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0 | MRI assessment of recurrent carpal tunnel syndrome after open surgical release of the median nerve | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | OBJECTIVE: The purpose of this study was to retrospectively determine the accuracy of MRI in identification of the morphologic features of median nerve dysfunction after surgical release of the median nerve for carpal tunnel syndrome. MATERIALS AND METHODS: Two blinded readers independently evaluated axial 1.5-T MR images for retinacular regrowth, morphologic characteristics of the median nerve, and presence of mass effect, fibrosis, and carpal tunnel decompression. All 47 patients (11 men, 36 women; mean age, 55 years; range, 27-81 years) had undergone open surgical release of the median nerve for carpal tunnel syndrome. Thirty-five patients had electromyographic evidence of recurrent carpal tunnel syndrome. The other 12 patients did not have electrophysiologic evidence of recurrent carpal tunnel syndrome and were the control group. RESULTS: A statistically significant difference between the recurrent carpal tunnel syndrome and control groups was found for fibrosis (p = 0.009), nerve enhancement (p = 0.04), and median nerve width (p = 0.008) and ratio (p = 0.01) at the pisiform level. CONCLUSION: MRI may be used in association with electromyography for accurate postoperative evaluation of the carpal tunnel |
0 | Bone mineral density and body composition in boys with distal forearm fractures: a dual-energy x-ray absorptiometry study | Distal Radius Fractures | OBJECTIVE: To determine whether boys with distal forearm fractures differ from fracture-free control subjects in bone mineral density (BMD) or body composition.
STUDY DESIGN: A case-control study of 100 patients with fractures (aged 3 to 19 years) and l00 age-matched fracture-free control subjects was conducted. Weight, height, and body mass index were measured anthropometrically. BMD values and body composition were determined by dual-energy x-ray absorptiometry.
RESULTS: More patients than control subjects (36 vs l4) were overweight (body mass index >85th percentile for age, P <.001). Patients had lower areal (aBMD) and volumetric (BMAD) bone mineral density values and lower bone mineral content but more fat and less lean tissue than fracture-free control subjects. The ratios (95% CIs) for all case patients/control subjects in age and weight-adjusted data were ultradistal radius aBMD 0.94 (0.91-0.97); 33% radius aBMD 0.96 (0.93-0.98) and BMAD 0.95 (0.91-0.99); spinal L2-4 BMD 0.92 (0.89-0.95) and BMAD 0.92 (0.89-0.94); femoral neck aBMD 0.95 (0.92-0.98) and BMAD 0.95 (0.91-0.98); total body aBMD 0.97 (0.96-0.99), fat mass 1.14 (1.04-1.24), lean mass 0.96 (0.93-0.99), and total body bone mineral content 0.94 (0.91-0.97).
CONCLUSIONS: Our results support the view that low BMC, aBMD, and BMAD values and high adiposity are associated with increased risk of distal forearm fracture in boys. This is a concern, given the increasing levels of obesity in children today. |
0 | Controlling costs without compromising quality: paying hospitals for total knee replacement | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. METHODS: The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. RESULTS: Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P < 0.001; chi) and 9.9% lower risk-adjusted total costs ($12,773-$11,512; P < 0.001; t test) than all study hospitals. Inefficiency accounted for 96% of excess costs. CONCLUSIONS: A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care |
0 | Disease Characteristics and Rheumatoid Arthritis Development in Patients with Early Undifferentiated Arthritis: A 2-year Followup Study | Glenohumeral Joint OA | OBJECTIVE: To examine the 2-year disease course in patients with undifferentiated arthritis (UA) focusing on fulfillment of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) classification criteria.
METHODS: Data were provided by the Norwegian Very Early Arthritis Clinic study, which included patients presenting with >= 1 swollen joint of <= 16 weeks' duration. UA was defined as patients not fulfilling the 2010 ACR/EULAR RA criteria and who did not have a clinical diagnosis other than RA at baseline. The main outcome was fulfillment of the 2010 RA criteria. Secondary outcomes were disease-modifying antirheumatic drug (DMARD) use, resolution of synovitis without use of DMARD during followup, and final clinical diagnosis.
RESULTS: We included 477 patients with UA of whom 47 fulfilled the 2010 ACR/EULAR RA criteria during followup (UA-RA) and 430 did not (UA-non-RA). Of the UA-RA patients, 70% fulfilled the criteria within the first 6 months. UA-RA patients were older, more often positive for rheumatoid factor and anticitrullinated protein antibodies, female, and ever smokers, and they more often presented with polyarticular arthritis, small joint involvement, and a swollen shoulder joint. During followup, 53% of UA-RA patients vs 13% of UA-non-RA patients used DMARD (p < 0.001). Overall, 71% of patients with UA achieved absence of clinical synovitis at final followup without use of DMARD. The most frequent final clinical diagnosis was UA (61%).
CONCLUSION: Only 9.8% of patients with UA fulfilled the 2010 RA criteria during 2-year followup. Small joint involvement and swollen shoulder joint were among the factors associated with RA development. In two-thirds of patients with UA, the arthritis resolved without use of DMARD. |
0 | Regional analgesia for improvement of long-term functional outcome after elective large joint replacement | Surgical Management of Osteoarthritis of the Knee CPG | This is the protocol for a review and there is no abstract. The objectives are as follows:The objective of the review is to investigate whether regional anaesthesia and analgesia improve long-term functional outcomes three, six or 12 months after surgery following elective major joint (knee, shoulder and hip) replacement surgery |
0 | Diagnosis and treatment of emergency surgeries in otorhinolaryngology, head and neck surgery during the covid-19 outbreak: A single center experience | Coronavirus Disease 2019 (COVID-19) | The 2019 Novel Coronavirus (2019-nCoV, SARS-CoV-2) infection has already been assigned as a Class B infectious disease requiring Class A management strategy according to â??the Law on the Prevention and Control of Infectious Diseases of the People's Republic of Chinaâ? and become a global pandemic. The incidence of emergencies in otorhinolaryngology, head and neck surgery such as foreign bodies in the esophagus and the respiratory tract, epistaxis, laryngeal obstruction with dyspnea, and head and neck trauma are relatively high. Emergency surgeries are required as some of these diseases progress rapidly and probably be life-threatening. In this article, we drafted the recommendations for diagnosis and treatment of emergency surgeries in otorhinolaryngology, head and neck surgery in the epidemic area of novel coronavirus pneumonia based on â??Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (Provisional; 7th Edition Revisions)â?and WHO guidelines, combined with the experience of emergency surgeries in the Department of Otorhinolaryngology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, which is at the center outbreak area of the SARS-CoV-2 pneumonia (COVID-19) in China, to improve the success rate of treatment for otorhinolaryngology, head and neck surgery emergency surgeries and to reduce the SARS-CoV-2 infection rate in the perioperative period. |
0 | The risk of fracture in patients with multiple sclerosis: the UK general practice research database | Management of Hip Fractures in the Elderly | Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We conducted a population-based cohort study using data from the UK General Practice Research Database linked to the National Hospital Registry (1997-2008). Incident MS patients (n = 5565) were matched 1:6 by year of birth, sex, and practice with patients without MS (controls). Cox proportional-hazards models were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5- and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost threefold increased risk of hip fracture [HR = 2.79, 95% confidence interval (CI) 1.83-4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR = 1.35, 95% CI 1.13-1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR = 1.85, 95% CI 1.14-2.98) or antidepressants (HR = 1.79, 95% CI 1.37-2.35) in the previous 6 months. Absolute fracture risks were low in younger MS patients but became substantial when patients were older than 60 years of age. It is concluded that MS is associated with an increased risk of fracture. Fracture risk assessment may be indicated in patients with MS, especially those prescribed GCs or antidepressants |
1 | Pain Control and Functional Milestones in Total Knee Arthroplasty: Liposomal Bupivacaine versus Femoral Nerve Block | AAHKS (9/10) Regional Nerve Blocks | BACKGROUND: Although pain management after total knee arthroplasty (TKA) affects rehabilitation, length of stay, and functional outcomes, pain management for patients undergoing TKA has yet to be standardized. Femoral nerve blocks (FNBs) are commonly used as an adjunct; however, these can result in transient quadriceps weakness and have been associated with in-hospital falls. Periarticular infiltration of liposomal bupivacaine has been recently introduced as a long-acting analgesic that can be administered without affecting motor function.
QUESTIONS/PURPOSES: (1) Does periarticular liposomal bupivacaine compared with FNB result in improved pain control as measured by pain scores and narcotic consumption? (2) How do liposomal bupivacaine and FNB compare in terms of gait and stairclimbing milestones and the proportion of patients who experienced a fall in the hospital?
METHODS: Between September 2013 and October 2014, a retrospective analysis was conducted involving 24 surgeons who performed a total of 1373 unilateral, primary TKAs. From September 2013 to April 2014, the routine approach to TKA pain management pathway consisted of preoperative administration of oral analgesics, intraoperative anesthesia (preferred spinal or general), an ultrasound-guided FNB, intraoperative analgesic cocktail injection, patient-controlled analgesia, and oral and IV narcotics for pain as needed. A total of 583 patients were included in this study group. Starting May 2014, FNBs were discouraged and there was department-wide adoption of liposomal bupivacaine. Liposomal bupivacaine became routinely used in all patients undergoing TKA with no other changes made to the multimodal analgesia protocol at that time, and 527 patients in this study group were compared with the FNB cohort. Chart review on a total of 1110 patients was conducted by a research assistant who was not participating in patient care. During the inpatient stay, pain scores during 8-hour intervals, narcotic use, and physical therapy milestones were compared.
RESULTS: With the numbers available, we detected no clinically important difference in pain scores throughout the hospital stay; however, patients treated with liposomal bupivacaine consumed very slightly less narcotics overall (96 +/- 62 versus 84 +/- 73 eq mg of morphine; [95% confidence interval, 11-13 mg]; p = 0.004) through postoperative Day 2 of inpatient hospitalization. Seventy-seven percent (406 of 527) of patients receiving liposomal bupivacaine achieved their gait milestones of clearing 100 feet of ambulation versus 60% (349 of 583) of patients receiving FNB (p < 0.001) before discharge. Likewise, 94% (497 of 527) of patients receiving liposomal bupivacaine completed stairs compared with 73% (427 of 583) of patients receiving FNB (p < 0.001). Patients who received liposomal bupivacaine were less likely to experience a fall during the hospital stay than were patients treated with FNB (3 of 527 [0.6%] versus 12 of 583 [2%]; p = 0.03).
CONCLUSIONS: In the absence of strong data supporting FNB over liposomal bupivacaine, we have modified our TKA pain management protocols by adopting liposomal bupivacaine in lieu of FNBs, facilitating rapid rehabilitation while providing adequate pain control.
LEVEL OF EVIDENCE: Level III, therapeutic study. |
0 | Periprosthetic fractures around cementless hydroxyapatite-coated femoral stems | Management of Hip Fractures in the Elderly | We studied 14 periprosthetic femoral fractures out of a series of 619 hydroxyapatite coated hip implants and compared the outcome to published treatment algorithms using the Vancouver classification. There were five type A fractures, six B1, two B2, and one type B3 fracture. All but one type A fractures were treated conservatively. Compared with the Vancouver classification, we observed a different fracture type in the type B fractures. No fractures at the tip of the stem were seen, as in cemented implants. Three B1 fractures were treated operatively due to fracture displacement, and three were treated conservatively. The B2 and B3 fractures were managed with long, uncemented, revision stems because of a disrupted bone-prosthesis interface. All fractures healed well. This study confirms that the modified algorithm of management of periprosthetic fractures, using the Vancouver classification, is a simple, reproducible, classification system for uncemented prostheses. Conservative treatment is a valid option if the implant is stable whilst surgical intervention is mandatory if the implant is loose. (copyright) Springer-Verlag 2005 |
0 | Comparison of Fixation Techniques for Acetabular Fractures Involving the Anterior Column with Disruption of the Quadrilateral Plate: A Biomechanical Study | Hip Fx in the Elderly 2019 | BACKGROUND: In elderly patients who have sustained an acetabular fracture involving disruption of the quadrilateral plate (QLP), postoperative loading of the joint beyond the level of partial weight-bearing can result in medial redisplacement of the QLP. The purpose of this biomechanical study was to compare the performances of 4 different fixation constructs intended to prevent medial redisplacement of the QLP.
METHODS: Anterior column posterior hemitransverse (ACPHT) fractures with disruption of the QLP were created on synthetic hemipelves (fourth-generation Sawbones models) and subsequently stabilized with (1) a 12-hole plate bridging the QLP (Group 1), (2) the plate with added periarticular screws along the QLP (Group 2), (3) the plate combined with an infrapectineal buttress plate (Group 3), or (4) the plate with the added periarticular screws as well as the buttress plate (Group 4). The point of load application on the acetabulum was defined to be the same as the point of application of maximum vertical hip contact force during normal walking. Loads were applied to simulate either partial weight-bearing (20 cycles, from 35 to 350 N) or inadvertent supraphysiologic loads (linearly increasing loads until the onset of failure, defined as fragment displacement of >3 mm). A universal testing machine was synchronized with a digital image correlation system to optically track redisplacement at the QLP. The level of significance was set at p < 0.05.
RESULTS: During experimental simulation of partial weight-bearing, maximum fracture step openings never exceeded 2 mm. During simulation of inadvertent supraphysiologic load, the median load to failure was higher (p < 0.05) in Group 2 (962 N; range, 798 to 1,000 N) and Group 4 (985 N; range, 887 to 1,000 N) compared with Group 1 (445 N; range, 377 to 583 N) and Group 3 (671 N; range, 447 to 720 N).
CONCLUSIONS: All 4 fixation constructs performed in an acceptable manner on testing with simulated partial weight-bearing. Only additional periarticular screws along the QLP increased the fixation strength.
