recall
int64 0
1
| article_title
stringlengths 5
500
| topic
stringlengths 21
84
| abstract
stringlengths 2
65.8k
|
|---|---|---|---|
0 |
Complex Primary Total Knee Arthroplasty: Long-Term Outcomes
|
PJI DX Updated Search
|
BACKGROUND: Total knee arthroplasty in patients with severe preoperative deformity, ligamentous instability, and/or marked bone loss occasionally requires a varus and valgus constrained or rotating-hinge design prosthesis. The purpose of this study was to compare patient populations that underwent primary total knee arthroplasty with constrained or unconstrained total knee arthroplasty implants to determine patient demographic characteristics, long-term survival, and reasons for reoperation and revision for each group. METHODS: We identified 28,667 primary total knee arthroplasties performed from 1979 to 2013 at our institution. A total of 427 knees had a varus and valgus constrained design and 246 knees underwent rotating-hinge total knee arthroplasties. Patient demographic information and preoperative diagnoses were analyzed by implant type. A multivariate analysis was performed to account for age, sex, and body mass index (BMI). Kaplan-Meier survival rates for each complication leading to reoperation or component revision were determined at 10 and 20 years. Adjusted hazard ratios were determined for the most common causes for reoperation and revision compared with a routine total knee arthroplasty control group. RESULTS: Patient demographic characteristics were significantly different (p < 0.05) between all groups for age, sex, and BMI. The varus and valgus constrained and rotating-hinge groups had decreased survival free of all-cause reoperation at 10 and 20 years compared with the unconstrained total knee arthroplasty group, with a hazard ratio of 1.74 (95% confidence interval [95% CI], 1.36 to 2.23) for the valgus and varus constrained group and 2.07 (95% CI, 1.58 to 2.70) for the rotating-hinge group. The adjusted hazard ratio for all-cause revision was significantly higher for the varus and valgus constrained group at 1.65 (p = 0.007) but not for the rotating-hinge group at 1.48 (p = 0.054) compared with the unconstrained total knee arthroplasty group. Wear and osteolysis, infection, and fracture were the most common reasons for component revision in both groups. CONCLUSIONS: We found increased reoperation and revision rates associated with the use of constrained implants at the time of index total knee arthroplasty. The rate of component revision for any reason at 10 years was >2 times higher in the constrained total knee arthroplasty groups compared with the unconstrained total knee arthroplasty group. At 20 years postoperatively, the component revision rate was >3 times higher. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence
|
0 |
Norepinephrine turnover in brown and white adipose tissue after partial lipectomy
|
Panniculectomy & Abdominoplasty CPG
|
Total body fat is restored after the surgical removal (i.e., partial lipectomy) of white adipose tissue (WAT), and this is accomplished via increases in the mass of nonexcised WAT pads. The underlying mechanism for this apparent regulation of total body fat is unknown. One possibility is via the sympathetic nervous system (SNS) innervation of WAT and brown adipose tissue (BAT) through the regulation of lipolysis and thermogenesis, respectively. Specifically, decreases in SNS activity might fuel lipectomy-induced body fat compensation through energy saved from decreased BAT thermogenesis and would promote lipid accretion through decreased WAT basal lipolysis. Therefore, we tested whether lipectomy triggered decreases in the SNS drive [as indicated by the norepinephrine turnover (NETO)] to nonexcised WAT or to BAT, at times before the lipectomy-induced fat pad mass compensation was complete. Siberian hamsters received either sham or bilateral epididymal WAT lipectomy, and NETO was measured in the remaining WAT and interscapular BAT (IBAT) before, and 3 and 6 weeks after surgery. Total dissected WAT, and inguinal and retroperitoneal WAT masses were significantly increased following lipectomy, whereas dorsal subcutaneous WAT and IBAT masses, as well as food intake, were unchanged. The only significant change in NETO was a marked decrease (approximately 90%) in IBAT NETO at Week 3 postlipectomy compared with the sham-lipectomized controls. These findings suggest that the lipid accretion of nonexcised WAT pads triggered by lipectomy may be partially fueled by decreased BAT thermogenesis, inasmuch as decreased IBAT NETO reflects decreased BAT heat production.
