expand and produce extracellular matrix (ECM) on 3D PLGA scaffolds.
CONCLUSIONS: We demonstrate for the first time that extracts obtained from chondrocytes of osteoarthritic knees promote chondrogenic differentiation of autologous IFPSCs. Moreover, combination of transdifferentiated IFPSCs with biodegradable PLGA 3D scaffolds can serve as an efficient system for the maintenance and maturation of cartilage tissue. These findings suggest its usefulness to repair articular surface in OA.
|
0 |
Cement pinning of osteoporotic distal radius fractures with an injectable calcium phosphate bone substitute: Report of 6 cases
|
Distal Radius Fractures
|
The treatment of osteoporotic distal radius fractures is frequently complicated by secondary displacements, mainly because of the posterior comminution. This work studies the advantages of injectable calcium phosphate cement, applied in addition to osteosynthesis with intrafocal pins. Our series comprises six osteoporotic patients with an average age of 77.5 years, showing a fracture of the distal radius osteosynthesized with pins. Cement has then been injected via the radial styloid. The result has been evaluated at an average interval of 14.7 months. The pain has been measured on an analogue visual scale and overall function by the DASH score. Mobility and gripping strength have been compared with the controlateral side. Radiographies have shown the presence of cement leakages, studied the resorption rate and measured secondary displacement. On the clinical level, the pain at the last examination was estimated at an average of 0.66 and total function at 30.28. Compared to the controlateral side, flexion-extension mobility was on average 95.3%, prono-supination 99%, and gripping strength 80.25%. There have been complaints of two resolutive reflex sympathetic dystrophy. Radiologically, the cement has distributed itself along the path of the trocar, in average quantities of 2 ml. Three anterior leaks of cement have been noticed, resorbed within a few months. The radio-ulnar index has lost on average 1.7 mm but the inclination of the radial glene has remained stable. At the last examination, resorption of the intra-osseous cement was partial three times and subtotal three times. Despite the paucity of the sample, it appears that adding calcium phosphate cement does not reduce secondary displacements. The asymptomatic extra-osseous leakages of cement disappeared on average in 6 months. The intra-osseous cement's resorption rate was slower. Despite the partial results, calcium phosphate cements retain a place in the treatment of distal radius fractures, provided that they remain injectable and address unstable fractures in porotic bone. © Springer-Verlag 2005.
|
0 |
Dislocation of posterior-stabilized mobile-bearing knee prosthesis. A case report
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Spin-out of mobile-bearing knees is a significant early complication of mobile-bearing total knee arthroplasty. Dislocation of the cam-post mechanism of fixed-bearing posterior-stabilized knees occurs more rarely. We have observed an unusual case of dislocation of posterior-stabilized rotating-platform total knee arthroplasty, which has both a cam-post mechanism and rotating platform. A 65-year-old man with knee osteoarthritis and cervical spondylotic myelopathy underwent total knee arthroplasty using a mobile-bearing prosthesis. The dislocation, which occurred 4 days postoperatively, could not be reduced by closed manipulation. However, spontaneous reduction occurred 6 days after the dislocation, which did not recur. A gap mismatch or trapezoidal-shaped gaps may lead to dislocation or spin-out of the bearing insert. This case illustrates that dislocation of a posterior-stabilized mobile-bearing total knee arthroplasty can occur, and both quadriceps deficiency and ligament laxity may contribute to the risk of dislocation. (copyright) 2006 Elsevier B.V. All rights reserved
|
0 |
Lower hip bone mass and proximal femur fractures in elderly patients: more valuable than lumbar vertebrae bone mineral density
|
Management of Hip Fractures in the Elderly
|
A decreased bone mineral density, such as osteoporosis, has been considered a factor closely associated with proximal femur fractures. We studied the relationship between osteoporosis and proximal femur fractures. Dual energy radiograph absorptiometry was used to measure the bone mineral density of 121 patients with a femur neck fracture and 134 patients with an intertrochanteric fracture. The bone density of the femoral neck, Ward's triangle, and the trochanteric region were measured. Two hundred seventeen normal patients who had undergone a bone mineral density test and were found to have no proximal femur fracture were used as the control group. Comparative analysis was performed after the patients were subdivided into different groups depending on sex and fracture type. The bone mineral density of the lumbar vertebra in patients with a proximal femur fracture was not significantly different from that of the control group, but the bone mineral density of the proximal femur in patients with a proximal femur fracture was significantly less than that of the control group. The bone mineral density of the group with an intertrochanteric fracture was lower than that of the femur neck fracture group. However, the difference was statistically insignificant. In bone mineral density comparisons, no significant differences were observed between the displaced and undisplaced femur neck fracture group and between the stable and the unstable intertrochanteric fracture group. The bone mineral density of elderly patients with a proximal femur fracture was significantly less than that of normal individuals. However, femur neck fractures in elderly men were less likely to be associated with a decreased bone mineral density. Little correlation between bone mineral densities of the proximal femur and fracture location (neck vs intertrochanter) and type (nondisplaced vs displaced neck, stable vs unstable intertrochanter) was found
|
0 |
The Freeman femoral component with hydroxyapatite coating and retention of the neck: an update with a minimum follow-up of 17 years
|
PJI DX Updated Search
|
The outcome at ten years of 100 Freeman hip stems (Finsbury Orthopaedics, Leatherhead, United Kingdom) retaining the neck with a proximal hydroxyapatite coating in a series of 52 men (six bilateral) and 40 women (two bilateral), has been described previously. None required revision for aseptic loosening. We have extended the follow-up to 20 years with a minimum of 17 years. The mean age of the patients at total hip replacement was 58.9 years (19 to 84). Six patients were lost to follow-up, but were included up to their last clinical review. A total of 22 patients (22 hips) had died, all from causes unrelated to their surgery. There have been 43 re-operations for failure of the acetabular component. However, in 38 of these the stem was not revised since it remained stable and there was no associated osteolysis. Two of the revisions were for damage to the trunnion after fracture of a modular ceramic head, and in another two, removal of the femoral component was because of the preference of the surgeon. In all cases the femoral component was well fixed, but could be extracted at the time of acetabular revision. In one case both components were revised for deep infection. There has been one case of aseptic loosening of the stem which occurred at 14 years. This stem had migrated distally by 7.6 mm in ten years and 8.4 mm at the time of revision at which stage it was found to be rotationally loose. With hindsight this component had been undersized at implantation. The survivorship for the stem at 17 years with aseptic loosening as the endpoint was 98.6% (95% confidence interval 95.9 to 100) when 62 hips were at risk. All remaining stems had a satisfactory clinical and radiological outcome. The Freeman proximally hydroxyapatite-coated femoral component is therefore a dependable implant and its continued use can be recommended
|
0 |
Effect of arthroscopic debridement for osteoarthritis of the knee on health-related quality of life