CLINICAL RELEVANCE: Redisplacement of the QLP resulting in an incongruency of the hip joint has been associated with poor long-term outcomes. Within the constraints of this study, periarticular long screws were superior to infrapectineal buttress plates in preventing medial redisplacement of the QLP. |
0 | Changes in the antiangiogenic properties of articular cartilage in osteoarthritis | Management of Hip Fractures in the Elderly | Avascularity is important for the unique biomechanical properties of articular cartilage, and normal cartilage actively repels vascular invasion. This study investigated whether the antiangiogenic properties changed in the presence of osteoarthritis (OA) by culturing explants of human articular cartilage on the chorioallantoic membrane (CAM) of chick embryos and investigating the incidence of vascular invasion and the effects of exogenous vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9). The results were compared with those of non-OA cartilage obtained after femoral neck fractures. Altogether, 72% of OA samples but only 5% of non-OA samples were invaded by the CAM, indicating that changes in the antiangiogenic properties represented a fundamental difference between control and OA cartilage. Exogenous VEGF or MMP-9 increased the frequency of invasion to 70%-100%. Invasion most frequently occurred into cartilage matrix from which proteoglycans had been lost, the latter being detectable by sirius red staining of cartilage collagen. VEGF was synthesized by chondrocytes in proportion to the severity of degradation and might exacerbate the loss of resistance to invasion. These results indicate that loss of resistance to vascular invasion distinguishes OA cartilage from normal articular cartilage, which may be important in the pathogenesis of OA |
0 | Incidence of total hip or knee replacement due to osteoarthritis in relation to thyroid function: a prospective cohort study (The Nord-Trøndelag Health Study) | OAK 3 - Non-arthroplasty tx of OAK | Background: To study whether thyroid function was associated with risk of hip or knee replacement due to primary osteoarthritis. Methods: In a prospective cohort study, data from the second and third survey of the Nord-Trøndelag Health Study were linked to the Norwegian Arthroplasty Register in order to identify total hip or knee replacement as a result of primary osteoarthritis. Results: Among 37 891 participants without previously known thyroid disease we recorded 978 total hip replacements (THRs) and 538 total knee replacements (TKRs) during a median follow-up time of 15.7 years. The analyses were adjusted for sex, age, BMI (body mass index), smoking, physical activity and diabetes. We did not find any association between TSH (thyroid stimulating hormone) and THR or TKR due to osteoarthritis. Neither were changes in TSH over time, or overt hypo- or hyperthyroidism, associated with incidence of THR or TKR. Conclusion: No association was found between thyroid function and hip or knee joint replacement due to osteoarthritis. |
0 | Disproportionate, age-related bone loss in long bone ends: A structural analysis based on dual-energy X-ray absorptiometry | Management of Hip Fractures in the Elderly | The width of long bone diaphyses apparently increase with age, a phenomenon that is suggested to have some positive impact on bone strength. On the other hand, these changes in size that are site-specific may cause a deterioration in the local mechanical integrity of the whole bone. Physical activity and calcium intake are known to be able to modify bone mass and size. It is, however, not known whether these lifestyle habits can modify the postulated disproportionate changes in bone size. To address this question, bone mineral content (BMC)-derived estimates of cross-sectional areas (CSA) of femur and radius in 158 premenopausal (mean age 43, standard deviation 2 years) and 134 postmenopausal (63 (2) years), clinically healthy women with contrasting long-term histories in physical activity and calcium intake were determined from dual-energy X-ray absorptiometry (DXA) data. The DXA-obtained BMC correlated strongly with the actual CSA (r = 0.94) determined with peripheral quantative computed tomography. The ratios between functionally interrelated CSA data (i.e., (radial shaft CSA/distal radius CSA), (trochanter CSA/femoral neck CSA), (femoral shaft CSA/trochanter CSA) and (femoral shaft CSA/femoral neck CSA)) were considered primary outcome variables. Neither physical activity nor calcium intake separately or interactively were associated with any CSA ratio. Age showed no interaction with physical activity or calcium intake but was independently associated with all CSA ratios, except the ratio of femoral shaft CSA to trochanteric CSA. This study indicated clearly that a preferential reduction in the cross-sectional area occupied by bone mineral occurs disproportionately at the long bone ends as compared with diaphyseal sites, and this apparently inherent, age-associated relative loss seems not to be prevented by physical activity or calcium intake. In particular, given the utmost clinical relevance of the proximal femur region, an observed loss in femoral neck CSA of about 10% in contrast to about a 5% loss in trochanteric CSA warrants further investigation regarding its potential role as a predictor for hip fracture. Not only the local differences in bone composition but also the biomechanical aspects are important factors underlying these apparent changes in CSA at the studied skeletal sites |
0 | Smartlipo MPX� sculpting of the body and face | Panniculectomy & Abdominoplasty CPG | Liposculpting of the body and face with the Smartlipo MPX� has given excellent, predictable and long-lasting results. Since June 2009, a total of 72 patients have undergone liposuction with the Smartlipo MPX. Of these, the Smartlipo MPX has been used on the abdomen in 17 cases, on the thighs in 15, on the neck and jowls in 25, on the cheeks in six and has also been used on the arms, buttocks, and breasts. Results have been favorable and long-lasting with up to 17 months' follow-up. Laser sculpting of the face has significantly decreased the jowling seen with aging. © 2011 Informa UK, Ltd. |
0 | Glenoid retroversion: The palaeopathological perspective | Glenohumeral Joint OA | Retroversion of the glenoid articular plane has not received sufficient attention in palaeopathological studies. Occasionally mentioned in severe forms of osteoarthritis, exceptionally studied in extreme congenital forms isolated or in the context of malformation syndromes and overlooked in cases of minor dysplasia, it is nonetheless a valuable marker for identifying debilitating pathological conditions, abnormal shoulder laxity or sequelae of obstetric palsy. It is sometimes associated with other anomalies of the shoulder, the acromion or the coracoid processes of the scapula or the proximal end of the humerus. In this contribution, we first define a new method for measuring glenoid retroversion based on recent embryological and anatomical findings. This new method is particularly well adapted to archaeological remains for its simplicity and the possibility of using it with very fragmentary scapulae. We then applied it to eight pathological cases of various origins, dysplasias or acquired forms of glenoid retroversion; semiological analysis enabled the definition of diagnostic criteria for the main aetiologies. Several new diagnostic features are described, in particular for sequelae of obstetric palsy in adults. |
0 | Management of progressive myopathic blepharoptosis with daily application of octyl-2-cyanoacrylate liquid bandage | Upper Eyelid and Brow Surgery | PURPOSE: To describe the results of a conservative and reversible technique for the treatment of progressive myopathic blepharoptosis in cases when surgery is not indicated, using octyl-2-cyanoacrylate liquid bandage. METHODS: Ten consecutive patients with progressive myopathic blepharoptosis were studied. Octyl-2-cyanoacrylate liquid bandage was applied to the upper eyelid to create a deeper eyelid crease. Margin reflex distance, photographs, and visual fields were obtained prior to and after treatment. RESULTS: All patients described a better appearance after application of the product, and none had an allergic response. All cases had an increase in the margin reflex distance and improvement in visual fields. CONCLUSION: Octyl-2-cyanoacrylate liquid bandage is an alternative method that is simple, safe, and effective in the management of severe blepharoptosis. Moreover, it can be used in patients without systemic conditions or those who are unwilling to undergo a surgical procedure. |
0 | One of two chondrocyte-expressed isoforms of cartilage intermediate-layer protein functions as an insulin-like growth factor 1 antagonist | AMP (Acute Meniscal Pathology) | OBJECTIVE: Aging and osteoarthritic (OA) cartilage commonly demonstrate enhanced expression of the large, transforming growth factor beta (TGFbeta)-inducible glycoprotein cartilage intermediate-layer protein (CILP) as well as enhanced extracellular inorganic pyrophosphate (PPi) that promotes the deposition of calcium pyrophosphate dihydrate crystals. In normal chondrocytes, TGFbeta induces elevated chondrocyte extracellular PPi. Insulin-like growth factor 1 (IGF-1) normally blocks this response and reduces extracellular PPi. However, chondrocyte resistance to IGF-1 is observed in OA and aging. Because CILP was reported to chromatographically fractionate with PPi-generating nucleotide pyrophosphatase phosphodiesterase (NPP) activity, it has been broadly assumed that CILP itself has NPP activity. Our objective was to directly define CILP functions and their relationship to IGF-1 in chondrocytes.
METHODS: Using primary cultures of articular chondrocytes from the knee, we defined the function of the previously described CILP (CILP-1) and of a recently described 50.6% identical protein that we designated the CILP-2 isoform.
RESULTS: Both CILP isoforms were constitutively expressed by primary cultured articular chondrocytes, but only CILP-1 expression was detectable in cultured knee meniscal cartilage cells. Neither CILP isoform had intrinsic NPP activity. But CILP-1 blocked the ability of IGF-1 to decrease extracellular PPi, an activity specific for the CILP-1 N-terminal domain. The CILP-1 N-terminal domain also suppressed IGF-1-induced (but not TGFbeta-induced) proliferation and sulfated proteoglycan synthesis, and it inhibited ligand-induced IGF-1 receptor autophosphorylation.
CONCLUSION: Two CILP isoforms are differentially expressed by chondrocytes. Neither CILP isoform exhibits PPi-generating NPP activity. But, increased expression of CILP-1, via N-terminal domain-mediated inhibitory effects of CILP-1 on chondrocyte IGF-1 responsiveness, could impair chondrocyte growth and matrix repair and indirectly promote PPi supersaturation in aging and OA cartilage. |
0 | Brachial plexus blocks: A review of approaches and techniques | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | Purpose: The purpose of this narrative review is to summarize the evidence derived from randomized controlled trials (RCTs) regarding established approaches and techniques for brachial plexus anesthesia. Source: Using the |
0 | Use of Allografts in Orthopaedic Surgery: Safety, Procurement, Storage, and Outcomes | AMP (Acute Meniscal Pathology) | The use of allografts has become a vital option for orthopaedic surgeons in the treatment of a variety of musculoskeletal lesions, ranging from osteochondral defects in the glenohumeral joint to meniscal deficiency in the young athlete. Nevertheless, barriers to treating a patient with an allograft-based procedure may arise from concerns over disease transmission, the navigation of tissue banks that supply allografts, the process of obtaining insurance approval, or optimal storage methods. This review serves to support orthopaedic surgeons in the incorporation of allografts into their practice by quelling these potential concerns. Fresh osteochondral allografts, fresh-frozen meniscal allografts, soft tissue allografts, and off-the-shelf cartilage products are the focus of this review amid broad overviews of allograft safety and tissue bank practices in the United States. |
0 | Outpatient arthroscopy of the knee under local anaesthesia | Surgical Management of Osteoarthritis of the Knee CPG | Arthroscopy of the knee was carried out under local anaesthesia in 313 outpatients, with arthroscopic surgery in 81. The procedure had to be abandoned because of apprehension in only 0.9%. With increasing experience, the number of arthroscopic meniscectomies increased from 5% to 64% of the lesions found. The method was particularly valuable in the assessment of patello-femoral pain since dynamic evaluation of patellar alignment, and the localisation of sensitive structures by palpation, was possible. The method is a safe, reliable and inexpensive alternative to the use of spinal or general anaesthesia for arthroscopy |
0 | Distal radius fixation through a mini-invasive approach of 15 mm. Part 1: Feasibility study | Distal Radius Fractures | The aim of this study was to determine the feasibility of a mini-approach for distal radius volar plating. A 15-mm incision was made in 11 cadaver wrists. A 41 mm length and 24 mm width plate was placed deep to the pronator quadratus then fixed using 2 K-wires. The 2 central epiphyseal screws were placed before pin removal, the lateral screws followed and finally the proximal ones. The number of control views needed was on average 1.9 mm, and the position of the plate was good in 10 cases and average in 1 case. The size of the incision after the operation was on average 16.3 mm. No complications were found. Our results show that volar plate fixation of distal radius fracture is feasible through a 15 mm approach. This approach is esthetic, respects noble structures and facilitates reduction due to ligamentotaxis. © 2013 Springer-Verlag. |
0 | Treatment of fractures of the medial epicondyle of the humerus | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | Forty-three children with a fracture of the medial epicondyle were reviewed; 20 had had non-operative treatment and 23 had been treated by operation. Any final disability was slight, irrespective of the treatment used. Although surgery was more likely to restore the fragment to its normal position (P = 0.0001) and achieve bony union (P = 0.04), minor symptoms were less common in the non-operatively treated group (P = 0.02). Instability of the elbow could not be demonstrated in any of the patients. It is recommended that operative treatment is employed only when an intra-articular fragment cannot be removed from the joint by manipulation |
1 | Effect of lavender oil massage on pain among patients with knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | Osteoarthritis (OA) is a progressive chronic joint disease with global relevance with up to 250 million people being affected from knee OA worldwide. The aim of this study was to evaluate the effect of Lavender oil massage on pain among patients with knee osteoarthritis. A convenient sample of 60 adult male and female patients who admitted to Rheumatology and Rehabilitation unit affiliated to Cairo University hospital in Egypt with confirmed diagnosis of knee OA divided into experimental (study) and control group. A quasi-experimental Time Series pre-post test non equivilant interrupted control design was utilized in the current study. Data was collected using Personal and Medical Background Information Form, Pain Numerical Rating Scaleand Lequesne Algo Functional Index of Severity. The study findings revealed that there were significant statistical differences of pain intensity score and OA severity between study and control group after application of lavender oil massage. Conclusion: Lavender oil massage was proved in this study to be effective on pain and OA severity among patients with knee osteoarthritis. |
1 | Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms | DoD PRF (Psychosocial RF) | BACKGROUND: Pain and post-traumatic stress disorder (PTSD) are frequently co-morbid in the aftermath of a traumatic event. Although several models attempt to explain the relationship between these two disorders, the mechanisms underlying the relationship remain unclear. The aim of this study was to investigate the relationship between each PTSD symptom cluster and pain over the course of post-traumatic adjustment. METHOD: In a longitudinal study, injury patients (n=824) were assessed within 1 week post-injury, and then at 3 and 12 months. Pain was measured using a 100-mm Visual Analogue Scale (VAS). PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS). Structural equation modelling (SEM) was used to identify causal relationships between pain and PTSD. RESULTS: In a saturated model we found that the relationship between acute pain and 12-month pain was mediated by arousal symptoms at 3 months. We also found that the relationship between baseline arousal and re-experiencing symptoms, and later 12-month arousal and re-experiencing symptoms, was mediated by 3-month pain levels. The final model showed a good fit [chi2=16.97, df=12, p>0.05, Comparative Fit Index (CFI)=0.999, root mean square error of approximation (RMSEA)=0.022]. CONCLUSIONS: These findings provide evidence of mutual maintenance between pain and PTSD. |
0 | Osteoporosis and skeletal fractures | Management of Hip Fractures in the Elderly | Osteoporosis affects millions of individuals worldwide, rendering them susceptible to fragility fractures of the spine, hip, and wrist and leading to significant morbidity, mortality, and economic cost. Given the substantial impact of osteoporosis on both patients and the medical community, it is imperative that physicians improve awareness and knowledge of osteoporosis in the setting of low-energy fractures. In this review, we provide information on effective means of preventing fragility fractures and introduce clinicians to issues pertinent to the patient who suffers an osteoporotic fracture. Prevention of fragility fractures centers around adequate mineral nutrition, including daily calcium and vitamin D supplementation, as well as prescription antiresorptive medications such as bisphosphonates or teriparatide therapy in severe cases, both of which have been shown to decrease future fracture risk. Balance and strength training also play important roles in the management of the osteoporotic patient, particularly following a low-energy fracture, and external hip protectors may be useful for certain patients. Kyphoplasty and vertebroplasty are two minimally invasive techniques that show great promise in the treatment of vertebral compression fractures, although questions regarding long-term biomechanical effects still exist. Traditionally, osteoporosis has been underdiagnosed and undertreated following a low-energy fracture in an elderly patient. Although treatment rates may be improving through public health initiatives, the majority of patients with osteoporosis remain inadequately treated. Perioperative intervention programs that focus on patient education about osteoporosis and treatment options lead to significant increases in intervention and treatment. Reducing the risk of skeletal fractures in patients susceptible to osteoporosis involves improved physician education on the risk factors and management of osteoporosis, as well as informing patients on the significance of dual-energy X-ray absorptiometry testing and medical treatment so that they may serve as their own healthcare advocates in this often-undertreated disease |
1 | Survivorship Analysis at 15 Years of Cemented Press-Fit Condylar Total Knee Arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | We performed a survival analysis on 354 cemented primary press-fit condylar total knee arthroplasties in 277 patients with prospective follow-up (mean, 8.8 years; range, 0.3-16.9 years). The number of patients alive reaching 15 years at follow-up for survival analysis was 15. The cumulative survival rate at 15 years was 81.7% (95% confidence interval, 72.1%-88.5%), using revision for all causes as our end point. Indications for revision in our patient group were aseptic loosening 4.5%, infection 2.3%, and exchange of polyethylene insert 1.1%. Our results indicate that the cemented press-fit condylar total knee arthroplasty has a good long-term survival, at 15 years, based on revision as the end point. (copyright) 2008 Elsevier Inc. All rights reserved |
1 | Costo Utilidad de Colagena Polivinil-Pirrolidona en el Tratamiento de Osteartrosis de Rodilla en Mexico | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: To assess the cost-utility of collagen-polyvinyl pyrrolidone (collagen-PVP), a new drug developed and manufactured in Mexico, compared to non-steroidal anti-inflammatory drugs in the treatment of patients with knee osteoarthritis (OA) in Mexico.
METHODS: A probabilistic Markov model with a lifetime horizon was designed to evaluate the costs and outcomes (QALYs) of collagen-PVP compared to NSAIDs in patients with OA. Data from randomized clinical trials conducted in Mexico were obtained as input for probabilities. Utility values were elicited from international publications and costs information and service utilization was obtained from official publications of the Instituto Mexicano de Seguro Social - IMSS. Cost per quality-adjusted life-years was calculated by using the Mexican Healthcare payer perspective. A discount rate of 5% for both cost and outcomes was used. Sensitivity analyzes were performed with variations in the parameters of gender, age, and price of collagen-PVP.
RESULTS: Patients treated with collagen-PVP showed a gain of 6.62 QALYs compared with 5.36 in patients with NSAIDs. The cost-utility ratio was higher in the NSAID group (MEX$ 170,010.76/QALY) compared to collagen-PVP (MEX $ 130,953.63/QALY). The incremental cost-utility ratio was MEX $ 35,194.16.