|
0 |
Camalexin-induced apoptosis in prostate cancer cells involves alterations of expression and activity of lysosomal protease cathepsin D
|
MSTS 2018 - Femur Mets and MM
|
Camalexin, the phytoalexin produced in the model plant Arabidopsis thaliana, possesses antiproliferative and cancer chemopreventive effects. We have demonstrated that the cytostatic/cytotoxic effects of camalexin on several prostate cancer (PCa) cells are due to oxidative stress. Lysosomes are vulnerable organelles to Reactive Oxygen Species (ROS)-induced injuries, with the potential to initiate and or facilitate apoptosis subsequent to release of proteases such as cathepsin D (CD) into the cytosol. We therefore hypothesized that camalexin reduces cell viability in PCa cells via alterations in expression and activity of CD. Cell viability was evaluated by MTS cell proliferation assay in LNCaP and ARCaP Epithelial (E) cells, and their respective aggressive sublines C4-2 and ARCaP Mesenchymal (M) cells, whereby the more aggressive PCa cells (C4-2 and ARCaPM) displayed greater sensitivity to camalexin treatments than the lesser aggressive cells (LNCaP and ARCaPE). Immunocytochemical analysis revealed CD relocalization from the lysosome to the cytosol subsequent to camalexin treatments, which was associated with increased protein expression of mature CD; p53, a transcriptional activator of CD; BAX, a downstream effector of CD, and cleaved PARP, a hallmark for apoptosis. Therefore, camalexin reduces cell viability via CD and may present as a novel therapeutic agent for treatment of metastatic prostate cancer cells.
|
0 |
Treatment of extended osteochondral lesions of the talus with a free vascularised bone graft from the medial condyle of the femur
|
Glenohumeral Joint OA
|
Large osteochondral lesions (OCLs) of the shoulder of the talus cannot always be treated by traditional osteochondral autograft techniques because of their size, articular geometry and loss of an articular buttress. We hypothesised that they could be treated by transplantation of a vascularised corticoperiosteal graft from the ipsilateral medial femoral condyle. Between 2004 and 2011, we carried out a prospective study of a consecutive series of 14 patients (five women, nine men; mean age 34.8 years, 20 to 54) who were treated for an OCL with a vascularised bone graft. Clinical outcome was assessed using a visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Radiological follow-up used plain radiographs and CT scans to assess graft incorporation and joint deterioration. At a mean follow-up of 4.1 years (2 to 7), the mean VAS for pain had decreased from 5.8 (5 to 8) to 1.8 (0 to 4) (p = 0.001) and the mean AOFAS hindfoot score had increased from 65 (41 to 70) to 81 (54 to 92) (p = 0.003). Radiologically, the talar contour had been successfully reconstructed with stable incorporation of the vascularised corticoperiosteal graft in all patients. Joint degeneration was only seen in one ankle. Treatment of a large OCL of the shoulder of the talus with a vascularised corticoperiosteal graft taken from the medial condyle of the femur was found to be a safe, reliable method of restoring the contour of the talus in the early to mid-term.
|
0 |
Induction of epithelial to mesenchymal transition in PMC42-LA human breast carcinoma cells by carcinoma-associated fibroblast secreted factors
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: Breast carcinoma is accompanied by changes in the acellular and cellular components of the microenvironment, the latter typified by a switch from fibroblasts to myofibroblasts.
METHODS: We utilised conditioned media cultures, Western blot analysis and immunocytochemistry to investigate the differential effects of normal mammary fibroblasts (NMFs) and mammary cancer-associated fibroblasts (CAFs) on the phenotype and behaviour of PMC42-LA breast cancer cells. NMFs were obtained from a mammary gland at reduction mammoplasty, and CAFs from a mammary carcinoma after resection.