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND: The available evidence supporting the use of arthroscopic debridement for the treatment of symptomatic osteoarthritis of the knee is largely retrospective and lacks validated health-related quality-of-life measures. The goal of the study was to prospectively assess a cohort of patients with osteoarthritis of the knee who were selected for arthroscopic debridement and determine which clinical criteria favor a sustained improvement in health-related quality of life after two years of follow-up. METHODS: One hundred and twenty-six patients with symptomatic primary osteoarthritis of the knee underwent arthroscopic debridement of the knee after failure of medical management. Two groups of surgeons (postgraduate fellows and attending staff) independently evaluated the patients preoperatively with use of a standardized assessment of clinical symptoms and signs and plain radiography. The intervention was arthroscopic debridement, which included resection of unstable chondral flaps and meniscal tears. Abrasion was not performed. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a disease-specific scale, and the Short Form-36 (SF-36), a generic outcome measure. RESULTS: Sixty-seven (53%) of the 126 patients were female, and the mean age (and standard deviation) was 61.7 +/- 8.6 years (range, forty-three to seventy-five years). The medial compartment was more frequently and severely involved, with 57% showing Grade-III or IV involvement, according to the system of Dougados et al. Seventy-nine patients (63%) had an unstable meniscal tear. Fifty-six patients (44%) were rated as having had a clinically important reduction in pain, as determined with the WOMAC pain scale, at two years after the arthroscopic debridement. Physicians were poor at predicting which patients would have improvement. The rate of accuracy of the fellows and staff was 54% and 59%, respectively, and their agreement was only slightly better than chance, with a kappa of 0.27 (95% confidence interval, 0.09 to 0.45). Only three variables were significantly associated with improvement: the presence of medial joint-line tenderness (p = 0.04), a positive Steinman test (p = 0.01), and the presence of an unstable meniscal tear at arthroscopy (p = 0.01). CONCLUSIONS: The prospectively evaluated quality-of-life benefit from arthroscopic debridement of the osteoarthritic knee is less than that reported in previous retrospective surveys on satisfaction. These results may serve as a baseline for comparison against more sophisticated procedures for resurfacing of the articular cartilage. Clinical variables were only partially helpful for predicting a successful result after arthroscopic debridement, and a search for other biologic markers (such as synovial fluid) may be of benefit. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence
|
0 |
Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years' follow-up
|
Osteochondritis Dissecans 2020 Review
|
PURPOSE: Focal chondral and osteochondral knee lesions are a common condition, particularly hard to treat, and often involve young active patients with high expectations in terms of symptomatic relief and return to sports. Autologous osteochondral transplantation allows the defect area to be restored with hyaline cartilage. The aim of this study is to analyse whether it represents a safe and effective treatment option for small-medium-sized knee chondral and osteochondral lesions in a young and active population. METHODS: Thirty-one patients (18 men, 13 women; mean age 32 ± ten; mean BMI 24 ± 3) affected by focal knee chondral and osteochondral lesions were enrolled and treated with autologous osteochondral transplantation. They were prospectively followed-up for 24 months with the IKDC-subjective, IKDC-objective, and Tegner scores. Adverse events and failures were also reported, as well as the Bandi score to detect symptoms from the donor area. RESULTS: A significant increase was reported in all the clinical scores adopted. In particular, the IKDC-subjective score increased from a basal value of 40.3 ± 16.2 to 62.6 ± 18.0 at the 12 months' evaluation, with a further significant increase up to 71.6 ± 20.5 at the final 24 months' follow-up (p < 0.0005). A positive trend was also found by analysing the IKDC-objective score. The Tegner score revealed a significant improvement from a basal value of 2.2 ± 1.8 to 3.7 ± 1.5 at the final evaluation (p = 0.003), although it was not possible to regain the same pre-injury sports activity level of 5.0 ± 2.2. Two failures were reported. The Bandi score revealed patients complaining of mild and moderate symptoms, not correlated to the lesion size. The presence of symptoms ascribable to the donor area was significantly correlated with a lower clinical outcome. CONCLUSIONS: Autologous osteochondral transplantation proved to be, at short-term evaluation, a suitable option to treat small-medium sized chondral and osteochondral lesions. However, clinical improvement is slow and a significant percentage of patients develop symptoms attributable to the donor area, thus reducing the overall benefit of this procedure.
|
0 |
Clinical and radiographic study of bone and joint lesions in 26 dogs with leishmaniasis
|
MSTS 2018 - Femur Mets and MM
|
Twenty-six dogs with parasitologically confirmed leishmaniasis and abnormalities of gait were studied to determine the most common radiollogical patterns of bone and joint lesions. The clinical findings included either lameness, joint pain and crepitation, soft tissue swelling and/or muscle atrophy. Bone lesions were observed radiographically in 12 of the 26 dogs; the radius and ulna were affected in seven, the tibia in six and the femur in six. Joint lesions were observed radiographically in 15 of the 26 dogs; the carpus and stifle were affected in all 15, and the tarsus in nine. There was a tendency for the bones and joints to be affected bilaterally. The radiographic patterns observed were different in the long bones and the joints. In the long bones, the most common pattern was periosteal and intramedullary proliferation, involving the diaphyses and related to the nutrient foramen; in the joints, two patterns, either non-erosive or erosive polyarthritis with soft-tissue swelling, were observed. The changes observed in the synovial fluid were associated in most cases with osteolytic lesions. However, Leishmania organisms were identified in the synovial fluid from joints without bony radiographic changes.
|
1 |
Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial
|
AAHKS (9/10) Regional Nerve Blocks
|
BACKGROUND: Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance.
OBJECTIVE: We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time.
DESIGN: A randomised, observer-blinded, equivalence trial.
SETTING: Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017.
PATIENTS: A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia.
INTERVENTION: In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 mug ml and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle.
MAIN OUTCOMES MEASURES: We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). The equivalence margin was 7.4 min.
RESULTS: Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (+/-SD) total anaesthesia time [15.3 (+/-6.5) vs. 20.1 (+/-9.0) min; mean difference, -4.8; 95% confidence interval, -8.1 to -1.9; P = 0.005] and mean (+/-SD) onset time [10.2 (+/-5.6) vs. 15.5 (+/-9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events.
CONCLUSION: Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (+/-7.4 min).
TRIAL REGISTRATION: www.clinicaltrials in the (Study ID: TCTR20160427003).
|
0 |
The use of bone morphogenic protein-7 (OP-1) in the management of resistant non-unions in the upper and lower limb
|
PJI DX Updated Search
|
The aim of the present study was to investigate the safety and efficacy of local implantation of BMP-7 for the treatment of resistant non-unions in the upper and lower limb. Fifty-two patients (30 males, mean age 52.8 years; range 20-81) were treated with local BMP-7 implantation in a bovine bone-derived collagen paste with or without revision of fixation. Thirty-six patients had closed injuries, ten had open injuries and six had infected non-unions. Patients had undergone a mean of 2 (1-5) operations prior to implantation of BMP-7. Clinical and radiological union was achieved in 94% at a mean time of 5.6 months (3-19). Two patients with subtrochanteric femoral fractures failed to achieve union secondary to inadequate fracture stabilisation, persistent unfavourable biological environment and systemic co-morbidities. One patient developed synostosis attributed to the BMP-7 application. This study demonstrates BMP-7 implanted in a bovine-derived collagen paste is an effective adjunctive treatment for resistant non-unions in the upper and lower limb
|
0 |
Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United kingdom Medical Research Council trials between 1980 and 2002--Medical Research Council Adult Leukaemia Working Party
|
MSTS 2022 - Metastatic Disease of the Humerus
|
PURPOSE: Early mortality in multiple myeloma (MM) is usually attributed to combined effects of active disease and comorbid factors. We have studied early deaths in a series of large multicenter trials to assess direct causes of death, their predictability, and whether current management strategies have reduced their frequency.
PATIENTS AND METHODS: A total of 3,107 newly diagnosed patients entered onto United Kingdom Medical Research Council MM trials from 1980 to 2002 were studied. Trial files, final clinical summaries, and postmortem reports were analyzed.
