recall
int64 0
1
| article_title
stringlengths 5
500
| topic
stringlengths 21
84
| abstract
stringlengths 2
65.8k
|
|---|---|---|---|
1 | Outcomes of intra-articular calcaneal fractures: surgical treatment of 114 consecutive cases at a maximum care trauma center | DoD SSI (Surgical Site Infections) | BACKGROUND: The aim of this retrospective monocentric study was to investigate the outcomes of surgically treated intra-articular calcaneus fractures in a maximum care trauma center.
METHODS: One hundred forty patients who had undergone surgery for intra-articular calcaneal fractures between 2002 and 2013 were included. One hundred fourteen cases with 129 fractures were eligible to participate in the study of which 80 were available for a clinical and radiological follow-up. 34 patients were followed up by telephone interview only. Outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form 36 Health Status Survey (SF-36), complications, and subsequent surgeries.
RESULTS: Mean follow-up was 91 months (range 12-183). The overall complication rate was 29% (37/129 ft). Disturbed wound healing (11%) and infection (5%) occurred most commonly. Non-union (4%) only occurred in smokers (p = 0.02). A high rate of posttraumatic subtalar arthritis (77%) and need for subsequent subtalar fusion (18%) without independent risk factors for subsequent subtalar fusion was found. The revision rate was high (60%) after primary fusion. Mean AOFAS-hindfoot score was 74 (Sanders I: 99, Sanders II: 74, Sanders III: 77, Sanders IV: 70). The postoperative Boehler angle improved significantly in all subgroups (p < 0.01). Patients with a decreased Boehler angle between postoperative images and the follow-up had significantly lower AOFAS hindfoot scores (p < 0.01).
CONCLUSIONS: Our data can aid decision-making in the treatment of calcaneal fractures. We advocate to use primary subtalar fusion with caution due to the high revision rate. Smoking status should always be considered.
LEVEL OF EVIDENCE: Level III, retrospective cohort study. |
0 | The effect of chlorhexidine/xylitol chewing-gum on cariogenic salivary microflora: a clinical trial in elderly patients | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | The effects of 14-day use of either a chlorhexidine/xylitol or a xylitol chewing gum on salivary levels of mutans streptococci, lactobacilli, and yeasts were determined for 53 subjects (mean age 79.49 +/- 7.7 years) participating in this randomised, double-blind, placebo-controlled trial. Salivary flow rates and enamel staining were measured and the attitudes of the subjects to gum chewing were evaluated by the use of structured questionnaires. The chlorhexidine/xylitol gum significantly reduced the salivary levels of mutans streptococci (p < 0.0001) lactobacilli (p < 0.05) and yeasts (p < 0.05) while the xylitol placebo gum produced significant reductions in mutans streptococci (p < 0.01) only. The study population found chewing gum twice per day for 10 min an acceptable method of receiving medication and improving oral health. Prior to gum use participants recognised persistent symptoms of dry mouth and their subjective evaluation of dry mouth was significantly (p < 0.001) related to the number of prescribed medications with xerostomic side-effects. The desire to continue gum use was significantly related to the subjects' evaluation of their oral dryness at baseline and to their perceived oral health gain from gum usage. Only those participants with stained enamel at baseline exhibited increased enamel staining following chlorhexidine/xylitol gum usage |
0 | The benefits and barriers to physical activity and lifestyle interventions for osteoarthritis affecting the adult knee | OAK 3 - Non-arthroplasty tx of OAK | Osteoarthritis prevalence is increasing, placing greater demands on healthcare and future socioeconomic costing models. Exercise and non-pharmacological methods should be employed to manage this common and disabling disease. Expectations at all stages of disease are increasing with a desire to remain active and independent. Three key areas have been reviewed; the evidence for physical activity, lifestyle changes and motivational techniques concerning knee osteoarthritis and the barriers to instituting such changes. Promotion of activity in primary care is discussed and evidence for compliance has been reviewed. This article reviews a subject that is integral to all professionals involved with osteoarthritis care. |
0 | Associations of knee muscle force, bone malalignment, and knee-joint laxity with osteoarthritis in elderly people | OAK 3 - Non-arthroplasty tx of OAK | [Purpose] From the viewpoint of prevention of knee osteoarthritis, the aim of this study was to verify how muscle strength and joint laxity are related to knee osteoarthritis. [Subjects and |
1 | Efficacy of botulinum toxin type a in the relief of Carpal tunnel syndrome: A preliminary experience | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | BACKGROUND AND OBJECTIVES: Botulinum toxin type A has been shown to relieve primary headaches, myofascial pain and various neuropathic pains. Carpal tunnel syndrome (CTS) is a common disorder resulting from median nerve compression at the wrist. As reports of botulinum toxin A in the treatment of CTS were limited, this study set out to evaluate the safety and tolerability of botulinum toxin A and its effects on the relief of nerve entrapment and pain in patients with CTS. METHODS: We conducted an open-label, prospective pilot study using 60 units of botulinum toxin A injected intracarpally in patients with primary CTS. Changes in median nerve conduction velocities, distal latencies, compound muscle action potentials and visual analogue scale (VAS) pain scores were evaluated for 3 months following injection. All adverse experiences, reported spontaneously or observed directly by the investigator, were recorded. RESULTS: Five women aged 52.2 +/- 2.5 years with 1-2 years' history of CTS were enrolled. Botulinum toxin A was well tolerated and safe. No exacerbated hand weakness was observed in any of the patients. At 3 months, pain was lessened in three patients, remained static in one patient, and was aggravated in one patient. The VAS pain score showed a trend to improvement during the 3 months of follow-up, although it did not reach statistical significance (p = 0.2). CONCLUSION: Our data suggest long-lasting antinociceptive effects of botulinum toxin A rather than electrophysiological restoration in patients with CTS. Intracarpal injection of botulinum toxin A was shown to be well tolerated and safe. A double-blind, placebo-controlled trial of botulinum toxin A in CTS is warranted since the current study may have been confounded by the placebo effect of intracarpal injection |
0 | The use of an anabolic steroid (nandrolone decanoate) to improve nutritional status after esophageal resection for carcinoma | Reconstruction After Skin Cancer | Anabolic steroids increase appetite and muscle mass. This randomized, double-blind trial investigates any nutritional benefits of anabolic steroid in patients after surgery for esophageal cancer. Forty patients were recruited: 19 patients had five injections of 50 mg nandrolone decanoate and 21 patients received placebo over 3 months, starting 1 month after surgery. Measurements of body weight, mid-arm muscle circumference (MAMC) and appetite were taken over a 6-month period. Nutrition was optimized by dietary advice and by esophageal dilatation if required. Percent ideal weight, percent ideal MAMC and appetite score did not show significant differences between steroid and placebo groups, but there was a trend to an increase over 6 months for percent ideal MAMC in the test group. With this protocol, we have experienced minimal side-effects. However, we have not demonstrated any therapeutic benefit with low-dose steroid. An increased dose schedule over a longer period might produce a significant response. |
0 | Acupuncture for peripheral joint osteoarthritis | SR for PM on OA of All Extremities | Background: Peripheral joint osteoarthritis is a major cause of pain and functional limitation. Few treatments are safe and effective.Objectives: To assess the effects of acupuncture for treating peripheral joint osteoarthritis.Search methods: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE, and EMBASE (both through December 2007), and scanned reference lists of articles.Selection criteria: Randomized controlled trials (RCTs) comparing needle acupuncture with a sham, another active treatment, or a waiting list control group in people with osteoarthritis of the knee, hip, or hand.Data collection and analysis: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We calculated standardized mean differences using the differences in improvements between groups.Main results: Sixteen trials involving 3498 people were included. Twelve of the RCTs included only people with OA of the knee, 3 only OA of the hip, and 1 a mix of people with OA of the hip and/or knee. In comparison with a sham control, acupuncture showed statistically significant, short-term improvements in osteoarthritis pain (standardized mean difference -0.28, 95% confidence interval -0.45 to -0.11; 0.9 point greater improvement than sham on 20 point scale; absolute percent change 4.59%; relative percent change 10.32%; 9 trials; 1835 participants) and function (-0.28, -0.46 to -0.09; 2.7 point greater improvement on 68 point scale; absolute percent change 3.97%; relative percent change 8.63%); however, these pooled short-term benefits did not meet our predefined thresholds for clinical relevance (i.e. 1.3 points for pain; 3.57 points for function) and there was substantial statistical heterogeneity. Additionally, restriction to sham-controlled trials using shams judged most likely to adequately blind participants to treatment assignment (which were also the same shams judged most likely to have physiological activity), reduced heterogeneity and resulted in pooled short-term benefits of acupuncture that were smaller and non-significant. In comparison with sham acupuncture at the six-month follow-up, acupuncture showed borderline statistically significant, clinically irrelevant improvements in osteoarthritis pain (-0.10, -0.21 to 0.01; 0.4 point greater improvement than sham on 20 point scale; absolute percent change 1.81%; relative percent change 4.06%; 4 trials;1399 participants) and function (-0.11, -0.22 to 0.00; 1.2 point greater improvement than sham on 68 point scale; absolute percent change 1.79%; relative percent change 3.89%). In a secondary analysis versus a waiting list control, acupuncture was associated with statistically significant, clinically relevant short-term improvements in osteoarthritis pain (-0.96, -1.19 to -0.72; 14.5 point greater improvement than sham on 100 point scale; absolute percent change 14.5%; relative percent change 29.14%; 4 trials; 884 participants) and function (-0.89, -1.18 to -0.60; 13.0 point greater improvement than sham on 100 point scale; absolute percent change 13.0%; relative percent change 25.21%). In the head-on comparisons of acupuncture with the 'supervised osteoarthritis education' and the 'physician consultation' control groups, acupuncture was associated with clinically relevant short- and long-term improvements in pain and function. In the head on comparisons of acupuncture with 'home exercises/advice leaflet' and 'supervised exercise', acupuncture was associated with similar treatment effects as the controls. Acupuncture as an adjuvant to an exercise based physiotherapy program did not result in any greater improvements than the exercise program alone. Information on safety was reported in only 8 trials and even in these trials there was limited reporting and heterogeneous methods.Authors' conclusions: Sham-controlled trials show statistically significant benefits; however, these benefits are small, do not meet our pre-defined thresholds for clinical relevance, and are probably due at least partially to placebo effects from incomplete blinding. Waiting list-controlled trials of acupuncture for peripheral joint osteoarthritis suggest statistically significant and clinically relevant benefits, much of which may be due to expectation or placebo effects |
0 | Body mass index moderates the association between gait kinetics, body composition, and femoral knee cartilage characteristics | AMP (Acute Meniscal Pathology) | This study compared femoral cartilage characteristics between age- and sex-matched individuals with (n = 48, age = 22.8 ± 3.5 years; body mass index [BMI] = 33.1 ± 4.1 kg/m2) and without obesity (n = 48 age = 22.0 ± 2.6 years; BMI = 21.7 ± 1.7 kg/m2) and evaluated the associations between body composition, quadriceps function, and gait kinetics with femoral cartilage characteristics. Medial and lateral femoral cartilage thickness, medial:lateral thickness ratio and medial and lateral cartilage echo intensity were measured using ultrasound imaging. Body composition was assessed using air displacement plethysmography. Quadriceps function was assessed via maximal isometric knee extension. Three-dimensional gait biomechanics were recorded to extract peak external knee flexion and adduction moments, and peak loading rate of the vertical ground reaction force. Cartilage outcomes were compared between groups using one-way multivariate analysis of variance. Stepwise moderated regression evaluated the association between body composition, quadriceps function, and gait kinetics with femoral cartilage outcomes in individuals with and without obesity. Medial (75.24 vs 65.84; P <.001, d = 1.02) and lateral (58.81 vs 52.22; P <.001, d = 0.78) femoral cartilage echo intensity were higher in individuals with compared with those without obesity. A higher body fat percentage was associated with higher medial and lateral cartilage echo intensity (?R2 = 0.09-0.12) in individuals with obesity. A higher knee adduction moment was associated with a larger medial:lateral thickness ratio (?R2 = 0.09) in individuals without obesity. No associations were found between quadriceps function and cartilage outcomes. These findings suggest that high body fat in adults with obesity is associated with cartilage echo intensity. The obese body mass index was also associated with a lack of a positive relationship between cartilage thickness and joint loading during walking. |
1 | Arthroscopically assisted meniscal allograft transplantation in the knee: a medium-term subjective, clinical, and radiographical outcome evaluation | AMP (Acute Meniscal Pathology) | BACKGROUND: Allograft meniscal transplantation is known as a possible procedure to solve pain and loss of function in the knee of patients with a history of subtotal or total meniscectomy.
PURPOSE: This work was undertaken to evaluate, using subjective questionnaires and clinical and radiographical scores, patients who underwent an arthroscopically assisted meniscal allograft transplantation with a minimum follow-up between 5 and 15 years (range, 62-169 months).
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: Demographic data of 49 patients (50 meniscal allograft transplantations) were collected. At the latest follow-up visit, the authors collected preoperative and follow-up Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and Short Form 36 (SF-36) scores, and visual analog scale (VAS) scores for pain for comparison. Patients were also evaluated with a standardized clinical examination of the knee to objectively evaluate knee-related symptoms. Standard weightbearing radiographs and a full-leg standing radiograph were performed to evaluate the progression of osteoarthritis and malalignment.
RESULTS: Five patients underwent total knee replacement and were considered failures, 8 patients could only be contacted by phone, and 2 patients were lost to follow-up, so 34 patients underwent the complete study protocol (except for 1 patient who did not have a radiographical evaluation because of pregnancy). The study group consisted of 18 men and 16 women, with a mean age of 33 years at the moment of transplantation and with an average follow-up of 8 years and 9 months. There were only a few concomitant procedures. There was a significant (P < .001) and clinically relevant decrease in the VAS (7 to 3.4) and increase in KOOS (35.8 to 60.2), Lysholm (39.7 to 71.8), and total SF-36 (51.5 to 75.2) from preoperative mean score to postoperative mean score. This improvement stayed consistent during the follow-up period. Despite this improvement, there was no increase in Tegner activity level (P = .604). The more severe the osteoarthritis, the less the improvement. There was a significant (P < .001) increase in osteoarthritis in 42% of the patients (14 of 33), as scored following the Kellgren-Lawrence classification. When strictly respecting the indications, there was no significant correlation between preoperative cartilage damage, preoperative osteoarthritis, alignment deviation, gender, and body mass index and the outcome scores or improvement. In this series, with few concomitant procedures, there was no difference in outcome between medial and lateral transplants.