RESULTS: We found greater expression of myofibroblastic markers in CAFs than in NMFs. Medium from both CAFs and NMFs induced novel expression of alpha-smooth muscle actin and cytokeratin-14 in PMC42-LA organoids. However, although conditioned media from NMFs resulted in distribution of vimentin-positive cells to the periphery of PMC42-LA organoids, this was not seen with CAF-conditioned medium. Upregulation of vimentin was accompanied by a mis-localization of E-cadherin, suggesting a loss of adhesive function. This was confirmed by visualizing the change in active beta-catenin, localized to the cell junctions in control cells/cells in NMF-conditioned medium, to inactive beta-catenin, localized to nuclei and cytoplasm in cells in CAF-conditioned medium.
CONCLUSION: We found no significant difference between the influences of NMFs and CAFs on PMC42-LA cell proliferation, viability, or apoptosis; significantly, we demonstrated a role for CAFs, but not for NMFs, in increasing the migratory ability of PMC42-LA cells. By concentrating NMF-conditioned media, we demonstrated the presence of factor(s) that induce epithelial-mesenchymal transition in NMF-conditioned media that are present at higher levels in CAF-conditioned media. Our in vitro results are consistent with observations in vivo showing that alterations in stroma influence the phenotype and behaviour of surrounding cells and provide evidence for a role for CAFs in stimulating cancer progression via an epithelial-mesenchymal transition. These findings have implications for our understanding of the roles of signalling between epithelial and stromal cells in the development and progression of mammary carcinoma.
|
0 |
Standard Anatomical and Visual Space for the Mouse Retina: Computational Reconstruction and Transformation of Flattened Retinae with the Retistruct Package
|
Upper Eyelid and Brow Surgery
|
The concept of topographic mapping is central to the understanding of the visual system at many levels, from the developmental to the computational. It is important to be able to relate different coordinate systems, e.g. maps of the visual field and maps of the retina. Retinal maps are frequently based on flat-mount preparations. These use dissection and relaxing cuts to render the quasi-spherical retina into a 2D preparation. The variable nature of relaxing cuts and associated tears limits quantitative cross-animal comparisons. We present an algorithm, "Retistruct," that reconstructs retinal flat-mounts by mapping them into a standard, spherical retinal space. This is achieved by: stitching the marked-up cuts of the flat-mount outline; dividing the stitched outline into a mesh whose vertices then are mapped onto a curtailed sphere; and finally moving the vertices so as to minimise a physically-inspired deformation energy function. Our validation studies indicate that the algorithm can estimate the position of a point on the intact adult retina to within 8° of arc (3.6% of nasotemporal axis). The coordinates in reconstructed retinae can be transformed to visuotopic coordinates. Retistruct is used to investigate the organisation of the adult mouse visual system. We orient the retina relative to the nictitating membrane and compare this to eye muscle insertions. To align the retinotopic and visuotopic coordinate systems in the mouse, we utilised the geometry of binocular vision. In standard retinal space, the composite decussation line for the uncrossed retinal projection is located 64° away from the retinal pole. Projecting anatomically defined uncrossed retinal projections into visual space gives binocular congruence if the optical axis of the mouse eye is oriented at 64° azimuth and 22° elevation, in concordance with previous results. Moreover, using these coordinates, the dorsoventral boundary for S-opsin expressing cones closely matches the horizontal meridian. © 2013 Sterratt et al.