RESULTS: Death within 60 days of trial entry occurred in 299 patients (10%). Logistic regression modeling identified beta 2-microglobulin, performance status, and age as the most important predictors of early death, but only with 61% sensitivity and 73% specificity. Forty-five percent of deaths were attributable to infection, which was often associated with bone pain (particularly thoracic pain) and delay in presenting to medical care. Neutropenia was present at diagnosis in only 11 of the 135 deaths from infection. Renal failure was present in 28% of early deaths and was linked to light-chain MM, hypercalcemia, dehydration, and nonsteroidal anti-inflammatory drugs. There was no time related reduction in the percentage or nature of early deaths in 1,550 patients older than 65 years receiving similar therapy between 1982 and 2002.
CONCLUSION: A tenth of patients die within 60 days of diagnosis of MM. Infection and renal failure are the main direct causes of early mortality, which cannot be accurately predicted by presenting prognostic features. All patients should be considered at high risk of death during induction therapy.
|
0 |
Symptoms and coping in Sri Lanka 20-21 months after the 2004 tsunami
|
DoD PRF (Psychosocial RF)
|
BACKGROUND: The estimated prevalence of clinically significant psychiatric and somatic symptoms in adults >1 year after the 2004 Asian tsunami is unknown.
AIMS: To estimate the prevalence of psychiatric and somatic symptoms and impairment in Sri Lanka 20-21 months after the 2004 Asian tsunami, and to assess coping strategies used by tsunami-affected individuals that contribute to post-tsunami adjustment.
METHOD: Homes from one severely affected area were randomly selected, and adult respondents were sampled utilising a modified Kish method. Instruments were administered in Sinhala to assess exposure, post-traumatic stress disorder (PTSD), depression, anxiety, somatic distress and impairment. Demographic variables and culturally-relevant coping activities were assessed.
RESULTS: The prevalence of clinically significant PTSD, depression and anxiety was 21%, 16% and 30% respectively. Respondents reported a mean of eight persistent and bothersome somatic complaints, which were associated with psychiatric symptoms and impairment. Thinking that one's life was in danger was the exposure item most strongly associated with symptoms and impairment. The majority of respondents found their own strength, family and friends, a Western-style hospital and their religious practice to be the most helpful coping aids.
CONCLUSIONS: A large minority of adults in one area of Sri Lanka reported significant psychiatric and somatic symptoms and impairment 20-21 months after the tsunami. Accurate data about risk for and resilience to impairing symptoms >1 year after disasters are necessary in order to develop rational surveillance and interventions.
|
0 |
Localization of frequency-dependent conduction block in carpal tunnel syndrome
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Frequency-dependent conduction block (FDB) has been demonstrated in subjects with carpal tunnel syndrome (CTS) when the median nerve was stimulated at 30-Hz frequency proximal to the carpal tunnel (CT). However, it was still questionable whether FDB occurred within the region of the CT or more distally. High-frequency nerve stimulation (HFNS) was performed in controls and in CTS subjects while stimulating the median nerve proximal and distal to the carpal tunnel. The degree of FDB was measured by comparing the 20th thenar CMAP with the 1st following a train of 20 stimuli at 30-Hz. FDB occurred across the CT in 11/12 studies (91.7%) and across the distal portion of the palmar aponeurosis-distal terminal motor branches in 5 of the 11 studies (41.7%). These results suggest that the safety margin for impulse transmission can be impaired distal to the presumed site of injury in CTS
|
0 |
Parameter on systemic conditions affected by periodontal diseases. American Academy of Periodontology
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
The American Academy of Periodontology has developed the following parameter on systemic conditions affected by periodontal diseases. It is well known that systemic conditions may affect the onset, progression, and treatment of such diseases (see Parameter on Periodontitis Associated With Systemic Conditions, pages 876-879). The concept of periodontal diseases as localized entities affecting only the teeth and supporting apparatus is increasingly being questioned. Periodontal diseases may have widespread systemic effects. While these effects may be limited in some individuals, periodontal infections may significantly impact systemic health in others, and may serve as risk indicators for certain systemic diseases or conditions. As part of the approach to establishing and maintaining health, patients should be informed of the possible effects of periodontal infection on their overall well-being. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy
|
0 |
Symptomatic disc herniation and serum lipid levels
|
AMP (Acute Meniscal Pathology)
|
Insufficient blood supply to the intervertebral disc (IVD) has been proposed to play a role as causative factor in IVD degeneration. There is an association between IVD diseases and increased risk of dying of ischaemic heart disease. Obesity and tobacco are potential risk factors for degenerative IVD disease. High blood cholesterol and triglycerides serum levels are risk factors for atherosclerosis, and could be responsible for a decreased in the blood supply to the already poor vascularized IVD. We performed a frequency-matched case-control study to determine the serum levels of patients with symptomatic herniated lumbar disc. We examined the fasting serum lipid levels in 384 subjects who were operated at our institution. Group 1 included 169 consecutive patients (115 men and 54 women; mean age: 59.1 years, range 29-85) who underwent surgery for symptomatic disc herniation. Group 2 (control group) included 169 patients (115 men and 54 women; mean age: 61 years, range 26-86) who underwent arthroscopic meniscectomy for a meniscal tear in the same period. These patients were frequency-matched by age (within 3 years) and gender with patients of Group 1. Sera were extracted from blood samples and the concentrations of total cholesterol (TC) and triglycerides (TG) were determined. When comparing the two groups, patients with symptomatic herniated lumbar disc showed statistically significant higher triglyceride concentration (P = 0.02) and total cholesterol concentration (P = 0.01). Serum lipid levels may be a risk factor for IVD pathology. An enhanced understanding of these factors holds the promise of new approaches to the prevention and management of IVD pathology.
|
0 |
Office carpal tunnel release with wrist block and wrist tourniquet
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Carpal tunnel release is usually performed in a hospital setting with regional anesthesia. The cost for use of the hospital operating room, anesthesia, and surgeon's fee is quite excessive. Over the past 5 years we have performed carpal tunnel releases in the office setting using wrist block anesthesia and a wrist tourniquet. There have been no complications, and the 20 patients interviewed and examined for this article preferred the office procedure over the hospital procedure. Carpal tunnel release can be performed safely in the office, and is less expensive than when done in a hospital setting
|
1 |
Systematic Review and Meta-Analysis of 12 Randomized Controlled Trials Evaluating the Efficacy of Invasive Radiofrequency Treatment for Knee Pain and Function
|
OAK 3 - Non-arthroplasty tx of OAK
|
Radiofrequency (RF) treatment is an invasive and promising procedure in the treatment of osteoarthritis (OA). A meta-analysis based on 12 RCT studies was to investigate whether invasive RF treatment is more effective in relieving knee pain and improving knee function. Relevant studies were searched on database of Pubmed, Embase, EBSCO, Cochrane library, Wanfang digital database, VIP database, and CNKI up to January 2018. A total of 841 participants from 12 publications were included. The weighted mean difference (WMD) and the corresponding 95% CIs were used to evaluate the difference in pain scores and OKS/WOMAC scores between RF treatment and control groups. The statistical analysis was performed by Stata 12.0. The pain scores (VAS) in the RF group were lower than those in the conservative treatment group after 1 week (WMD-1.77, 95% CI-2.93 to-0.61, P<0.01), 1 month (WMD-1.40, 95% CI-1.98 to-0.82, P<0.01), and 3 months (WMD-1.32, 95% CI-2.27 to-0.37, P<0.01) of treatment, while there was no significant improvement in knee function. In subgroup analyses by site of radiofrequency, RF mode showed some discrepancies in the WMD of VAS between the treatment and control groups. In addition, subgroup analysis and meta-regression showed that the efficacy of RF treatment for reducing pain is reversely related to female ratio, and we did not find any surgery-related adverse reactions. RF treatment significantly reduces the knee pain, but rarely improves the knee joint function. Radiofrequency ablation has better efficacy than pulsed radiofrequency ablation in reducing pain. Furthermore, subgroup analysis and meta-regression suggested that women are more sensitive to RF treatment than men.