CONCLUSION: Meniscal allograft transplantation may result in important pain relief and functional improvement in patients with a history of (sub)total meniscectomy and pain localized in the affected compartment. Strictly following the indications, meniscal transplantation can give good and predictable results. In 58% of patients, there was no increase in osteoarthritis according to the Kellgren-Lawrence classification. In 42%, there was a slight or moderate increase in osteoarthritis. No severe increase was noted. |
0 | Wrist splint versus conventional casting for the management of wrist fractures | Distal Radius Fractures | INTERVENTION: This is a RCT with two arms â? intervention group and control. The intervention group will have their distal radius fracture managed with the adaptable wrist splint (low risk medical device) to immobilise the fracture. This will be applied by the fracture clinic staff who are qualified nurses and doctors. Their management of clinic attendance will follow the same protocol as the control group (traditional plaster cast) in terms of follow up appointment and Xâ?rays. The researcher (registered physiotherapist) will moniter both groups weekly with telephone questionnaires and identify any risks as appropriate to refer onto the orthodpaedic consultant. The adaptable wrist splint is a custom fitted, prefabricated ride device which allows for adjustment and adaptation for fracture reduction and stabilisation. It consists of a volar plate, dorsal plate, proximal strap and ratchetâ?legs linking the volar and dorsal plates together. Once the plates are pressed together guided by the ratchet legs , it is then locked. The device is not able to be removed by participants at any time. The overall duration of splint wear is for 6 weeks. CONDITION: Distal wrist fractures PRIMARY OUTCOME: The modified Patient Reported Wrist Evaluation looks at pain and function. This is a. composite outcome. The pain rating is the average amount of pain in the wrist over the past week. The scale is from zero (never) to 10 (always). It specifically asks for ratings at rest; when doing a task with a repeated wrist movement when lifting a heavy object; when it is at its worst and how often you have pain. The function looks at specific activities where you rate the amount of difficulty you experience over the past week performing on a scale of; zero (no difficulty) to 10 (it was so difficult you were unable to do it). The specific activities are turn a door knob using my affected hand; cut meat using a knife in my affected hand; fasten buttons on my shirt; use my affected hand to push up fro a chair;carry a 4.5 kg object in my affected hand and use bathroom tissue with my affected hand. The usual activities rate again from zero (you did not experience any difficulty) to 10 (it was so difficult you were unable to do it) included; personal care activities (washing, dressing); household work (cleaning, maintenance); when lifting a heavy object; work (your job or usual everyday work) and recreational activities). SECONDARY OUTCOME: Maintenance of fracture position Health care users perception of comfort and convenience of adaptable wrist splint. Health professionals experience of using adaptable wrist splint INCLUSION CRITERIA: Nonâ?displaced distal radius fracture. Able to give informed consent. Age 65 and over. |
0 | Injuries of the hand and forearm in young children caused by steam roller presses in laundries | DOD - Acute Comp Syndrome CPG | Fourteen children (median age 43 months, range 14-82 months; 7 girls and 7 boys) were treated for mangle injuries (one hot steam, and 13 cold roller presses) to the hand and forearm between 1996-2002 at the Department of Hand Surgery, Malmo, Sweden. All children had unilateral skin damage with avulsion or necrosis of skin in nine. Seven of the 14 had signs of compartment and carpal tunnel syndromes and three had fractures (phalanges or hamate bone). Initial treatment included fasciotomy, decompression, and skin revision with split skin grafts and later further skin cover, including one pedicled ulnar flap. IN eight the injuries healed uneventfully, while six had slight consequences (such as minor extension deficit of fingers or slight contracture of the scar). Ten of the 14 children came from immigrant families. Mangle injuries can be prevented through better supervision of children by parents when the mangle is being used, and dissemination of information of the potential hazards in relevant languages in residential areas with large immigrant populations. |
0 | Whole-exome sequencing identifies a novel ALMS1 mutation (p.Q2051X) in two Japanese brothers with Alstrom syndrome | Upper Eyelid and Brow Surgery | PURPOSE: No mutations associated with Alstrom syndrome (AS), a rare autosomal recessive disease, have been reported in the Japanese population. The purpose of this study was to investigate the genetic and clinical features of two brothers with AS in a consanguineous Japanese family. METHODS: Whole-exome sequencing analysis was performed on two brothers with AS and their unaffected parents. We performed a complete ophthalmic examination, including decimal best-corrected visual acuity, slit-lamp and funduscopic examination, visual-field and color-vision testing, full-field electroretinography, and optical coherence tomography. Fasting blood tests and systemic examinations were also performed. RESULTS: A novel mutation (c.6151C>T in exon 8) in the Alstrom syndrome 1 (ALMS1) gene that causes a premature termination codon at amino acid 2051 (p.Q2051X), was identified in the homozygous state in the affected brothers and in the heterozygous state in the parents. The ophthalmologic findings for both brothers revealed infantile-onset severe retinal degeneration and visual impairment, marked macular thinning, and severe cataracts. Systemic findings showed hepatic dysfunction, hyperlipidemia, hypogonadism, short stature, and wide feet in both brothers, whereas hearing loss, renal failure, abnormal digits, history of developmental delay, scoliosis, hypertension, and alopecia were not observed in either brother. The older brother exhibited type 2 diabetic mellitus and obesity, whereas the younger brother had hyperinsulinemia and subclinical hypothyroidism. CONCLUSIONS: A novel ALMS1 mutation was identified by using whole-exome sequencing analysis, which is useful not only to identify a disease causing mutation but also to exclude other gene mutations. Although characteristic ophthalmologic findings and most systemic findings were similar between the brothers, the brothers differed slightly in terms of glucose tolerance and thyroid function. |
0 | Cost of infection after surgery for intracapsular fracture of the femoral neck | PJI DX Updated Search | INTRODUCTION: We investigated the financial and human costs of postoperative infection for intracapsular fracture of the femoral neck at a district general hospital in the UK. METHODS: Data on postoperative infections after surgical treatment for intracapsular fracture of the femoral neck were collected prospectively from June 2005 to April 2009. Infected patients were pairwise-matched (1:2 ratio) with a non-infected group of patients from a database on hip fractures. Costs of additional surgery, duration of hospital stay, and opportunity costs were calculated using Primary Care Trust (PCT) tariffs and PCT-specific data. RESULTS: A total of 525 patients were treated with total hip replacement (n=110) or hip hemiarthroplasty (n=415). Seventeen patients (3.2%) were identified as having a surgical-site infection. Eight (1.5%) deep infections and nine (1.7%) superficial infections were documented. Compared with the non-infected group, duration of hospital stay and the prevalence of mortality doubled. Repeat surgery and the costs associated with hospital admission were increased significantly in the infected group. Mean financial loss associated with an infected patient was pound7,726, whereas an uninfected patient brought pound153 of profit to the hospital. When opportunity costs were considered, an infected patient represented pound24,397 of lost income. CONCLUSIONS: Postoperative infection after surgical treatment for intracapsular fracture of the femoral neck has a significant negative impact on duration of hospital stay and financial costs, and demonstrates a trend towards an increase in the prevalence of mortality |
0 | New and Common Perioperative Pain Management Techniques in Total Knee Arthroplasty | AAHKS (8) Anesthetic Infiltration | Optimal pain control in patients undergoing total knee arthroplasty (TKA) is imperative for good rehabilitation and functional outcomes. However, despite technological advancements, surgeons continue to struggle with adequate pain management in their patients. Current modalities in use, such as patient-controlled analgesia, opioids, and epidural anesthetics, provide good pain relief but can be associated with side effects and serious complications. As a result, newer pain control modalities have been used to try to reduce the use of opioids while providing adequate pain relief. Currently, there are no clear guidelines or evidence for an optimum postoperative TKA analgesic regimen. Our aim was to evaluate the recent literature and provide a summary of the newer perioperative analgesic modalities. Evidence suggests that analgesics, such as newer oral medications, peripheral nerve blocks, and periarticular injections, may improve pain management, rehabilitation, and patient satisfaction, as well as reduce opioid consumption. The literature has also highlighted that a multimodal approach to pain management may provide the best results. However, determining which modalities provide superior pain control is still being extensively studied, and further research is needed. |
0 | Evaluation of driving performance in patients with juvenile macular dystrophies | Upper Eyelid and Brow Surgery | The driving performance of 20 subjects with central vision impairment due to either Stargardt disease or cone-rod dystrophy (visual acuity, 20/40 to 20/70) was compared with that of 29 control subjects with normal vision who had similar driving histories. Driving performance was defined by accident involvement based on self-report and state records and by an evaluation of performance on an interactive driving simulator. The proportion of individuals involved in accidents in the central vision loss group was comparable to that of the control group. For 13 of the 20 subjects with central vision loss who did not restrict their driving to daylight hours, there was a greater likelihood of involvement in nighttime accidents than in the control group. Visual function measures and simulator indexes did not predict accident involvement for the central visual loss group, although these subjects showed longer braking response times and a greater number of lane boundary crossings than the control group. These findings are in contrast to our previously published report of subjects with retinitis pigmentosa, who were more likely to have been involved in both daytime and nighttime accidents than a control group and for whom visual field extent was significantly related to accident involvement. |
1 | Influence of Menisci on Tibiofemoral Contact Mechanics in Human Knees: A Systematic Review | AMP (Acute Meniscal Pathology) | <b>Purpose:</b> Menisci transfer axial loads, while increasing the load-bearing tibiofemoral contact area and decreasing tibiofemoral contact pressure (CP). Numerous clinical and experimental studies agree that an increased CP is one predominant indicator for post-traumatic osteoarthritis (PTOA) of the knee joint. However, due to the immense variability in experimental test setups and wide range of treatment possibilities in meniscus surgery, it is difficult to objectively assess their impact on the CP determination, which is clearly crucial for knee joint health. Therefore, the aim of this systematic review is to investigate the influence of different meniscal injuries and their associated surgical treatments on the CP. Secondly, the influence of different test setups on CP measurements is assessed. On the basis of these results, we established the basis for recommendations for future investigations with the aim to determine CPs under different meniscal states. |
0 | Bisphosphonate Fractures as a Cause of Painful Total Hip Arthroplasty | PJI DX Updated Search | Osteoporotic fractures pose a significant health concern for postmenopausal women. Bisphosphonate therapy has been shown to decrease the risk of these fractures. The bisphosphonate alendronate was approved by the US Food and Drug Administration for use in the United States in 1995, but questions have recently arisen concerning low-energy subtrochanteric femur fractures sustained by chronic users. Although no definitive association or causality between bisphosphonates and these fractures has been established, numerous cautionary reports exist concerning the duration of use and safety of alendronate in osteoporotic patients. This article reports 3 occurrences of bisphosphonate-associated atypical femur fractures as an etiology of periprosthetic hip pain in the total hip arthroplasty (THA) patient. These fractures are particularly concerning because these patients are often not advised to protect their weight bearing simply due to a painful THA and may sustain a catastrophic failure if not followed closely. Several theories have been suggested concerning the pathophysiology of atypical low-energy subtrochanteric fractures following bisphosphonate use. Each patient described in this article carried a diagnosis of rheumatoid arthritis and underwent chronic medical therapy; each patient experienced a delay in the diagnosis and onset of therapy due to low suspicion for bisphosphonate-associated fracture. This problem may become more common in the clinical setting; therefore, one must be vigilant and aware of this etiology of periprosthetic hip pain |
0 | Extra spinal osteoarticular tuberculosis: a case series of 66 patients from a tertiary care hospital in Karachi | Dental Implant Infection | The demographic, clinical and laboratory data of patients diagnosed as extra-spinal osteoarticular tuberculosis, presenting at Department of Orthopaedic Surgery, Abbasi Shaheed Hospital, Karachi Medical and Dental College, Karachi, between December 2006 and January 2009 were analysed. There were 66 patients registered for the study. Forty four (66.66%) patients were females. The mean age was 26.5 +/- 13.5 years. Swelling and pain were the commonest symptoms. Knee and hip were the most frequent sites involved. The mean time to diagnosis was 12.32 +/- 18 months (range = 2- 96 months). Six (09.09%) patients had history of previous pulmonary kochs. Nine (13.63%) had concurrent pulmonary and 1(01.51%) had concurrent intestinal kochs. The average first hour ESR was 48 mm/h (16-102). Manteoux test was positive in 26/42 patients. Acid Fast Bacilli (AFB) stain was positive in 1/25 while culture was positive in 7/25 specimens. There was 1(14.28%) case of MDR tuberculosis. Most of the patients (95.45%), were diagnosed on positive histopathology report of involved tissues showing chronic granulomatous reaction with caseous necrosis. |
0 | Wrist arthroplasty--a systematic review | PJI DX Updated Search | INTRODUCTION: Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and partial wrist arthroplasty (T/PWA) has been used on a regular basis since the 1960's. The objective of this study was to review the literature on second, third and fourth generation implants. METHODS: The review was conducted according to the PRISMA-guidelines. A search was made using a protocolled strategy and well-defined criteria in PubMed, in the Cochrane Library and by screening reference lists. RESULTS: 37 publications describing a total of 18 implants were selected for analysis. 16 of the publications were useful for the evaluation of implant longevity. Despite methodological shortcomings in many of the source documents, a summary estimate was possible. CONCLUSION: It seems that T/PWA has a good potential to improve function through pain reduction and preservation of mobility. The risk of severe complications - deep infection and instability problems - is small with the available implants. Implant survival of 90-100% at five years are reported in most series - if not all - using newer second generation and third generation implants, but declines from five to eight years. Periprosthetic osteolysis/radiolucency is frequently reported. Its causes and consequences are not clarified |
0 | State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment | Management of Hip Fractures in the Elderly | OBJECTIVES: To increase recognition of geriatric rehabilitation and to provide recommendations for practice and future research. DATA SOURCES: A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database. STUDY SELECTION: One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports. DATA EXTRACTION: The following major geriatric rehabilitation subtopics were identified: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in geriatric rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies. DATA SYNTHESIS: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references. CONCLUSIONS: Frail elderly patients should be screened for rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to geriatric rehabilitation should be interdisciplinary and use a comprehensive geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of geriatric rehabilitation are most effective, screening, and what outcomes are sustainable |
0 | Relationship between plasma levels of hyaluronic acid and amyloid-associated osteoarthropathy in chronic hemodialysis patients | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Plasma levels of hyaluronic acid (HA) and acute-phase reactants were determined in chronic hemodialysis patients with or without carpal tunnel syndrome (CTS) and/or shoulder pain, which are characteristic symptoms of amyloid-associated osteoarthropathy. While levels of acute-phase reactants tended to be higher in the patients with CTS and/or shoulder pain than in patients without these symptoms, the difference was not significant. However, plasma levels of HA were significantly higher in the patients with these symptoms. Analysis of plasma levels of HA in age-matched patients also demonstrated a significant correlation between elevated levels of HA and the presence of CTS and/or shoulder pain. Among the patients with CTS and/or shoulder pain, those patients with bone cysts in the carpal bone or humeral head had significantly higher plasma levels of HA than patients without bone cysts. Thus, there appears to be a relationship between elevated plasma HA and amyloid-associated osteoarthropathy in chronic hemodialysis patients that is more specific than any correlation with levels of acute-phase reactants |
0 | Anti-arthritic agents: Progress and potential | OAK 3 - Non-arthroplasty tx of OAK | Abstract Osteoarthritis and rheumatoid arthritis are the two most common types of arthritis. Cartilage breakdown is a key feature of both diseases which contributes to the pain and joint deformity experienced by patients. Therefore, anti-arthritis drugs are of great importance. The aim of this review is to present recent progress in studies of various agents against osteoarthritis and rheumatoid arthritis. The structures and activities of anti-arthritic agents, which used in medical practice or are in development, are presented and discussed. The effects and mechanisms of action of opioids, glucocorticoids, non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, natural products derived from plants, nutraceuticals, and a number of new and perspective agents are considered. Various perspective targets for the treatment of osteoarthritis and rheumatoid arthritis are also discussed. Trials of good quality are needed to draw solid conclusions regarding efficacy of many of the studied agents. Unfortunately, to date, there is no pharmacologic agent proven to prevent the progression of both diseases, and there is an urgent need for further development of better anti-arthritic agents. |
0 | Hyperbaric oxygen therapy as an adjuvant to standard therapy in the treatment of diabetic foot ulcers | DoD SSI (Surgical Site Infections) | Background and Aims: Chronic diabetic foot ulcers pose a major problem because of associated limb threatening complications. The aim of the present study was to evaluate the efficacy of hyperbaric oxygen therapy (HBOT) as an adjuvant to standard therapy for treatment of diabetic foot ulcers. Material and Methods: A total of 54 patients with diabetic foot ulcer of Wagner grade II-IV were recruited in this prospective, randomized, double blind study. Patients were randomized to receive HBOT along with standard therapy (group H; n = 28) or standard therapy alone (group S; n = 26). Patients were given 6 sessions per week for 6 weeks and followed up for 1 year. Outcomes were measured in terms of healing, and need for amputation, grafting or debridement. Parametric continuous variables were analyzed using Student unpaired t-test and categorical variables were analyzed using Chi square test. Results: The diabetic ulcers in 78% patients in Group H completely healed without any surgical intervention while no patient in group S healed without surgical intervention (P = 0.001). 2 patients in group H required distal amputation while in Group S, three patients underwent proximal amputation. Conclusion: The present study shows that hyperbaric oxygen therapy is a useful adjuvant to standard therapy and is a better treatment modality if combined with standard treatment rather than standard treatment alone for management of diabetic foot ulcers. |
0 | Liver abnormalities in pregnancy | DOD - Acute Comp Syndrome CPG | Abnormalities of liver function (notably rise in alkaline phosphatase and fall in serum albumin) are common in normal pregnancy, whereas rise in serumbilirubin andaminotransferase suggest either exacerbation of underlying pre-existing liver disease, liver disease related to pregnancy or liver disease unrelated to pregnancy. Pregnant women appear to have a worse outcome when infected with Hepatitis E virus. Liver diseases associated with pregnancy include abnormalities associated hyperemesis gravidarum, acute fatty liver disease, pre-eclampsia, cholestasis of pregnancy and HELLP syndrome. Prompt investigation and diagnosis is important in ensuring a successful maternal and foetal outcome. In general, prompt delivery is the treatment of choice for acute fatty liver, pre-eclampsia and HELLP syndrome and ursodeoxycholic acid is used for cholestasis of pregnancy although it is not licenced for this indication. © 2013 Elsevier Ltd. All rights reserved. |
0 | Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | Tourniquet time and its relationship to blood loss and deep vein thrombosis were studied in 80 cases of unilateral total knee arthroplasty. These data were part of a prospective multicenter double-blind study on thromboprophylaxis for knee surgery. This study reports on the cases done at one institution in which the tourniquet was used in three different ways: group 1, no tourniquet use; group 2, limited tourniquet use for cementing time only; group 3, tourniquet use throughout the whole case. Blood loss was significantly related to tourniquet time (P = .0001). The incidence of deep vein thrombosis was not related to the tourniquet group (P = .9) |
0 | The Munich Knee Questionnaire: Development and Validation of a New Patient-Reported Outcome Measurement Tool for Knee Disorders | AMP (Acute Meniscal Pathology) | PURPOSE: To develop and validate an all-purpose patient-reported outcome questionnaire for a patient-based follow-up examination regarding knee disorders.
METHODS: Each scale of the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Lysholm knee score, Western Ontario Meniscal Evaluation Tool (WOMET) score, and Tegner score was analyzed, and after matching of the general topics, the dedicated items underwent a fusion to the final Munich Knee Questionnaire (MKQ) item and a score comprising 33 items was created. In a prospective clinical study, we evaluated validity, reliability, and responsiveness in 152 physical active patients (75 women and 77 men; mean age, 47 years) with traumatic as well as degenerative knee disorders.
RESULTS: Test-retest reliability was substantial, with intraclass correlation coefficients of at least 0.91. Construct validity and responsiveness were confirmed by correlation coefficients of 0.78 to 0.86 (P = .01) and 0.41 to 0.71, respectively. Correlation coefficients of the original scores (KOOS, IKDC, Lysholm, WOMET, and Tegner) and the scores calculated from the MKQ were between 0.80 and 0.91 (P = .01).
CONCLUSIONS: The MKQ is a reliable and valid patient-reported outcome questionnaire for assessing knee function. It seems to enable the calculation of the original items of the KOOS, IKDC score, Lysholm knee score, WOMET score, and Tegner score.