|
0 |
Use magnetic resonance imaging to assess articular cartilage
|
PJI DX Updated Search
|
Magnetic resonance imaging (MRI) enables a noninvasive, three-dimensional assessment of the entire joint, simultaneously allowing the direct visualization of articular cartilage. Thus, MRI has become the imaging modality of choice in both clinical and research settings of musculoskeletal diseases, particular for osteoarthritis (OA). Although radiography, the current gold standard for the assessment of OA, has had recent significant technical advances, radiographic methods have significant limitations when used to measure disease progression. MRI allows accurate and reliable assessment of articular cartilage which is sensitive to change, providing the opportunity to better examine and understand preclinical and very subtle early abnormalities in articular cartilage, prior to the onset of radiographic disease. MRI enables quantitative (cartilage volume and thickness) and semiquantitative assessment of articular cartilage morphology, and quantitative assessment of cartilage matrix composition. Cartilage volume and defects have demonstrated adequate validity, accuracy, reliability and sensitivity to change. They are correlated to radiographic changes and clinical outcomes such as pain and joint replacement. Measures of cartilage matrix composition show promise as they seem to relate to cartilage morphology and symptoms. MRI-derived cartilage measurements provide a useful tool for exploring the effect of modifiable factors on articular cartilage prior to clinical disease and identifying the potential preventive strategies. MRI represents a useful approach to monitoring the natural history of OA and evaluating the effect of therapeutic agents. MRI assessment of articular cartilage has tremendous potential for large-scale epidemiological studies of OA progression, and for clinical trials of treatment response to disease-modifying OA drugs
|
1 |
Factors affecting long-term results after arthroscopic partial meniscectomy
|
Anterior Cruciate Ligament Injuries CPG
|
The purpose of this study was to determine functional and radiographic changes on long-term followup of knees with isolated meniscal tears. Sixty-seven patients were evaluated retrospectively with an average of 12.2 years' followup using the scale of Tapper and Hoover. The criteria for the radiographic results were the Fairbank's changes as the standard comparing the preoperative and the postoperative conditions of the affected knee with the contralateral knee. Seventy-nine percent of the patients had a satisfactory outcome in terms of function. The amount of meniscus removed and the Outerbridge classification of the articular cartilage at the time of the meniscectomy were determining factors for long-term functional results. Osteoarthritic deterioration was seen in 48% of patients after the surgery, but radiographic deterioration after arthroscopic partial meniscectomy was mild on long-term followup. Medial meniscectomy and the amount of meniscus removed were risk factors for postoperative radiographic change. Age, gender, and the degree of cartilage degeneration at the time of operation, in contrast, showed no significant association. Arthroscopic partial meniscectomy for isolated meniscal injury yields favorable functional results but leads to significantly increased osteoarthritic change in the long-term
|
0 |
A randomized, controlled, prospective study evaluating the effect of patellar eversion on functional outcomes in primary total knee arthroplasty
|
PJI DX Updated Search
|
Background: Patellar mobilization technique during total knee arthroplasty has been debated, with some suggesting that lateral retraction, rather than eversion, of the patella may be beneficial. We hypothesized that patients with knees surgically exposed using patellar lateral retraction would have comparable outcomes with patients with knees surgically exposed using patellar eversion. Methods: After an a priori power analysis, 120 patients with degenerative arthrosis were prospectively enrolled and were randomized to one of two patellar exposure techniques during the primary total knee arthroplasty: lateral retraction or eversion. The primary outcome measure was one-year, dynamometer-measured quadriceps strength. The secondary outcome measures evaluated during hospital stay included the ability to straight-leg raise, visual analog scale in pain, walking distance, and length of stay. The secondary outcome measures that were evaluated preoperatively and through a one-year follow-up included the Short Form-36 Physical Component Summary and Mental Component Summary scores, range of motion, quadriceps strength, and radiographic rate of patella baja and tilt. Results: A mixed-model analysis of variance