|
0 |
Morbimortality in adult patients with septic arthritis: a three-year hospital-based study
|
PJI DX Updated Search
|
BACKGROUND: The objective of this ambispective study was to determine outcomes and associated factors for adult patients with confirmed septic arthritis (SA). METHODS: All adult patients admitted to Amiens University Hospital between November 2010 and December 2013 with confirmed SA were included in the study. Patients with prosthetic joint infections were excluded. A statistical analysis was performed in order to identify risk factors associated with a poor outcome (including mortality directly attributable to SA). RESULTS: A total of 109 patients (mean +/- SD age: 60.1 +/- 20.1; 74 male/35 females) were diagnosed with SA during the study period. The most commonly involved sites were the small joints (n = 34, 31.2 %) and the knee (n = 25, 22.9 %). The most frequent concomitant conditions were cardiovascular disease (n = 45, 41.3 %) and rheumatic disease (n = 39, 35.8 %). One hundred patients (91.7 %) had a positive microbiological culture test, with Staphylococcus aureus as the most commonly detected pathogen (n = 59, 54.1 %). Mortality directly attributable to SA was relatively infrequent (n = 6, 5.6 %) and occurred soon after the onset of SA (median [range]: 24 days [1-42]). Major risk factors associated with death directly attributable to SA were older age (p = 0.023), high C-reactive protein levels (p = 0.002), diabetes mellitus (p = 0.028), rheumatoid arthritis and other inflammatory rheumatic diseases (p = 0.021), confusion on admission (p = 0.012), bacteraemia (p = 0.015), a low creatinine clearance rate (p = 0.009) and the presence of leg ulcers/eschars (p = 0.003). The median duration of follow-up (in patients who survived for more than 6 months) was 17 months [6-43]. The proportion of poor functional outcomes was high (31.8 %). Major risk factors associated with a poor functional outcome were older age (0.049), hip joint involvement (p = 0.003), the presence of leg ulcers/eschars (p = 0.012), longer time to presentation (0.034) and a low creatinine clearance rate (p = 0.013). CONCLUSIONS: In a university hospital setting, SA is still associated with high morbidity and mortality rates
|
0 |
Effects of alcohol-related disease on hip fracture and mortality: A retrospective cohort study of hospitalized medicare beneficiaries
|
HipFx Supplemental Cost Analysis
|
Objectives. This study investigated the effect of alcohol-related disease on hip fracture and mortality. Methods. A retrospective cohort design was used. The study cohort consisted of hospitalized Medicare beneficiaries with alcohol-related disease (n = 150 119) and randomly matched controls without alcohol-related disease (n = 726 218) identified through the 1988-1989 inpatient claims file. Incidence rates of hip fracture and mortality were examined. Results: During the study period, 20 620 patients developed hip fracture, with 6973 cases among patients with alcohol-related disease and 13 647 cases among patients without alcohol-related disease. After adjustment for potential confounders, patients with alcohol-related disease had a 2.6-fold increased risk of hip fracture relative to patients without alcohol-related disease (95% confidence interval = 2.5, 2.6). Patients with alcohol-related disease had a higher risk of mortality at 1 year after hip fracture. Conclusions: Alcohol-related disease increases the risk of hip fracture significantly and reduces long-term survival. The present results suggest that patients hospitalized for alcohol-related disease should be targeted for hip fracture prevention programs
|
0 |
Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting
|
HipFx Supplemental Cost Analysis
|
OBJECTIVES: To determine the prevalence and economic effect of inappropriate proton pump inhibitor (PPI) use in an ambulatory care setting. STUDY DESIGN: Retrospective medical record review of random sample with subgroup analysis. METHODS: Patients were categorized according to appropriateness of pharmacotherapy based on documented upper gastrointestinal tract diagnoses, gastrointestinal or extraesophageal symptoms, or gastroprotection. Adverse events potentially associated with PPI use were identified. RESULTS: Of 946 patients in an ambulatory care setting, 35.4% were given PPI therapy for an appropriately documented upper gastrointestinal tract diagnosis, 10.1% received PPIs empirically for symptomatic treatment based on extraesophageal symptoms, 18.4% received PPIs for gastroprotection, and 36.1% had no documented appropriate indication for PPI therapy. In a subgroup analysis, 48.6% of patients across all 4 categories received PPIs without documentation of reevaluation of upper gastrointestinal tract symptoms, accounting for 1034 patient-years of PPI use. The total cost of inappropriate PPI use was $233,994 based on over-the-counter PPI costs and $1,566,252 based on average wholesale price costs. Potentially related adverse events in this cohort included Clostridium difficile-associated diarrhea (6 cases) and community-acquired pneumonia (1 case), but no cases of hip fracture or vitamin B12 deficiency were identified. CONCLUSIONS: Proton pump inhibitors are often overused in the ambulatory care setting without documented valid indications. Inappropriate use of PPIs is associated with substantial cost expenditure and with the potential for adverse events
|
0 |
High-level South Korean athletesâ?? experiences of injury and rehabilitation
|
DoD PRF (Psychosocial RF)
|
Although the biopsychosocial model of sport injury rehabilitation (Brewer, Andersen, & Van Raalte, 2002) is one of the most comprehensive frameworks to address athletesâ?? postinjury responses, there has been little research centralizing the myriad of cultural factors (e.g., nationality, ethnicity, socioeconomic status) that can impact psychological, social/contextual, and biological factors that, in turn, impact athletesâ?? recovery. The purpose of the current study was to explore high-level South Korean athletesâ?? experiences of injury and rehabilitation. Retrospective semistructured interviews were conducted with 11 retired high-level South Korean athletes. Employing Consensual Qualitative Research (CQR) methodology (Hill, 2012), four domains were constructed from the data: (a) Experience of the South Korean Sport System, (b) Immediate Post-Injury Perceptions, (c) Experience of Recovery Process, and (d) Post-Injury Reflections. The findings indicated that participantsâ?? experiences of the forced hierarchy and power dynamics within the South Korean athletic specialist system influenced perceived sport injury rehabilitation outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
|
1 |
The use of vacuum assisted closure (VAC) in soft tissue injuries after high energy pelvic trauma
|
DoD LSA (Limb Salvage vs Amputation)
|
BACKGROUND: Application of vacuum-assisted closure (VAC) in soft tissue defects after high-energy pelvic trauma is described as a retrospective study in a level one trauma center. MATERIALS AND METHODS: Between 2002 and 2004, 13 patients were treated for severe soft tissue injuries in the pelvic region. All musculoskeletal injuries were treated with multiple irrigation and debridement procedures and broad-spectrum antibiotics. VAC was applied as a temporary coverage for defects and wound conditioning. RESULTS: The injuries included three patients with traumatic hemipelvectomies. Seven patients had pelvic ring fractures with five Morel-Lavallee lesions and two open pelviperineal trauma. One patient suffered from an open iliac crest fracture and a Morel-Lavallee lesion. Two patients sustained near complete pertrochanteric amputations of the lower limb. The average injury severity score was 34.1 +/- 1.4. The application of VAC started in average 3.8 +/- 0.4 days after trauma and was used for 15.5 +/- 1.8 days. The dressing changes were performed in average every 3 days. One patient (8%) with a traumatic hemipelvectomy died in the course of treatment due to septic complications. CONCLUSION: High-energy trauma causing severe soft tissues injuries requires multiple operative debridements to prevent high morbidity and mortality rates. The application of VAC as temporary coverage of large tissue defects in pelvic regions supports wound conditioning and facilitates the definitive wound closure.