CLINICAL RELEVANCE: The MKQ facilitates the comparison of treatment results in knee disorders and allows the evaluation of treatment efficacy. Identified inadequate treatment concepts could be eliminated, leading to increased patient satisfaction and optimized quality of health care. |
0 | Microbial diversity in saliva of oral squamous cell carcinoma | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | In the oral cavity, chronic inflammation has been observed at various stages of oral squamous cell carcinomas (OSCC). Such inflammation could result from persistent mucosal or epithelial cell colonization by microorganisms. There is increasing evidence of the involvement of oral bacteria in inflammation, warranting further studies on the association of bacteria with the progression of OSCC. The objective of this study was to evaluate the diversity and relative abundance of bacteria in the saliva of subjects with OSCC. Using 454 parallel DNA sequencing, ~58000 PCR amplicons that span the V4-V5 hypervariable region of rRNAs from five subjects were sequenced. Members of eight phyla (divisions) of bacteria were detected. The majority of classified sequences belonged to the phyla Firmicutes (45%) and Bacteroidetes (25%). Further, 52 different genera containing approximately 860 (16.51%) known species were identified and 1077 (67%) sequences belonging to various uncultured bacteria or unclassified groups. The species diversity estimates obtained with abundance-based coverage estimators and Chao1 were greater than published analyses of other microbial profiles from the oral cavity. Fifteen unique phylotypes were present in all three OSCC subjects. (copyright) 2011 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd |
0 | Does the location of the surgery or the specialty of the physician affect malpractice claims in liposuction? | Panniculectomy & Abdominoplasty CPG | BACKGROUND. There is increasing national dialogue on who should perform liposuction and where it should be performed. OBJECTIVE. To determine the effect of the location of liposuction surgery and the specialty of the physician on the incidence of malpractice claims. METHODS. Physicians Insurance Association of America malpractice data from 1995-1997 was analyzed. RESULTS. Hospital-based liposuction had more than 3 times the rate of malpractice settlements than office-based liposuction. Dermatologists accounted for less than 1% of malpractice claim settlements in liposuction. CONCLUSION. Dermatologic liposuction education has emphasized small volume cases performed under local anesthesia using the tumescent technique. The safety of this approach appears to be validated in terms of decreased malpractice settlements. |
0 | Gait rehabilitation: a new biofeedback device for monitoring and enhancing weight-bearing over the affected lower limb | Management of Hip Fractures in the Elderly | AIM: Gait rehabilitation programs often require either partial weight-bearing (PWB) or encourage full weight-bearing (FWB) on the affected limb. Until recently, there was no objective and practical way to measure correct weight-bearing during ambulation. The present study evaluates a new in-shoe device (SmartStep, Andante Medical Devices Ltd.) for measuring the amount of weight on the affected limb and for biofeedback gait training.METHODS: The first part of the study aimed to establish the validity of the SmartStep by comparing the results obtained from this device with the results obtained from a force plate. The second part aimed to evaluate the effectiveness of the SmartStep as a biofeedback method in patients who have been referred for FWB gait rehabilitation. Analysis was based on independent samples t-test and chi squared test for evaluating statistically significant differences between the 2 gait rehabilitation modes.RESULTS: The SmartStep could repeat the same results with 0.53 kg error of mean. Statistically significant correlation was found between results obtained from the SmartStep and from the force plate (R2=0.9067 and P=0.004). The use of the SmartStep auditory biofeedback, significantly (P=0.00031) improved patients' weight-bearing over the affected limb in the experimental group (7.9 kg +/-5.28) as compared to the control group (0.7+/-2.41 kg).CONCLUSIONS: The SmartStep proved to be very reliable since it generated significant repeatable results which correlated significantly with those obtained from a force plate. Patients recommended for FWB gait can significantly improve body weight loading over the affected limb by the use of the SmartStep auditory biofeedback |
0 | Obtaining intra-articular bone grafts arthroscopically for intra-articular grafting | Diagnosis and Treatment of Osteochondritis Dissecans AUC | Autogenous bone graft is frequently necessary for arthroscopic procedures and even small open procedures that involve cruciate revision, osteochondritis dissecans repair, and fracture reduction and internal fixation. Currently used sites to obtain bone graft are the iliac crest and Gerdy's tubercle. This article describes an arthroscopic technique for harvest of small amounts of bone graft from the distal femur. This avoids the morbidity of the extra-articular harvest. Tube harvesters frequently used for osteochondral autografts are the primary tool required for this technique. However, as described, the obtaining of bone graft is much less technically exacting than when procuring osteochondral bone plugs. This provides a safe, simple way to obtain extra autogenous bone at minimal additional operative morbidity |
0 | Neuro-ophthalmological assessment using spinal anaesthesia | Surgical Management of Osteoarthritis of the Knee CPG | Purpose: The aim of the study was to compare the neuro-ophthalmological and anaesthetic effects of isobaric levobupivacaine and bupivacaine when intrathecally administered for knee arthroscopy. Material and Methods: A prospective, double-blind, randomized study with 60 ASA grade I-II patients aged 18-65 years awaiting knee arthroscopy under spinal anaesthesia. There were two patient groups of 15 which received 12.5 mg of isobaric bupivacaine or levobupivacaine. Upon arrival at the anaesthetic room, and 5 minutes after initiating spinal anaesthesia, a complete ocular examination was performed, including the tests that follow in this order: 1) near best-corrected visual acuity of each eye; 2) Amsler Grid Test; 3) extrinsic and intrinsic ocular motility assessment; 4) Bielchowsky test. When surgery ended, each patient completed a neuro-ophthalmologic symptoms questionnaire. It also was completed by telephone at 24 hours, 72 hours and 1 week after spinal anaesthesia. Results: No neuro-ophthalmological side effects were noted before or after spinal anaesthesia in either group. Follow-up on days 1, 3 and 7 post-surgery revealed neither neuro-ophthalmological symptoms nor other side effects. Conclusions: Intradural anesthesia with bupivacaine or levobupivaine have no perioperatory neuro-ophthalmological side effects |
1 | Management of suprapatellar synovial plica, a common cause of anterior knee pain: A clinical review | OAK 3 - Non-arthroplasty tx of OAK | Background and aim of the work: Suprapatellar synovial plica is caused by a congenital thickening of the synovial membrane and is generally asymptomatic. In the literature, suprapatellar plicae are described as one of the causes of anterior knee pain however, their real role in determining symptoms is controversial. The aim of the current paper is to describe the anatomy, classifications, pathophysiology, symptoms and management of suprapatellar plica syndrome, as well as the differential diagnosis from other causes of anterior knee pain. Method: Via a search within the MEDLINE/PubMed database, a current review was conducted, and the results summarized. Results: Due to idiopathic, traumatic or inflammatory conditions, plicae can become pathological, causing anterior knee pain with possible knee clicking, swelling, giving way and locking after prolonged flexion of the knee. The diagnosis should be formulated based on an accurate medical history and clinical examination, followed by an appropriate imaging study. However, arthroscopy remains the â??golden standardâ? for detecting all synovial plica. Conclusions: In patients with anterior knee pain, where doubt is present in the imaging investigation for intraarticular or periarticular lesions, pathological suprapatellar synovial plica must be suspected. The treatment should initially be conservative, but in cases where symptoms persist, patients should undergo arthroscopy to confirm diagnosis and to determine a suitable treatment. In the presence of pathological plica associated with cartilage damage of the femoral condyle or patella at the time of diagnostic arthroscopy, plicae excision leads to favourable results in a high number of cases. (www.actabiomedica.it). |
0 | Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament-Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs | AMP (Acute Meniscal Pathology) | BACKGROUND: Ramp lesions are characterized by disruption of the peripheral meniscocapsular attachments of the posterior horn of the medial meniscus. Ramp repair performed at the time of anterior cruciate ligament reconstruction (ACLR) has been shown to improve knee biomechanics.
PURPOSE: The primary objectives of this study were to evaluate the incidence of and risk factors for ramp lesions among a large series of patients undergoing ACLR. Secondary objectives were to determine the reoperation rate for failure of ramp repair, defined by subsequent reoperations for partial medial meniscectomy.
STUDY DESIGN: Case-control study; Level of evidence, 3. Case series; Level of evidence, 4.
METHODS: All patients underwent transnotch posteromedial compartment evaluation of the knee during ACLR. Ramp repair was performed if a lesion was detected. Potentially important risk factors were analyzed for their association with ramp lesions. A secondary analysis of all patients who underwent ramp repair and had a minimum follow-up of 2 years was undertaken to determine the secondary partial meniscectomy rate for failed ramp repair.
RESULTS: The overall incidence of ramp lesions in the study population was 23.9% (769 ramp lesions among 3214 patients). Multivariate analysis demonstrated that the presence of ramp lesions was significantly associated with the following risk factors: male sex, patients aged <30 years, revision ACLR, chronic injuries, preoperative side-to-side laxity >6 mm, and concomitant lateral meniscal tears. The secondary meniscectomy rate was 10.8% at a mean follow-up of 45.6 months (range, 24.2-66.2 months). Patients who underwent ACLR + anterolateral ligament reconstruction had a >2-fold reduction in the risk of reoperation for failure of ramp repair as compared with patients who underwent isolated ACLR (hazard ratio, 0.457; 95% CI, 0.226-0.864; P = .021).
CONCLUSION: There is a high incidence of ramp lesions among patients undergoing ACLR. The identification of important risk factors for ramp lesions should help raise an appropriate index of suspicion and prompt posteromedial compartment evaluation. The overall secondary partial meniscectomy rate after ramp repair is 10.8%. Anterolateral ligament reconstruction appears to confer a protective effect on the ramp repair performed at the time of ACLR and results in a significant reduction in secondary meniscectomy rates. |
0 | Peripheral arterial injuries: A study of four hundred and seventeen cases | DoD LSA (Limb Salvage vs Amputation) | In this article 417 patients are examined retrospectively. They are reviewed according to their ages, sex, types of injuries, clinical findings, surgical approaches and complications. Most of them were young males (78%) between 11-30 years of age (65%) and 74% were injured by sharp weapons and gunshots. Femoral artery injuries were seen in 29% of all patients. Amputation was performed in 6.4% of cases, but in the popliteal artery group the amputation ratio was 14%. Thirteen patients died from hypovolemic shock or acute renal failure (3.12%). |
0 | Management in non-traumatic arm, neck and shoulder complaints: differences between diagnostic groups | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Arm, neck and/or shoulder complaints are common in western societies. In the Netherlands, general practice guidelines are issued on shoulder pain and epicondylitis only. Little is known about actual management of the total range of diagnoses. The objectives of the study are: to determine management in patients consulting the GP with a new episode of non-traumatic arm neck and shoulder complaints up to 6 months after the first consultation. To evaluate differences in management between patients with specific diagnoses versus non-specific diagnoses and between specific diagnostic groups. In a prospective cohort study in general practice. We recruited 682 eligible patients. Data on diagnosis, management, patient- and complaint-characteristics were collected. Co-occurrence of treatment options was presented in scaled rectangles. After 6 months, additional diagnostic tests had been performed in 18% of the patients, mainly radiographic examination (14%). Further, 49% had been referred for physiotherapy and 12% to the medical specialist. Patients with specific diagnoses were more frequently referred for specialist treatment, and patients with non-specific diagnoses for physiotherapy. Corticosteroid injections (17%) were mainly applied specific diagnoses (e.g. impingement syndrome, frozen shoulder, carpal tunnel and M. Quervain). Frequencies of prescribed medication (51%) did not differ between specific and non-specific diagnoses. In 19% of the patients no referral, prescribed analgesics or injection was applied. Braces (4%) were mainly prescribed in epicondylitis. Overall, management most frequently consisted of prescribed analgesics and referral for physiotherapy. Specific and non-specific diagnostic subgroups differed in the frequency corticosteroid injections were applied, and referrals to physiotherapy and to a medical specialist |
1 | Less invasive posterior surgical approach for hip joint replacement--complications and limitations | Management of Hip Fractures in the Elderly | BACKGROUND: We attempted to analyse the difficulties and risk of complications associated with total hip replacement using a limited posterior approach and standard instrumentation. MATERIAL AND METHODS: A series of 85 consecutive cases (47 females and 38 males; age range 22-87 years; mean age: 65.6 +/- 10.4) of total hip replacement using a modified Gibson approach were analyzed prospectively. Bilateral surgery was performed in 7 patients. There were 44 non-cemented arthroplasties. Body mass index varied from 22 to 36 (body weight 78-104 kg) and the length of the operative wound varied from 6.5 to 14 cm (mean 9.8 +/- 1.3 cm). The wound was 14 centimeters long in six subjects with a BMI of 35-36. The procedure was performed in a lateral decubitus position using an appropriately limited posterior approach. After careful coagulation of blood vessels surrounding the base of the femoral head posteriorly, the obturator and gemelli tendons and the posterior part of the joint capsule were cut through as close to the femoral attachment (T) as possible. This made it possible to dislocate the joint posteriorly. Further stages of the procedure were performed in a typical manner, with special attention paid to the preservation of the tendon of the piriformis muscle. Continuity of the muscle was re-examined following the reposition of the artificial joint. RESULTS: Two injuries to the piriform tendon were observed. Persistent bleeding from vessels surrounding the femoral neck base occurred in 5 patients while in four others there was transient paresis of the peroneal muscles and dorsal extensors of the ipsilateral foot, probably caused by extension of the sciatic nerve. There was one oblique fracture of the proximal femoral shaft. We did not observe significant errors in postoperative joint geometry. Mean intraoperative blood loss was 400 ml. We did not note postoperative dislocations or infections. CONCLUSIONS: On the basis of our observations of a series of 85 patients, minimizing the extent of the posterior surgical approach for hip joint replacement seems an attractive alternative to the classical extensive technique. Our material reveals a relatively high incidence of transient paresis of the peroneal part of the sciatic nerve. The introduction of appropriate instrumentation and the accumulation of experience will certainly decrease the risk of extension of the sciatic nerve in the operative wound |
0 | Preoperative prediction for regaining ambulatory ability in paretic non-ambulatory patients with metastatic spinal cord compression | MSTS 2022 - Metastatic Disease of the Humerus | Objectives: To analyze the predictive factors for postoperative ambulatory recovery in paretic non-ambulatory patients with metastatic spinal cord compression (MSCC). Setting: Japan. Methods: Eighty-two consecutive patients (74.4% men; mean age, 66.2 years) who could not walk before surgery due to cervical or thoracic MSCC and underwent posterior decompressive surgery between 2003 and 2014 were included. Patients were divided into two groups according to ambulatory status at 6 weeks after surgery: recovery (group R) and non-recovery (group NR). To evaluate the speed of progression of motor deficits, we assessed the period from onset of neurological symptoms to gait inability (T1). Results: Fifty patients (61.0%) regained the ability to walk (group R). The period of T1 demonstrated a positive correlation with probability of ambulatory recovery (P=0.00; Kendall's tau-b=0.38), and a receiver operating characteristic curve analysis showed that the cutoff value of T1 was 5 days (area under the curve=0.72; P=0.001). In multivariate analysis, o6 days of T1 was one of the independent risk factors for failing to regain ambulatory ability (odds ratio, 8.74; P=0.00). Conclusions: The speed of progression of motor deficits can independently and powerfully predict the chance of postoperative ambulatory recovery as well as previously identified predictors. Since information about the speed of progression can be obtained easily by interviewing patients or family members, even if the patient is in an urgent state, our results will be helpful in clinical decisionmaking. |
0 | Perioperative inflammatory response in major fracture: do geriatric patients behave differently? | Hip Fx in the Elderly 2019 | PURPOSE: Interleukin-6 is a mainly proinflammatory interleukin and an indicator for the magnitude of surgery. The IL-6 serum concentration correlates with injury severity, the extent of tissue trauma and has negative impact on prognosis. To date it is unclear whether the immunologic changes assessed are age dependent. The aim of this study is to compare the surgical inflammatory response in different age groups.
METHODS: Data were collected at a level-1 university trauma center in a prospective, consecutive cohort study. IL-6 levels were analyzed via ELISA from venous blood samples of cohorts of injuries with typical peak incidence: patients with unstable fractures of the spine (SP) for a middle-aged group and patients with fractures of the proximal femur (PF) for a geriatric group. Surgical treatment was performed using minimal-invasive instrumentation.
RESULTS: 25 patients in group SP (age: 51 years +/- 20) and 16 patients in the group PF (age: 73 years +/- 16) were analysed. Group PF showed higher baseline IL-6 concentrations. Surgical treatment was followed by a significant increase of IL-6 levels in both groups 4 and 24 h postoperatively. Concentration profiles were similar, but increase was significantly higher in the PF group 4 h after surgery.