CONCLUSIONS: This is the first economic evaluation of a new medication developed in Mexico and conducted partially with local data. The results of this study allow concluding that collagen-PVP is deemed as the dominant alternative compared with NSAIDs in the treatment of knee osteoarthritis. |
0 | The deterioration of calcified cartilage integrity reflects the severity of osteoarthritis-A structural, molecular, and biochemical analysis | AMP (Acute Meniscal Pathology) | The calcified cartilage zone (CCZ) is a thin interlayer between the hyaline articular cartilage and the subchondral bone and plays an important role in maintaining the joint homeostasis by providing biological and mechanical support from unmineralized cartilage to the underlying mineralized subchondral bone. The hallmark of CCZ characteristics in osteoarthritis (OA) is less well known. The aim of our study is to evaluate the structural, molecular, and biochemical composition of CCZ in tissues affected by primary knee OA and its relationship with disease severity. We collected osteochondral tissue samples stratified according to disease severity, from 16 knee OA patients who underwent knee replacement surgery. We also used meniscectomy-induced rat samples to confirm the pathophysiologic changes of human samples. We defined the characteristics of the calcified cartilage layer using a combination of morphological, biochemical, proteomic analyses on laser micro-dissected tissue. Our results demonstrated that the Calcium/Phosphate ratio is unchanged during the OA progression, but the calcium-binding protein and cadherin binding protein, as well as carbohydrate metabolism-related proteins, undergo significant changes. These changes were further accompanied by thinning of the CCZ, loss of collagen and proteoglycan content, the occurrence of the endochondral ossification, neovasculature, loss of the elastic module, loss of the collagen direction, and increase of the tortuosity indicating an altered structural and mechanical properties of the CCZ in OA. In conclusion, our results suggest that the calcified cartilage changes can reflect the disease progression. |
0 | ASCs derived from burn patients are more prone to increased oxidative metabolism and reactive oxygen species upon passaging | Panniculectomy & Abdominoplasty CPG | BACKGROUND: Patients with severe burn injury (over 20% of the total body surface area) experience profound hypermetabolism which significantly prolongs wound healing. Adipose-derived stem cells (ASCs) have been proposed as an attractive solution for treating burn wounds, including the potential for autologous ASC expansion. While subcutaneous adipocytes display an altered metabolic profile post-burn, it is not known if this is the case with the stem cells associated with the adipose tissue. METHODS: ASCs were isolated from discarded burn skin of severely injured human subjects (BH, n?=?6) and unburned subcutaneous adipose tissue of patients undergoing elective abdominoplasty (UH, n?=?6) and were analyzed at passages 2, 4, and 6. Flow cytometry was used to quantify ASC cell surface markers CD90, CD105, and CD73. Mitochondrial abundance and reactive oxygen species (ROS) production were determined with MitoTracker Green and MitoSOX Red, respectively, while JC-10 Mitochondrial Membrane Potential Assays were also performed. Mitochondrial respiration and glycolysis were analyzed with a high-resolution respirometer (Seahorse XFe24 Analyzer). RESULTS: There was no difference in age between BH and UH (34?±?6 and 41?±?4?years, respectively, P?=?0.49). While passage 2 ASCs had lower ASC marker expression than subsequent passages, there were no significant differences in the expression between BH and UH ASCs. Similarly, no differences in mitochondrial abundance or membrane potential were found amongst passages or groups. Two-way ANOVA showed a significant effect (P?<?0.01) of passaging on mitochondrial ROS production, with increased ROS in BH ASCs at later passages. Oxidative phosphorylation capacities (leak and maximal respiration) increased significantly in BH ASCs (P?=?0.035) but not UH ASCs. On the contrary, basal glycolysis significantly decreased in BH ASCs (P?=?0.011) with subsequent passaging, but not UH ASCs. CONCLUSIONS: In conclusion, ASCs from burned individuals become increasingly oxidative and less glycolytic upon passaging when compared to ASCs from unburned patients. This increase in oxidative capacities was associated with ROS production in later passages. While the autologous expansion of ASCs holds great promise for treating burned patients with limited donor sites, the potential negative consequences of using them require further investigation. |
0 | Disparities in Utilization of Outpatient Rehabilitative Care Following Hip Fracture Hospitalization With Respect to Race and Ethnicity | HipFx Supplemental Cost Analysis | Nguyen-Oghalai TU, Ottenbacher KJ, Kuo Y-F, Wu H, Grecula M, Eschbach K, Goodwin JS. Disparities in utilization of outpatient rehabilitative care following hip fracture hospitalization with respect to race and ethnicity. Objective: To compare the prevalence of discharge home to self-care after hip fracture hospitalization among the elderly in 3 racial groups: whites, Hispanics, and blacks. Design: Secondary data analysis. Setting: US hospitals. Participants: Patients (N=34,203) aged 65 and older with Medicare insurance discharged after hip fracture hospitalization between 2001 and 2005. Interventions: Not applicable. Main Outcome Measure: Discharge home to self-care. Results: Bivariate analyses showed higher rates of discharge home to self-care among minorities, 16.4% for Hispanics, 8.7% for blacks, and 5.9% for whites. Hispanics had 3-fold higher odds of being discharged home to self-care, and blacks had about 50% higher odds of being discharged home to self-care after adjusting for age, sex, Klabunde's comorbidity index, income, year of admission, type of hip fracture, surgical stabilization procedure, and length of hospital stay. Conclusions: The higher rate of discharge home to self-care among minorities underscores the risk of suboptimal outpatient rehabilitative care among minorities with hip fracture. (copyright) 2009 American Congress of Rehabilitation Medicine |
0 | The effectiveness of autologous conditioned serum in the treatment of knee osteoarthritis | SR for PM on OA of All Extremities | CLINICAL SCENARIO: Osteoarthritis (OA) is a debilitating degenerative disease affecting an estimated 27 million Americans. A systematic review found that patients with a previous history of traumatic knee injury are at increased risk of developing knee OA, regardless of specific injury. It is vital for the maintenance of quality of life for individuals affected with OA that the treatment options available be able to reduce symptoms and restore quality of living. The pain-relief benefits of traditional injection treatments are small to moderate and have a limited duration. It was found that at 2 wk postinjection that corticosteroids were more effective than hyaluronic acid (HA) injections. Autologous conditioned serum (ACS) injection is a novel treatment that has shown favorable results. However, many clinicians continue to use HA injections for reduction of symptoms in patients with osteoarthritis when the use of ACS may be more beneficial. FOCUSED CLINICAL QUESTION: For patients with knee OA, is an ACS injection more efficient at producing a reduction in symptoms than HA or a saline injection? |
1 | The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis | Anterior Cruciate Ligament Injuries CPG | The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50% of those with a diagnosed anterior cruciate ligament or meniscus tear have osteoarthritis with associated pain and functional impairment: the young patient with an old knee. These individuals make up a substantial proportion of the overall osteoarthritis population. There is a lack of evidence to support a protective role of repair or reconstructive surgery of the anterior cruciate ligament or meniscus against osteoarthritis development. A consistent finding in a review of the literature is the often poor reporting of critical study variables, precluding data pooling or a meta-analysis. Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. In evaluating medical treatment, we now expect large randomized clinical trials complemented by postmarketing monitoring. We should strive toward a comparable level of quality of evidence in surgical treatment of knee injuries. In instances in which a randomized clinical trial is not feasible, natural history and other observational cohort studies need to be as carefully designed and reported as the classic randomized clinical trial, to yield useful information |
0 | The association between weight-bearing status and early complications in hip fractures | DoD SSI (Surgical Site Infections) | Background: Early mobilization and weight-bearing have been proposed to improve hip fracture outcomes. This study aimed to compare early postoperative complications and outcomes of patients who underwent weight-bearing as tolerated (WBAT) on postoperative day one (POD1) with those that did not on: (1) 30-day mortality; (2) 30-day postoperative major and minor complications; (3) length of stay (LOS); and (4) discharge disposition after hip fracture management. Methods: The NSQIP database was used to identify 7947 hip fracture patients managed with a hemiarthroplasty and internal fixation, sliding hip screw, or cephalomedullary nail, for a total of 5845 patients were allowed to WBAT on POD1. They were compared to patients who were non-WBAT using adjusted multivariate regression models to evaluate the effect of WBAT status on the outcomes above. Results: Among the cephalomedullary nail patients, WBAT on POD1 was associated with a decreased likelihood of mortality. In the cephalomedullary nail and sliding hip screw treatment groups, patients were less likely to experience major and minor complications if they were WBAT on POD1. WBAT patients had shorter LOS in the sliding hip screw and cephalomedullary nail treatment groups. Patients were less likely to be discharged to a non-home facility when WBAT on POD1 regardless of treatment. Conclusion: Early weight-bearing after surgical care of hip fracture seems to decrease morbidity and mortality; however, this effect is treatment dependent. These findings further support the need for early mobilization and rapid recovery programs in the care of hip fracture patients. Level of evidence: Level III. |
0 | High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis with Kissing Lesions in Relatively Young Patients | OAK 3 - Non-arthroplasty tx of OAK | Purpose: The purpose of this study is to compare the clinical and radiographic outcomes of high tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) in advanced medial compartment arthritis accompanied by kissing lesions in relatively young patients.
Materials and Methods: Forty-five patients were divided into the HTO (n=23) and UKA (n=22) groups. Clinically, we evaluated the Lysholm knee scoring scale, visual analogue scale, Hospital for Special Surgery, and Western Ontario and McMaster Universities Osteoarthritis index scores preoperatively, 6 and 12 months postoperatively, and at the final follow-up. Radiographically, we measured the femoral-tibial angle and mechanical axis deviation preoperatively and at the final follow-up.
Results: All clinical outcomes gradually improved in both groups from the postoperative period to the final follow-up. At the final follow-up, all clinical outcomes were slightly better in the UKA group than in the HTO group; however, differences were not statistically significant.
Conclusions: HTO is comparable to UKA in terms of clinical outcomes. Thus, the results of this study suggest that HTO might be a good alternative treatment to UKA for medial unicompartmental arthritis accompanied by kissing lesions in relatively young patients. |
1 | Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: a randomized controlled trial | Management of Hip Fractures in the Elderly | OBJECTIVE: To compare the effect of early discharge and home-based therapy with conventional hospital rehabilitation on patient and caregiver outcomes at 12 months after hip fracture. DESIGN: Randomized controlled trial. SETTING: Acute and subacute care with follow-up in a community setting in Australia. PARTICIPANTS: Sixty-six older adults admitted to acute care after hip fracture who were assessed as needing rehabilitation. INTERVENTIONS: Eligible patients were randomized to either home-based (n=34) or hospital (n=32) rehabilitation. Patients assigned to the home-based group were discharged home within 48 hours of randomization. Patients assigned to hospital rehabilitation received usual care. MAIN OUTCOME MEASURES: Modified Barthel Index (MBI), timed up and go (TUG) test, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index. RESULTS: At 12 months, 56 of 66 (85%) participants were available for follow-up assessment. Both groups achieved significant improvements in MBI and TUG test scores. Patients in both groups had a significant decline in the physical score of the SF-36 and there were no differences between groups. Caregivers of patients allocated to receive home-based therapy reported a reduction in burden after 12 months. Over that period, there was a significant reduction in the burden for caregivers of those patients who received home rehabilitation (P=.020). CONCLUSION: For patients who were previously functionally independent and living in the community, early return home with increased involvement of caregivers after hip fracture resulted in similar patient outcomes (home vs hospital) and less caregiver burden at 12 months |
0 | Secondary Primary Malignancy Risk in Patients With Cervical Cancer in Taiwan: A Nationwide Population-Based Study | MSTS 2022 - Metastatic Disease of the Humerus | To evaluate the risk of secondary primary malignancy (SPM) in patients with cervical cancer using a nationwide population-based dataset.Patients newly diagnosed with cervical cancer between 1997 and 2011 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated by comparing with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models.During the 14-year study period (follow-up of 223,062 person-years), 2004 cancers developed in 35,175 patients with cervical cancer. The SIR for all cancers was 1.56 (95% confidence interval, 1.50-1.63, P < 0.001). SIRs for follow-up periods of >10, 5 to 10, 1 to 5, and <1 year were 1.37, 1.51, 1.34, and 2.59, respectively. After the exclusion of SPM occurring within 1 year of cervical cancer diagnosis, SIRs were significantly higher for cancers of the esophagus (2.05), stomach (1.38), colon, rectum, and anus (1.36); lung and mediastinum (2.28), bone and soft tissue (2.23), uterus (3.76), bladder (2.26), and kidneys (1.41). Multivariate analysis showed that age >=60 was a significant SPM risk factor (hazard ratio [HR] 1.59). Different treatments for cervical cancer, including radiotherapy (HR 1.41) and chemotherapy (HR 1.27), had different impacts on SPM risk. Carboplatin and fluorouracil independently increased SPM risk in cervical cancer patients.Patients with cervical cancer are at increased risk of SPM development. Age >=60 years, chemotherapy, and radiotherapy are independent risk factors. Carboplatin and fluorouracil also increased SPM risk independently. Close surveillance of patients at high risk should be considered for the early detection of SPMs. |
0 | A cell-free scaffold-based cartilage repair provides improved function hyaline-like repair at one year | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: Bone marrow stimulation techniques in cartilage repair such as drilling are limited by the formation of fibrous to hyaline-like repair tissue. It has been suggested such techniques can be enhanced by covering the defect with scaffolds. We present an innovative approach using a polyglycolic acid (PGA)-hyaluronan scaffold with platelet-rich-plasma (PRP) in drilling.
QUESTIONS/PURPOSES: We asked whether (1) PRP immersed in a cell-free PGA-hyaluronan scaffold improves patient-reported 1-year outcomes for the Knee injury and Osteoarthritis Score (KOOS), and (2) implantation of the scaffold in combination with bone marrow stimulation leads to the formation of hyaline-like cartilage repair tissue.
PATIENTS AND METHODS: We reviewed 52 patients who had arthroscopic implantation of the PGA-hyaluronan scaffold immersed with PRP in articular cartilage defects of the knee pretreated with Pridie drilling. Patients were assessed by KOOS. At 9 months followup, histologic staining was performed in specimens obtained from five patients to assess the repair tissue quality.
RESULTS: The KOOS subscores improved for pain (55 to 91), symptoms (57 to 88), activities of daily living (69 to 86), sports and recreation (36 to 70), and quality of life (38 to 73). The histologic evaluation showed a homogeneous hyaline-like cartilage repair tissue.