|
0 |
Management of osteochondral lesions of the ankle joint by implantation of autologous chondrocytes
|
Osteochondritis Dissecans 2020 Review
|
PUPOSE OF THE STUDY The treatment of osteochondral lesions of weight-bearing joints remains a serious therapeutic challenge, largely due to the minimal ability of articular hyaline cartilage to regenerate. The authors present the long-term clinical and MRI results of treating deep chondral and osteochondral defects of the ankle joint by the method of implantation of autologous chondrocytes in the form of a solid chondrograft. MATERIAL AND METHODS: The method of solid chondrograft implantation in the ankle joint was used in our Department from the year 2003. Between 2003 and 2013, this method was used in 31 patients, 16 men and 15 women. Their average age at the time of implantation was 29 years (16 to 50 years). The follow-up period ranged from 16 to 145 months (average, 57 months). The clinical outcome was evaluated using the Mazur questionnaire. At follow-up all patients underwent regular MRI examinations and the results were assessed on the basis of Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Twelve patients required a second-look arthroscopy. RESULTS: A comparison of the Mazur pre-operative scores with those obtained at 1, 2 and 5 years post-operatively showed marked improvement of ankle joint function. The average pre-operative value of 30.0 (based on responses of 31 patients) increased to the average of 89.7 (based on results of 11 patients). At 1 year post-operatively, the average MOCART score for a group of 18 patients was 78.3; at 5 post-operative years, the average value for nine patients examined was 77.0. Complete filling of defects at 1 year of follow-up was found in 88.1% and, at 5 years, it was recorded in 83.3% of the patients examined. DISCUSSION: The articular hyaline cartilage is a highly differentiated tissue and its ability of repair is very limited. Therefore every damage to the articular surface should be regarded as a pre-arthritic condition// disease. Currently, there are several options of treating a damaged articular cartilage, but none of them makes its complete healing certain. A lot of studies concerned with long-term results of implanting autologous chondrocytes in the knee are available in the literature, but only few authors present long-term clinical and radiographic outcomes of ankle joint treatment similar to ours. CONCLUSIONS: Based on our clinical and MRI results, the method of autologous chondrocyte implantation can be recommended since it has good long-term results, provides repair of articular cartilage and allows for patientsâ?? return to activities of daily living.
|
0 |
Associations between neurocognitive functioning and social and occupational resilience among South African women exposed to childhood trauma
|
DoD PRF (Psychosocial RF)
|
<b>Background</b>: Prior research on adaptation after early trauma among black South African women typically assessed resilience in ways that lacked contextual specificity. In addition, the neurocognitive correlates of social and occupational resilience have not been investigated. <b>Objective</b>: The primary aim of this exploratory study was to identify domains of neurocognitive functioning associated with social and occupational resilience, defined as functioning at a level beyond what would be expected given exposure to childhood trauma. <b>Methods</b>: A sample of black South African women, N = 314, completed a neuropsychological battery, a questionnaire assessing exposure to childhood trauma, and self-report measures of functional status. We generated indices of social and occupational resilience by regressing childhood trauma exposure on social and occupational functioning, saving the residuals as indices of social and occupational functioning beyond what would be expected given exposure to childhood trauma. <b>Results</b>: Women with lower non-verbal memory evidenced greater social and occupational resilience above and beyond the effects attributable to age, education, HIV status, and depressive and posttraumatic stress symptoms. In addition, women with greater occupational resilience exhibited lower semantic language fluency and processing speed. <b>Conclusion</b>: Results are somewhat consistent with prior studies implicating memory effects in impairment following trauma, though our findings suggest that reduced abilities in these domains may be associated with greater resilience. Studies that use prospective designs and objective assessment of functional status are needed to determine whether non-verbal memory, semantic fluency, and processing speed are implicated in the neural circuitry of post-traumatic exposure resilience.
|
0 |
Functional outcome in knee osteoarthritis after treatment with hylan G-F 20: a prospective study
|
Surgical Management of Osteoarthritis of the Knee CPG
|
OBJECTIVE: To assess functional change in patients with knee osteoarthritis (OA) after treatment with intra-articular hyaluronic acid (Hylan G-F 20; Synvisc). DESIGN: Prospective case series with 6-month follow-up. SETTING: Outpatient community orthopedic practice. PARTICIPANTS: Eighty-four consecutive patients referred to private orthopedic group with symptoms and radiographic evidence of unilateral or bilateral knee OA who had either failed or could not tolerate the side effects of conservative treatment. Sixty-one patients completed the study. Nineteen patients were lost to follow-up. Four patients withdrew from study due to subsequent knee arthroplasty. INTERVENTION: Three weekly injections of Hylan G-F 20 into one or both (if bilaterally symptomatic) knees (110 knees total). OUTCOME MEASURE: SF-36 Health Survey was completed before treatment and 6 months after treatment. RESULTS: Statistically significant improvement (p < .001) in Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, and Role-Emotional categories on 6-month follow-up survey. Age and percent above ideal body weight were not significant predictors of functional change. CONCLUSION: Efficacy of intra-articular injection of Hylan G-F 20 for knee OA 6 months after injection is demonstrated in several categories of the SF-36, indicating a measurable improvement in overall functioning in these patients
|
0 |
The effect of tibio-femoral over-distraction in primary knee arthroplasty
|
Surgical Management of Osteoarthritis of the Knee CPG
|
PURPOSE: Overstuffing the patellofemoral joint has been associated with poor post-operative outcomes. No study has assessed the effect of over-distracting the tibio-femoral joint in the vertical plane and its effects on function and quality of life. The purpose of this study is to assess the effect of tibio-femoral joint distraction on function and quality of life after total knee arthroplasty. METHODS: Measurements of knee joint distraction were devised using long-leg alignment radiographs. Seventy-three patients were prospectively recruited and their joint distraction measured post-operatively. A comparison was made between the level of joint distraction and functional outcomes as measured by the International Knee Society score and its components, such as pain and flexion, and the Knee injury and Osteoarthritis Outcome Score and quality of life as measured by the Short-Form 12 score. Twelve-month follow-up was achieved. RESULTS: Knee joint over-distraction post-arthroplasty correlated significantly with Knee Society score (p = 0.041), flexion (p = 0.005) and pain (p = 0.002). Those knees that were over-distracted post-operatively suffered more pain, less flexion and a lower International Knee Society score compared with their counterparts. No correlation was found between over-distracting the knee joint and quality of life. CONCLUSION: Over-distracting the tibio-femoral joint during arthroplasty is a significant predictor of reduction in function and increase in pain in the short to medium term. When between sizes of tibial inserts, the surgeon should consider using the thinner option. LEVEL OF EVIDENCE: Prospective cohort study, Level II
|
0 |
The somatopause: an indication for growth hormone therapy?