CONCLUSION: Both the operative treatment of fractures in a middle-aged (SP) and a geriatric group (PF) lead to significant increasing of IL-6 levels. In view of a comparative surgical burden, these data suggest that age may be a confounding factor for a surgery induced pro-inflammatory response in the early postoperative stage. |
0 | Prediction of Central Nervous System Relapse of Diffuse Large B-Cell Lymphoma Using Pretherapeutic [18F]2-Fluoro-2-Deoxyglucose (FDG) Positron Emission Tomography/Computed Tomography | MSTS 2022 - Metastatic Disease of the Humerus | Central nervous system (CNS) relapse of diffuse large B-cell lymphoma (DLBCL) is a rare complication, but has a poor prognosis with unknown pathophysiology. Recent trials of CNS prophylaxis have shown to be ineffective, despite patient's selection using several known clinical risk factors. In this study, the authors evaluated the value of pretreatment [F]2-Fluoro-2-deoxyglucose positron emission tomography in predicting CNS relapse in DLBCL patients. The authors analyzed 180 pathologically confirmed DLBCL patients, retrospectively. Patients underwent [F]2-Fluoro-2-deoxyglucose positron emission tomography/computed tomography before first line rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone therapy. Clinical characteristics were evaluated and total lesion glycolysis (TLG) with a threshold margin of 50% was calculated.Among age, sex, Ann Arbor stage, International Prognostic Index, revised International Prognostic Index, high serum lactate dehydrogenase level, presence of B symptoms, bulky disease (>=10 cm), extranodal lesion involvement, bone marrow involvement, high metabolic tumor volume ( >450 mL), and high TLG50 (>2000), the high TLG50 was the only significant prognostic factor for predicting CNS relapse in a multivariate analysis (P = 0.04). Kaplan-Meir survival analysis between high TLG50 (>2000) and low TLG50 (<=2000) groups revealed significantly different mean progression free survival (PFS) of 1317.2 +/- 134.3 days and 1968.6 +/- 18.3 days, respectively (P < 0.001). High TLG50 on [F]2-Fluoro-2-deoxyglucose positron emission tomography/computed tomography is the most significant predictor of CNS relapse in un-treated DLBCL patients. |
0 | A modified technique for tibial bone sparing in unicompartmental knee arthroplasty | OAK 3 - Non-arthroplasty tx of OAK | Background: Previously, the authors modified the surgical technique to preserve tibial bone mass for Oxford unicompartmental knee arthroplasty (UKA). The purpose of this study was to determine the clinical outcomes and values of this modified technique. Methods: Clinical data of 34 consecutive patients who underwent the unilateral modified UKA technique (modified group, 34 knees) were retrospectively analyzed. To compare the outcome, a match-paired control group (conventional group, 34 knees) of an equal number of patients using the conventional technique system in the same period were selected and matched with respect to diagnosis, age, pre-operative range of motion (ROM), and radiological grade of knee arthrosis. Clinical outcomes including knee Hospital for Special Surgery (HSS) score, ROM, and complications were compared between the two groups. Post-operative radiographic assessments included hip-knee-ankle angle (HKA), joint line change, implant position, and alignment. Results: The mean follow-up time was 38.2 ± 6.3 months. There was no difference in baseline between the two groups. The amount of proximal tibial bone cut in the modified group was significantly less than that of the conventional group (4.7 ± 1.1 mm vs. 6.7 ± 1.3 mm, t = 6.45, P < 0.001). Joint line was elevated by 2.1 ± 1.0 mm in the modified group compared with -0.5 ± 1.7 mm in the conventional group (t = -7.46, P < 0.001). No significant differences were observed between the two groups after UKA with respect to HSS score, VAS score, ROM, and HKA. Additionally, the accuracy of the post-operative implant position and alignment was similar in both groups. As for implant size, the tibial implant size in the modified group was larger than that in the conventional group (Ï?2 = 4.95, P = 0.035).Conclusions:The modified technique for tibial bone sparing was comparable with the conventional technique in terms of clinical outcomes and radiographic assessments. It can preserve tibial bone mass and achieve a larger cement surface on the tibial side. |
1 | What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers? | PJI DX Updated Search | BACKGROUND: Periprosthetic joint infection is a serious complication after THA and commonly is treated with a two-stage revision. Antibiotic-eluting cement spacers are placed for local delivery of antibiotics. Aspirations may be performed before the second-stage reimplantation for identification of persistent infection. However, limited data exist regarding the diagnostic parameters of synovial fluid aspiration with or without saline lavage from a hip with an antibiotic-loaded cement spacer. QUESTIONS/PURPOSES: We asked: (1) For hips with antibiotic cement spacers, does saline lavage influence the diagnostic validity of aspirations? (2) What is the diagnostic accuracy of preoperative aspirations performed on hips with antibiotic cement spacers using the Musculoskeletal Infection Society (MSIS) criteria, stratified by saline and nonlavage? (3) For hips with antibiotic spacers, what are the optimal thresholds for synovial fluid white blood cell (WBC) count and polymorphonuclear neutrophil (PMN) percentage for diagnosing infections? METHODS: One hundred seventy-four hips (155 patients) with antibiotic-eluting cement spacers inserted between October 2012 and July 2015 were reviewed. Of these, 98 hips (80 patients) met the inclusion criteria and were included in the analysis (77 nonlavage, 21 saline lavage aspirations). Laboratory data from the aspiration and preoperative workup and intraoperative details were collected. Infection status of each hip procedure was determined based on a modified MSIS criteria using serologic, histologic, and intraoperative findings (sinus tract communicating with the joint at surgery or two positive intraoperative periprosthetic cultures with the same organism or two of the three following criteria: elevated erythrocyte sedimentation rate [ESR] [> 30 mm/hour] and C-reactive protein [CRP] [> 10 mg/L], a single positive intraoperative periprosthetic tissue culture, or a positive histologic analysis of periprosthetic tissue [> 5 neutrophils per high power field]). The diagnostic parameters were calculated for the MSIS criteria thresholds for synovial fluid (ie, WBC count > 3000 cells/microL and PMN percentage > 80%). Optimal thresholds were calculated for the corrected synovial WBC count and PMN percentage with a receiver operating characteristic curve. Separate analyses were performed for the hips with successful aspirations (nonlavage group) and those with saline lavage aspirations. RESULTS: The WBC count and PMN percentage were higher in hips with infection than in hips without infection when nonlavage aspirations were done (WBC count, 6680 cells/microL +/- 6980 cells/microL vs 2001 +/- 4825; mean difference, 4679; 95% CI, 923-8436; p = 0.015; PMN percentage, 83% +/- 13% vs 44% +/- 30%; mean difference, 39%; 95% CI, 39%-49%; p < 0.001) and the findings between infected and noninfected aspirations were not different when saline lavage aspirations were done (WBC count, 782 cells/microL +/- 696 vs 307 cells/microL +/- 343; mean difference, 475; 95% CI, -253 to 1203; p = 0.161; PMN percentage, 67% +/- 15% vs 58% +/- 28%; mean difference, 10%; 95% CI, -11% to 30%; p = 0.331). Aspirations performed without lavage yielded good diagnostic accuracy in all parameters (WBC count, 78% [95% CI, 70%-86%]; PMN percentage. 79% [95% CI, 70%-88%]; positive culture: 84% [95% CI, 81%-90%]; at least one of the above: 79% [95% CI, 70%-88%]); but in the saline lavage group, none had WBC counts above the threshold (diagnostic accuracies for WBC count, 0%; PMN percentage, 71% [95% CI, 62%-86%]; positive culture, 76% [95% CI, 76%-86%]; at least one: 71% [95% CI, 57%-91%]). Because saline lavage did not result in differences between aspirations from infected and noninfected hips, we calculated the optimal thresholds in the nonlavage group only; the optimal threshold for synovial WBC count was 1166 cells/microL and for synovial PMN the percentage was 68%, which corresponds to WBC count diagnostic accuracy of 78% (95% CI, 69%-87%) and PMN percentage accuracy of 78% (95% CI, 69%-87%). CONCLUSIONS: Because the MSIS criteria thresholds resulted in suboptimal sensitivities owing to a higher number of false negatives, we recommend considering lower WBC count and PMN percentage thresholds for hip-spacer aspirations. Furthermore, the WBC count and PMN percentage results from aspirations performed with saline lavage are not reliable for treatment decisions. LEVEL OF EVIDENCE: Level III, diagnostic study |
0 | Tubercular arthritis of the elbow joint following olecranon fracture fixation and the role of TGF-beta in its pathogenesis | DoD SSI (Surgical Site Infections) | Tuberculosis (TB) occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity. We report one such case of a 48-year-old female, who presented in the emergency department with an olecranon fracture which was open reduced and internally fixed with tension band wiring. Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery. The discharge was sent for culture and sensitivity tests, and the patient was managed by antibiotics and daily dressings. There was wound dehiscence and the underlying implant was exposed, which was removed at 12 weeks after surgery. Repeat debridements and dressings continued for 6 months, but the discharge from the wound site continued. X-rays of the elbow performed at 6 months raised the suspicion of TB, which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue. Following the confirmation, patient was put on antitubercular drugs. The patient responded to antitubercular drug therapy (ATT), the purulent discharge from the wound ceased, and eventually the wound healed after 2 months of starting ATT. |
1 | Fasciotomy for severe, blunt and penetrating trauma of the extremity | DOD - Acute Comp Syndrome CPG | Blunt or penetrating injuries to the extremity with vascular or severe soft tissue and skeletal trauma frequently require fasciotomy. Long term follow-up studies of these patients are rare. From 1976 to 1983, 85 patients underwent 39 fasciotomies upon the upper extremities and 57 upon the lower. Amputations were required in 11 patients; four due to primary vascular compromise, six to severe crush injury and one to electric burn with myonecrosis. The fasciotomy was not etiologically related to limb loss in any of these patients. Osteomyelitis occurred in two patients. Long term follow-up data was obtained by telephone and mail survey from 23 of the 61 patients five to 11 years after injury. Pain, weakness and paresthesia were major determinants of long term morbidity. Chronic edema was present in two patients. Seven of the patients interviewed were unemployed due to the injuries they received to the extremities. Most symptoms were believed to be due to the severity of the injury, and none were directly attributed to the fasciotomy. When fasciotomy is indicated, it is a safe adjunctive procedure in limb salvage and contributes very little to the long term morbidity of patients with severe trauma to the extremity. |
0 | Histoplasmosis infection presenting as an isolated subcutaneous periarticular upper limb swelling in the immunosuppressed patient | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Atypical mycobacterial and fungal infections may occur in immunosuppressed patients. The impaired host response can make the clinical presentation atypical. Blood and tissue cultures may be negative in the acute phase of the illness, which can lead to a delay in diagnosis. In those patients with |
0 | Periprosthetic joint infections: a clinical practice algorithm | PJI DX Updated Search | PURPOSE: periprosthetic joint infection (PJI) accounts for 25% of failed total knee arthroplasties (TKAs) and 15% of failed total hip arthroplasties (THAs). The purpose of the present study was to design a multidisciplinary diagnostic algorithm to detect a PJI as cause of a painful TKA or THA. METHODS: from April 2010 to October 2012, 111 patients with suspected PJI were evaluated. The study group comprised 75 females and 36 males with an average age of 71 years (range, 48 to 94 years). Eighty-four patients had a painful THA, while 27 reported a painful TKA. The stepwise diagnostic algorithm, applied in all the patients, included: measurement of serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels; imaging studies, including standard radiological examination, standard technetium-99m-methylene diphosphonate (MDP) bone scan (if positive, confirmation by LeukoScan was obtained); and joint aspiration with analysis of synovial fluid. RESULTS: following application of the stepwise diagnostic algorithm, 24 out of our 111 screened patients were classified as having a suspected PJI (21.7%). CRP and ESR levels were negative in 84 and positive in 17 cases; 93.7% of the patients had a positive technetium-labeled bone scan, and 23% a positive LeukoScan. Preoperative synovial fluid analysis was positive in 13.5%; analysis of synovial fluid obtained by preoperative aspiration showed a leucocyte count of > 3000 cells mu/l in 52% of the patients. CONCLUSIONS: the present study showed that the diagnosis of PJI requires the application of a multimodal diagnostic protocol in order to avoid complications related to surgical revision of a misdiagnosed "silent" PJI. LEVEL OF EVIDENCE: Level IV, therapeutic case series |
0 | Incidence of skeletal morbidity rates over time in patients with multiple myeloma-related bone disease as reported in randomized trials employing bone-modifying agents | MSTS 2018 - Femur Mets and MM | AIM: The purpose of this review was to investigate if advances in bone-targeted therapies have decreased the incidence of skeletal morbidity rates over time in patients with multiple myeloma-related bone disease.
METHODS: A literature search was conducted over the OvidSP platform in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify Phase III results from bone-targeted therapy trials in patients with multiple myeloma. The skeletal morbidity rate was the end point of interest, and for each study, a mean year of enrollment ([start of enrollment + end of enrollment]/2) was calculated.
RESULTS: A total of eight study arms were identified, with only two placebo arms; therefore, a weighted linear regression was not feasible and only intervention treatment arms were analyzed. A statistically significant downward trend in the skeletal morbidity rate was observed in all intervention arms.
CONCLUSION: The incidence of skeletal morbidity rates has decreased significantly over time in patients with multiple myeloma. |
0 | Severe hand injuries in children related to farm tractors: A report of 70 cases | DoD SSI (Surgical Site Infections) | BACKGROUND: The purpose of this study was to review tractor-related childhood hand injuries. METHODS: Seventy children (53 males, 17 females; range 1 to 11 years) were admitted to our unit. Patients were analyzed according to sex, age, pattern of injury, type of treatment and functional results. The first step of the treatment included extensive debridement and irrigation. Patients with complex tissue defects were treated with multi-stage reconstruction procedures. Patients with amputations or partial amputations were treated with amputation of the devascularized digits. RESULTS: The most common injuries were amputations and complex tissue defects. Other types of injuries were fractures, partial amputations and skin defects. In 20 cases, skin defects were covered with split-thickness skin grafts and the functional results were good. In 40 cases with complex soft tissue injuries, skin defects were covered with flaps. The functional results were good in 30 and fair in 10. In 50 digits with complete amputations, attempts at revascularization immediately after injury failed in all patients. The functional results were good in 40, fair in 5 and poor in 5. All fractures healed in 6 weeks and no complications related with bone healing were observed. CONCLUSION: The concepts of aggressive debridement, fracture reduction, and early soft tissue coverage are central to the care of these hand injuries. |
1 | Lateral fixation of AO type-B2 ankle fractures in the elderly: the Knowles pin versus the plate | DoD SSI (Surgical Site Infections) | The study was a retrospective evaluation and comparison. Seventy-five elderly patients (>50 years) with AO type-B2 ankle fractures were treated by open reduction and internal fixation. All patients were followed up retrospectively for at least 12 months. The 75 patients were divided into two groups, based on the method of treatment. The Knowles pin (KP) group included 45 patients with an average age of 62.7 years. The tubular plate (TP) group included 30 patients with an average age of 60.0 years. The clinical results were compared between the two groups. Both of the groups were similar in respect to the injury mechanisms, fracture pattern, open fracture grade, compounding medical conditions, and ankle score (all P values <0.28). However, the KP group had significantly smaller wound incisions, shorter surgery time, shorter hospital stay, less meperidine use, less symptomatic hardware, and lower complication rates than the TP group (all P values <0.03). In conclusion, lateral fixation of AO type-B2 ankle fractures in the elderly by the Knowles pin is recommended due to its simplicity, efficacy and low complication rate. |
0 | A valgus angulation fracture of the proximal humeral epiphysis | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | The case presented illustrates a previously unreported form of valgus angulation of a proximal humeral epiphyseal fracture. For reduction this fracture requires traction and adduction, not abduction, of the arm |
0 | Environmental factors associated with crash-related mortality and injury among taxi drivers in New South Wales, Australia | DoD PRF (Psychosocial RF) | This exploratory study aims to investigate the associations between some environmental factors and the increased risk of motor vehicle crash-related injuries among taxi drivers. Information utilised in the study are obtained from police reports of all road traffic accidents that occurred on the roads between 1996 and 2000 in New South Wales (NSW), Australia. Of the 7923 taxi drivers who were involved in crashes, nearly 10% (n = 750) were killed or injured. Results indicate sex, and two environmental factors are significantly associated with an increased risk of crash-related mortality and injury among taxi drivers. The adjusted relative risk of crash-related mortality and injury is increased by 60% for those who work the night shift (OR = 1.59, 95%CI = 1.35-1.88), and by 20% for those who do not carry any passenger on board (OR = 1.20, 95%CI = 1.02-1.41) should these drivers be involved in a crash. The increased relative risk of crash-related mortality and injury is nearly 2.5 times for female taxi drivers (OR = 2.30, 95%CI = 1.45-3.65) when compared with their male counterparts. (PsycINFO Database Record (c) 2018 APA, all rights reserved) |
0 | Post-Mortem Evaluation of Potentially Survivable Hemorrhagic Death in a Civilian Population | DoD LSA (Limb Salvage vs Amputation) | BACKGROUND: Although the survivability of military extremity hemorrhage is well documented, equivalent civilian data are limited. We analyzed statewide autopsy records in Maryland to determine the number of hemorrhagic deaths that might have been potentially survivable with prompt hemorrhage control. Similar analyses of battlefield deaths led to life-saving changes in military medical practice. STUDY DESIGN: This is a retrospective study of decedent records. The objective is to estimate the number of hemorrhagic deaths that might have been prevented by prompt placement of an extremity tourniquet. Maryland autopsy records from 2002 to 2016 were selected using the following search terms: amputation, arm/arms, avulsion, exsanguination, extremity/extremities, leg/legs. The records were analyzed by applying a checklist of previously developed military criteria to characterize deaths as potentially survivable or nonsurvivable with prompt use of a tourniquet. Suicides and decedents less than 18 years old were excluded. The study did not use information about living participants. Two expert reviewers independently evaluated and scored the death records. Deaths were classified as either potentially survivable or nonsurvivable. A third reviewer broke any ties. RESULTS: There were 288 full autopsy records included in the final analysis. Of the eligible decedents reviewed during the 14-year period, 124 of 288 had potentially survivable wounds; 164 had nonsurvivable wounds. CONCLUSIONS: Over the 14-year study interval, 124 Maryland decedents-an average of 9 per year-might have been saved with prompt placement of a tourniquet. If extrapolated, approximately 480 people in the US might be saved per year. These results provide evidence to support educating and equipping the public to provide bleeding control. |
1 | Post-operative analgesia following total knee arthroplasty: comparison of low-dose intrathecal morphine and single-shot ultrasound-guided femoral nerve block: a randomized, single blinded, controlled study | AAHKS (9/10) Regional Nerve Blocks | BACKGROUND AND OBJECTIVES: Total knee arthroplasty often results in marked postoperative pain. A recent meta-analysis supports the use of femoral nerve block or alternatively spinal injection of morphine plus local anaesthetic for post-operative analgesia. On the other hand, the use of intrathecal morphine may be associated with a large number of distressing side effects (itching, urinary retention, nausea and vomiting, delayed respiratory depression). The aim of this study was to compare the effectiveness of femoral nerve block and low dose intrathecal morphine in post-operative analgesia after primary unilateral total knee arthroplasty.
MATERIAL AND METHODS: Fifty-two consecutive patients scheduled for primary unilateral total knee arthroplasty were allocated to the intrathecal morphine group (ITM group) or to the femoral nerve block group (FNB group). In ITM group a subarachnoid puncture was performed at the L3-L4 inter-vertebral space with hyperbaric bupivacaine 15 mg plus 100 mcg of preservative-free morphine. Patients allocated to the FNB group received a single-injection ultrasound-assisted femoral nerve block with ropivacaine 0.75% 25 ml before the spinal injection of hyperbaric bupivacaine 15 mg. All patients received postoperative patient-controlled-analgesia (PCA) morphine, using a 1-mg bolus and a 5-minute lockout period. Data were analyzed using Student t test or two-way analysis of variance (ANOVA) for repeated measures with time and treatment as the 2 factors. Post hoc comparisons were performed by Bonferroni test. Statistical significance for all test was a p value < 0.05.
RESULTS: Patient characteristics were similar between the 2 groups. We found a statistically significant differences in postoperative pain between the two groups: ITM group had the lower visual analogic pain score (VAS) values. Morphine consumption was lower in the ITM group: average consumption within the first 6 hours was 0.9 mg in IT group compared to 3.1 mg in FNB group; at 12 h 4.2 mg vs 6.3 mg; at 24 h 6.9 mg vs 10.3 mg; at 48 h 9.7 mg vs 13.6 mg. However, the difference in the opiate consumption was not statistically different (p value = 0.06). Thirteen patients in ITM group experienced itching, only 5 in FNB group. We did not find any difference in the two treatment groups in the use of antiemetic and antipruritic medication. No cases of respiratory depression was recorded.