CONCLUSIONS: The cell-free PGA-hyaluronan scaffold combined with PRP leads to cartilage repair and improved patient-reported outcomes (KOOS) during 12 months of followup. Histologic sections showed morphologic features of hyaline-like repair tissue. Long-term followup is needed to determine if the cartilage repair tissue is durable.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. |
1 | Arthroscopic meniscal repair: Current techniques and outcomes | AMP (Acute Meniscal Pathology) | Arthroscopic treatment of meniscal pathology is one of the most common orthopaedic procedures in the United States, constituting 10-20% of all surgeries performed in many centers. This review summarizes the surgical indications and the actual operative techniques in arthroscopic meniscal repair. |
0 | Quantitative ultrasound: use in screening for susceptibility to stress fractures in female army recruits | HipFx Supplemental Cost Analysis | QUS measurements were made on 4139 female Army recruits at the beginning of basic training (BT). QUS predicted stress fracture in female recruits as well as it predicts hip fracture in elderly women. Recruits with low QUS values and a history of smoking and not exercising had an extremely high risk of stress fracture. INTRODUCTION: Stress fractures during basic military training (BT) cause morbidity for the recruits and expense for the Military Services. Females have a higher incidence than males. If recruits at high risk for stress fracture could be accurately identified before they began BT, the military might find it advantageous to provide adaptive training programs for them. Currently no accurate methods of risk identification are available. We measured quantitative ultrasound (QUS) in a population sample of female Army recruits to determine if QUS is a useful tool for determining soldiers at high risk of stress fracture during BT. MATERIALS AND METHODS: We recruited 93% of the population of female recruits entering BT at Fort Leonard Wood, MO, during a 10-month period. We measured calcaneal QUS and administered a risk factor questionnaire at baseline and ascertained stress fractures during the 8 weeks of BT. Logistic regression was used to calculate relative risk (RR) of stress fracture. The area under the receiver-operating characteristic (ROC) curve was also analyzed to determine the sensitivity and specificity of speed of sound (SOS) in predicting stress fracture. RESULTS: The incidence of stress fracture was 4.7%. SOS was significantly related to the risk of stress fracture. (p < 0.000) The area under the ROC curve was 0.70. The relative risk (RR) of fracture of those in the lowest quintile (Q1) of SOS was 6.7. The highest risk of stress fracture was found in the subgroup of white women in Q1 of SOS who smoked and didn't exercise (RR, 14.4). Over 16% of the fractures occurred in this subgroup, which indicates that about six of these women would need to be assigned to an alternate BT regimen to prevent one stress fracture. CONCLUSIONS: The combination of QUS measurements with evaluation of individual risk factors can identify recruits who are at the very highest risk of stress fracture. The military may find these data helpful to determine the cost-effectiveness of alternate BT regimens |
0 | Thumb reconstruction with a free neurovascular wrap-around flap from the big toe: long-term follow-up of thirty cases | DoD LSA (Limb Salvage vs Amputation) | From March 1982 to December 1992, 30 cases of thumb reconstruction with a free neurovascular wrap-around flap from the big toe were performed at Korea University Hospital. Twenty-nine of a total of 30 cases were successful and obtained excellent functional and cosmetic results. Postoperative complications included 1 case of graft failure, 6 partial skin necroses, 1 malunion, and 15 cases of resorption of iliac bone graft including 1 case of fatigue fracture of grafted bone. Even for the first metacarpal neck amputations, thumb reconstruction with a free neurovascular wrap-around flap was possible; however, limitation of motion of the reconstructed thumb and resorption of the grafted bone occurred. Thumb reconstruction with a wrap-around free flap from the big toe gives excellent cosmetic and functional results and causes minimal morbidity on the donor site. |
0 | Wear and lysis is the problem in modular TKA in the young OA patient at 10 years | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Most long-term followup studies of younger patients who underwent TKA include a relatively high percentage of rheumatoid patients, whose function and implant durability may differ from those with osteoarthritis (OA). QUESTIONS/PURPOSES: The purpose of this study was to evaluate the minimum 10 year followup of TKA performed in more active patients with OA, using modular tibial components, to determine the durability of that construct. Specifically, we determined (1) survivorship; (2) revision rates; (3) functional scores; and (4) rates of radiographic failure at a minimum 10 year followup. METHODS: We retrospectively reviewed 59 patients (67 knees) with OA who underwent primary total knee arthroplasty with posterior cruciate retaining (27%) or posterior cruciate substituting (73%) components which had modular tibial trays. Patients were evaluated clinically for need of revision and Knee Society, SF-36 and WOMAC scores as well as UCLA and Tegner activity scores. Radiographs were evaluated for loosening and osteolysis. The minimum followup of living patients was 10 years (mean, 12.4 years; range, 10 to 18.4 years). Ten patients (11 knees) died; two patients (2 knees) were lost to followup. RESULTS: Ten patients (11 knees; 16%) had revisions for aseptic loosening and/or osteolysis. Thirty-one patients (65%) were still performing moderate labor or sports activities. The average UCLA score was 5.5 (range, 2-9). No nonrevised knee demonstrated radiographic loosening. CONCLUSION: Most patients in this active patient population continued to have acceptable function although 16% underwent revision for wear and/or osteolysis. Isolated tibial insert exchange alone was performed in four of the 11 (36%) revised knees. These data should provide comparison for total knee arthroplasties performed in younger patients with newer designs and newer bearing materials. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence |
0 | Entrapment neuropathy of the palmar cutaneous branch of the median nerve in carpal tunnel syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | OBJECTIVE: The aim of this study is to elucidate the significance of electrophysiological data of the palmar cutaneous branch of the median nerve (PCBm) in the diagnosis entrapment of the PCBm concomitant with carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Clinical and electrophysiological studies were conducted for abnormal sensation of the thenar eminence in eight CTS patients. Sensory nerve action potentials (SNAPs) of the PCBm were recorded from bipolar surface electrodes over the forearm using an orthodromic method. The preoperative SNAP evaluation was compared with the operative findings. RESULTS: The eight patients were divided into two groups based on the characteristics of SNAPs of the PCBm; five patients had normal SNAPs of the PCBm and three patients had delayed or absent SNAPs. Open surgery confirmed entrapment of the PCBm in one patient in the first group and all patients in the latter group. CONCLUSIONS: Although clinical symptoms were not always reliable to diagnose entrapment of the PCBm in CTS, electrophysiological study of the PCBm was highly sensitive (75%) and entirely specific (100%) to demonstrate the entrapment of the PCBm preoperatively |
0 | The chemokine receptor CXCR7 is a critical regulator for the tumorigenesis and development of papillary thyroid carcinoma by inducing angiogenesis in vitro and in vivo | MSTS 2018 - Femur Mets and MM | Papillary thyroid carcinoma (PTC) is a well-differentiated neoplasm, but it can transfer early to cervical lymph nodes. Accumulating evidences have confirmed the important roles of CXCR7 in tumor cell proliferation, invasion, metastasis, and angiogenesis. Our previous study demonstrated CXCR7 modulated proliferation, apoptosis, and invasion of PTC cells. In this study, we evaluated the effect of expression of CXCR7 in PTC cells on angiogenesis and whether its expression had an influence on the tumor growth of PTC in vivo. We evaluated the effect of CXCR7 on interleukin-8 (IL-8) and vascular endothelial growth factor (VEGF) secretion, angiogenesis, and tumor growth by ELISA, endothelial tube formation assay, and a xenograft tumor model in nude mice. Immunohistochemistry was used to assess expression of CD34 in tumor of mice. In vitro and in vivo studies in PTC cells suggested that the alteration of CXCR7 expression was correlated with angiogenesis and tumor growth. Moreover, CXCR7 mediated the expression of IL-8 and VEGF, which might be involved in the regulation of tumor angiogenesis. These findings suggest that CXCR7 affects the growth of PTC cells and participates in the tumorigenesis of PTC, probably through regulating angiogenesis by the proangiogenic VEGF or IL-8. |
0 | Diabetes and peripheral neuropathy: keeping people on their own two feet | DoD LSA (Limb Salvage vs Amputation) | Peripheral neuropathy is one of the most common forms of diabetes-related neuropathy, and most commonly affects the feet. Loss of sensation leaves the feet at risk of damage--from environmental hazards, incorrectly fitting footwear or un-felt pressure damage--which can lead to the need for amputations. This article discusses how to reduce the risk of peripheral neuropathy through glycaemic control, and the steps that need to be taken to reduce the risk of injury on the neuropathic foot. |
0 | Patellar resurfacing in total knee arthroplasty for osteoarthritis: a meta-analysis | SR for PM on OA of All Extremities | PURPOSE: Whether to resurface the patella during a primary total knee arthroplasty remains a controversial issue. The aim of this study was to determine the advantages and disadvantages of patellar resurfacing during total knee arthroplasty for osteoarthritis through an evaluation of the current literature. METHODS: A meta-analysis of randomized controlled trials comparing patellar resurfacing with nonresurfacing during total knee arthroplasties was performed. The focus of this analysis was on outcomes of reoperation, anterior knee pain and knee scores. RESULTS: Ten trials assessing 1,003 knees were eligible. The absolute risk of reoperation was reduced by 4% (95% confidence interval, 1-7%) in the patellar resurfacing arm (between-study heterogeneity, P = 0.06, I (2) = 45%), implying that one would have to resurface 25 patellae (95% confidence interval, 14-100 patellae) in order to prevent one reoperation. Only seven trials provided adequate data of anterior knee pain for a quantitative synthesis. On the basis of those seven trials, there was no difference between the two groups in terms of anterior knee pain. Anterior knee pain after total knee arthroplasty could have multiple etiologies such as surgical factors and nonresurfaced patella is not the sole cause of this problem. CONCLUSION: The available evidence indicates that patellar resurfacing reduce the risk of reoperation after total knee arthroplasty for osteoarthritis. Not resurfacing the patella might be considered a reasonable option, but patients must accept the increased risk of reoperation for which the quantitative evidence-based synthesis is mild. Based on the evidence provided by this study and those previously published ones, the authors do not now resurface the patella as a matter of routine for patients having a primary total knee arthroplasty for osteoarthritis |
1 | Intraarticular sprifermin (recombinant human fibroblast growth factor 18) in knee osteoarthritis: a randomized, double-blind, placebo-controlled trial | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: To evaluate the efficacy and safety of intraarticular sprifermin (recombinant human fibroblast growth factor 18) in the treatment of symptomatic knee osteoarthritis (OA).
METHODS: The study was a randomized, double-blind, placebo-controlled, proof-of-concept trial. Intraarticular sprifermin was evaluated at doses of 10 mug, 30 mug, and 100 mug. The primary efficacy end point was change in central medial femorotibial compartment cartilage thickness at 6 months and 12 months as determined using quantitative magnetic resonance imaging (qMRI). The primary safety end points were nature, incidence, and severity of local and systemic treatment-emergent adverse events (AEs) and acute inflammatory reactions, as well as results of laboratory assessments. Secondary end points included changes in total and compartment femorotibial cartilage thickness and volume as assessed by qMRI, changes in joint space width (JSW) seen on radiographs, and pain scores on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
RESULTS: One hundred ninety-two patients were randomized and evaluated for safety, 180 completed the trial, and 168 were evaluated for the primary efficacy end point. We found no statistically significant dose response in change in central medial femorotibial compartment cartilage thickness. Sprifermin was associated with statistically significant, dose-dependent reductions in loss of total and lateral femorotibial cartilage thickness and volume and in JSW narrowing in the lateral femorotibial compartment. All groups had improved WOMAC pain scores, with statistically significantly less improvement at 12 months in patients receiving the 100-mug dose of sprifermin as compared with those receiving placebo. There was no significant difference in serious AEs, treatment-emergent AEs, or acute inflammatory reactions between sprifermin and placebo groups.
CONCLUSION: No statistically significant relationship between treatment group and reduction in central medial femorotibial compartment cartilage thickness was observed; however, prespecified structural secondary end points showed statistically significant dose-dependent reductions after sprifermin treatment. Sprifermin was not associated with any local or systemic safety concerns. |
0 | Extended trochanteric osteotomy via the direct lateral approach in revision hip arthroplasty | Management of Hip Fractures in the Elderly | A review of the results of the extended trochanteric osteotomy through a modified direct lateral approach in revision total hip arthroplasty was done. We reviewed 44 patients (45 procedures) at a minimum of 2 years followup (mean, 3.8 years; range, 2.1-7.2 years). There were 26 men and 18 women with a mean age at the time of surgery of 70.8 years (range, 36.9-90.4 years). Indications for use of the trochanteric osteotomy included facilitation of cement removal (25 procedures), proximal femoral varus deformity (14 procedures), trochanteric malposition (five procedures), and previous trochanteric osteotomies with significant bony overgrowth (three procedures). The mean length of the osteotomy was 133.9 mm. The mean migration of the osteotomized fragment was 2.1 mm (range, 0-20 mm) with significantly more proximal migration seen with the use of cerclage wires when compared with cables. There were two cases of trochanteric escape, for which the patients required repeat open reduction internal fixation. There were two late fractures of the greater trochanter. One femoral component had early subsidence for which the patient required re-revision with a further extended trochanteric osteotomy. The mean time to union of the remaining 40 hips was 10.3 months (range, 6-24 months). There only was one dislocation postoperatively. The extended trochanteric osteotomy through the modified direct lateral approach in revision total hip arthroplasty is a reproducible and reliable technique with a lower dislocation rate but a higher incidence of trochanteric fracture and escape than previously described with its use in the posterior approach |
0 | What is the prevalence of musculoskeletal problems in the elderly population in developed countries? A systematic critical literature review | SR for PM on OA of All Extremities | BACKGROUND: The proportion of older people will be tripled by the year 2050. In addition, the incidence of chronic musculoskeletal (MSK) conditions will also increase among the elderly people. Thus, in order to prepare for future health care demands, the magnitude and impact of MSK conditions from this growing population is needed. The objective of this literature review is to determine the current prevalence of MSK disorders in the elderly population. METHODS: A systematic literature search was conducted in Pubmed on articles in English, published between January 2000 and July 2011. Studies from developed countries with prevalence estimates on elderly people (60+) on the following MSK conditions were included: Non-specific extremity pain, rheumatoid arthritis, osteoarthritis, osteoporosis, and back pain. The included articles were extracted for information and assessed for risk of bias. RESULTS: A total of 85 articles were included with 173 different prevalence estimates. Musculoskeletal disorders are common in the elderly population, but due to heterogeneity of the studies, no general estimate on the prevalence of MSK can be determined. Women report more often MSK pain than men. Overall, prevalence estimates either remain fairly constant or increase slightly with increasing age, but with a tendency to decrease in the oldest (80+) people. CONCLUSIONS: Musculoskeletal disorders remain prevalent in the elderly population. Given the increasing proportion of elderly population in the world population and the burden of MSK diseases among the elderly people, efforts must be made to maintain their functional capacity for as long as possible through optimal primary and secondary health care |
0 | Clinical patterns and management of primary mucosal melanoma: a single centre experience | Reconstruction After Skin Cancer | BACKGROUND: Primary mucosal melanomas (MM) are rare neoplasms arising from melanocytes in mucosal membranes. Delayed diagnosis and aggressive disease biology contribute to a poorer prognosis. The clinical patterns of MMs treated in a large tertiary centre, and the differences between MMs in the head and neck versus other anatomical sites are described. METHODS: A retrospective review of 43 patients diagnosed with MM in the head and neck, urogenital, esophageal and anorectal sites from 1993 to 2015 was conducted. RESULTS: Distribution of head and neck, urogenital and gastrointestinal MM were 42, 30 and 28% respectively. Disease extent was local in 44%, regional in 40% and distal in 12% at diagnosis. Head and neck MMs were more likely to be diagnosed at an earlier stage as compared to other sites (P = 0.04). Surgery was performed with curative intent in 72%, while 2% had palliative surgery for symptom control. Of the remaining patients who did not undergo surgery, four had palliative chemotherapy and/or radiotherapy. Median disease-free survival was 13 months (1-179 months). There was a significantly longer time to locoregional recurrence in head and neck MM (16 months) compared to other sites (11 months) (P = 0.03). The 2-year overall survival was also significantly higher in head and neck MM (P = 0.003). CONCLUSION: MM of the head and neck is diagnosed at an earlier stage and associated with a longer time to locoregional recurrence. Surgical resection is the mainstay of treatment and may offer long-term survival benefit in selected patients. |