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Human aging causes adverse changes in body composition, a fall in bone mineral density, a deterioration in physical performance, a worsening cardiovascular risk profile, and increased morbidity and mortality. In addition, growth hormone (GH) secretion and serum insulin-like growth factor (IGF)-I levels fall. GH deficiency in adults causes similar changes to those observed with aging, which has led to the suggestion that the elderly are GH deficient and would benefit from GH treatment. Randomized controlled studies have demonstrated modest benefits when GH treatment has been used alone or in combination with exercise or sex steroids. GH treatment in adults over 60 years of age is associated with a high incidence of adverse effects, particularly peripheral edema, arthralgia, and carpal tunnel syndrome. Studies to date have been for a maximum of 12 months, so long-term safety data are not available in this setting. There are particular concerns over the links between the GH-IGF-I axis and the development of cancer in the normal population. Long-term studies are required to determine the efficacy and safety of GH treatment in older adults who are not GH deficient. At the present time, there are insufficient data on sustained efficacy, safety, or cost effectiveness to support the use of GH as an anabolic agent in adults over 60 years of age
|
0 |
Arthroscopic debridement of unicompartmental arthritis: fact or fiction?
|
OAK 3 - Non-arthroplasty tx of OAK
|
Patients with recurrent or mechanical symptoms of unicompartmental knee arthritis that have failed conservative management are candidates for surgical intervention. Surgical options include debridement, lavage, chondroplasty, bone marrow-stimulating techniques, chondrocyte transfer, and chondrocyte implantation. These techniques have been well studied but it is still unclear which technique is superior. Various factors need to be accounted for when choosing the proper technique; among the factors discussed are the patient's age and the size of the articular cartilage defect.
|
0 |
Management of proximal femoral fractures in the presence of hip resurfacing arthroplasty: Peri-operative considerations and a meta analysis
|
SR for PM on OA of All Extremities
|
Periprosthetic fractures which occur in close proximity to an in situ hip resurfacing prosthesis can pose a technically demanding challenge to orthopaedic surgeons. While this is currently an uncommon problem, it is logical to assume that as the numbers of hip resurfacing arthroplasties increase, we are likely to see larger numbers of patients with this presentation. In these cases, if the resurfacing prosthesis in not functioning well, the choice to replace it is easy. If it is well functioning, this decision becomes more difficult however. We present a case illustrating our experience with this unusual problem. We discuss our treatment strategy, the issues and options which need to be considered before treating these patients and review the current literature addressing this topic. (copyright) 2008 Springer-Verlag
|
0 |
Dentifrices containing new agents for the control of plaque and gingivitis: microbiological aspects
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Antimicrobial agents have been proposed as playing an important role in controlling plaque and gingivitis. Unfortunately, a large number of potential compounds are unsuitable for use in dentifrices because they lack "substantivity", produce undesirable side-effects, or are incompatible with toothpaste ingredients. New agents that have been successfully incorporated into dentifrices include plant extracts, phenolic compounds and metal salts. Several products are currently being based on the phenol, Triclosan. Triclosan has a broad spectrum of antimicrobial activity against yeasts and oral bacteria. To enhance its clinical efficacy, Triclosan has been combined either with a co-polymer or with another compatible antimicrobial agent, zinc citrate. The co-polymer acts to increase the oral retention of Triclosan, and has resulted in further reductions in salivary bacterial counts in vivo. Zinc salts also have antimicrobial activity, and at low concentrations, can inhibit glycolysis and bacterial proteases. In mixed culture chemostat studies, Triclosan selectively inhibited Gram-negative periodontopathic bacteria; additive effects were obtained when zinc citrate and Triclosan were combined. In an experimental human gingivitis study, a zinc citrate/Triclosan dentifrice reduced plaque accumulation and gingivitis compared to a placebo paste; the ratio of anaerobic/aerobic bacteria and the proportions of Actinomyces species in plaque were also reduced. The prolonged use of a zinc citrate/Triclosan dentifrice neither significantly altered the ecology of supragingival plaque nor led to the selection of Triclosan-resistant bacteria. The data suggest that dentifrices containing new antimicrobial agents could be of clinical relevance in the prevention and control of plaque and gingivitis
|
0 |
Injuries to the elbow
|
Distal Radius Fractures
|
Presented is an outline of the anatomy, biomechanics and function of the elbow joint, as it relates to normal and sporting activities. A variety of elbow injuries, including fractures of the olecranon, radial head and distal humerus are presented with appropriate methods of treatment. The aim to return patients to early functional activity is stressed. Soft tissue and more chronic over-use problems are briefly discussed, and a treatment regimen presented. In general, elbow injuries which involve acute fractures, dislocations and ligament injuries should be treated aggressively, in order to achieve early functional mobility. The more chronic over-use elbow problems should be viewed with a certain caution, and results are not as predictable following treatment of such injuries and over-use problems.
|
1 |
Effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis: randomized controlled trial
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Patients with knee and/or hip osteoarthritis (OA) are less physically active than the general population, while the benefits of physical activity (PA) have been well documented. Based on the behavioral graded activity treatment, we developed a Web-based intervention to improve PA levels in patients with knee and/or hip OA, entitled "Join2move". The Join2move intervention is a self-paced 9-week PA program in which the patient's favorite recreational activity is gradually increased in a time-contingent way.
OBJECTIVE: The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and/or hip OA would result in improved levels of PA, physical function, and self-perceived effect compared with a waiting list control group.
METHODS: The study design was a two-armed randomized controlled trial which was not blinded. Volunteers were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were: (1) aged 50-75 years, (2) self-reported knee and/or hip OA, (3) self-reported inactivity (30 minutes of moderate PA, 5 times or less per week), (4) no face-to-face consultation with a health care provider other than general practitioners, for OA in the last 6 months, (5) ability to access the Internet weekly, and (6) no contra-indications to exercise without supervision. Baseline, 3-month, and 12-month follow-up data were collected through online questionnaires. Primary outcomes were PA, physical function, and self-perceived effect. In a subgroup of participants, PA was measured objectively using accelerometers. Secondary outcomes were pain, fatigue, anxiety, depression, symptoms, quality of life, self-efficacy, pain coping, and locus of control.
RESULTS: Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% (168/199) after 3 months and 75.4% (150/199) after 12 months. In this study, 94.0% (94/100) of participants actually started the program, and 46.0% (46/100) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (difference=6.5 points, 95% CI 1.8-11.2) and a positive self-perceived effect (OR 10.7, 95% CI 4.3-26.4) compared with the control group. No effect was found for self-reported PA. After 12 months, the intervention group showed higher levels of subjective (difference=21.2 points, 95% CI 3.6-38.9) and objective PA (difference=24 minutes, 95% CI 0.5-46.8) compared with the control group. After 12 months, no effect was found for physical function (difference=5 points, 95% CI -1.0 to 11.0) and self-perceived effect (OR 1.2, 95% CI 0.6-2.4). For several secondary endpoints, the intervention group demonstrated improvements in favor of the intervention group.
CONCLUSIONS: Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.