CONCLUSIONS: Our results show that low dose of intrathecal morphine may be safe and more efficient than single-shot femoral nerve block for post-operative analgesia after total knee arthroplasty. |
1 | Percutaneous pinning versus volar locking plate fixation for dorsally displaced distal radius fractures- reoperation rates over an eight year period | Distal Radius Fractures | Purpose: To compare reoperation rates between closed reduction with percutaneous pinning (CRPP) and internal fixation with a volar locking plate (VLP) for the treatment of distal radius fractures.
Methods: A retrospective review of all patients with dorsally displaced distal radius fractures presenting to a hospital over an eight-year period.
Results: 1364 procedures were reviewed after applying the exclusion criteria; 663 underwent CRPP and 701 underwent VLP. The results showed that CRPP had higher rates of revision surgery due to fixation failure than VLP (p=0.003), however there was no statistical significance in overall reoperation rates when all complications were considered (p=0.060). This was due to higher rates of tendon related problems (p=0.003), neurological complications (p=0.005) and hardware removal (p=0.01) in the VLP group.
Conclusion: Overall reoperation rates were similar between both techniques however there were differences in complication profile and nature of revision surgery. This information is useful when discussing treatment options with patients to help guide selection of the best procedure for that individual. |
0 | Atypical femoral fractures and bisphosphonate treatment: experience in two large United Kingdom teaching hospitals | Management of Hip Fractures in the Elderly | We performed a retrospective review of all patients admitted to two large University Hospitals in the United Kingdom over a 24-month period from January 2008 to January 2010 to identify the incidence of atypical subtrochanteric and femoral shaft fractures and their relationship to bisphosphonate treatment. Of the 3515 patients with a fracture of the proximal femur, 156 fractures were in the subtrochanteric region. There were 251 femoral shaft fractures. The atypical fracture pattern was seen in 27 patients (7%) with 29 femoral shaft or subtrochanteric fractures. A total of 22 patients with 24 atypical fractures were receiving bisphosphonate treatment at the time of fracture. Prodromal pain was present in nine patients (11 fractures); 11 (50%) of the patients on bisphosphonates suffered 12 spontaneous fractures, and healing of these fractures was delayed in a number of patients. This large dual-centre review has established the incidence of atypical femoral fractures at 7% of the study population, 81% of whom had been on bisphosphonate treatment for a mean of 4.6 years (0.04 to 12.1). This study does not advocate any change in the use of bisphosphonates to prevent fragility fractures but attempts to raise awareness of this possible problem so symptomatic patients will be appropriately investigated. However, more work is required to identify the true extent of this new and possibly increasing problem |
0 | Total condylar knee arthroplasty for valgus and combined valgus-flexion deformity of the knee | Surgical Management of Osteoarthritis of the Knee CPG | Total condylar knee arthroplasty was performed on 64 knees with fixed valgus or valgus/flexion deformities. The technique for release of tight lateral and posterior structures is important to balance the ligament. Clinical results were rated good and excellent in 95% of the knees. Four patients with excessive flexion deformities required 6 weeks of cast bracing in the immediate postoperative period for instabilities caused by an imbalance in the spacing in flexion and extension. In no joint in the entire series did stability deteriorate with time. There were no patellar complications or nerve palsies noted. Radiographic evaluation revealed well-fixed components in 92% of the arthroplasties. None has required revision for mechanical loosening to date. With proper technique the total condylar prosthesis can be employed in knees with valgus or valgus/flexion deformities to give predictably good results. The total condylar III prosthesis may be required in severe combined deformities for added stability |
0 | Autologous Matrix-Induced Chondrogenesis: A Systematic Review of the Clinical Evidence | AMP (Acute Meniscal Pathology) | BACKGROUND:: The addition of a type I/III collagen membrane in cartilage defects treated with microfracture has been advocated for cartilage repair, termed "autologous matrix-induced chondrogenesis" (AMIC). PURPOSE:: To examine the current clinical evidence regarding AMIC for focal chondral defects. STUDY DESIGN:: Systematic review. METHODS:: A systematic review was performed by searching PubMed, ScienceDirect, and Cochrane Library databases. Inclusion criteria were clinical studies of AMIC for articular cartilage repair, written in English. Relative data were extracted and critically analyzed. PRISMA guidelines were applied, the methodological quality of the included studies was assessed by the modified Coleman Methodology Score (CMS), and aggregate data were generated. RESULTS:: Twenty-eight clinical articles were included: 12 studies (245 patients) of knee cartilage defects, 12 studies (214 patients) of ankle cartilage defects, and 4 studies (308 patients) of hip cartilage defects. The CMS demonstrated a suboptimal study design in the majority of published studies (knee, 57.8; ankle, 55.3; hip, 57.7). For the knee, 1 study reported significant clinical improvements for AMIC compared with microfracture for medium-sized cartilage defects (mean defect size 3.6 cm2) after 5 years (level of evidence, 1). No study compared AMIC with matrix-assisted autologous chondrocyte implantation (ACI) in the knee. For the ankle, no clinical trial was available comparing AMIC versus microfracture or ACI. In the hip, only one analysis (level of evidence, 3) compared AMIC with microfracture for acetabular lesions. For medium-sized acetabular defects, one study (level of evidence, 3) found no significant differences between AMIC and ACI at 5 years. Specific aspects not appropriately discussed in the currently available literature include patient-related factors, membrane fixation, and defect properties. No treatment-related adverse events were reported. CONCLUSION:: This systematic review reveals a paucity of high-quality, randomized controlled studies testing the AMIC technique versus established procedures such as microfracture or ACI. Evidence is insufficient to recommend joint-specific indications for AMIC. Additional nonbiased, high-powered, randomized controlled clinical trials will provide better clinical and structural long-term evidence, thus helping to define possible indications for this technique. |
0 | Local infiltration analgesia versus regional blockade for postoperative analgesia in total knee arthroplasty: A meta-analysis of randomized controlled trials | PJI DX Updated Search | Background: Total knee arthroplasty (TKA) is one of the most commonly performed procedures while postoperative analgesia still remains challenging. The efficacy and safety of local infiltration analgesia (LIA) versus regional blockade (RB; epidural analgesia and/or peripheral nerve block) for pain management after TKA are controversial. Objectives: The purpose of this meta-analysis was to determine whether LIA compared with RB would provide better postoperative pain control, consume less morphine, facilitate early functional recovery, entail a differential risk of side effects and complications, and allow a shorter length of stay. Study Design: This meta-analysis pooled all data published in randomized controlled trials (RCTs) examining the efficacy and safety of LIA versus RB following TKA. Setting: The work was performed at Affiliated Cixi Hospital, Wenzhou Medical University. Methods: Literature in English was searched using EMBASE, Medline, Cochrane Library, CINAHL, Web of Science, and Scopus from inception to April 2015. RCTs that compared LIA and RB for postoperative analgesia following TKA were included. Methodological quality was assessed using the Cochrane Back Review Group checklist, and a sensitivity analysis was performed. Sixteen RCTs with a total of 1,206 patients were finally included in our study. Results: The results of our meta-analysis indicate that patients managed by LIA showed significantly lower numeric rating scale (NRS) score at rest (WMD: -0.40 [-0.72, -0.07]; P = 0.02) when compared with those managed by RB. Difference of morphine consumption was not significant (WMD: -1.39 [-7.21, 4.44]; P = 0.64) between the 2 groups. In terms of early functional recovery, the LIA group showed more straight leg raise (RR: 2.90 [2.15, 3.93]; P < 0.00001) on the first postoperative day; better range of motion within one week (WMD: 4.33 [2.61, 6.05]; P < 0.00001), but not at 3 months (WMD: 1.98 [-0.02, 3.98]; P = 0.05); and comparable knee society score (WMD: -8.79 [-27.05, 9.48]; P = 0.35). Length of hospital stay of the LIA group was marginally shorter (WMD: -0.25 [-0.49, -0.01]; P = 0.05) than that of the RB group. Risk of side effects and complications were comparable between groups. Limitations: The lack of a standard criterion regarding the technique details of LIA and heterogeneity resulting from the various analgesic components, dosages, and different administration methods might have posed a bias on the results. Conclusion: Our results have indicated that LIA provided better analgesia than RB at rest and preserved quadriceps function in the immediate postoperative period, which may be beneficial to early functional recovery. And its safety profile is reliable. With the biases in our meta-analysis, a rigorous and adequately powered RCT is needed to validate our results |
0 | Prevalence of delirium, risk factors and cognitive functions in elderly hip fracture patients with general and spinal anesthesia | Management of Hip Fractures in the Elderly | Introduction: Delirium is a serious cause of morbidity and mortality for geriatric patients with hip fractures. The aim of this study is to investigate the prevalence of postoperative delirium after hip fractures in Turkey in the presence of certain risk factors, and to determine the effects of anesthesia on postoperative cognitive functions. Materials and Method: 70 patients with hip fracture ((greater-than or equal to)60 years) were included in this study. All patients were evaluated with Structured Clinical Interview for DSM-IV, Mini- Mental State Examination (MMSE) and Delirium Rating Scale (DRS) preoperatively and postoperatively. Results: Of the 70 hip fracture patients 16 (22.9%) developed post-operative delirium. On multivariate analysis, delirium history, older age ((greater-than or equal to)75 years) and metabolic abnormalities were found to be the predisposing risk factors for postoperative delirium. Type of anesthesia, presence of a chronic disease and multiple drug use were not found to be the precipitating factors for postoperative delirium. Cognitive functions were impaired for all the patients according to MMSE and DRS scores. Conclusion: Previous delirium history and older age are irreversible risk factors and supportive treatment in regard to metabolic anomalies may reduce the risk of postoperative delirium in hip fracture patients. However, the type of anesthesia was not a risk factor increasing the prevalence of postoperative delirium and cognitive dysfunction |
0 | Relation between increase in length of hip axis in older women between 1950s and 1990s and increase in age specific rates of hip fracture | Management of Hip Fractures in the Elderly | OBJECTIVE: To determine whether length of hip axis in elderly women has increased over the past 40 years and, if so, whether the increase may have contributed to the increase in the age adjusted rate of hip fractures during those years. DESIGN: Retrospective assessment of anteroposterior x ray films of the pelvis. SETTING: Radiology department of a rheumatology hospital, New Zealand. PATIENTS: Two cohorts of women aged > 60 (mean 70) who were x rayed on the same apparatus in either the 1950s or the 1990s. MAIN OUTCOME: Length of hip axis (distance from the medial aspect of the pelvis to the lateral aspect of the femur along the axis of the femoral neck), length of femoral neck (length of hip axis excluding the femoral head and more medial structures), and width of femoral neck (see figure). RESULTS: Both the mean length of the hip axis and the mean length of the femoral neck were significantly greater in the women whose x ray films were taken in the 1990s than in those in the 1950s (124.0 mm (SE 1) v 130.5 (1), P = 0.0002; 79.4 (1) v 84.9 (1), P < 0.0001, respectively). The width of the femoral neck did not change, and the lengths expressed as ratios to width were greater in the more recent x ray films, indicating that these findings are not due to an unrecognised change in radiographic technique. CONCLUSIONS: An increase in the length of the hip axis in elderly women in New Zealand during the past 40 years has occurred which is large enough to account for the increase in the age adjusted rate of hip fractures during those years |
0 | Trauma admissions in the elderly: how does a patient's age affect the likelihood of their being admitted to hospital after a fracture? | Management of Hip Fractures in the Elderly | In two projects we have studied patients presenting to Accident and Emergency (A&E) departments with a fracture, to examine how their age influences their likelihood of admission. Over 1 year from April 1994 we collected data on all 6467 Cardiff residents who presented to the city's A&E department with a fracture. In total 1226 (19%) were admitted. Overall, only 12% of those under 65, but 47% of older patients required admission. This was largely a reflection of the age-distribution of hip fracture, an injury for which admission is inevitable. In a subsequent study of eight A&E departments in South Wales we therefore considered the proportion of patients admitted following fractures at specific anatomical sites. In people over the age of 55 we identified 6889 fractures, 2115 (31%) of which led to admission. After standardisation to control for the age-distribution of incidence for different fracture sites, we found that the likelihood of admission was 22% greater for people aged over 65 years. Elderly people very often require hospital admission after a fracture, primarily as a consequence of the types of fractures that they tend to sustain. Admissions directly attributable to the effects of age and age-related medical, psychiatric and social comorbidity appear of more limited significance |
0 | An ultrasonographic and anatomical study of carpal tunnel, with special emphasis on the safe zones in percutaneous release | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | We examined 40 wrists of 12 embalmed and eight fresh cadavers and defined the relative position of the flexor retinaculum to the neurovascular structure, ultrasonographic markers and safe zones by ultrasonography and anatomical dissection. Both longitudinal and transverse ultrasonographic sections clearly depicted the flexor retinaculum, neurovascular bundles, median nerve, flexor tendons and bony boundaries of the underlying joints. Topographic measurement showed [i] good correlation between the actual extent of the flexor retinaculum and the ultrasonographically determined distance between bony landmarks in all hands, and [ii] the widths and lengths of well-defined safe zones. A comparison study confirmed the accuracy of ultrasonography. We conclude that these ultrasonographic landmarks can locate the flexor retinaculum and facilitate safe and complete carpal tunnel release with open or minimally invasive techniques |
0 | Regulatory T cell frequency in patients with melanoma with different disease stage and course, and modulating effects of high-dose interferon-α 2b treatment | Reconstruction After Skin Cancer | Background: High-dose interferon-alpha 2b (IFN-α 2b) is the only approved systemic therapy in the United States for the adjuvant treatment of melanoma. The study objective was to explore the immunomodulatory mechanism of action for IFN-α 2b by measuring serum regulatory T cell (Treg), serum transforming growth factor-β (TGF-β), interleukin (IL)-10, and autoantibody levels in patients with melanoma treated with the induction phase of the high-dose IFN-α 2b regimen.Methods: Patients with melanoma received IFN-α 2b administered intravenously (20 MU/m2 each day from day 1 to day 5 for 4 consecutive weeks). Serum Treg levels were measured as whole lymphocytes in CD4+ cells using flow cytometry while TGF-β, IL-10, and autoantibody levels were measured using enzyme-linked immunosorbent assays.Results: Twenty-two patients with melanoma received IFN-α 2b treatment and were evaluated for Treg levels. Before treatment, Treg levels were significantly higher in patients with melanoma when compared with data from 20 healthy subjects (P = 0.001; Mann-Whitney test). Although a trend for reduction of Treg levels following IFN-α 2b treatment was observed (average decrease 0.29% per week), statistical significance was not achieved. Subgroup analyses indicated higher baseline Treg levels for stage III versus IV disease (P = 0.082), early recurrence versus no recurrence (P = 0.017), deceased versus surviving patients (P = 0.021), and preoperative neoadjuvant versus postoperative adjuvant treatment groups (not significant). No significant effects were observed on the levels of TGF-β, IL-10, and autoantibodies in patients with melanoma treated with IFN-α 2b.Conclusions: Patients with melanoma in this study showed increased basal levels of Treg that may be relevant to their disease and its progression. Treg levels shifted in patients with melanoma treated with IFN-α 2b, although no firm conclusions regarding the role of Tregs as a marker of treatment response or outcome can be made at present. © 2010 Ascierto et al; licensee BioMed Central Ltd. |
0 | Cementless total hip arthroplasty using titanium, plasma-sprayed implants: a study with 10 to 15 years of follow-up | PJI DX Updated Search | PURPOSE: To evaluate long-term outcomes of total hip arthroplasty (THA) using the Perfecta cementless system. METHODS: 73 men and 76 women aged 65 to 88 (mean, 71) years underwent 168 THAs using the Perfecta cementless system and were followed up for a mean of 13 (10 to 15) years. 19 patients had bilateral THA. The diagnoses were idiopathic osteoarthritis (n=121), osteonecrosis of the femoral head (n=25), rheumatoid arthritis (n=14), and post-traumatic osteoarthritis (n=8). Patients were evaluated clinically and radiographically before and after THA. RESULTS: The mean Harris hip score improved from 40 to 84 (p<0.001); the score was excellent or good in 130 hips, fair in 17, and poor in 21. The mean Merle D'Aubigne score improved from 4 to 10 (p<0.001); the score was excellent or good in 138 hips, fair in 9, and poor in 21. Poor results were due to aseptic revision of the cup (n=16) or stem (n=3) or deep infection (n=2). Thigh pain that limited activities of daily living was noted in 3 hips. 142 patients could walk without a limp, 5 had a slight limp, and 3 had a moderate limp and used a cane. The mean Short Form-12 score for the physical function was 49 and for the mental health was 56; the mean Western Ontario and McMaster Universities Osteoarthritis Index was 39; the mean visual analogue scale score for satisfaction was 8. Two patients developed deep infection at postoperative months 8 and 50 and were treated with 2-staged revision. Five patients had hip dislocation within 2 months; 3 of whom endured recurrent dislocation and underwent revision surgery; they had acetabular malposition with excessive anteversion despite a correct acetabular angle. 13 other cups were revised because of loosening or extensive osteolysis (n=10) and polyethylene wear (n=3) after a mean interval of 6 (range, 4-10) years. Three stems were revised because of aseptic loosening after a mean interval of 7 (range, 6-9) years. The survivorship at 14 years was 99% for stems and 91% for cups. CONCLUSION: The long-term outcome of the Perfecta cementless stem was good; most major complications occurred in the cup |
0 | Blood loss closely correlates with body mass index in total hip arthroplasty performed through direct lateral approach | Hip Fx in the Elderly 2019 | Objectives: To investigate total blood loss (TBL),intraoperative blood loss (IBL), post-operative drainage (POD), and other related variables in total hip arthroplasty (THA) performed through direct lateral approach. Methods: This study was completed in Shanghai Sixth People's Hospital, Shanghai, China, between January and December 2010. We analyzed 113 patients treated by THA through direct lateral approach. Recordable blood loss (RBL) was measured and TBL was calculated according to the Gross formula. Ordinal logistic regression analysis was used for TBL, IBL, and POD, with gender, age, body mass index (BMI) disease duration, and operative time as independent variables. Results: The average operative time was 51.5 ± 10.4(range: 35-70) minutes, with an average RBL of 454 ± 144(range: 150-180) ml. Average TBL was significantly higher (975 ±355, range: 430-2020 ml; p<0.001). In the analysis of variables, BMI closely correlated with TBL, IBL, and POD, with odds ratios of 4.80(95% CI: 2.63-8.78 [TBL]), 5.39 (95% CI: 2.84-10.25 [IBL]), and 4.37 (95% CI: 2.43-7.89 [POD]). Moreover, TBL (54.172) IBL (55.198) and POD(39.139) correlated with trend test BMI. Conclusion: The TBL, IBL, and POD closely correlate with BMI in patients undergoing THA through direct lateral approach. |
0 | Clinical and radiological midterm results from using the Fixion expandable intramedullary nail in transverse and short oblique fractures of femur and tibia | DoD SSI (Surgical Site Infections) | Background: A locked nail is the principal method used to eliminate rotatory components in femoral and tibial fractures. Nevertheless, weight bearing is not directed onto the fracture site, slowing down the healing process; another possibility is to use a large-diameter nail and ream the canal to obtain as much adherence as possible and increase the grip, but this can cause a number of complications. The expandable nail is a new option that in theory should remove some problems with previous techniques. Materials and methods: This was a retrospective nonrandomized study encompassing 21 femoral fractures and 27 tibial fractures in 45 patients. They were classified according to the AO classification. Clinical and radiological checks were done at one, three, and six months and at one year from the surgery in order to check for signs of clinical and radiological healing. A good alignment was considered to be the presence of a deformity of less than 5 in the sagittal and lateral planes and the absence of rotatory clinically evident problems. This protocol was adhered to up to six months after surgery by all of the patients, while only 62.2% performed the last control. The mean follow-up was 15 months. A second group of 48 consecutive fractures (24 femural and 24 tibial) treated with locked nail was created to compare surgical times. Results: Appropriate alignment was observed in all cases; the healing process appeared slower: radiological healing occurred in most cases at six months. The following complications were reported: a case of intraoperative fracture widening with no effect on the treatment; a case of a lesion of the tip of the nail with pneumatic system rupture that necessitated nail substitution; two cases of retarded consolidation at six months, with both tibial fractures treated successfully by intralesion platelet gel; a case of incarcerated nail on 17 removals, resolved by shearing. We had no cases of clinically evident compartment syndrome or pulmonary embolism. Conclusions: The expandable Fixion nail presents significant advantages in the treatment of transverse and short oblique fractures of femur and tibia because it is easy to use, involves minimal X-ray exposure and can control rotations. Nevertheless, it high cost limits its use. We consider it as an alternative to locked nail. © Springer-Verlag 2008. |