0 | Imaging in multiple myeloma | MSTS 2018 - Femur Mets and MM | In multiple myeloma, imaging is required to determine the stage of disease and to anticipate impending bone fractures. Whereas the traditionally used Durie and Salmon staging system includes lytic bone lesions in plain films as criteria, modern systems include MRI findings. MRI is most sensitive to both diffuse bone marrow involvement as well as solid plasma cell tumors. Whole-body low-dose CT (WBCT) may replace plain films in the near future, since it is quicker, more sensitive, and is better tolerated by patients. Intramedullary lesions are well seen as long as they are located in long bones where they are surrounded by fat. Diffuse bone marrow infiltration as well as intravertebral lesions, however, are difficult to detect with WBCT in the absence of frank destruction of cancellous bone. PET or PET-CT with 18-fluoro-deoxyglucose (FDG) are insensitive to diffuse bone marrow infiltration, but may help to assess treatment response in solitary or multiple solid plasma cell tumors which have a high FDG uptake before treatment. |
0 | Dislocation after total hip arthroplasty: A single surgeon's experience | Management of Hip Fractures in the Elderly | The purpose of this article is to evaluate the dislocations that occurred in a single surgeon practice over a 26 year period. After extensive research, the authors concluded that dislocation continues to occur long after the initial arthroplasty procedure. Patients should be aware that more than a quarter of dislocations occur 2 years following surgery. Use of modular 22 millimeter components were associated with the highest dislocation rate. These components should be used very cautiously. Constrained liners have helped decrease the dislocation rate following revision for dislocation |
0 | Prospective assessment of thoracic kyphosis in postmenopausal women with osteoporosis | Management of Hip Fractures in the Elderly | We attempt to assess quantitatively thoracic kyphosis and its influence on incident fractures and quality of life over three years in postmenopausal women with osteoporosis and the effect of strontium ranelate on thoracic kyphosis progression. This study was performed on women with postmenopausal osteoporosis from the Spinal Osteoporosis Therapeutic Intervention (SOTI) and Treatment of Peripheral Osteoporosis (TROPOS) studies. Vertebral fractures were assessed on lateral thoracic radiographs performed at baseline and at three years according to standardized procedure. Kyphosis index (KI, %), was defined as the percentage ratio between the maximum depth of thoracic curvature and the height measured from the T4 to the T12 vertebrae. Baseline characteristics of the 3218 patients (1594 strontium ranelate, 1624 placebo) were mean age 73.3 years, spine bone mineral density (BMD) T-score (L2-4) -3.1, femoral neck T-score -3.0, and KI 25.4%. In the placebo group, patients with the highest baseline KI experienced significantly more vertebral fractures than those with medium KIs [relative risk (RR) = 1.53; 95% confidence interval (CI) 1.19-1.96, p < .001) or the lowest KIs (RR = 1.70, 95%CI 1.32-2.21, p < .001), even after adjusting for the presence of prevalent fractures, age, body mass index (BMI), and BMD. There was no difference in the risk of nonvertebral fractures according to baseline KI. Three-year changes in quality-of-life physical scores reflected significantly better status for patients in the lowest tertile of KI compared with those in the highest at baseline. Over three years, the KI increased for all patients, indicating worsening of thoracic kyphosis, whatever the presence of prevalent or incident vertebral fractures. This KI progression was lower in the strontium ranelate group than in the placebo group. Thoracic kyphosis is a risk factor for vertebral fractures over three years and influences physical capacity changes in postmenopausal women with osteoporosis. Thoracic kyphosis progression over three years is lower in a subgroup of strontium ranelate-treated patients compared with placebo-treated patients |
0 | Osteochondral allograft reconstruction: Improvements in surgical techniques and allograft processing | OAK 3 - Non-arthroplasty tx of OAK | Fresh osteochondral allograft (OCA) transplantation has more than a 100-year clinical history. Many clinical and basic scientific studies have been performed with the result that allografting is now part of the cartilage repair paradigm for the treatment of chondral or osteochondral lesions. In the knee joint, allografting has also been successfully used in complex joint reconstruction for the treatment of osteonecrosis, fracture malunion, and selected cases of osteoarthritis. Unlike many other cartilage repair techniques, OCAs have the ability to restore mature, hyaline articular cartilage to the affected area. By virtue of their composite structure (cartilage and bone), allografts also can restore diseased or damaged bone often present in large or complex lesions. The surgical techniques of allografting are relatively straightforward, and many clinical studies have shown excellent results. OCAs do present the surgeon with unique and important differences from other cartilage repair techniques, such as limited allograft tissue availability and the potential for transmission of infectious disease from the graft or immunologic response by the recipient. Ongoing investigations continue to clarify the indications, surgical techniques, and clinical outcomes of fresh OCAs. © 2014 Elsevier Inc. |
0 | Treatment of periprosthetic infections: an economic analysis | PJI DX Updated Search | This review summarizes the existing economic literature, assesses the value of current data, and presents procedures that are the less costly and more effective options for the treatment of periprosthetic infections of knee and hip. Optimizing antibiotic use in the prevention and treatment of periprosthetic infection, combined with systemic and behavioral changes in the operating room, the detection and treatment of high-risk patient groups, as well as the rational management of the existing infection by using the different procedures according to each particular case, could allow for improved outcomes and lead to the highest quality of life for patients and the lowest economic impact. Nevertheless, the cost-effectiveness of different interventions to treat periprosthetic infections remains unclear |
0 | Cautery dissection in levator surgery | Upper Eyelid and Brow Surgery | This report describes a new technique that facilitates dissection of tissue planes and essentially eliminates intraoperative bleeding, two of the most frequently encountered problems during levator surgery. The described technique has been used in more than 450 consecutive eyelids with congenital and acquired ptosis requiring levator surgery. Disinsertion or dehiscence of the aponeurosis was found in less than 5% of the cases of involutional ptosis. |
0 | Proximal tibial osteotomy for osteoarthritis of the knee with varus deformity | Surgical Management of Osteoarthritis of the Knee CPG | Objective: Correction of the axial malalignment to slow down wear tear of the medial compartment of the knee in instances of medial compartment osteoarthritis with varus deformity. Return to nearly normal weight-bearing ability of the knee. Indications: Patients up to a biologic age of 65 years with medial compartment osteoarthritis with varus malalignment. Contraindications: Morbid obesity, circulatory disturbances, gait disorders neurologic in origin, osteoarthritis of all three compartments. Surgical Technique: 1st step: oblique fibular osteotomy between proximal and middle third without internal fixation. 2nd step: anterolateral approach to the proximal tibia from distal-lateral to medial-proximal and resection of a bony wedge leaving the medial cortex intact. Internal fixation with a six-hole semitubular plate using a tensioner for compression of the fragments. Results: In 113 patients 121 valgus realignment tibial osteotomies for medial compartment osteoarthritis were performed by three surgeons. Minimal postoperative follow-up period 10 years. 86% of the osteotomies required no further treatment even after 10 years, a total knee replacement was done in only three patients between the 7th and 10th postoperative year. (copyright) Urban & Vogel Munchen |
0 | Clinical outcomes of radiation therapy in the management of Langerhans cell histiocytosis | Hip Fx in the Elderly 2019 | Objectives: Langerhans cell histiocytosis (LCH) is a rare disease with variable clinical presentation. In the present study, we report on the effectiveness and clinical complications of radiation therapy in children with LCH. Materials and Methods: We retrospectively reviewed all patients with LCH treated with radiation therapy over a 6-decade period at a single institution. Radiotherapy data, clinical features, radiographic data, and vital status were analyzed. Results: The mean age at diagnosis for 69 patients was 5.3 years (3 mo to 37 y) and the median duration of follow-up was 6 years (7 d to 32 y). Radiation therapy was performed for 169 sites, primarily bone lesions. The median radiotherapy dose was 10 Gy (2.5 to 45 Gy). Radiographic follow-up data were available for 139 of the sites treated and clinical follow-up was available for 156 of sites treated. The radiographic local control was 91.4%, and 13% of lesions showed complete sclerosis or reconstitution of bone. A total of 90.4% of patients reported stabilization or improvement in lesion-related symptoms, most often pain. Twelve patients had diabetes insipidus at diagnosis or during followup. Eight of these patients received radiation treatment to the pituitary and none experienced a reduction in desmopressin dosage posttreatment. Radiation complications were few, including femoral neck fracture in 1 patient and facial asymmetry in 3 patients. No secondary malignancies were observed. Conclusions: Radiotherapy for LCH has high rates of local control and symptomatic improvement. Importantly, however, there is evidence of short-term and long-term morbidity when children are treated with low-dose irradiation. |
1 | Personal and workplace psychosocial risk factors for carpal tunnel syndrome: a pooled study cohort | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | BACKGROUND: Between 2001 and 2010, six research groups conducted coordinated multiyear, prospective studies of carpal tunnel syndrome (CTS) incidence in US workers from various industries and collected detailed subject-level exposure information with follow-up symptom, physical examination, electrophysiological measures and job changes. OBJECTIVE: This analysis of the pooled cohort examined the incidence of dominant-hand CTS in relation to demographic characteristics and estimated associations with occupational psychosocial factors and years worked, adjusting for confounding by personal risk factors. METHODS: 3515 participants, without baseline CTS, were followed-up to 7 years. Case criteria included symptoms and an electrodiagnostic study consistent with CTS. Adjusted HRs were estimated in Cox proportional hazard models. Workplace biomechanical factors were collected but not evaluated in this analysis. RESULTS: Women were at elevated risk for CTS (HR=1.30; 95% CI 0.98 to 1.72), and the incidence of CTS increased linearly with both age and body mass index (BMI) over most of the observed range. High job strain increased risk (HR=1.86; 95% CI 1.11 to 3.14), and social support was protective (HR=0.54; 95% CI 0.31 to 0.95). There was an inverse relationship with years worked among recent hires with the highest incidence in the first 3.5 years of work (HR=3.08; 95% CI 1.55 to 6.12). CONCLUSIONS: Personal factors associated with an increased risk of developing CTS were BMI, age and being a woman. Workplace risk factors were high job strain, while social support was protective. The inverse relationship between CTS incidence and years worked among recent hires suggests the presence of a healthy worker survivor effect in the cohort |
0 | Complications during the treatment of missed Monteggia fractures with unilateral external fixation: a report on 20 patients in a 10-year period in a tertiary referral center | Distal Radius Fractures | The treatment of a missed Monteggia (MM) fracture dislocation is still controversial. We describe our initial experience with ulnar osteotomy and progressive correction with unilateral external fixator in MM. We retrospectively evaluated 20 children undergoing ulnar osteotomy and progressive distraction angulation by unilateral external fixator to treat MM. Nine patients had closed reduction, whereas 11 patients had simultaneous open reduction, repair, or reconstruction of the annular ligament and K-wire stabilization of the radiocapitellar joint. Patients were followed for an average of 3 (1-11) years. Three children developed aseptic nonunion and one child had delayed union. A distal level of the osteotomy significantly increased the rate of nonunion or delayed union. At the final follow-up, eight children had complete reduction of the radial head, six children had partial reduction, whereas in six cases, the radial head remained dislocated. The angulation and the level of the osteotomy significantly influenced the relocation, whereas the open reduction had no significant effect on the final position of the radial head. At the final follow-up, the Kim's score averaged 93.25. The flexion-extension arc significantly improved postoperatively, and it was positively correlated with the angulation. The ulnar osteotomy and progressive traction-angulation by unilateral external fixator can achieve satisfactory results in MM, if a meticulous surgical technique is applied; care must be taken regarding the level of osteotomy and the progressive traction-angulation. |
0 | A Rodent Model to Evaluate the Tissue Response to a Biological Scaffold When Adjacent to a Synthetic Material | Acellular Dermal Matrix | The use of biologic scaffold materials adjacent to synthetic meshes is commonplace. A prevalent clinical example is two-staged breast reconstruction, where biologic scaffolds are used to provide support and coverage for the inferior aspect of the synthetic expander. However, limited data exist regarding either the kinetics of biologic scaffold integration or the host tissue response to the biologic scaffold materials used for this application or other applications in which such scaffold materials are used. The present study evaluated the temporal host response to a biological scaffold when placed adjacent to a synthetic material. Evaluation criteria included quantification of material contracture and characterization of the host cell response and tissue remodeling events. Results show a decreased thickness of the collagenous tissue layer at biologic scaffold/silicone interface compared to the abdominal wall/silicone interface during the 12-week experimental time course. All test materials were readily incorporated into surrounding host tissue. |
1 | Bisphosphonates for advanced prostate cancer | MSTS 2018 - Femur Mets and MM | BACKGROUND: Prostate cancer is the most common cancer in men in many western countries. It is characterized by its propensity for bone metastases which occur in more than 80% of patients with advanced disease. Patients are at risk of complications including pain, hypercalcaemia, bone fracture and spinal cord compression. Hormonal treatment is the mainstay of treatment for these patients but most of them will then become hormone refractory. Bisphosphonates act by inhibiting osteoclast activities and are a potential therapeutic option for metastatic prostate cancer. In addition, they have been shown to reduce pain in patients with bone metastases as a consequence of multiple myeloma. Early uncontrolled studies of bisphosphonates in metastatic prostate cancer patients have shown encouraging results.
OBJECTIVES: The objective of this review was to determine the effectiveness of bisphosphonates in relieving pain in patients with bone metastases from prostate cancer.
SEARCH STRATEGY: Studies were identified by electronic search of bibliographic databases including MEDLINE, EMBASE, CancerLit and the Cochrane Controlled Trials Register. Handsearching included Proceedings of American Society of Clinical Oncology and reference lists of all eligible trials identified.
SELECTION CRITERIA: Randomised controlled studies comparing the effectiveness of bisphosphonates with placebo or open control for pain relief in patients with bone metastases from prostate cancer.
DATA COLLECTION AND ANALYSIS: Data were extracted from eligible studies and included study design, participants, interventions and outcomes. Comparable data were pooled together for meta-analysis with intention-to-treat principle. Outcomes included pain response, analgesic consumption, skeletal events (including pathological fractures, spinal cord compression, bone radiotherapy, bone surgery), prostate cancer death, disease progression, radiological response, PSA response, adverse events, performance status, quality of life and comparisons between different routes, doses and types of bisphosphonates.
MAIN RESULTS: One thousand nine hundred and fifty-five patients from ten studies were included in this review. The pain response rates were 27.9% and 21.1% for the treatment group and the control group, respectively, with an absolute risk difference of 6.8%. The OR for pain response was 1.54 (95% CI 0.97 to 2.44, P = 0.07), showing a trend of improved pain relief in the bisphosphonate group, although this was not statistically significant. The rates for skeletal events were 37.8% and 43.0% for the treatment group and the control group, respectively, with an absolute risk difference of 5.2%. The OR for skeletal events was 0.79 (95% CI 0.62 to 1.00, P = 0.05). A significant increase in nausea was observed in patients who received bisphosphonates compared to placebo. No increase in other adverse events was observed. There was no statistically significant difference between the bisphosphonate group and the control group in terms of prostate cancer death, disease progression, radiological response and PSA response. There are insufficient data to guide the choice of bisphosphonates or the dose and the route of administration .