|
0 |
Causes and effects of surgical delay in patients with hip fracture: A cohort study
|
HipFx Supplemental Cost Analysis
|
Background: The clinical effect of surgical delay in older patients with hip fracture is controversial. Discrepancies among study findings may be due to confounding that is caused by the reason for the delay or a differential effect on patient risk subgroups. Objective: To assess the effect of surgical delay on hospital outcomes according to the cause of delay. Design: Prospective cohort study. Setting: A hip fracture unit in a university hospital in Spain. Patients: 2250 consecutive elderly patients with hip fracture. Measurements: Time to surgery, reasons for surgical delay, adjusted in-hospital death, and risk for complications. Results: Median time to surgery was 72 hours. Lack of operating room availability (60.7%) and acute medical problems (33.1%) were the main reasons for delays longer than 48 hours. Overall, rates of hospital death and complications were 4.35% and 45.9%, respectively, but were 13.7% and 74.2% in clinically unstable patients. Longer delays were associated with higher mortality rates and rates of medical complications. After adjustment for age, dementia, chronic comorbid conditions, and functionality, this association did not persist for delays of 120 hours or less but did persist for delays longer than 120 hours (P = 0.002 for overall time effect on death and 0.002 for complications). The risks were attenuated after adjustment for the presence of acute medical conditions as the cause of the delay (P = 0.06 for time effect on mortality and 0.31 on medical complications). Risk for urinary tract infection remained elevated (odds ratio, 1.54 [95% CI, 0.99 to 2.44]). No interaction between delay and age, dementia, or functional status was found. Limitation: This was a single-center study without postdischarge follow-up. Conclusion: The reported association between late surgery and higher morbidity and mortality in patients with hip fracture is mostly explained by medical reasons for surgical delay, although some association between very delayed surgery and worse outcomes persists. (copyright) 2011 American College of Physicians
|
0 |
Is global quality of life reduced before fracture in patients with low-energy wrist or hip fracture? A comparison with matched controls
|
Management of Hip Fractures in the Elderly
|
BACKGROUND: The aims of the study were (i) to examine global quality of life (GQOL) before fracture in patients with low-energy wrist or hip fracture compared with an age- and sex-matched control group, and (ii) to identify relationships between demographic variables, clinical fracture variables, and health- and global-focused quality of life (QOL) prior to fracture. METHODS: Patients with a low-energy fracture of the wrist (n = 181) or hip (n = 97) aged >or= 50 years at a regional hospital in Norway and matched controls (n = 226) were included. The participants answered retrospectively, within two weeks after the fracture, a questionnaire on their GQOL before the fracture occurred using the Quality of Life Scale (QOLS), and health-focused QOL using the Short Form-36, physical component summary, and mental component summary scales. A broad range of clinical data including bone density was also collected. ANOVA and multiple linear regression analysis were used to analyse the data. RESULTS: Osteoporosis was identified in 59% of the hip fracture patients, 33% of the wrist fracture patients, and 16% of the controls. After adjusting GQOL scores and the three sub-dimensions for known covariates (sociodemographics, clinical fracture characteristics, and health-focused QOL), the hip patients reported significantly lower scores compared with the controls, except for the sub-dimension of personal, social, and community commitment (p = 0.096). Unadjusted and adjusted GQOL scores did not differ between the wrist fracture patients and controls. Sociodemographics (age, sex, education, marital status), clinical fracture variables (osteoporosis, falls, fracture group) and health-focused QOL explained 51.4% of the variance in the QOLS, 35.2% of the variance in relationship and marital well-being, 59.3% of the variance in health and functioning, and 24.9% of the variance of personal, social, and community commitment. CONCLUSION: The hip fracture patients had lower GQOL before the fracture occurred than did controls, even after adjusting for known factors such as sociodemographics, clinical variables and health-focused QOL. The findings suggest that by identifying patients with low GQOL, in addition to other known risk factors for hip fracture, may raise the probability to target preventive health care activities
|
0 |
The RM Pressfit vitamys: 5-year Swiss experience of the first 100 cups
|
Hip Fx in the Elderly 2019
|
BACKGROUND: The RM Pressfit vitamys is a titanium particle-coated monoblock cup with vitamin E stabilised highly cross-linked polyethylene. Initial fixation is achieved via press-fit with subsequent stability by bone on-growth. This is the first study to report the 5-year results of this design.
METHODS: We performed a prospective cohort study according to STROBE guidelines of 100 consecutive total hip replacements (THRs) in 92 patients all with ceramic heads. Demographic data, pre/postoperative visual analogue scale (VAS) for pain and satisfaction, Harris Hip Scores (HHS) and complications were recorded. Radiographic analysis of osteolysis and loosening was complemented by EBRA (Einzel-Bild-Rontgen-Analyse) evaluation of cup movement.
RESULTS: Our cohort comprised 48 women (mean age 67; SD 10.4) and 44 men (mean age 69; SD 7.8). The mean body mass index was 27 kg/m2 (SD 4.6). Surgical indications were osteoarthritis 96%, avascular necrosis 3% and fracture 1%. 82% had a direct anterior approach, 15% anterolateral and 3% trans-gluteal. 4 surgeons were involved. 1 cup was repositioned and fixed with screws within a week of index surgery. There were 2 intraoperative femoral fractures, 3 haematomata with 1 requiring drainage and 1 deep infection settling with an open washout and modular exchange. Mean VAS satisfaction increased from 3.8 (SD 2.0) to 8.8 at 6 weeks (SD 1.4) and 9.5 (SD 1.3) at 5 years. The HHS functional scores were 58.9 (SD 13.2) preoperatively and 94.6 (SD 6.6) at 5 years. Radiographic analysis showed neither progressive radiolucency nor osteolysis. Mean migration was 1.5 mm after 5 years.
CONCLUSIONS: Mid-term results of the RM Pressfit vitamys cup are encouraging.
|
1 |
Impact of time to surgery in upper femoral fracture in orthogeriatrics
|
Hip Fx in the Elderly 2019
|
INTRODUCTION: Treatment of hip fracture in the elderly is a major public health issue. Orthogeriatric departments have been developed for these patients at high risk of complications. Time to surgery seems to be an important factor in the care pathway, but remains controversial.
OBJECTIVES: The aim of this study was to assess the impact of less than 24 hours' time to surgery on 1-year morbidity and mortality in patients managed in our orthogeriatric department.
HYPOTHESIS: The study hypothesis was that<24 hours' time to surgery decreases mortality in elderly patients with upper femoral fracture.
MATERIALS AND METHODS: A retrospective cohort study from September 2015 to July 2016 included patients aged 75 years and older, eligible for orthogeriatric management of upper femoral fracture. Patients with comorbidities were prioritized for admission and for access to the operating room. Time to surgery was defined as time between the arrival in A&E and transfer to the operating room. The primary endpoint was 1-year survival. Comorbidities were assessed on Charlson score. ROC curve analysis determined the optimal cut-off for time to surgery. Variables significantly associated with mortality were included in a Cox regression model to estimate the adjusted effect of time to surgery on mortality.
RESULTS: One hundred and eight patients were included; mean age, 87+/-6.2 years; 26 male (24.1%), 82 female (75.9%). One-year mortality was 24.1% (26/108). Mean time to surgery was 14.1+/-30.9hours. ROC curve analysis showed a rise in mortality after a cut-off of 22hours 37minutes (p<0.0001).
CONCLUSION: Within a dedicated orthogeriatric department, time to surgery is a significant factor in the management of hip fractures in the elderly. Patients should be prioritized for theater and ideally receive "early" surgery within 24hours of admission to A&E. The potential benefit of "ultra-early" surgery (time to surgery<6hours) requires robust assessment.