1 | Arthroscopic Repair for Parrot Beak Tear of Lateral Meniscus with Reduction Suture and Inside-Out Technique | AMP (Acute Meniscal Pathology) | Parrot beak tear is a white-white meniscal injury that often occurs in isolated injuries. Partial meniscectomy for parrot beak tears is often recommended, owing to the avascular zone; however, partial meniscectomy, especially with the lateral meniscus, has a high failure rate for return to sports, leading to residual meniscus extrusion and lateral compartment osteoarthritis. Thus, we have developed a repair technique to preserve the parrot beak tear of the avascular zone. This is a modification of the inside-out repair with additional reduction sutures. We recommend this procedure as a technique for repairing avascular parrot beak tears of the lateral meniscus. |
0 | Single-institution outcome experience using AlloDerm® as temporary coverage or definitive reconstruction for cutaneous and soft tissue malignancy defects | Reconstruction After Skin Cancer | Definitive reconstruction after excision of cutaneous and soft tissue malignancies is sometimes limited as a result of lack of native tissue coverage options, patient comorbidities, or pending permanent margin analysis. Acellular dermis (AlloDerm®) reconstruction offers an excellent coverage alternative in these situations. We describe our experience using AlloDerm for coverage of skin and soft tissue defects. An Institutional Review Board approved review of patients undergoing skin/soft tissue coverage with AlloDerm from 2006 to 2012 was performed. Clinicopathologic variables, early postoperative findings, and subjective final cosmetic outcome were analyzed. Sixty-seven patients underwent AlloDerm reconstruction. Melanoma (67%) was the most frequent diagnosis. The median defect size was 42 cm2 (range, 2 to 340 cm2), involving predominantly the lower extremity (45%) or head and neck (32%). AlloDerm was intended for use as a temporary dressing in 64 per cent (43 of 67) and permanent coverage in 24 (36%). Ten patients required reexcision for positive margins. Twenty-five (37%) underwent split-thickness skin graft or flap coverage after AlloDerm placement. Radiation was administered to 16 patients (24%) after AlloDerm reconstruction within a median of 53 days after surgery (range, 18 to 118 days). At first postoperative examination (median, 11 days after surgery), 85 per cent had evidence of healthy AlloDerm incorporation. Cellulitis was the most frequent complication (13%), all resolving with oral antibiotics. AlloDerm reconstruction after skin and soft tissue resection offers a suitable coverage alternative and may serve as a bridge to permanent reconstruction or as a permanent biologic dressing of complex surgical defects. In situations in which adjuvant radiation is needed, AlloDerm can be used without major complications. Copyright Southeastern Surgical Congress. All rights reserved. |
0 | Impulsive behavior and its correlates among patients with schizophrenia in a tertiary care psychiatry setting in Mansoura | DoD PRF (Psychosocial RF) | BACKGROUND AND OBJECTIVES: Impulsive behavior has been repeatedly identified as a major problem in schizophrenia. Our objective was to examine the possible demographical and clinical correlates for impulsive behavior in patients with schizophrenia.
METHODS: Fifty-eight patients with schizophrenia and Seventy-seven healthy controls were recruited. Sociodemographic data were collected and they were subjected to the Barratt Impulsiveness Scale (BIS), Positive and Negative Syndrome scale (PANSS), and Trauma Assessment for Adults-Brief Revised Version (TAA).
RESULTS: Correlations between impulsive behavior and psychosocial variables were examined. A significant association between level of impulsive behavior and severity of psychopathological symptoms was observed (P=0.0001). Young age (P=0.001), male patients (P=0.0001) and those with history of childhood sexual or physical abuse (P=0.0001), were more impulsive. Linear regression (step wise) analysis model showed that male sex (P=0.001), positive symptoms (P=0.006), and childhood physical abuse (P=0.001) were significant associations.
CONCLUSION: Male gender, positive symptoms as well as history of physical and sexual abuse before 18 years of age are important predictors for high levels of impulsive behavior in schizophrenia patients. |
1 | Outcome of Gartland type II and type III supracondylar fractures treated by Blount's technique | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | BACKGROUND: According to some orthopedic surgeons, almost all supracondylar humerus fractures should be treated operatively by reduction and pinning. While according to others, closed reduction and immobolization should be used for Gartland type II and some type III fractures. However, the limit of this technique remains unclear. We present 74 patients with displaced extension-type supracondylar fractures treated by closed reduction and immobilization with a collar sling fixed to a cast around the wrist. The purpose of the study is to give a more precise limitation of this technique. MATERIALS AND METHODS: Retrospective data acquisition of 74 patients with a Gartland type II or type III fractures treated by closed reduction and immobilization (Blount's technique) between January 2004 and December 2007 was done. The mean age was 6.3 years (range, 2-11). The mean time of follow-up was 6.5 months (range, 3-25). All open injuries and complex elbow fracture dislocations or T-condylar fractures were excluded from the study. All patients were evaluated with standardized anteroposterior and true lateral x-rays of the elbow, and Flynn criteria were used for functional assessment. RESULTS: Gartland type II fractures had 94% good or excellent final results. Gartland type III fractures had 73% good or excellent final result. The Gartland type III outcome depended on the displacement. The fractures remained stable in 88% for the posterior displacement, and 58% for the posteromedial displacement. These displacements were mild. However, for the posterolaterally displaced fractures, only 36% were stable; 36% had a mild displacement and 27% had a major displacement. CONCLUSION: Pure posterior displacement is more stable than posteromedial displacement which is more stable than posterolaterally displaced fractures. This study suggests that Gartland type II and pure posterior or posteromedial displaced Gartland type III fractures can be treated by closed reduction and immobilization with success |
0 | Report of the Primary Outcomes for Gait Mechanics in Men of the ACL-SPORTS Trial: Secondary Prevention With and Without Perturbation Training Does Not Restore Gait Symmetry in Men 1 or 2 Years After ACL Reconstruction | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: Movement asymmetries during walking are common after anterior cruciate ligament (ACL) injury and reconstruction and may influence the early development of posttraumatic osteoarthritis. Preoperative neuromuscular training (like perturbation training, which is neuromuscular training requiring selective muscle activation in response to surface perturbations) improves gait asymmetries and functional outcomes among people who are ACL-deficient, but the effect of postoperative perturbation training on gait mechanics after ACL reconstruction is unknown.
QUESTIONS/PURPOSES: Among men undergoing ACL reconstruction, we sought to compare strength, agility, and secondary prevention (SAP) treatment with SAP plus perturbation training (SAP+PERT) with respect to (1) gait mechanics; and (2) elimination of gait asymmetries 1 and 2 years after ACL reconstruction.
METHODS: Forty men were randomized into a SAP group or a SAP+PERT group after ACL reconstruction and before returning to preinjury activities. Participants were required to achieve >= 80% quadriceps muscle strength symmetry, minimal knee effusion, full ROM, no reports of pain, and completion of a running progression (all between 3 and 9 months postoperatively) before enrollment. Of 94 potentially eligible athletic male patients evaluated < 9 months after ACL reconstruction, 54 were excluded for prespecified reasons. Participants underwent motion analysis during overground walking at 1 and 2 years postoperatively. Variables of interest included (1) sagittal and frontal plane hip and knee angles and moments at peak knee flexion angle; (2) sagittal plane hip and knee angles and moments at peak knee extension angle; (3) sagittal plane hip and knee excursion during weight acceptance; and (4) sagittal plane hip and knee excursion during midstance. We also calculated the proportion of athletes in each group who walked with clinically meaningful interlimb asymmetry in sagittal plane hip and knee variables and compared these proportions using odds ratios. There was no differential loss to followup between groups.
RESULTS: There were no differences between the SAP or SAP+PERT groups for the biomechanical gait variables. The involved limb's knee excursion during midstance for the SAP (mean +/- SD: 1 year: 15degree +/- 5degree; 2 years: 16degree +/- 5degree) and SAP+PERT (1 year: 16degree +/- 5degree; 2 years: 15degree +/- 4degree) athletes was not different between groups at 1 year (mean difference: -1degree; 95% confidence interval [CI], -5degree to 2degree; p = 0.49) or 2 years (mean difference: 1degree; 95% CI, -2degree to 4degree; p = 0.54). There were no differences between SAP and SAP+PERT athletes regarding the elimination of gait asymmetries, and gait asymmetries persisted to a large degree in both groups 1 and 2 years postoperatively. At 1 year, 11 of 18 SAP and 11 of 20 SAP+PERT athletes walked with truncated knee excursions during weight acceptance (odds ratio: 0.8, p = 0.70) and midstance (SAP 12 of 18, SAP+PERT 12 of 20; odds ratio: 0.8, p = 0.67), whereas at 2 years postoperatively, truncated knee excursions during weight acceptance (SAP seven of 17, SAP+PERT eight of 19; odds ratio: 1.0, p = 0.96) and midstance (SAP five of 17, SAP+PERT 11 of 19; odds ratio: 3.3, p = 0.09) remained prevalent.
CONCLUSIONS: We found that a comprehensive, progressive return-to-sport training program with or without perturbation was not effective at restoring interlimb symmetry among men 1 or 2 years after ACL reconstruction. Although gait asymmetries improved from 1 to 2 years postoperatively, meaningful asymmetries persisted in both groups. To restore gait symmetry after ACL reconstruction, additional interventions likely are necessary.
LEVEL OF EVIDENCE: Level II, therapeutic study. |
0 | Role of Metal-on-Metal Resurfacing in the Treatment of Late Stage Osteonecrosis | AAHKS (2) Corticosteroids | Many patients with osteonecrosis of the femoral head present or end up with late-stage disease. There are few options beyond standard total hip arthroplasty available for these patients. Metal-on-metal resurfacing arthroplasty offers a viable alternative for some of these patients. The early- and midterm results appear to be similar to standard hip arthroplasty. This treatment method may be especially efficacious in certain patient populations such as sickle cell anemia, systemic lupus erythematosus, for whom the results of standard total hip arthroplasties have not been optimal. Studies evaluating resurfacing over longer periods of time are being performed and may provide further insights into how femoral failures can best be reduced. © 2007 Elsevier Inc. All rights reserved. |
1 | The value of the history in the diagnosis of carpal tunnel syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Details of the clinical history were elicited by questionnaire from 8,223 patients with suspected carpal tunnel syndrome and compared with the neurophysiological findings. Distribution of symptoms to the radial part of the hand and nocturnal exacerbation of symptoms showed the strongest individual correlations with positive nerve conduction studies. The regression model derived from the complete questionnaire achieved an overall sensitivity of 79% and specificity of 55% for the diagnosis of carpal tunnel syndrome when compared with the nerve conduction study results as a gold standard. A simple regression model for evaluating the history compares favourably with widely used clinical signs in its ability to predict the findings of nerve conduction studies |
0 | Osteochondral autologous transfer combined with valgus high tibial osteotomy: long-term results and survivorship analysis | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Deep osteochondral defects of the medial femoral condyle in young and active patients are a serious condition that might lead to early osteoarthritis of the knee joint. Concomitant varus malalignment most likely promotes this process because of overloading of the medial compartment. Osteochondral autologous transfer (OAT) combined with valgus high tibial osteotomy (HTO) might therefore be a comprehensive solution to preserve long-term knee function in these patients. PURPOSE: To evaluate clinical long-term results and analyze survival rates (conversion to knee joint arthroplasty) after combined OAT and valgus HTO in young and active patients with symptomatic osteochondral defects of the medial femoral condyle and concomitant varus malalignment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1998 and 2008, combined OAT and valgus HTO was performed in 86 patients with deep osteochondral defects of the medial femoral condyle and concomitant varus malalignment >2 degrees ; 74 patients (86%) were available for follow-up evaluation. The mean age of patients was 38 years, and the mean follow-up time was 7.5 years. Knee function was assessed using the Lysholm score, and pain intensity was measured using the visual analog scale (VAS). The survival rates of this combined procedure were evaluated. Failure was defined as conversion to knee joint arthroplasty during the follow-up period. RESULTS: Adjusted to follow-up time, the Lysholm score showed a mean increase of 33 points (95% CI, 27.1-39.4; P < .001) from 40 to 73, representing a significant improvement compared with preoperatively. The VAS score decreased by a mean of 4.8 points (95% CI, 4.1-5.5; P < .001) from 7.5 to 2.7, and 93% of the patients were satisfied with the results of the operative procedure. Mean survival rates were 95.2% +/- 2.7% at 5 years, 93.2% +/- 3.3% at 7 years, and 90.1% +/- 4.4% at 8.5 years after surgery. CONCLUSION: Combined OAT and valgus HTO is an option to successfully treat patients with deep osteochondral defects of the medial femoral condyle and concomitant varus malalignment. Significantly improved knee function, decreased pain intensity, and a high survivorship rate can be expected up to 8.5 years postoperatively |
0 | Efficacy of ropivacaine compared with ropivacaine plus sufentanil for postoperative analgesia after major knee surgery | AAHKS (8) Anesthetic Infiltration | This study compared the analgesic efficacy of an epidural infusion of ropivacaine and ropivacaine with sufentanil following major knee surgery. In a double-blind clinical trial, 115 adult patients received either epidural ropivacaine (R group, 2 mg.ml(-1)), or ropivacaine (2 mg.ml(-1)) with sufentanil (RS group, 1 microg.ml(-1)), using a patient-controlled epidural analgesia technique. Pain scores (visual analogue scale, VAS, and the simple descriptive scale, SDS), side-effects, motor block and treatment quality were recorded at 6, 12 and 24 h after the insertion of the epidural catheter. In the RS group, analgesic efficacy was significantly greater than in the R group between 12 and 24 h following insertion of the epidural catheter (VAS: 92.9% vs. 72.9%, p = 0.009). There was no significant difference during the other periods. Pruritus, nausea and vomiting were significantly more frequent in the RS group. Good postoperative analgesia was obtained with an epidural infusion of ropivacaine (2 mg.ml(-1)). When this local anaesthetic was administered with sufentanil, there was an improvement in the analgesic effect but a significant increase in the number of patients who reported adverse effects. The differences were more pronounced 12 h after the beginning of the analgesic schedule. This study failed to demonstrate any worthwhile clinical benefit from the addition of sufentanil. |
0 | Impact of Image-Derived Instrumentation on Total Knee Arthroplasty Revision Rates: An Analysis of 83,823 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry | OAK 3 - Non-arthroplasty tx of OAK | Background:Computer navigation and image-derived instrumentation (IDI) are technology-based methods developed to improve outcomes and potentially reduce revision total knee arthroplasty (TKA). IDI refers to the use of manufactured, patient-specific surgical jigs. Conflicting reports exist on IDI-associated improvements in outcomes. The primary aim of the current study was to compare the rates of revision among TKA cases in which components were initially implanted with use of IDI, computer navigation, or neither of these methods ("other" TKA). The secondary aim was to determine whether the outcomes of IDI differed for specific subgroups.Methods:Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for the 3 TKA groups: IDI, computer-navigated, and other TKA. The study period was from the first IDI procedure recorded by the AOANJRR (April 2010) to December 31, 2016. The analysis was restricted to primary TKA cases undertaken for osteoarthritis and involving patellar resurfacing and the use of a cross-linked polyethylene insert. Subanalyses were performed to evaluate the effects of age, sex, implantation method, IDI manufacturer, prosthetic design, and prosthesis type on the rates of revision. Kaplan-Meier estimates of survivorship described the time to first revision. Hazard ratios (HRs, Cox proportional hazards models) with adjustment for age and sex were used to compare revision rates.Results:IDI was used in 5,486 primary TKA procedures. There was no significant difference among the groups in the cumulative percent revision (CPR) at 5 years: 3.3% (95% confidence interval [CI], 2.4% to 4.6%) for IDI, 2.4% (95% CI, 2.2% to 2.7%) for the computer-navigated group, and 2.5% (95% CI, 2.3% to 2.7%) for other TKA. Posterior-stabilized TKA with use of the IDI method had a significantly higher rate of revision at >3 months (HR, 1.45 [95% CI, 1.02 to 2.04]; p = 0.036), as did IDI TKA in the â?¤65-year-old patient cohort (HR, 1.52 [95% CI, 1.10 to 2.09]; p = 0.010), compared with computer-navigated TKA. Patellar revision was significantly more likely in the IDI group.Conclusions:IDI TKA demonstrated no overall difference in early to mid-term revision rates compared with standard implantation methods. However, elevated rates of revision were seen with posterior-stabilized TKA, in patients â?¤65 years of age, and for patellar revision, meaning that this method should be used with some caution and requires further study.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. |
0 | Factors Affecting Depressive Symptoms among North Korean Adolescent Refugees Residing in South Korea | DoD PRF (Psychosocial RF) | We examined factors affecting the depressive symptoms and the relationship between depression and quality of life among 131 North Korean adolescent refugees aged 12-24 years. We compared sociodemographic, social, and individual characteristics and perceived the quality of life between participants with and without depression. Thirty-seven refugees (28.2%) had clinically significant depressive symptoms. The refugees with depression were younger (t = 2.67; p = 0.009), more likely to be male (chi2 = 6.98; p = 0.009), and more likely to have a Chinese father (chi2 = 9.05; p = 0.003) than those without depression. The refugees with depression had lower levels of psychological social support (t = 2.96; p = 0.004) and resilience (t = 4.24; p < 0.001) and higher levels of alcohol problems (t = -2.08; p = 0.043), aggression (t = -3.15; p = 0.003), and post-traumatic stress disorder (PTSD; t = -2.89; p = 0.004). They also reported lower levels of life satisfaction (t = 3.31; p = 0.001) and had a more negative view of their future (t = 2.68; p = 0.010). Interventions to increase resilience, to decrease the impact of traumatic events, and to provide psychological support may be helpful for North Korean adolescent refugees at risk of depression. |
0 | Distribution of clinical risk factors for fracture in a Brussels cohort of postmenopausal women: The FRISBEE study and comparison with other major cohort studies | Hip Fx in the Elderly 2019 | Objectives The estimation of fracture risk using clinical risk factors (CRFs) is of primary concern in osteoporosis management, but only some risk factors have been thoroughly evaluated and incorporated in predictive models. We have launched a large prospective study, the â??Fracture Risk Brussels Epidemiological Enquiryâ?? (FRISBEE), to develop a new predictive model for osteoporotic fractures. The aims of this report are to describe the methodology of the FRISBEE study and to compare the distribution of CRFs in our cohort with those reported in other large studies. Study design FRISBEE is a new study that prospectively evaluates a cohort of 3560 post-menopausal women (aged 60â??85 years) followed yearly for the occurrence of fragility fractures. Multiple validated CRFs, densitometry (DXA) values and intake of medication were systematically registered at baseline. The distribution of the FRISBEE CRFs has been compared with the distributions of CRFs in the cohorts used to develop the FRAX® model as well as in more recent cohorts. For these recent cohorts, we focused on CRFs not included in FRAX®. Results The most frequently encountered CRFs used in FRAX® were a prior fragility fracture (27.1%) and a parental history of hip fracture (13.4%). The prevalence of some CRFs not integrated in FRAX® was relatively high, such as the use of proton pump inhibitors (20.8%) and a history of fall(s) (19.7%). The prevalence of many CRFs was quite variable between cohorts; for example, the prevalence of â??personal prior fragility fractureâ?? ranged from 9% to 51%. Conclusion We found considerable heterogeneity in the prevalence of CRFs between cohort studies. The impact of these differences on the predictive value of a particular CRF is unknown. We will construct a predictive model calibrated to the Belgian population. More importantly, the FRISBEE study should allow us to determine the predictive value of newly recognized CRFs in addition to the FRAX® algorithm to reliably estimate fracture risk. |
0 | More radial shortening after low-energy Colles' fractures is associated with type 2 diabetes mellitus among postmenopausal women, irrespective of bone mineral density | Distal Radius Fractures | BACKGROUND: Recent meta-analysis data reveal that patients with type 2 diabetes mellitus (DM) have a higher risk of fracture, despite higher bone mineral density (BMD), than patients without type 2 DM. The purpose of this study was to compare BMD and distal radial shortening after low-energy Colles' fractures among Japanese postmenopausal women aged >=50 years with type 2 DM with those in women without it (non-DM).