showed no significant differences between the two groups in the one-year outcome measures. At one year postoperatively, quadriceps strength was not different between groups (p = 0.77), and the range of motion significantly improved (p < 0.01) from preoperative values by a mean value (and standard deviation) of 6ð ñ 17ð, with no significant difference (p = 0.60) between groups. The Short Form-36 Physical Component Summary score and Mental Component Summary score significantly improved (p < 0.01) for both study groups from preoperatively to one year postoperatively with no significantly different effects between groups (time x group, p = 0.85 for the Physical Component Summary score and p = 0.71 for the Mental Component Summary score), and the scores were not different at one year after surgery. There were no significant differences between groups in the change in frequency of the radiographic patella baja (p = 0.99) or the radiographic patellar tilt (p = 0.77) from before surgery to one year after surgery. Conclusions: Lateral retraction of the patella did not lead to superior postoperative results compared with eversion of the patella during total knee arthroplasty as evaluated using our primary outcome measure of one-year, dynamometer measured quadriceps strength or our secondary outcome measures. Level of-Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright é 2014 by The Journal of Bone and Joint Surgery, Incorporated
|
0 |
Risk factors of recurrent hamstring injuries: a systematic review
|
DoD PRF (Psychosocial RF)
|
Although recurrent hamstring injury is a frequent problem with a significant impact on athletes, data on factors determining the risk for a recurrent hamstring injury are scarce. To systematically review the literature and provide an overview of risk factors for re-injury of acute hamstring muscle injuries. Prospective studies on risk factors for re-injury following acute hamstring injuries were systematically reviewed. Medical databases and reference lists of the included articles were searched. Two reviewers independently selected potential studies and assessed methodological quality; one reviewer extracted the data. A best-evidence synthesis of all studied risk factors was performed. Of the 131 articles identified, five prospective follow-up studies fulfilled our inclusion criteria. These studies reported a recurrence incidence of 13.9-63.3% in the same playing season up to 2 years after initial injury. Limited evidence for three risk factors and one protective factor for recurrent hamstring injury was found; patients with a recurrent hamstring injury had an initial injury with a larger volume size as measured on MRI (47.03 vs 12.42 cm(3)), more often had a Grade 1 initial trauma (Grade 0: 0-30.4%; Grade 1: 60.9-100%; Grade 2: 8.7%) and more often had a previous ipsilateral anterior cruciate ligament (ACL) reconstruction (66.6% vs 17.1%) independent of graft selection. Athletes in a rehabilitation programme with agility/stabilisation exercises rather than strength/stretching exercises had a lower risk for re-injury (7.7% vs 70%). No significant relationship with re-injury was found for 11 related determinants. There was conflicting evidence that a larger cross-sectional area is a risk factor for recurrent hamstring injury. There is limited evidence that athletes with a larger volume size of initial trauma, a Grade 1 hamstring injury and a previous ipsilateral ACL reconstruction are at increased risk for recurrent hamstring injury. Athletes seem to be at lower risk for re-injury when following agility/stabilisation exercises.
|
1 |
Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review
|
AMP (Acute Meniscal Pathology)
|
PURPOSE: Magnetic resonance imaging (MRI) is of great aid in the diagnosis of knee lesions. Most diagnostic studies comparing MRI and arthroscopy have shown good diagnostic performance in detecting lesions of the menisci and cruciate ligaments. Nevertheless, arthroscopy has remained the reference standard for the diagnosis of internal derangements of the knee, against which alternative diagnostic modalities should be compared.
METHODS: We took arthroscopy to be the 'gold standard', and we undertook a systematic review of MRI and arthroscopy in the diagnosis of internal derangements of the knee. We used Coleman scoring methodology to identify scientifically sound articles in a reproducible format.
RESULTS: MRI is highly accurate in diagnosing meniscal and anterior cruciate ligament (ACL) tears. It is the most appropriate screening tool before therapeutic arthroscopy. It is preferable to diagnostic arthroscopy in most patients because it avoids the surgical risks of arthroscopy. The results of MRI differ for medial and lateral meniscus and ACL, with only 85% accuracy.