LEVEL OF EVIDENCE: IV, Retrospective cohort study.
|
0 |
Special features of total knee replacement in hemophilia
|
OAK 3 - Non-arthroplasty tx of OAK
|
Total knee replacement is an operation frequently needed by hemophilia patients, which greatly improves their quality of life. This operation, however, carries a higher risk of bleeding and infection for hemophiliacs than it does for osteoarthritis sufferers. It is advisable to implant prosthetic components using antibiotic-loaded cement. It is essential to maintain a level of 100% of the replacement clotting factor for 2 weeks. Hematological treatment must be established, depending on the patient's factor levels and other pharmacokinetic parameters such as recovery and half-life, optimal doses and treatment time. It is preferable to use general anesthesia due to the risk of spinal bleeding. The lifespan of total knee replacement in hemophilic patients is shorter than in patients with osteoarthritis because of the increased risk of infection. © 2013 Informa UK Ltd.
|
0 |
Complex and revision arthrodesis of the ankle and hindfoot
|
DoD SSI (Surgical Site Infections)
|
Primary as well as revision arthrodesis procedures of the ankle are associated with a high rate of complications including nonunion, malunion, infection, wound healing problems, damage to nerves and blood vessels, and gait disturbance secondary to malposition, all of which have prompted the development of various techniques to avoid or minimize said complications. In addition to those dilemmas are other complex scenarios such as failed total ankle arthroplasty and paralytic or neuropathic deformities which can render a plethora of problems for the treating physician to deal with, including maintenance of length and alignment, and problems with prior incisions or soft tissue damage with a potential for delays in wound healing or complications with bony union.
|
0 |
Molecular signatures of age-associated chronic degeneration of shoulder muscles
|
Glenohumeral Joint OA
|
Chronic muscle diseases are highly prevalent in the elderly causing severe mobility limitations, pain and frailty. The intrinsic molecular mechanisms are poorly understood due to multifactorial causes, slow progression with age and variations between individuals. Understanding the underlying molecular mechanisms could lead to new treatment options which are currently limited. Shoulder complaints are highly common in the elderly, and therefore, muscles of the shoulder's rotator cuff could be considered as a model for chronic age-associated muscle degeneration. Diseased shoulder muscles were characterized by muscle atrophy and fatty infiltration compared with unaffected shoulder muscles. We confirmed fatty infiltration using histochemical analysis. Additionally, fibrosis and loss of contractile myosin expression were found in diseased muscles. Most cellular features, including proliferation rate, apoptosis and cell senescence, remained unchanged and genome-wide molecular signatures were predominantly similar between diseased and intact muscles. However, we found down-regulation of a small subset of muscle function genes, and up-regulation of extracellular region genes. Myogenesis was defected in muscle cell culture from diseased muscles but was restored by elevating MyoD levels. We suggest that impaired muscle functionality in a specific environment of thickened extra-cellular matrix is crucial for the development of chronic age-associated muscle degeneration.
|
0 |
Antibiotic prophylaxis for infective endocarditis: ethical care in the era of revised guidelines
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Beginning in 1955, the American Heart Association recommended antibiotic prophylaxis among patients with certain structural heart diseases to decrease the likelihood of infective endocarditis (IE) following dental procedures. Over the ensuing 52 years, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines were revised to address gastrointestinal and genitourinary procedures and to modify the assessment of relative risks and specific regimens for prophylaxis. Throughout the various revisions, prophylaxis was recommended for individuals who were at increased risk of developing IE based on best evidence and consensus opinion, albeit in the absence of randomized controlled trials. In 2007, the AHA published a revised guideline statement dramatically restricting its recommendations for antibiotic prophylaxis against IE. In 2008, these views were incorporated in an ACC/AHA guideline update on the management of patients with heart valve disease. The revisions represent a dramatic shift in terms of the patients for whom antibiotic prophylaxis is recommended and the procedures for which it is recommended. What is striking about the new guidelines is that the change in recommendations was based not on new data, but on a change in philosophy despite the lack of new data. To some degree, the arguments for and against antibiotic prophylaxis become those of philosophy, ethics, and the role of evidence-based medicine. This manuscript attempts to briefly examine those arguments and discuss why the revised guidelines may fail to respect the ethical principles of beneficence and patient autonomy
|
0 |
Rectus Abdominis Fat Transfer (RAFT) in Lipoabdominoplasty: A New Technique to Achieve Fitness Body Contour in Patients that Require Tummy Tuck
|
Panniculectomy & Abdominoplasty CPG
|
OBJECTIVE: To describe a new technique to achieve a fit-look in lipoabdominoplasty patients through liposculpture and rectus abdominis fat transfer (RAFT). METHODS: Patients with a body mass index under 26 and of both genders scheduled for abdominoplasty or body lift were selected for this procedure. Fat was transferred directly to the rectus abdominis muscle after flap elevation during lipoabdominoplasty. RESULTS: A total of 26 patients were operated on with this technique. No complications attributable to the fat grafting were noticed. All patients had a high satisfaction level with the procedure. Demonstrative cases are shown. DISCUSSION: The RAFT technique is a useful and effective technique to improve results in standard lipoabdominoplasty. Its main limitation is the adequate selection of the patient. The RAFT technique can be incorporated easily to common day practice. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
|
0 |
Aurothiomalate inhibits the expression of mPGES-1 in primary human chondrocytes
|
AAHKS (2) Corticosteroids
|
OBJECTIVES: Microsomal prostaglandin E synthase-1 (mPGES-1) is a terminal enzyme in the production of prostaglandin E2 (PGE2) and its expression is upregulated during inflammation. mPGES-1 is considered as a potential drug target for the treatment of arthritis to reduce adverse effects related to the current non-steroidal anti-inflammatory drugs (NSAIDs). Our aim was to study the expression of mPGES-1 in primary human chondrocytes and whether the expression is affected by clinically used antirheumatic drugs.
METHOD: Primary human chondrocytes were isolated from cartilage samples obtained from patients undergoing total knee replacement surgery. Expression of mPGES-1 was studied by quantitative real-time polymerase chain reaction (PCR) and Western blot analysis. PGE2 levels were measured by enzyme-linked immunosorbent assay (ELISA).
RESULTS: mPGES-1 expression in primary human chondrocytes was enhanced when the cells were exposed to interleukin-1beta (IL-1beta) and mPGES-1 protein levels continued to increase up to the 96-h follow-up. Aurothiomalate inhibited mPGES-1 expression and PGE2 production in a dose-dependent manner, as did the anti-inflammatory steroid dexamethasone. Other disease-modifying antirheumatic drugs (DMARDs) studied (sulfasalazine, methotrexate, and hydroxychloroquine) did not alter mPGES-1 expression.
CONCLUSIONS: The results introduce aurothiomalate as the first, and so far the only, DMARD found to be able to inhibit mPGES-1 expression. The effect is likely involved in the mechanisms of action of this gold-containing DMARD in rheumatic diseases. The results are implicated in the regulatory mechanisms of mPGES-1 expression, which are under intensive research.
|
0 |
Subchondral drilling for articular cartilage repair: A systematic review of translational research
|
OAK 3 - Non-arthroplasty tx of OAK
|
Articular cartilage defects may initiate osteoarthritis. Subchondral drilling, a widely applied clinical technique to treat small cartilage defects, does not yield cartilage regeneration. Various translational studies aiming to improve the outcome of drilling have been performed; however, a robust systematic analysis of its translational evidence was still lacking. Here, we performed a systematic review of the outcome of subchondral drilling for knee cartilage repair in translational animal models. A total of 12 relevant publications studying 198 animals was identified, detailed study characteristics were extracted, and methodological quality and risk of bias were analyzed. Subchondral drilling led to improved repair outcome compared with defects that were untreated or treated with abrasion arthroplasty for cartilage repair in multiple translational models.Within the 12 studies, considerable subchondral bone changes were observed, including subchondral bone cysts and intralesional osteophytes. Furthermore, extensive alterations of the subchondral bone microarchitecture appeared in a temporal pattern in small and large animal models, together with specific topographic aspects of repair. Moreover, variable technical aspects directly affected the outcomes of osteochondral repair. The data from this systematic review indicate that subchondral drilling yields improved short-term structural articular cartilage repair compared with spontaneous repair in multiple small and large animal models. These results have important implications for future investigations aimed at an enhanced translation into clinical settings for the treatment of cartilage defects, highlighting the importance of considering specific aspects of modifiable variables such as improvements in the design and reporting of preclinical studies, together with the need to better understand the underlying mechanisms of cartilage repair following subchondral drilling.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.