AUTHORS' CONCLUSIONS: Bisphosphonates should be considered for patients with metastatic prostate cancer for the treatment of refractory bone pain and prevention of skeletal events. More research is needed to guide the choice of bisphosphonates, optimal treatment schedule as well as cost-benefit comparisons. Combining results from different studies is difficult because different tools were used to assess pain, and also, bisphosphonates vary considerably in potency. This review highlights the need for standardisation and co-ordination among researchers in cancer pain studies. [References: 51] |
0 | The outcome of femoral component revision arthroplasty with impaction allograft bone grafting and a cemented polished Exeter stem: A prospective cohort study of 208 revision arthroplasties with a mean follow-up of ten years | PJI DX Updated Search | We report the clinical and radiographic outcomes of 208 consecutive femoral revision arthroplasties performed in 202 patients (119 women, 83 men) between March 1991 and December 2007 using the X-change Femoral Revision System, fresh-frozen morcellised allograft and a cemented polished Exeter stem. All patients were followed prospectively. The mean age of the patients at revision was 65 years (30 to 86). At final review in December 2013 a total of 130 patients with 135 reconstructions (64.9%) were alive and had a non re-revised femoral component after a mean follow-up of 10.6 years (4.7 to 20.9). One patient was lost to follow-up at six years, and their data were included up to this point. Re-operation for any reason was performed in 33 hips (15.9%), in 13 of which the femoral component was re-revised (6.3%). The mean pre-operative Harris hip score was 52 (19 to 95) (n = 73) and improved to 80 (22 to 100) (n = 161) by the last follow-up. Kaplan-Meier survival with femoral re-revision for any reason as the endpoint was 94.9% (95% confidence intervals (CI) 90.2 to 97.4) at ten years; with femoral re-revision for aseptic loosening as the endpoint it was 99.4% (95% CI 95.7 to 99.9); with femoral re-operation for any reason as the endpoint it was 84.5% (95% CI 78.3 to 89.1); and with subsidence ââ°Â¥ 5 mm it was 87.3% (95% CI 80.5 to 91.8). Femoral revision with the use of impaction allograft bone grafting and a cemented polished stem results in a satisfying survival rate at a mean of ten years' follow-up |
0 | Persistence, localization, and external control of transgene expression after single injection of adeno-associated virus into injured joints | OAK 3 - Non-arthroplasty tx of OAK | A single intra-articular injection of adeno-associated virus (AAV) results in stable and controllable transgene expression in normal rat knees. Because undamaged joints are unlikely to require treatment, the study of AAV delivery in joint injury models is crucial to potential therapeutic applications. This study tests the hypotheses that persistent and controllable AAV-transgene expression are (1) highly localized to the cartilage when AAV is injected postinjury and (2) localized to the intra-articular soft tissues when AAV is injected preinjury. Two AAV injection time points, postinjury and preinjury, were investigated in osteochondral defect and anterior cruciate ligament transection models of joint injury. Rats injected with AAV tetracycline response element (TRE)-luciferase received oral doxycycline for 7 days. Luciferase expression was evaluated longitudinally for 6 months. Transgene expression was persistent and controllable with oral doxycycline for 6 months in all groups. However, the location of transgene expression was different: postinjury AAV-injected knees had luciferase expression highly localized to the cartilage, while preinjury AAV-injected knees had more widespread signal from intra-articular soft tissues. The differential transgene localization between preinjury and postinjury injection can be used to optimize treatment strategies. Highly localized postinjury injection appears advantageous for treatments targeting repair cells. The more generalized and controllable reservoir of transgene expression following AAV injection before anterior cruciate ligament transection (ACLT) suggests an intriguing concept for prophylactic delivery of joint protective factors to individuals at high risk for early osteoarthritis (OA). Successful external control of intra-articular transgene expression provides an added margin of safety for these potential clinical applications. © Copyright 2013, Mary Ann Liebert, Inc. |
0 | The functional consequences of glaucoma for eye-hand coordination | Upper Eyelid and Brow Surgery | PURPOSE: To examine whether patients with glaucoma exhibit differences in visually guided reaching-and-grasping (prehension) behavior compared with normally sighted control subjects. METHODS: Sixteen patients with glaucoma and 16 control subjects with no ocular disease participated. Participants were required to reach out and precision grasp one of two cylindrical objects placed on a table top in front of them in laboratory conditions in three viewing conditions (binocular, right eye alone, left eye alone). Lightweight reflective markers were placed on the subject's preferred hand for recording its movement in three-dimensional space. Three motion capture units recorded the motion of these markers as the subjects reached out and precision grasped household objects. Various indices of prehension planning, execution, and control were quantified. Visual fields (VF) were measured using standard automated perimetry generating monocular mean deviation (MD) scores. Binocular VF sensitivity was estimated by using the integrated visual field (IVF). Stereoacuity was measured with the Frisby stereoacuity test. Significant differences in prehension movement between patients and control subjects in each viewing condition were investigated, and associations between prehension kinematics and VF sensitivity were examined. RESULTS: The patients and control subjects were of a similar age (median [range]: patient group, 72.2 years [62.5-86.9]; control group, 69.0 years [64.3-78.3]). The patient group had asymmetrical disease and relatively minor binocular overlapping defects (better eye MD, -5.7 dB [-16.7 to +0.45 dB]; worse eye MD, -11.8 dB [-29.3 to -1.5 dB]; IVF score, 3 [0-36]). They exhibited slightly poorer stereoacuity levels than did the control subjects (patient group, 55 sec arc [40-110]; control group, 40 sec arc [20-80; Mann-Whitney U test, P < 0.05]). They also showed statistically significant delays in average movement onset (MO: approximately 100 ms delay, Mann-Whitney U test P < 0.0001) and overall movement time (OMD: approximately 140 ms delay; Mann-Whitney U test P < 0.05), suggesting impairments in initial movement planning and control. Deficits were exhibited in the reaching component, with data suggesting that glaucomatous patients made more tentative movements when reaching for the object. These deficits correlated with both increasing severity of VF defect and impaired stereoacuity. There were no differences in grasping characteristics between patients and control subjects in this sample. CONCLUSIONS: This study provides evidence that patients with glaucoma exhibit deficits in eye-hand coordination compared with the age-matched normally sighted control. Further study is needed to assess the specific effect of field loss location on prehension kinematics. |
0 | Gartland types IIB and III supracondylar fractures of the humerus in children: is Blount's method effective and safe? | Pediatric Supracondylar Humerus Fracture 2020 Review | BACKGROUND: Blount's method is controversial for the treatment of Gartland types IIB and III supracondylar fracture of the humerus (SCFH) in children. The purpose of this study was to evaluate the clinical and radiologic outcomes and the failure and complication rates. METHODS: All types IIB and III SCFH treated with Blount's method from 2003-2013 were included in this retrospective single-center study. Clinical assessment was performed according to Flynn criteria. Baumann angle, anteversion angle, anterior humeral line, and humeroulnar angle were measured for radiographic assessment. RESULTS: Among 447 children with types IIB and III SCHF, 339 were treated according to Blount's method. There were 173 boys (51%), and the mean age was 6.3 years (1-14 years); 71% were type III. Mean time to surgery was 5.7 hours. According to Flynn criteria, results were satisfactory in 91% of cases. No compartment syndrome was encountered. There were 16 (4.7%) secondary displacements requiring surgical revision. Five (1.9%) children developed a cubitus varus deformity. At latest follow-up, the mean Baumann angle was 74.7° (95% confidence interval, 74.1-75.3), the mean anteversion angle was 39.9° (95% confidence interval, 39.5-40.3), the anterior humeral line was normal in 87.6% of cases, and the mean humeroulnar angle was 8.7°. CONCLUSION: Blount's method is appropriate to manage types IIB and III SCFH, provided anatomic and stable reduction is obtained. |
0 | Transient femoral neuropathy after abdominoplasty | Panniculectomy & Abdominoplasty CPG | Femoral nerve injury is a rare complication of abdominal and pelvic surgery. Although it has been described after a variety of operative procedures, this article describes what may be the first reported occurrence of femoral neuropathy after abdominoplasty. |
0 | Sclerostin Regulation, Microarchitecture, and Advanced Glycation End-Products in the Bone of Elderly Women With Type 2 Diabetes | Hip Fx in the Elderly 2019 | Increased circulating sclerostin and accumulation of advanced glycation end-products (AGEs) are two potential mechanisms underlying low bone turnover and increased fracture risk in type 2 diabetes (T2D). Whether the expression of the sclerostin-encoding SOST gene is altered in T2D, and whether it is associated with AGEs accumulation or regulation of other bone formation-related genes is unknown. We hypothesized that AGEs accumulate and SOST gene expression is upregulated in bones from subjects with T2D, leading to downregulation of bone forming genes (RUNX2 and osteocalcin) and impaired bone microarchitecture and strength. We obtained bone tissue from femoral heads of 19 T2D postmenopausal women (mean glycated hemoglobin [HbA1c] 6.5%) and 73 age- and BMI-comparable nondiabetic women undergoing hip replacement surgery. Despite similar bone mineral density (BMD) and biomechanical properties, we found a significantly higher SOST (p = .006) and a parallel lower RUNX2 (p = .025) expression in T2D compared with non-diabetic subjects. Osteocalcin gene expression did not differ between T2D and non-diabetic subjects, as well as circulating osteocalcin and sclerostin levels. We found a 1.5-fold increase in total bone AGEs content in T2D compared with non-diabetic women (364.8 +/- 78.2 versus 209.9 +/- 34.4 mug quinine/g collagen, respectively; p < .001). AGEs bone content correlated with worse bone microarchitecture, including lower volumetric BMD (r = -0.633; p = .02), BV/TV (r = -0.59; p = .033) and increased trabecular separation/spacing (r = 0.624; p = .023). In conclusion, our data show that even in patients with good glycemic control, T2D affects the expression of genes controlling bone formation (SOST and RUNX2). We also found that accumulation of AGEs is associated with impaired bone microarchitecture. We provide novel insights that may help understand the mechanisms underlying bone fragility in T2D. © 2020 American Society for Bone and Mineral Research (ASBMR). |
1 | The incidence of early radiolucencies about a pegged glenoid component using cement pressurization | Glenohumeral Joint OA | Glenoid component loosening is the most common early mode of failure of total shoulder arthroplasty (TSA) We hypothesised that the use of a pegged glenoid component with a modern glenoid reaming system and an instrumented cement pressurization technique would achieve a low prevalence of early radiolucent lines. Of 81 patients having TSA with a cemented, all polyethylene, 3-peg glenoid component for primary glenohumeral osteoarthritis, 69 had high quality radiographs available for analysis. All preoperative and initial postoperative radiographs were reviewed and graded in a blinded manner using previously established criteria. When the radiolucency grade of cement fixation was converted to a numeric scale of 0 (no radiolucency) to 5 (grossly loose), the mean cementing score was 0.14 + 0.06. Of the 69 shoulders, 62 (90%) had no radiolucencies. These techniques to improve glenoid fixation resulted in a low incidence of early radiolucencies about the glenoid component in patients having TSA for primary glenohumeral osteoarthritis. |
0 | Height loss predicts subsequent hip fracture in men and women of the Framingham Study | Management of Hip Fractures in the Elderly | BACKGROUND: Although height is a risk factor for osteoporotic fracture, current risk assessments do not consider height loss. Height loss may be a simple measurement that clinicians could use to predict fracture or need for further testing. OBJECTIVE: To examine height loss and subsequent hip fracture, evaluating both long-term adult height loss and recent height loss. METHODS: Prospective cohort of 3,081 adults from the Framingham Heart Study. Height was measured biennially since 1948, and cohort followed for hip fracture through 2005. Adult height loss from middle-age years across 24 years and recent height loss in elderly years were considered. Cox proportional hazard regression was used to estimate association between height loss and risk of hip fracture. RESULTS: Of 1,297 men and 1,784 women, mean baseline age was 66y (SD7.8). Average height loss for men was 1.06 inches (0.76), and for women was 1.12 inches (0.84). 11% of men and 15% of women lost >/= 2 inches of height. Mean follow-up was 17y during which 71 men and 278 women had incident hip fractures. For each 1-inch of height loss, HR = 1.4 in men (95%CI: 1.00, 1.99), and 1.04 in women (95%CI: 0.88, 1.23). Men and women who lost >/= 2 inches of height had increased fracture risk (compared to 0 to <2 inches) of borderline significance: men HR = 1.8, 95%CI: 0.86, 3.61; women HR = 1.3, 95%CI: 0.90, 1.76. Recent height loss in elders significantly increased the risk of hip fracture, 54% in men and 21% in women (95%CI: 1.14, 2.09; 1.03, 1.42, respectively). CONCLUSIONS: Adult height loss predicted hip fracture risk in men in our study. Recent height loss in elderly men and women predicted risk of hip fracture. (c) 2011 American Society for Bone and Mineral Research |
0 | Custom-made, antibiotic-loaded, acrylic cement spacers using a dental silicone template for treatment of infected hip prostheses | Dental Implant Infection | PURPOSE: Antibiotic-loaded acrylic cement (ALAC) spacers are useful for treatment of infected prostheses in the course of a two-stage revision. Spacers are handmade or are made using a commercial template, with reportedly good treatment outcomes. This study aimed to confirm the usefulness of custom-made ALAC spacers shaped like bipolar hip prostheses using a dental silicone template for treatment of infected hip prostheses, and described their manufacture., METHODS: This study evaluated 10 patients who underwent two-stage revision for treatment of infected hip prostheses. Custom-made ALAC spacers were used in all patients. Templates were made with dental silicone. We investigated the following in treatment of the infected hip prostheses: bacterial pathogens; antibiotic-cement mixtures; waiting time to revision; dislocation, breakage, and migration of custom-made ALAC spacers; current hip status; progress during follow-up; presence or absence of recurrence; and walking ability., RESULTS: Dislocation, breakage, and migration were not observed in custom-made ALAC spacers. All patients recovered after two-stage revision without additional surgery and showed no recurrence during the follow-up period., CONCLUSION: Custom-made ALAC spacers shaped like bipolar hip prostheses using a template made of dental silicone may be useful for treatment of infected hip prostheses. |
0 | Patients' experiences of hip fracture | Management of Hip Fractures in the Elderly | BACKGROUND: Hip fracture is a major cause of mortality and morbidity, particularly among older people, but there is little information on how individuals experience this. AIMS: This study was conducted to explore the experiences of individuals who had suffered a hip fracture. The aim was not to produce generalizable findings but, rather, to generate a rich description of the experience of incurring and recovering from a hip fracture, to inform nursing practice. METHOD: Phenomenological methodology was used. A purposeful sample of five older patients was interviewed, following a stay in a community hospital for rehabilitation after surgical repair of a hip fracture. The unstructured interviews were tape-recorded, transcribed verbatim and analysed for significant statements and meanings. FINDINGS: Four major themes emerged: the injury experience, the pain experience, the recovery experience and the disability experience. The injury experience consisted of storytelling, recalling the experience of the injury itself. The pain experience consisted of coping with the pain. The recovery experience involved the operation, beginning the struggle of recovery, and regaining independence. The disability experience consisted of the disability itself, depending on others, and being housebound. CONCLUSIONS: Pain management, meeting psychological and physical needs for nursing care, planning for discharge, and ensuring a reasonable quality of life are areas for nursing care development. Consideration of appropriate settings for rehabilitation is needed and there should be further investigation into improving quality of life after discharge |
1 | Proximal Biceps Long Head: Anatomy, Biomechanics, Pathology | Trial Systematic Review Project | The intra-articular course of the long head of the biceps tendon (LHBT) through the glenohumeral joint is a special anatomical feature. It originates at the supraglenoid tubercle with fibers deriving directly from the glenoid labrum and is stabilized by a pulley complex at the entrance into the bicipital groove. The LHBT is biomechanically important for the glenohumeral joint and is considered as dynamic stabilizer that acts in synergy with other structures like the rotator cuff. The characteristic anterior shoulder pain of LHBT pathology can be caused by chronic inflammation, ruptures, instability, or by a combination of these. Due to its anatomical and biomechanical interaction with other structures, isolated lesions of the LHBT are extremely rare. Rotator cuff tears are highly associated with pathology of the LHBT. The complexity of LHBT lesions represents a major challenge for the clinician regarding both diagnosis and treatment. |
0 | Staged wise-pattern skin excision for reconstruction of the large and ptotic breast | Reduction Mammoplasty for Female Breast Hypertrophy | BACKGROUND: The postmastectomy reconstruction of large and/or ptotic breasts poses a more difficult aesthetic challenge than the reconstruction of small or moderately sized breasts because of an excessively large skin envelope in both horizontal and vertical dimensions. The Wise-pattern skin excision best addresses this excess skin but is associated with a high incidence of tissue necrosis with subsequent wound breakdown, primarily at the T point. To optimize the aesthetic potential and minimize complications in the setting of these large skin envelopes, the authors have deconstructed the single-stage Wise-pattern skin excision into a two-stage procedure, eliminating the need for a primary simultaneous T-point closure.
METHODS: In the first stage, the mastectomy and reconstruction are performed using a vertical excision, which tightens the breast skin envelope horizontally. In the second stage, the redundant skin at the inframammary fold is excised horizontally, tightening the breast skin envelope vertically. The summation of the two staged excisions recreates the Wise pattern, breaking up the T point into two straightforward primary closures.
RESULTS: Twelve patients (21 breasts) underwent successful reconstruction using the staged Wise-pattern skin excision. The breast size, shape, and projection of the patients were greatly improved without any wound complications.