METHODS: One-hundred and ten postmenopausal women aged >=50 years with distal radius fractures resulting from a fall were enrolled in this study. Twelve patients had DM. BMD, type I collagen cross-linked N-telopeptide (NTX), undercarboxylated osteocalcin (ucOC), estimated glomerular filtration rate (eGFR), grip strength of the unfractured hand, unipedal standing time, and the degree of radial shortening were measured.
RESULTS: There were no significant differences in age and body height between the two groups. The DM group had significantly greater body weight and body mass index than the non-DM group. BMDs of the lumbar spine and proximal hip were significantly higher in the DM group than in the non-DM group. NTX, ucOC, grip strength, and the percentage of women with unipedal standing time <15 s did not differ between the two groups. Stepwise regression analysis identified DM and shorter unipedal standing time as significant factors associated with more radial shortening, and identified more radial shortening and lower eGFR as significant factors associated with DM.
CONCLUSIONS: More radial shortening after low-energy Colles' fractures was significantly associated with type 2 DM among postmenopausal women aged >=50 years, irrespective of BMD. |
1 | The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women | DoD PRF (Psychosocial RF) | OBJECTIVES: We explored the association between traumatic events and mental health among girls and women trafficked for sexual exploitation.
METHODS: We used subscales of the Brief Symptom Inventory and Harvard Trauma Questionnaire to interview 204 trafficked girls and women in 7 posttrafficking service settings. Multivariate logistic regression models based on interview data were fitted for depression, anxiety, and posttraumatic stress disorder (PTSD) separately and adjusted for pretrafficking abuse to determine impact of trafficking-related trauma exposures.
RESULTS: Injuries and sexual violence during trafficking were associated with higher levels of PTSD, depression, and anxiety. Sexual violence was associated with higher levels of PTSD (adjusted odds ratio [AOR] = 5.6; 95% confidence interval [CI] = 1.3, 25.4). More time in trafficking was associated with higher levels of depression and anxiety (AOR = 2.2; 95% CI = 1.1, 4.5). More time since trafficking was associated with lower levels of depression and anxiety but not of PTSD.
CONCLUSIONS: Our findings inform the emerging field of mental health care for trafficked persons by highlighting the importance of assessing severity and duration of trafficking-related abuses and need for adequate recovery time. Therapies for anxiety, PTSD, and mood disorders in low-resource settings should be evaluated. |
0 | Hand-arm vibration syndrome: a common occupational hazard in industrialized countries | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Regular exposure to hand-transmitted vibration can result in symptoms and signs of peripheral vascular, neurological and other disorders collectively known as the hand-arm vibration syndrome (HAVS). A significant proportion of workers can suffer from HAVS after using vibrating power tools. HAVS is a chronic and progressive disorder. Early recognition and prevention is the key to managing vibrating tool exposures and health effects. This article gives a broad overview of the condition with a detailed account of its pathogenesis, identification and management |
0 | Identifying changes in gait waveforms following a strengthening intervention for women with knee osteoarthritis using principal components analysis | OAK 3 - Non-arthroplasty tx of OAK | Lower limb strengthening exercise is pivotal for the management of symptoms related to knee osteoarthritis (OA). Though improvement in clinical symptoms is well documented, concurrent changes in gait biomechanics are ill-defined. This may occur because discrete analyses miss changes following an intervention, analyses limited to the knee undermine potential mechanical trade-offs at other joints, or strengthening interventions not been designed based on biomechanical principles. The purpose of this study was to characterize differences in entire gait waveforms for sagittal plane ankle, knee, and hip angles and external moments; the knee adduction moment; and frontal plane hip angle and moment following 12-weeks of a previously designed novel lower limb strengthening program. Forty women with knee OA completed two laboratory visits: one at baseline and one immediately following intervention (follow-up). Self-report measures, strength, and gait analyses were completed at each visit. Principal components analyses were completed for sagittal angles and external moments at the ankle, knee, and hip joints, as well as frontal plane angle and moment for the hip. |
1 | Shoulder arthroplasty in the presence of posterior glenoid bone loss | Glenohumeral Joint OA | Chronic osteoarthritis of the glenohumeral joint, traumatic injury, post-reconstruction arthropathy, and developmental conditions such as glenoid dysplasia can result in posterior glenoid bone loss and excessive retroversion of the glenoid. Shoulder replacement in this setting is technically challenging and characterized by higher rates of complications and revisions. Current options that should be considered for managing glenoid bone loss that results in >15degree of retroversion include bone-grafting, augmented glenoid components, and reverse total shoulder replacement. Asymmetric reaming is commonly used to improve version but should be limited to correction of 10degree to 15degree of retroversion in order to preserve subchondral bone. Bone-grafting of glenoid defects has had mixed results and has been associated with graft-related complications, periprosthetic radiolucencies, and glenoid component failure; however, it provides a biologic option for patients with severe bone loss. Implantation of an augmented polyethylene glenoid component offers the potential to improve version while preserving subchondral bone, but the procedure is technically demanding and without clinical follow-up data at this point. Reverse total shoulder arthroplasty offers improved fixation and stability compared with an anatomic prosthesis for elderly patients with severe glenoid bone loss but is associated with a high complication rate. Glenoid dysplasia is defined as a deformity that results in >25degree of glenoid retroversion. Advanced imaging needs to be obtained in order to ensure enough glenoid bone stock is present to allow anatomic glenoid component placement. |
0 | An Evaluation of the Safety and Effectiveness of Total Hip Arthroplasty as an Outpatient Procedure: A Matched-Cohort Analysis | AAHKS (8) Anesthetic Infiltration | BACKGROUND: Outpatient hip arthroplasty is being performed more routinely; however, safety remains a concern. The purpose of this study was to compare the rate of adverse events of outpatient total hip arthroplasty (THA) and assess barriers to discharge.
METHODS: We examined 136 patients who underwent unilateral THA by one surgeon and were discharged on the same day of surgery. Using propensity matching, 136 inpatients who received the same procedure, and were discharged on postoperative day one or later, were identified. For each cohort, 90-day occurrence of adverse events, readmissions, and emergency visits were recorded and compared. Adverse events were graded using the OrthoSAVES tool. A secondary objective was to assess potential barriers to same-day discharge.
RESULTS: Within 90 days postoperatively, 12 outpatients (8.82%) and 14 inpatients (10.29%) developed an adverse event. There were no significant differences between the rate or severity of adverse events between the 2 groups and no serious adverse events in either group. In the outpatient group, there was a correlation between the dosage of spinal anesthetic (bupivacaine) given and time required to stay in postanesthetic care unit postoperatively.
CONCLUSION: When comparing the 2 groups, there were no differences in adverse events at 90 days. At our center, in the appropriate patient population, outpatient THA is a safe and cost-effective option. A potential barrier to mobility postoperatively and successful same-day discharge is the time required to stay in postanesthetic care unit postoperatively, which was significantly correlated with an increased dose of spinal anesthetic given in our outpatient cohort. |
0 | Knee joint loading indices before and 3 months after arthroscopic partial medial meniscectomy | Surgical Management of Osteoarthritis of the Knee CPG | Purpose: Increased knee adduction moment (KAM) is considered an important marker of medial compartment loading in knee osteoarthritis (OA) research. Patients undergoing arthroscopic partial medial meniscectomy (APMM) are at increased risk of developing medial compartment knee OA. APMM may contribute to altered knee joint loading patterns. The aim of this pilot study was to determine the shortterm changes in knee joint loading indices after medial APMM. Methods: We investigated indices of knee joint loading using 3D gait analysis in 16 patients (13 men, 46.0 (SD 6.9 yrs),178.7 (7.0) cm, 81.1 (10.7) kg, 25.4 (3.5) kg/m2) undergoing APMM for a medial meniscus tear. All patients had no radiographic knee OA (i.e. K/L grade 0 or 1) in the leg undergoing APMM and in their uninjured control leg at the baseline assessment prior to surgery. Exclusion criteria were: back problems, previous knee surgery, other co-morbidities affecting lower extremity function, low activity level (i.e. only indoor walking). Patients were assessed prior to and 3 months post APMM. Walking gait data were collected (100 Hz) using a 6-camera Vicon MX system (Vicon, Oxford, UK) with the Plug-in-Gaitmarker set. Ground reaction forceswere recorded in synchrony with the cameras (1000Hz) using two force plates (AMTI, OR6- 7-1000,Watertown, MA, USA). The following indices of knee joint loading were calculated using inverse dynamics and reported relative to body size (Nm/BWnullHT%): peak KAM, KAM impulse (i.e. the positive area under the KAM-time curve) and peak knee flexion moment. All motion data were collected barefoot during gait at patients' self-selected walking speed. Variables were calculated for each trial, then averaged over five trials. At the follow-up patients were instructed to walk with the same speed, allowing amargin of(plus or minus)5%. Paired t-testswere used totest for differences in the change of knee joint loading indices between operated and control legs frombefore APMMto the 3month follow-up and to evaluate potential differences between the operated and control legs at the baseline. Results: Frompre surgery to 3month post APMM, therewas a significantly larger increase in KAM impulse in the operated leg compared with the control leg (p = 0.03). A tendency towards a larger increase in peak KAM was also observed in the operated comparedwith the control leg (p= 0.10) (Table 1). Loading indices were generally higher in the control knee compared to the leg undergoing APMMprior to surgery, even though this only approached statistical significance for peak knee flexion moment (peak KAM, p = 0.29; KAM impulse, p = 0.14; peak flexion moment, p = 0.06). Conclusions: Our preliminary data indicate that knee joint loading indices increasewithin the first 3months postmedial APMMcompared to the non-operated contralateral knee.Whether this is influenced by changes in pain status or is a result of APMM per se warrants further investigation. (Table Presented) |
0 | Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction | DoD SSI (Surgical Site Infections) | Background Reconstruction of extensive bone and compound defects in the foot and ankle is challenging. This cross-sectional study aimed to assess the outcomes of free iliac crest flap in foot and ankle reconstruction. Methods We retrospectively reviewed patient records and identified 13 cases with 1 osseous and 12 composite free iliac crest grafts for compound fracture (n = 3) or sequelae (n = 10) in the foot and ankle. We applied the visual analogue scale foot and ankle, the Oswestry disability index, and the 15D health-related quality of life (HRQoL) instruments. Results The average follow-up period was 3.9 years (range, 1.3-8.0 years). Four patients underwent early reoperations; venous and arterial reanastomosis (n = 1), minor wound revision (n = 2), or flap reconstruction due to partial necrosis of the skin island (n = 1). The median time to bone union was 23 months (range, 7-46 months). One permanent pseudoarthrosis occurred. One patient underwent late below-knee amputation due to chronic pain and functional impairment. One patient required flap reconstruction due to a late donor-site defect. Seven patients completed the questionnaires on an average of 14.7 years postoperatively (range, 2.0-26.9 years). Noted impairment of the donor site and of the reconstructed limb ranged from none to significant. Five (out of seven) patients had a HRQoL comparable to that of an age-standardized general population. Conclusions The free iliac crest flap is a feasible option for extensive compound fractures and bone-healing complications in the foot and ankle. It can also be used to achieve ankle arthrodesis when other techniques have failed and in patients at high risk for amputation. |
0 | Impact of liposomal bupivacaine administration on postoperative pain in patients undergoing total knee replacement | AAHKS (5) Gabapentinoids | STUDY OBJECTIVE: To determine whether liposomal bupivacaine, a long-acting anesthetic indicated for single-dose wound infiltration to produce postoperative analgesia, has an impact on postoperative pain in patients undergoing total knee arthroplasties (TKAs).
DESIGN: Single-center retrospective cohort study.
SETTING: Large tertiary and quaternary care hospital.
PATIENTS: A total of 120 adults who underwent TKA between March 1, 2013, and October 31, 2013; of those patients, 55 patients received an intraoperative dose of liposomal bupivacaine 266 mg (active treatment group), and 65 did not receive the drug (control group).
MEASUREMENTS AND MAIN RESULTS: The primary end point was the mean area under the curve (AUC) of numeric rating scale (NRS) pain scores from the end of surgery to 48 hours after surgery. Secondary end points included measures of postoperative pain up to 24 hours after surgery, opioid consumption within 48 hours after surgery, duration of hospitalization, and ambulation distance from the end of surgery to discharge. No significant differences were noted in the primary or secondary end points between patients who received or did not receive an intraoperative dose of liposomal bupivacaine. The mean +/- SD AUC of NRS pain scores was 199.59 +/- 67.11 and 192.94 +/- 70.41 for the liposomal bupivacaine and control groups, respectively (p=0.658). Use of adjunctive analgesics was higher among patients in the control group, particularly for those receiving celecoxib, pregabalin, and continuous regional ropivacaine infusions, which may have minimized any differences in pain control between the treatment groups.