CONCLUSIONS: Study design characteristics should also be taken into account whenever a study on MRI assessing its diagnostic performance is designed or reviewed. [References: 71]
|
0 |
Use of an Ultrasound-Based Navigation System for an Accurate Acetabular Positioning in Total Hip Arthroplasty. A Prospective, Randomized, Controlled Study
|
Management of Hip Fractures in the Elderly
|
The purpose of this study was to compare an ultrasound-based navigation system with an imageless navigation system with surface registration in the postoperative acetabular cup position. A prospective randomized controlled study of 2 groups of 40 patients each was performed. In the first group, cup positioning was assisted by an ultrasound-based navigation system, and in the second group, the cup was assisted by imageless navigation system with surface registration. There was significantly more outliers in the imageless navigation group. In addition, there was statistical significance in the anteversion angles and in the anteversion error between the imageless navigation and ultrasound-based navigation groups. Ultrasound-based navigation improves cup positioning in total hip arthroplasty better than an imageless navigation system by reducing the outliers, achieving a higher accuracy of anteversion. (copyright) 2012 Elsevier Inc
|
0 |
Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus
|
OAK 3 - Non-arthroplasty tx of OAK
|
Meniscectomy remains one of the most frequent orthopedic procedures, despite meniscal sparing having been advocated for several decades now. Incidence is excessive in the light of scientifically robust studies demonstrating the interest of meniscal repair or of nonoperative treatment for traumatic tear and of nonoperative treatment for degenerative meniscal lesions. It is high time that the paradigm shifted, in favor of meniscal preservation. In traumatic tear, and most particularly longitudinal vertical tear in vascularized zones, repair shows a high success rates in terms of recovery time, functional outcome and cartilage protection. Leaving the meniscus alone may be an option in asymptomatic lesions of the lateral meniscus during anterior cruciate ligament (ACL) reconstruction. Posterior ramp lesions (in associated ACL tear), traumatic root tears and radial lesions are also excellent indications for repair, although it has to be borne in mind that the natural history of these lesions is not completely understood and nonoperative treatment also may be considered. Degenerative meniscal lesions are frequently revealed by MRI in middle-aged or elderly subjects. They are closely related to tissue aging and thus probably to osteoarthritic processes. Meniscectomy was long considered the treatment of choice. All but 1 of the 8 recent randomized studies reported non-superiority of arthroscopy over nonoperative treatment, which should thus be the first-line choice, with arthroscopic meniscectomy reserved for cases of failure, or earlier in case of "considerable" mechanical symptoms. Horizontal cleavage in young athletes is a particular case, requiring meniscal repair, to avoid a meniscectomy, which would inevitably be extensive in a young active patient. More than ever, the take-home message is: save the meniscus!
|
0 |
Emerging anabolic treatments for osteoporosis
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Therapy for osteoporosis is principally centered on the use of agents that block bone resorption and supplementation with vitamin D and calcium. Although these drugs are effective in reducing the risk of subsequent fractures, and modestly increasing bone density, most patients being treated for osteoporosis still have low bone mass and a greater risk of fracture. Anabolic agents stimulates bone formation, strength, and mass. In addition, there is emerging evidence that anabolic agents can reduce subsequent fracture risk. The two most promising agents, parathyroid hormone (PTH) and GH/IGF-I, act to increase osteoblast medicated bone formation. A review of the potential usefulness of PTH and GH/IGF-I is presented
|
1 |
The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany--a demographic simulation model
|
HipFx Supplemental Cost Analysis
|