CONCLUSIONS: The staged Wise-pattern skin excision for breast reconstruction is a simple technique that delivers superior results for the challenging reconstruction of large and/or ptotic breasts. This method offers an aesthetically pleasing breast shape, allows for the correction of ptosis, eliminates wound complications, and results in a standard Wise-pattern scar. |
1 | Advantages of exercise in rehabilitation, treatment and prevention of altered morphological features in knee osteoarthritis. A narrative review | OAK 3 - Non-arthroplasty tx of OAK | Knee osteoarthritis (OA) represents one of the most common causes of disability in the world. It leads to social, psychological and economic costs with financial consequences, also because a further increase is expected. Different knee OA treatments are usually considered in relation to the stage of the disease, such as surgical management and pharmacologic and non-pharmacologic treatments. Treatment should begin with the safest and least invasive one, before proceeding to more invasive, expensive ones. Non-pharmacologic, behavioral treatments of knee OA are recommended not only in rehabilitation but also in prevention because many risk factors, such as excess weight, obesity and joint tissue inflammation, can be monitored and thus prevented. In the present review, we analyze data from the most recent literature in relation to the effects of physical exercise on prevention, therapy and rehabilitation in knee OA. All data suggest that physical exercise is an effective, economical and accessible tool to everyone, in the treatment and prevention of knee OA. The literature search was conducted on PubMed, Scopus and Google Scholar using appropriate keywords in relation to knee osteoarthritis. |
1 | MR imaging findings of lesions involving cartilage and bone in the paediatric knee: a pictorial review | Osteochondritis Dissecans 2020 Review | The knee is the joint which is most commonly imaged by MRI in children and adolescents. With increasing participation in competitive sports, traumatic knee injuries with osteochondral lesions are increasingly common in children. However, it is also important to exclude non traumatic conditions that result in defects of the articular cartilage and/or subchondral bone plate or growth plate of the knee, since timely diagnosis and therapy may help prevent lifelong disability in these patients. Moreover, there are normal variants that occur in the ossifying knee that should not be mistaken for lesions. The aim of this essay is to review the wide range of conditions that may result in MRI signal changes of the ossifying knee in children. |
0 | Patellar resurfacing in posterior cruciate ligament retaining total knee arthroplasty (PATRES): design of a randomized controlled clinical trial | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: Anterior knee pain may occur after total knee arthroplasty (TKA). Patellar resurfacing, which is considered to lower the incidence of anterior knee pain after TKA, remains controversial. In the present study clinical and radiological outcomes after TKA performed on patients with clinical and radiological signs of femorotibial and patellofemoral osteoarthritis (OA) with and without patellar resurfacing will be compared.
METHODS/DESIGN: Fifty patients will be included in a randomized controlled trial. Patients scheduled for TKA with clinical and radiological signs of femorotibial and patellofemoral OA will be included. Arthritis of the patellofemoral joint was determined based on the preoperative Baldini and Merchant X-ray views, which is assessed by the orthopaedic surgeon who treats the patient. Exclusion criteria are rheumatoid arthritis, history of patellar fracture, tuberosity transposition, high tibial osteotomy (HTO), hip arthroplasty and posterior cruciate ligament insufficiency. Patients will be randomized to undergo TKA either with or without patellar resurfacing. Outcomes will be assessed preoperatively, at 6 weeks and at 6, 12, 18 and 24 months postoperatively. Primary outcome measure is the patellofemoral scoring system according to Baldini. Secondary outcome measures are the Knee Society clinical rating system (KSS) and the Knee Osteoarthritis Outcome Scale (KOOS) scores. Conventional weight-bearing radiographs, and views according to Baldini will be used to asses component loosening, wear, and patellofemoral problems including fracture or loosening of resurfaced patellae, subluxation and wear of non-resurfaced patellae.
DISCUSSION: There is no consensus regarding patellar resurfacing during primary TKA. Current prospective studies fail to determine any differences in clinical outcome among patients after TKA with or without patellar resurfacing. This randomized controlled trial has been designed to determine the effectiveness of patellar resurfacing during TKA in patients undergoing TKA who have clinical and radiological signs of tibiofemoral and patellofemoral OA, using a specific patellofemoral outcome measurement.
TRIAL REGISTRATION: Netherlands Trial Registry NTR3108. |
0 | Fibulin-3 serum and urine levels in the diagnosis and severity assessment of primary knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | Objectives: Osteoarthritis (OA) is the most widespread joint disease and is a major cause of joint pain and disability in the middle aged and elderly population. The diagnosis of OA is based on clinical and radiographic changes that occur late after disease progression, and hence does not allow early detection of structural damage. Therefore, there is an acute need for reliable biochemical markers that can facilitate its earlier diagnosis. This study was commenced to identify fibulin-3 levels in serum and urine of patients with primary knee OA and to investigate their relationship with severity of the disease. Material and methods: Fifty female patients with primary knee OA were compared to 25 healthy female controls. Fibulin-3 in serum and urine were measured using enzyme-linked immunosorbent assay (ELISA). Severity of knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the Knee Outcome Survey Activities of Daily Living (KOSADL) scale. Radiographic grading of knee OA was performed by Kellgren-Lawrence (K-L) criteria. Results: Serum and urine fibulin-3 were higher in patients (286.00 ±145.00 ng/ml and 104.60 ±32.73 ng/ml, respectively) than in controls (26.00 ±5.77 ng/ml and 13.60 ±4.21 ng/ml, respectively). Fibulin-3 in serum and urine correlated (p < 0.001) with each other (r = 0.930) and with the severity of knee pain by WOMAC index (r = 0.909 and 0.928, respectively), inversely correlated with KOS-ADL (r = -0.913 and -0.953, respectively), and with radiographic grading of K-L (r = 0.855 and 0.875, respectively). Conclusions: Fibulin-3 serves as a biomarker of knee OA disease severity and could predict disease progression. Assessing urine fibulin-3 could be an applicable and easy method to diagnose knee OA and to follow up disease progression. |
0 | The Efficacy of Platelet-Derived Growth Factor as a Bone-Stimulating Agent | DoD SSI (Surgical Site Infections) | Nonunion remains the most impactful complication following ankle and hindfoot arthrodesis. Historically, surgeons have relied on autologous bone graft (ABG) to combat nonunion risk. Although effective, ABG remains limited in quantity, varies in quality, and can be associated with harvest site pain and morbidity. Use of alternative bone-stimulating agents, however, avoids harvesting an autograft, and provides a more predictable dose-response efficacy. This article highlights findings from basic science, animal, and human clinical research that led to the approval of Augment Bone Graft. We present an adaptation of the surgical techniques described for investigators participating in the pivotal trial. |
0 | Responding to Trauma at Sea: A Case Study in Psychological First Aid, Unique Occupational Stressors, and Resiliency Self-Care | DoD PRF (Psychosocial RF) | The U.S. Navy deploys Special Psychiatric Rapid Intervention Teams (SPRINT) to sites of military disasters to assist survivors and the command. SPRINT functions primarily as a consultant to help commands effectively respond to the mental health needs of their service members following a traumatic event. Utilizing the principles of psychological first aid, the overall goal of SPRINT is to mitigate long-term mental health dysfunction and facilitate recovery at both the individual and unit level. We present a case study of a SPRINT mission to a deployed U.S. Navy ship in response to a cluster of suicides and subsequent concerns about the well-being of the remaining crew. Throughout this mission, important themes emerged, such as the impact of accumulated operational stressors and the subsequent development of mental health stigma. Also, this case study demonstrates the potential effectiveness of introducing resiliency self-care meditation training to remote environments that lack ready access to mental health resources. From here, SPRINT can provide a model for immediate disaster mental health response that has potential relevancy beyond the military. |
1 | Proximal tibial metaphyseal fractures with severe soft tissue injury: clinical and functional results at 2 years | DoD LSA (Limb Salvage vs Amputation) | BACKGROUND: Controversy exists regarding management of proximal tibial metaphyseal fractures with severe soft tissue injury. It is unclear whether limb salvage or early amputation results in the best functional and clinical outcomes. QUESTIONS/PURPOSE: We hypothesized that in this group of patients, there is no difference in functional outcomes, complication rates, clinical outcomes, or objective physical function related to the treatment approach. METHODS: We used the LEAP study database to perform a retrospective comparative review of a subset of patients with proximal tibial metaphyseal fractures (AO/OTA 41A, B, and C) with associated severe soft tissue injuries comparing the outcomes of patients who were treated with either limb salvage or amputation. RESULTS: Although there were major differences in clinical and functional outcomes based on patients' sociodemographics at 2 years, no differences in clinical or functional outcomes were detected regardless of whether amputation or limb salvage was performed. Severity of soft tissue injury was more predictive of outcome than the surgical approach used. CONCLUSIONS: Sociodemographics and soft tissue injury severity are more important than treatment approach for predicting clinical and functional outcomes at 2 years in patients with proximal tibia metaphyseal fractures with severe soft tissue injury. LEVEL OF EVIDENCE: Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence. |
0 | Closed reduction methods for treating distal radial fractures in adults | Management of Hip Fractures in the Elderly | BACKGROUND: Fracture of the distal radius is a common clinical problem. Displaced fractures are usually reduced using closed reduction methods, which are non-surgical and generally comprise traction and manipulation. The resulting position is then stabilised, typically by plaster cast immobilisation. OBJECTIVES: To examine the evidence for the relative effectiveness of different methods of closed reduction for displaced fractures of the distal radius in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, CINAHL, the National Research Register (UK), conference proceedings and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials comparing different methods of closed reduction. We also included trials where the use or not of anaesthesia was tested concurrently with different methods of reduction. DATA COLLECTION AND ANALYSIS: Both authors independently selected trials and assessed methodological quality. Data were extracted independently by one author and checked by the other. No pooling was possible. MAIN RESULTS: Three trials involving a total of 404, mainly female and older, people with displaced fractures of the distal radius were included. These failed to assess functional outcome, and only one trial reported on complications.One trial found no statistically significant differences between mechanical reduction using finger trap traction and manual reduction in anatomical outcomes. All participants of this trial were given intravenous regional anaesthesia.One trial compared a novel method of manual reduction where the non-anaesthetised patient actively provided counter-traction versus traditional manual reduction under intravenous regional anaesthesia. While participants of the novel method group suffered more, yet not intolerable, pain during the reduction procedure, the latter was shorter in duration. No differences in anatomical outcome were detected.The third study compared mechanical reduction involving a special device without anaesthesia versus manual reduction under haematoma block (local anaesthesia). Less pain during the reduction procedure was recorded for the mechanical traction group. Both methods yielded similar radiological results. Fewer participants of the mechanical traction group had signs of neurological impairment, mainly finger numbness, at five weeks but this difference was not statistically significant by one year. AUTHORS' CONCLUSIONS: There was insufficient evidence from comparisons tested within randomised controlled trials to establish the relative effectiveness of different methods of closed reduction used in the treatment of displaced fractures of the distal radius in adults. COMPARISONS OF METHODS USED IN ADULTS TO PUT BONE FRAGMENTS OF A FRACTURED WRIST BACK INTO PLACE: Wrist fractures (breaks) are common injuries in adults, especially in people with osteoporosis (bone loss). Bone fragments may need to be put back into place to restore anatomy and reduce the risk of further soft-tissue damage. The process of doing this is called reduction and usually the patient is given anaesthesia beforehand. In closed reduction, often termed manipulation, the displaced fragments are repositioned using various manoeuvres while keeping the overlying skin intact. Traction to pull the fragments apart is provided either manually involving two people or with a mechanical device such as 'finger-traps' attached to two or more fingers and a counterweight suspended over the upper arm. The reduced fracture is then stabilised, typically by plaster cast immobilisation, to help it to heal.Three randomised controlled trials involving a total of 404, mainly female and older, people with displaced fractures of the distal radius are included in this review. None of the trials assessed functional outcome, and only one trial reported on complications. Each trial compared different methods of reduction. One trial, in which all participants had intravenous regional anaesthesia, found no significant differences in anatomical outcomes between mechanical reduction using finger trap traction and manual reduction. The second trial compared two methods of manual reduction. These were a novel method of manual reduction where participants actively provided counter-traction without being given anaesthesia versus traditional manual reduction under intravenous regional anaesthesia. The participants of the novel method group suffered more but not intolerable pain during the reduction procedure, which was shorter in duration. No differences in anatomical outcome were detected. The third trial compared mechanical reduction involving a special device without anaesthesia versus manual reduction under haematoma block (local anaesthesia). Less pain during the reduction procedure was recorded for the mechanical traction group. Both methods yielded similar anatomical results. Fewer participants of the mechanical traction group had signs of neurological impairment, mainly finger numbness, at five weeks but this difference was not statistically significant by one year.The review concluded that there was not enough evidence to decide whether there was any difference between the various methods tested |
0 | Non-surgical periodontal therapy with adjunctive topical doxycycline: A double-masked, randomized, controlled multicenter study. II. Microbiological results | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Background: Topical application of active substances offers an additional option in periodontal therapy. The aim of this study was to examine the influence of the administration of a novel, biodegradable 14% doxycycline gel on microbiological findings, in connection with scaling and root planing. Methods: One hundred ten patients in three centers (Frankfurt and Heidelberg, Germany; Nijmegen, The Netherlands) with moderate to advanced periodontitis were evaluated in this randomized, double-masked, split-mouth clinical trial. In each patient, three test teeth were randomly assigned to one of three treatment modalities: 1) scaling and root planing (SRP) alone; 2) SRP with subgingival placebo gel (VEH); or 3) SRP and 14% doxycycline gel (DOX). Subgingival plaque samples were analyzed at baseline and 3 and 6 months after therapy for Actinobacillus actinomycetemcomitans (A.a.), Tannerella forsythensis (T.f.), Porphyromonas gingivalis (P.g.), and Treponema denticola (T.d.) using a RNA probe. Samples from 10 patients were tested for resistance against doxycycline, amoxicillin/clavulanic acid, cefoxitin, clindamycin, and metronidazole using agar diffusion testing. Results: The largest decrease in pathogens was found after 3 months, with the most pronounced differences between DOX and SRP (P<0.05). At 6 months, pathogens were still reduced markedly in all groups. Treatment results were consolidated for VEH and DOX, with a slight deterioration for SRP (DOX versus SRP: P<0.001). Resistance was observed to amoxycillin/clavulanic acid, cefoxitin, clindamycin, and metronidazole (four isolates) but not to doxycycline. Conclusion: The addition of subgingival instillation of a 14% doxycycline gel resulted in pronounced reduction of periodontal pathogens after 3 months and stabilizing results up to 6 months after therapy. Resistance to doxycycline was not induced |
0 | The evolution of the compartment syndrome since 1948 as recorded in the JBJS (B) | DOD - Acute Comp Syndrome CPG | This paper describes how we came to understand the pathophysiology of Volkmann's ischaemic contracture with references to relevant papers in this Journal, and the investigation and management of acute compartment syndrome is briefly discussed. ©2007 British Editorial Society of Bone and Joint Surgery. |
0 | Cost-effectiveness of a multifactorial fracture prevention program for elderly people admitted to nursing homes | HipFx Supplemental Cost Analysis | Background: Fractures are one of the most costly consequences of falls in elderly patients in nursing homes. Objectives: To compare the cost-effectiveness of a nullmultifactorial fracture prevention programnull provided by a multidisciplinary team with nullno preventionnull in newly admitted nursing home residents. Methods: We performed a cost-utility analysis using a Markov-based simulation model to establish the effectiveness of a multifaceted fall prevention program from the perspective of statutory health insurance (SHI) and long-term care insurance (LCI). The rate of falls was used to estimate the clinical and economic consequences resulting from hip and upper limb fractures. Robustness of the results was assessed using deterministic and probabilistic sensitivity analyses. Results: Compared to no prevention a multifactorial prevention program for nursing home residents resulted in a cost-effectiveness ratio of (euro)21,353 per quality-adjusted life-year. The total costs for SHI/LCI would result in (euro)1.7 million per year. Results proved to be robust following deterministic and probabilistic sensitivity analyses. Conclusion: Multifactorial fracture prevention appears to be cost-effective in preventing fractures in nursing home residents. Since the results were based on the number of falls further research is required to confirm the results |
0 | Superficial soft tissue sarcomas (S-STS): a study of 367 patients from the French Sarcoma Group (FSG) database | MSTS 2022 - Metastatic Disease of the Humerus | AIM: The specific natural history of superficial soft tissue sarcomas (S-STS) has been rarely considered. We describe the clinical characteristics of a large series of S-STS (N=367) from the French Sarcoma Group (GSF-GETO) database and analyse the prognostic factors affecting outcome.
METHODS: We performed univariate and multivariate analyses for overall survival (OS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS).
RESULTS: The median age was 59 years. Fifty-eight percent patients were female. Tumour locations were as follows: extremities, 55%; trunk wall, 35.4%; head and neck, 8% and unknown, 1.6%. Median tumour size was 3.0 cm. The most frequent tumour types were unclassified sarcoma (24.3%) and leiomyosarcoma (22.3%). Thirty-three percent of cases were grade 3. Median follow-up was 6.18 years. The 5-year OS, MFS and LRFS rates were 80.9%, 80.7% and 74.7%, respectively. Multivariate analysis retained histological type and wide resection for predicting LRFS and histological type and grade as prognostic factors of MFS. The factors influencing OS were age, histological type, grade and wide resection. STS with early invasion into but not through the underlying fascia had a significantly poorer MFS than with strict S-STS.