CONCLUSION: Liposomal bupivacaine did not improve pain control in patients undergoing TKA when compared with historical management strategies; however, differences may have been obscured by increased utilization of adjunctive analgesics among patients in the control group. |
0 | Validation of diagnostic codes for subtrochanteric, diaphyseal, and atypical femoral fractures using administrative claims data | Management of Hip Fractures in the Elderly | Administrative claims databases have large samples and high generalizability. They have been used to evaluate associations of atypical femoral fractures with bisphosphonates. We developed and assessed accuracy of claims-based algorithms with hospital and physician diagnosis codes for these fractures. Medical records and radiology reports of all adults admitted at University of Alabama at Birmingham Health System from 2004 to 2008 with International Classification of Diseases, Ninth Revision hospital discharges and surgeons' fracture repair codes for subtrochanteric femoral fractures and random sample of other femoral fractures were reviewed. We identified 137 persons with suspected subtrochanteric femoral fractures and randomly selected 50 persons with either suspected diaphyseal femoral fractures or hip fractures other than subtrochanteric and diaphyseal femoral fractures (typical hip fractures). Eleven patients had radiographic features indicative of atypical femoral fractures. The positive predictive value (PPV) of claims-based algorithms varied with primary or secondary positions on discharge diagnoses and the sources of diagnosis codes. The PPV for fractures ranged 69-89% for subtrochanteric femoral, 89-98% for diaphyseal femoral, and 85-98% for typical hip fractures. The PPV of administrative codes for defining a femoral fracture as atypical was low and imprecise. Claims-based algorithms combining hospital discharges with surgeon's diagnosis codes had high PPV to identify the site of subtrochanteric or diaphyseal femoral fractures vs typical hip fractures. However, claims-based data were not accurate in identifying atypical femoral fractures. These claims algorithms will be useful in future population-based observational studies to evaluate associations between osteoporosis medications and subtrochanteric and diaphyseal femoral fractures |
0 | Relationship between blood lead levels and nerve conduction velocities | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Nerve conduction velocities decrease in lead poisoning even in the absence of neurologic deficits. Such impairment has also been shown among lead workers whose blood lead levels (Pb-B) had not exceeded 70 (mu)g/100 ml. The present study deals with 78 workers, 66 men and 12 women, who had been occupationally exposed to lead for several years and whose Pb-B level had been regularly monitored. The reference group comprised 34 workers, 29 men, 5 women, without any known occupational exposure to lead or other neurotoxic chemicals. The motor conduction velocity (MCV) of the median, ulnar, deep peroneal and posterior tibial nerves, the conduction velocity of the slower motor fibers (CVSF) of the ulnar and peroneal nerves as well as the sensory conduction velocity (SCV) and the distal sensory conduction velocity (dSCV) of the median ulnar and sural nerves were measured. MCVs and SCVs, especially in the arm nerves, were increasingly slower with increasing Pb-B levels. A statistically significant dose-effect relationship was found between the maximal Pb-B level ever measured and the MCV, SCV, dSCV and the motor distal latency of the median nerve, the CVSF and the SCV of the ulnar nerve and the MCV of the posterior tibial nerve. The prevalence of abnormal conduction velocities in one or more nerves increased from 27% in the group with maximal Pb-B levels between 40 and 49 (mu)/100 ml to 53% in the group with maximal Pb-B levels equal to or exceeding 70 (mu)g/100 ml, suggesting dose-response relationship. The slowing of nerve conduction velocities should be regarded as a warning sign of incipient neuropathy. As lead accumulates in the organism, neither the Pb-B level nor toxic effects induced by lead are quickly reversible after cessation of exposure or hygienic improvements. It is proposed that impairment of nervous function may be induced by substantially lower Pb-B levels than expected hitherto, and that this impairment is a function of the lead uptake |
0 | Component motion in bipolar cemented hemiarthroplasty | Management of Hip Fractures in the Elderly | A total of 17 patients with a cemented bipolar Hastings hemiarthroplasty were examined clinically and radiologically between 1 and 3 years after being treated for a displaced femoral neck fracture. Only a minor part of the motion in the Hastings prostheses took place between the metal femoral head and the polyethylene liner (intraprosthetic). In seven cases, no "true" intraprosthetic motion weightbearing was observed (including five cases with intraprosthetic motion caused by impingement). The relative amount of intraprosthetic motion did not decrease with weightbearing. The functional result was not correlated to the relative amount of intraprosthetic motion with weightbearing. In conclusion, the short-term success of the bipolar prostheses is probably not accomplished by a reduction in extraprosthetic motion caused by the biarticular design but by other factors, including the optimal indications for hemiarthroplasty (high age, low activity level), the consistent use of acrylic bone cement, and the shock-absorbing effect of the polyethylene liner |
0 | All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study | Surgical Management of Osteoarthritis of the Knee CPG | OBJECTIVE: To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip. DESIGN: Population based cohort study. SETTING: General practices in the southwest of England. PARTICIPANTS: 1163 patients aged 35 years or over with symptoms and radiological confirmation of osteoarthritis of the knee or hip. MAIN OUTCOME MEASURES: Age and sex standardised mortality ratios and multivariable hazard ratios of death after a median of 14 years' follow-up. RESULTS: Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70). Excess mortality was observed for all disease specific causes of death but was particularly pronounced for cardiovascular (standardised mortality ratio 1.71, 1.49 to 1.98) and dementia associated mortality (1.99, 1.22 to 3.25). Mortality increased with increasing age (P for trend <0.001), male sex (adjusted hazard ratio 1.59, 1.30 to 1.96), self reported history of diabetes (1.95, 1.31 to 2.90), cancer (2.28, 1.50 to 3.47), cardiovascular disease (1.38, 1.12 to 1.71), and walking disability (1.48, 1.17 to 1.86). However, little evidence existed for increased mortality associated with previous joint replacement, obesity, depression, chronic inflammatory disease, eye disease, or presence of pain at baseline. The more severe the walking disability, the higher was the risk of death (P for trend <0.001). CONCLUSION: Patients with osteoarthritis are at higher risk of death compared with the general population. History of diabetes, cancer, or cardiovascular disease and the presence of walking disability are major risk factors. Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity |
0 | Long term effects of laterally wedged insoles on knee frontal plane biomechanics in patients with medial knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | Purpose: The aim of this study was to examine the effects of laterally wedged insoles to treat knee osteoarthritis on frontal plane mechanics and knee varus moment after one year. Methods: Fourteen individuals diagnosed as having medial knee osteoarthritis (OA) and 13 healthy controls were included in this study. Patients wore bilateral full length laterally wedged insoles with medial longitudinal arch, made of high density ethyl vinyl acetate, with 5° tilt angle in their shoes on a regular basis for at least one year. Three dimensional kinematics and kinetics were recorded as the knee OA patients walked in the laboratory after nearly one year both barefoot and with their insoles. Results: Knee angles and total range of motion in the frontal plane were not significantly different between walking conditions when compared to control group (p>0.05). Walking speed and step width were similar when patients walked barefoot and with laterally wedged insoles (p>0.05). Knee varus moment was prominently high when walking barefoot, and significantly decreased with laterally wedged insoles (p<0.05). Conclusion: Our data suggests that use of 5° laterally wedged insole have significant effects on knee varus moment in knee OA. |
0 | Prophylactic antibiotics in pediatric orthopedic surgery: current practices | AMP (Acute Meniscal Pathology) | A limited survey of 90 orthopedic surgery programs throughout the U.S.A. was conducted to determine the use of prophylactic antibiotics in pediatric orthopedic operations. Prophylaxis was used most often in the Harrington rod procedure (80.7%); less often in hip (64.2%) and knee (44.7%) reconstructive surgery; rarely in meniscus repairs (8.0%) and in lengthening of Achilles tendons (2.3%). Cephalosporins (85%) were the antibiotics prescribed most frequently. The first dose was administered before surgery in 89.6% of the operations. Prophylaxis was discontinued within five days in 96% of the operations. These data provide a pattern of the use of prophylaxis in pediatric orthopedic surgery. |
0 | Subchondral insufficiency fracture of the femoral head in elderly people | PJI DX Updated Search | We evaluated the clinical course of subchondral insufficiency fracture of the femoral head (SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearing conservative treatment. During the follow-up period, the patients with intractable pain underwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edge angle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC was classified as mild (<2 mm), moderate (2-4 mm), and severe (>4 mm). The progression or new development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation between clinical outcomes and the extent of initial FHC. However, a significantly larger proportion of patients that underwent THA showed JSN and FHC progression compared to the symptom improvement group. The risk factor significantly associated with failed conservative treatment was JSN (P=0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinical results of conservative treatment for SIFFH in elderly patients are relatively poor. The patients with JSN are at higher risk of failed conservative treatment |
0 | Diagnosis of discoid lateral meniscus of the knee on MR imaging | AMP (Acute Meniscal Pathology) | To establish the quantitative MR diagnostic criteria for discoid lateral meniscus, MR imaging of 60 knees with arthroscopically confirmed discoid lateral menisci and 134 knees with semilunar lateral menisci were analyzed. Following four quantitative parameters were measured. (1) Meniscal width (MW): The minimum meniscal width on the coronal slice. (2) Ratio of the meniscus to the tibia (RMT): The ratio of minimum meniscal width to maximum tibial width on the coronal slice. (3) Percent coverage of the meniscus (PCM): The ratio of the sum of the width of the anterior and posterior horns to the meniscal diameter on the sagittal slice showing the maximum meniscal diameter. (4) Continuity of the anterior and posterior horns (CAPH): The number of consecutive sagittal slices showing continuity between the anterior and posterior horns of the meniscus on the sagittal slice. The cut-off values of each parameter to discriminate between the discoid and semilunar meniscus were calculated based on a univariate logistic regression analysis. The sensitivity and specificity were also calculated for each of 4 parameters and combinations of these parameters. The cut-off value was 15 mm for the MW, 20% for the RMT, 75% for the PCM, and 3 slices for the CAPH. The sensitivity and specificity of the four parameters ranged between 87% and 50% and between 99% and 92%, respectively. The most accurate diagnostic criterion was either the RMT > or = 20% or the PCM > or = 75%, and the sensitivity and specificity were 95% and 97%, respectively, even when torn menisci were included. |
0 | Endoscopic versus open great saphenous vein harvesting for femoral to popliteal artery bypass | DoD LSA (Limb Salvage vs Amputation) | Objective: Conflicting data exist on outcomes of open vein harvest (OVH) and endoscopic vein harvest (EVH) for infrainguinal bypass. The purpose of this study was to compare outcomes between OVH and EVH in femoral to popliteal artery bypasses. Methods: A retrospective review was performed of all patients undergoing common femoral to popliteal artery bypass with great saphenous vein between January 1997 and June 2014. Bypasses using arm or composite vein were excluded, as were those performed for popliteal artery aneurysms or trauma. Harvest was typically performed by dedicated surgical assistants. Patients were analyzed by either OVH or EVH of vein. The primary outcome was primary patency. Secondary outcomes included assisted primary and secondary patency and major wound complications. Statistical analysis was performed for categorical and continuous variables with life-table and survival statistics for long-term outcomes. Results: In the study time, 505 patients underwent femoral-popliteal bypass; 262 patients and 280 limbs met the inclusion criteria. OVH was performed on 194 (69%) limbs and EVH on 86 (31%). There was no significant difference between the groups in terms of demographics, comorbidities, and preoperative Rutherford classification. Mean follow-up was 34 months. Six of 13 operators (46%) used both harvest techniques. At 5 years, OVH demonstrated higher rates of primary patency compared with EVH (62.8% vs 47%; P =.006) and higher rates of assisted primary patency (81.2% vs 64.3%; P =.003). Secondary patency was not significantly different between groups. The average number of graft interventions was less frequent with EVH, although this trend was not statistically significant (0.1 OVH vs 0.3 EVH; P =.1). EVH also had a lower rate of major wound complications per limb (n = 16; 8% OVH vs 0% EVH; P =.004). Conclusions: OVH was associated with superior primary and assisted primary patencies compared with EVH at 5 years, yet OVH was associated with higher wound complications. Surgeons should weigh the risk of wound complications vs decreased primary and primary assisted patency when deciding which method to use for vein harvest. |
0 | Site-specific response of bone to exercise in premenopausal women | Management of Hip Fractures in the Elderly | We studied the response of bone at specific skeletal sites to either lower body exercise alone or complemented with upper body exercise in premenopausal women. Thirty-five exercisers and 24 age-matched controls completed the 12-month study. Exercising women (N = 35) were randomly assigned to either lower body resistance plus jump exercise (LOWER) (N = 19) or to lower and upper body resistance plus jump exercise (UPPER + LOWER) (N = 16). Exercisers trained three times per week completing 100 jumps and 100 repetitions of lower body resistance with or without 100 repetitions of upper body resistance exercise at each session. Intensity for lower body exercise was increased using weighted vests for jump and resistance exercises, respectively. Intensity for upper body exercise was increased using greater levels of tautness in elastic bands. Bone mineral density (BMD) at the total hip, greater trochanter, femoral neck, lumbar spine and whole body were measured by dual energy X-ray absorptiometry (Hologic QDR-1000/W) at baseline, 6 and 12 months. Data were analyzed first including all enrolled participants who completed follow-up testing and secondly including only those women whose average attendance was > or =60% of prescribed sessions. Group differences in 12-month %change scores for BMD variables were analyzed by univariate ANCOVA adjusted for baseline differences in age. Post hoc tests were performed to determine which groups differed from one another. Initial analysis showed significant differences in greater trochanter BMD between each exercise group and controls, but not between exercise groups (2.7%+/-2.5% and 2.2%+/-2.8% vs. 0.7%+/-1.7%, for LOWER and UPPER + LOWER vs. controls, respectively; p < 0.02) and near significant group differences at the spine (p = 0.06). Excluding exercisers with low compliance, group differences at the greater trochanter remained, while spine BMD in UPPER + LOWER was significantly different from LOWER and controls, who were not significantly different from one another (1.4%+/-3.9% vs. -0.9%+/-1.7% and -0.6%+/-1.8%, for UPPER + LOWER vs. LOWER and controls, respectively; p < 0.05). No significant differences among groups were found for femoral neck, total hip or whole body BMD. Our data support the site-specific response of spine and hip bone density to upper and lower body exercise training, respectively. These data could contribute to a site-specific exercise prescription for bone health |
1 | Radiographic Changes Five Years After Treatment of Meniscal Tear and Osteoarthritic Changes | AMP (Acute Meniscal Pathology) | OBJECTIVE: Meniscal tear in persons aged 45+ years is typically managed with physical therapy (PT), with arthroscopic partial meniscectomy (APM) offered to those who do not respond. Prior studies suggest APM may be associated with greater progression of radiographic changes.
METHODS: We assessed changes between baseline and 60 months in Kellgren-Lawrence (KL) grade and OARSI radiographic score (including subscores for joint space narrowing and osteophytes) in subjects aged 45-85 enrolled in a 7-center randomized trial comparing outcomes of APM with PT for meniscal tear, osteoarthritis changes, and knee pain. The primary analysis classified subjects according to treatment received. To balance APM and PT groups, we developed a propensity score and used inverse probability weighting (IPW). We imputed 60-month change in OARSI score for subjects who underwent total knee replacement (TKR). In a sensitivity analysis, we classified subjects by randomization group.
RESULTS: We analyzed data from 142 subjects (100 APM, 42 PT). Mean (SD) weighted baseline OARSI radiographic score was 3.8 (3.5) in the APM group, 4.0 (4.9) in the PT group. OARSI scores increased by a mean of 4.1 (95% CI 3.5-4.7) in the APM group and 2.4 (95% CI 1.7-3.2) in the PT group (p<0.001), due to changes in the osteophyte component. We did not observe statistically significant differences in KL grade. Sensitivity analyses yielded similar findings as the primary analysis.
CONCLUSIONS: Subjects treated with APM had greater progression in OARSI Score due to osteophyte progression, but not in KL grade. The clinical implications of these findings require investigation. |
0 | Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | A retrospective chart review was performed on patients treated at a level one trauma centre for displaced intra-articular calcaneal fractures by a single trauma surgeon between January 1998 and July 2007. Patients were treated with open reduction and internal fixation utilising the extended lateral incision and a new type of fixation not described before. Threaded 1.575 mm (0.062 in.) Kirschner wires (K-wires) were used for fixation post-operatively along with standard plates, screws and bone substitute. There were 278 fractures in 246 patients that were treated with ORIF for displaced intra-articular calcaneal fractures during this 9-year period. Standard calcaneal lateral approach and hardware was supplemented with percutaneous threaded K-wires. An average of 5.0 fully threaded 1.575 mm K-wires were inserted per calcaneal fracture. Five (1.8%) patients had a K-wire infection; 0.6% of all K-wires became infected and 3.1% of K-wires broke. Lateral calcaneal apical wound issues are minimised and patients experience an overall low complication rate. The fixation also ensures non-weightbearing compliance |
1 | A Survey of Expert Opinion Regarding Rotator Cuff Repair | Trial Systematic Review Project | Many patients with rotator cuff tears have questions for their surgeons regarding the surgical procedure, perioperative management, restrictions, therapy, and ability to work after a rotator cuff repair. The purpose of our study was to determine common clinical practices among experts regarding rotator cuff repair and to assist them in counseling patients. We surveyed 372 members of the American Shoulder and Elbow Surgeons (ASES) and the Association of Clinical Elbow and Shoulder Surgeons (ACESS); 111 members (29.8%) completed all or part of the survey, and 92.8% of the respondents answered every question. A consensus response (>50% agreement) was achieved on 49% (24 of 49) of the questions. Variability in responses likely reflects the fact that clinical practices have evolved over time based on clinical experience. |
0 | The use of PRP injections in the management of knee osteoarthritis | PRP (Platelet-Rich Plasma) | Osteoarthritis (OA) is a degenerative disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture that commonly affects the knee and/or hip joints. It is a major world public health problem and is predicted to increase rapidly with an ageing population and escalating rate of obesity. Autologous blood-derived products possess much promise in the repair and regeneration of tissue and have important roles in inflammation, angiogenesis, cell migration and metabolism in pathological conditions, including OA. Utilising platelet-rich plasma (PRP) to treat tendon, ligament and skeletal muscle has shown variable results across many studies with the current evidence base for the efficacy of PRP in treating sports injuries remaining inconclusive. More uniformly positive results have been observed by various studies for PRP in OA knee in comparison to hyaluronic acid, other intra-articular injections and placebo than in other musculoskeletal tissue. However, methodological concerns as well as satisfactory PRP product classification prevent the true characterisation of this treatment. Thus, further research is required to investigate how leukocyte inclusion, activation and platelet concentration affect therapeutic efficacy. Furthermore, the optimisation of timing, dosage, volume, frequency and rehabilitation strategies need to be ascertained. For knee OA management, these concerns must be addressed before this promising treatment can be widely implemented. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.