CONCLUSION: S-STS represent a separate category characterised by a better outcome. Adequate surgery, i.e. wide resection, is essential in the management of S-STS. |
0 | The current economic burden of illness of osteoporosis in Canada | Hip Fx in the Elderly 2019 | Summary: We estimate the current burden of illness of osteoporosis in Canada is double ($4.6 billion) our previous estimates ($2.3 billion) due to improved data capture of the multiple encounters and services that accompany a fracture: emergency room, admissions to acute and step-down non-acute institutions, rehabilitation, home-assisted or long-term residency support. Introduction: We previously estimated the economic burden of illness of osteoporosis-attributable fractures in Canada for the year 2008 to be $2.3 billion in the base case and as much as $3.9 billion. The aim of this study is to update the estimate of the economic burden of illness for osteoporosis-attributable fractures for Canada based on newly available home care and long-term care (LTC) data. Methods: Multiple national databases were used for the fiscal-year ending March 31, 2011 (FY 2010/2011) for acute institutional care, emergency visits, day surgery, secondary admissions for rehabilitation, and complex continuing care, as well as national dispensing data for osteoporosis medications. Gaps in national data were supplemented by provincial and community survey data. Osteoporosis-attributable fractures for Canadians age 50+ were identified by ICD-10-CA codes. Costs were expressed in 2014 dollars. Results: In FY 2010/2011, the number of osteoporosis-attributable fractures was 131,443 resulting in 64,884 acute care admissions and 983,074 acute hospital days. Acute care costs were $1.5 billion, an 18Â % increase since 2008. The cost of LTC was 33.4 times the previous estimate ($31 million versus $1.03 billion) because of improved data capture. The cost for rehabilitation and secondary admissions increased 3.4 fold, while drug costs decreased 19Â %. The overall cost of osteoporosis was over $4.6 billion, an increase of 83Â % from the 2008 estimate. Conclusion: Since the 2008 estimate, new Canadian data on home care and LTC are available which provided a better estimate of the burden of osteoporosis in Canada. This suggests that our previous estimates were seriously underestimated. |
0 | Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: A systematic review | Pediatric Supracondylar Humerus Fracture 2020 Review | A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. Of these, only two relevant prospective research studies focusing on RA or PCA and their relationship to CS were identified. Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population. |
0 | Radionuclide bone SPeCT/CT in the evaluation of knee pain: Comparing two-phase bone scintigraphy, SPeCT and SPeCT/CT | Osteochondritis Dissecans 2020 Review | Objective: To assess the role of single photon emission computed tomography (SPECT/CT) in the evaluation of knee pain as well as comparing bone scintigraphy (BS), SPECT and SPECT/CT, and assessing the incremental value of SPECT/CT. methods: BS, SPECT and SPECT/CT of patients with knee pain (39 patients, 65 knees, 105 lesions) were directly compared for lesion detection, localisation and characterisation using lesion-based, knee-based and patient-based analyses in this retrospective study. results: Lesion detection: BS (91.4%), SPECT (100%) and SPECT/CT (100%). SPECT and SPECT/CT detected significantly more lesions than BS (p < 0.05). Lesion localisation: BS (38.5-41.7%), SPECT (74.4-83.3%) and SPECT/CT (100%). SPECT localised significantly more lesions than BS; SPECT/CT localised significantly more lesions than BS and SPECT (p < 0.01). Lesion characterisation: BS (23.0-52.1%), SPECT (30.8-56.2%) and SPECT/CT (92.3-96.9%). SPECT/CT characterised significantly more lesions than BS and SPECT (p < 0.01). Characterisation of non-arthropathy lesions: BS (6.25%), SPECT (12.5%) and SPECT/CT (93.75%). SPECT/CT characterised significantly more non-arthropathy lesions than BS and SPECT (p < 0.01). BS and SPECT detected none, while SPECT/CT detected 100% of the causative/ contributing/associated conditions that co-existed with osteoarthritis. Therefore SPECT/CT detected not only just osteoarthritis but also the causative/contributing/ associated conditions. Conclusion: SPECT/CT added significant incremental value to BS and SPECT irrespective of whether evaluation was lesion-based, knee-based or patient-based. SPECT/CT represents a viable alternative to MRI, and addition of SPECT/CT to BS and SPECT should be considered in the evaluation of knee pain. advances in knowledge: Incremental value of bone SPECT/CT in knee pain. |
0 | Metabolic Pattern of Asymptomatic Hip-Prosthesis by 18F-FDG-Positron-Emission-Tomography | PJI DX Updated Search | BACKGROUND: Joint replacement is a procedure with a major impact on the quality of life of patients with joint degenerative disease or traumatic injuries. However, some patients develop symptoms after the intervention caused by mechanical loosening or infection. Metabolic imaging by 18F-FDG-PET investigated in these patients isoften hampered by low specificity for diagnosis of possible septic vs. mechanical loosening. The reason for this shortcoming is to our opinion the unawareness of physiological remodeling processes that could be seen in asymptomatic patients. OBJECTIVES: In order to overcome this drawback, we aimed to find out the physiological metabolic functional pattern in asymptomatic patients with implanted hip prosthesis. PATIENTS AND METHODS: Twelve patients (6 males, 6 females); mean age 73 +/- 7 (range 58 - 91) years were prospectively enrolled in the study. The patients were admitted to our department for oncological referral with implanted hip prostheses. All patients explained no symptoms with regard to their implanted prosthesis. The attenuation corrected images were used for analysis. RESULTS: Fourteen hip prostheses in 12 patients were visually analyzed. Seven out of 14 prostheses among 12 patients showed focal periprosthetic enhanced metabolism, two of which showed two sites of enhanced uptake; whereas, the remaining five prostheses showed singular hypermetabolic areas within the periprosthetic site. The remaining seven prostheses in the other five patients showed no periprosthetic-enhanced uptake. CONCLUSION: Of the asymptomatic patients investigated, 58% showed focal enhanced periprosthetic glucose metabolism. This finding should be taken into consideration as a more probable unspecific metabolic pattern for correct interpretation of 18F-FDG-PET studies in patients with suspected septic loosening of the hip prosthesis |
0 | Migration of Polyethylene Fixation Screw After Total Knee Arthroplasty | PJI DX Updated Search | Duracon (Howmedica, Rutherford, NJ) posterior stabilized total knee system has a snap fit locking mechanism of a tibial polyethylene, including an additional locking screw for further fixation of polyethylene. We report 13 cases of locking screw migration from tibial component after Duracon posterior stabilized primary total knee arthroplasty. Among 13 knees, screw migration in 10 asymptomatic cases was incidentally detected during regular follow-up, and they were just observed in the outpatient clinic. Only 3 knees had moderate pain, swelling, and instability, and revision was done on 2 of 3 knees. é 2009 Elsevier Inc. All rights reserved |
0 | Undernutrition and Anorexia in the Older Person | AAHKS (2) Corticosteroids | Minimizing frailty in older age is important to individuals and society, as the increasing prevalence of chronic disease is leading to greater disability and health care costs. Nutritional frailty can be defined as the disability that occurs in old age due to rapid, unintentional loss of body weight and sarcopenia (lack of lean mass). This article provides a brief overview of the prevalence and consequences of undernutrition, age-related changes to appetite, food intake, and body composition, the factors contributing to the development of anorexia and undernutrition, and recommended management strategies. © 2009 Elsevier Inc. All rights reserved. |
0 | Total knee arthroplasty after failed high tibial osteotomy | DOD - Acute Comp Syndrome CPG | Total knee arthroplasty performed after failed high tibial osteotomy is an important subgroup encompassing close to 10% of replacements performed and may be difficult in 20% to 40% of these patients. The problems in this group can be different from those encountered with primary of revision total knee arthroplasty. The authors present a review of the literature on this subject including assessments of variables affecting outcome. Preoperative clinical and radiographic factors to be considered are discussed and surgical technical factors are delineated. |
0 | Isolated Versus Full Component Revision in Total Knee Arthroplasty for Aseptic Loosening | AMP (Acute Meniscal Pathology) | Background: Revision of both femoral and tibial components of a total knee arthroplasty (TKA) for aseptic loosening has favorable outcomes. Revision of only one loose component with retention of others has shorter operative time and lower cost; however, implant survivorship and clinical outcomes of these different operations are unclear. Methods: Between January 2009 and December 2019, a consecutive cohort of revision TKA was reviewed. Univariate and multivariable analyses were used to study correlations among factors and surgical related complications, time to prosthesis failure, and functional outcomes (University of California Los Angeles, Knee Society functional, knee osteoarthritis and outcome score for joint replacement, Veterans RAND 12 (VR-12) physical, and VR-12 mental). Results: A total of 238 patients underwent revision TKA for aseptic loosening. The mean follow-up time was 61 months (range 25 to 152). Ten of the 105 patients (9.5%) who underwent full revision (both femoral and tibial components) and 18 of the 133 (13.5%) who underwent isolated revision had subsequent prosthesis failure [Hazard ratio (HR) 0.67, P = .343]. The factor analysis of type of revision (full or isolated revision) did not demonstrate a significant difference between groups in terms of complications, implant failures, and times to failure. Metallosis was related to early time to failure [Hazard ratio 10.11, P < .001] and iliotibial band release was associated with more complications (Odds ratio 9.87, P = .027). Preoperative symptoms of instability were associated with the worst improvement in University of California Los Angeles score. Higher American Society of Anesthesiologists status and higher Charlson Comorbidity Index were related with worse VR-12 physical (-30.5, P = .008) and knee osteoarthritis and outcome score for joint replacement (-4.2, P = .050) scores, respectively. Conclusion: Isolated and full component revision TKA for aseptic loosening does not differ with respect to prosthesis failures, complications, and clinical results at 5 years. Poor American Society of Anesthesiologists status, increased comorbidities, instability, and a severe bone defect are related to worse functional improvement. Level of evidence: III, cohort with control. |
0 | Correlation between the immunophenotypical presentation of dendritic cells and the clinical response to anti-rheumatic treatment in rheumatoid arthritis | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Dendritic cells (DCs) are potent antigen-presenting cells (APC) that are deeply implicated in the initiation and exacerbation of rheumatoid arthritis (RA). Active RA is associated with an activated DCs population as demonstrated by high expression of adhesion and co-stimulatory molecules. PURPOSE: To compare the expression of adhesion and co-stimulatory molecules on DCs from synovial tissue (ST) in patients (pts) with RA and the clinical status before and after treatment with disease modifying antirheumatic drugs (DMARDs). METHODS: Samples of ST were obtained from RA patients at the time of hip or knee replacement or arthroscopy. Clinical status (assessed by the American College of Rheumatology - |
0 | Treatment of humeral shaft fractures by retrograde locked nailing | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | From 1992 to 1994, 29 middle and 19 distal humeral shaft fractures (39 acute fractures, six nonunions, and three pathologic fractures) in 48 patients were treated by retrograde locked nailing. The first eight acute fractures were treated with Seidel nails, the other 40 fractures with specially designed humeral locked nails. Nails were inserted from the supracondylar (6) or the olecranon fossa (42) entry portal. With a single operation, all acute fractures and nonunions achieved osseous union without serious complications. The average time to union was 8.2 weeks for acute fractures and 14.2 weeks for nonunions. Recovery of shoulder function was complete. Elbow motion was excellent in all but one nonunion that resulted from a Type IIIB open fracture. Two patients with supracondylar entry had apex to posterior angular malunion. One patient with a distal comminuted fracture had varus malunion. Three patients had an iatrogenic bony split, but healing was unaffected. Patients with pathologic fractures maintained satisfactory arm function postoperatively. Given the few complications and good functional recovery seen in this study, retrograde locked nailing appears to be a good alternative treatment in middle and distal humeral shaft fractures. The olecranon fossa approach, with more linearity to the humerus, is preferred. In the authors' experience, humeral locked nails are inserted more easily and are associated with fewer complications than are Seidel nails |
0 | Joint instability and osteoarthritis | Glenohumeral Joint OA | Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA. |
0 | Articular interposition of broken trochanteric wires | Management of Hip Fractures in the Elderly | A case of recurrent dislocation of total hip arthroplasty with intra- articular migration of broken trochanteric wires and interposition between the articulating surfaces of the prosthetic components is reported. The patient was treated with revision total arthroplasty with good result. This unusual complication should always be considered when performing trochanteric osteotomy in total hip replacement |
0 | OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines | Surgical Management of Osteoarthritis of the Knee CPG | PURPOSE: To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world. METHODS: Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale. RESULTS: Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided. CONCLUSION: Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available |
0 | How frequent is rotational mismatch within 0(degrees)(plus or minus)10(degrees) in kinematically aligned total knee arthroplasty? | Surgical Management of Osteoarthritis of the Knee CPG | Rotational mismatch of the tibial component on the femoral component within 0(degrees)(plus or minus)10(degrees) is associated with better function after mechanically aligned total knee arthroplasty (TKA). Kinematically aligned TKA has gained interest; however, the percentage of kinematically aligned TKA within 0(degrees)(plus or minus)10(degrees) is unknown. The authors prospectively followed all patients who underwent TKA for primary osteoarthritis between December 2011 and April 2012 (194 patients, 195 knees). Each underwent kinematically aligned TKA with manual instruments. Aligning the anteroposterior axis of the tibial component parallel to the line that bisects the oval boundary of the lateral tibial condyle set internal/external rotation. Removing bone from the posterior femoral condyles equal in thickness to the femoral component after correction for cartilage wear set internal/external rotation and anteroposterior translation of the femoral component. Rotational mismatch of the tibial component on the femoral component was determined from a computed tomography scan of the knee. Ninety-seven percent of kinematically aligned TKA with fixed-bearing components had a rotational mismatch within 0(degrees)(plus or minus)10(degrees) (overall range, -11(degrees) to 11(degrees)). This percentage was higher and the range narrower than the 85% of TKA within 0(degrees)(plus or minus)10(degrees) and the -14(degrees) to 16(degrees) range reported for mechanically aligned TKA. The use of manual instruments to kinematically aligned TKA reliably limited rotational mismatch to within 0(degrees)(plus or minus)10(degrees), which has been associated with better function |
0 | Iatrogenic infrapatellar saphenous neuritis: A case report | Surgical Management of Osteoarthritis of the Knee CPG | Case Description: Patients who present with worsening knee pain following surgical intervention can be an enigma to the patient and physician. In this case report we discuss a 32-year-old man who presented with a chief complaint of left knee pain secondary to patellar chondromalacia. This pain was refractory to conventional conservative management. The patient subsequently underwent left knee arthroscopy. During the post-operative period the patient's knee pain worsened; described as burning and tingling then weak, hot, swollen and became very sensitive to touch. His pain was only relieved by an injection of local anesthetic and corticosteroid. In clinic patient's knee exhibited allodynia at the medial aspect of the knee; adjacent to the arthroscopy incision. The region of hypersensitivity was consistent with the anatomic location of the infrapatellar branch of the saphenous nerve. MRI done after arthroscopy was only significant for mild pre-patellar tendon and soft tissue swelling. Based on clinical presentation, history, physical examination, response to injection and MRI findings we diagnosed the patient with infrapatellar saphenous nerve neuralgia. Setting: Tertiary Care Hospital. Results or Clinical Course: We diagnosed the patient with infrapatellar saphenous nerve neuralgia and we recommended physical therapy, ultrasound desensitization therapy and gabapentin 300mg at night, which were not tolerated. Our plan is to have patient undergo diagnostic nerve block. If patient benefits from this procedure he will be evaluated for neurectomy or neurolysis, for long term relief. Discussion: A key part of this diagnosis was the patient's clinical presentation, symptoms of allodynia on physical examination and immediate relief after injection. After correctly diagnosing infrapatellar saphenous neuralgia there are a multitude of treatment options available that can provide adequate relief. Conclusions: It is prudent that one is aware of iatrogenic cutaneous nerve trauma, specifically neuropathic pain secondary to saphenous nerve neuritis after surgical procedures. There is evidence that this neuropathic pain severely limits the quality of life or our patients. Once correctly diagnosed, there are numerous beneficial treatment options available that will effectively ameliorate such pain |
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