To predict the burden of incident osteoporosis attributable fractures (OAF) in Germany, an economic simulation model was built. The burden of OAF will sharply increase until 2050. Future demand for hospital and long-term care can be expected to substantially rise and should be considered in future healthcare planning. INTRODUCTION: The aim of this study was to develop an innovative simulation model to predict the burden of incident OAF occurring in the German population, aged >50, in the time period of 2010 to 2050. METHODS: A Markov state transition model based on five fracture states was developed to estimate costs and loss of quality adjusted life years (QALYs). Demographic change was modelled using individual generation life tables. Direct (inpatient, outpatient, long-term care) and indirect fracture costs attributable to osteoporosis were estimated by comparing Markov cohorts with and without osteoporosis. RESULTS: The number of OAF will rise from 115,248 in 2010 to 273,794 in 2050, cumulating to approximately 8.1 million fractures (78 % women, 22 % men) during the period between 2010 and 2050. Total undiscounted incident OAF costs will increase from around 1.0 billion Euros in 2010 to 6.1 billion Euros in 2050. Discounted (3 %) cumulated costs from 2010 to 2050 will amount to 88.5 billion Euros (168.5 undiscounted), with 76 % being direct and 24 % indirect costs. The discounted (undiscounted) cumulated loss of QALYs will amount to 2.5 (4.9) million. CONCLUSIONS: We found that incident OAF costs will sharply increase until the year 2050. As a consequence, a growing demand for long-term care as well as hospital care can be expected and should be considered in future healthcare planning. To support decision makers in managing the future burden of OAF, our model allows to economically evaluate population- and risk group-based interventions for fracture prevention in Germany
|
0 |
Shared decision making, preoperative expectations, and postoperative reality: differences in physician and patient predictions and ratings of knee surgery outcomes
|
AMP (Acute Meniscal Pathology)
|
PURPOSE: The present study was performed to determine the extent to which physicians and patients rate preoperative and postoperative knee pain and function differently, and to determine whether physicians or patients more accurately predict postoperative knee pain and function.
TYPE OF STUDY: Longitudinal, prospective study.
METHODS: Ninety-eight patients requiring either anterior cruciate ligament reconstruction surgery or meniscectomy and related surgery were interviewed 1 week before surgery, as well as 3 and 24 weeks postoperatively. Patients and their physicians completed ratings on knee pain and function at each time point. In addition, at their preoperative visit, patients and physicians completed ratings predicting their postoperative pain and functional status.
RESULTS: Physicians rated patients as having less pain and greater knee function preoperatively and at 24 weeks postoperatively. Patients had more significant differences between predicted and actual ratings.
CONCLUSIONS: Physicians tended to underestimate knee pain and overestimate knee function compared with patients. However, physicians better predicted postoperative knee pain and function ratings than did patients. These findings suggest that physician-patient discussions about preoperative expectations and postoperative reality might be an important part of clinical care.
LEVEL OF EVIDENCE: Level II, Prospective Longitudinal Study.
|
1 |
Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis : a systematic review
|
Non-Arthroplasty Treatment of Osteoarthritis of the Knee AUC
|
QUESTION: What are the effects of strength training alone, exercise therapy alone, and exercise with additional passive manual mobilisation on pain and function in people with knee osteoarthritis compared to control? What are the effects of these interventions relative to each other? DESIGN: A meta-analysis of randomised controlled trials. PARTICIPANTS: Adults with osteoarthritis of the knee. INTERVENTION TYPES: Strength training alone, exercise therapy alone (combination of strength training with active range of motion exercises and aerobic activity), or exercise with additional passive manual mobilisation, versus any non-exercise control. Comparisons between the three interventions were also sought. OUTCOME MEASURES: The primary outcome measures were pain and physical function. RESULTS: 12 trials compared one of the interventions against control. The effect size on pain was 0.38 (95% CI 0.23 to 0.54) for strength training, 0.34 (95% CI 0.19 to 0.49) for exercise, and 0.69 (95% CI 0.42 to 0.96) for exercise plus manual mobilisation. Each intervention also improved physical function significantly. No randomised comparisons of the three interventions were identified. However, meta-regression indicated that exercise plus manual mobilisations improved pain significantly more than exercise alone (p = 0.03). The remaining comparisons between the three interventions for pain and physical function were not significant. CONCLUSION: Exercise therapy plus manual mobilisation showed a moderate effect size on pain compared to the small effect sizes for strength training or exercise therapy alone. To achieve better pain relief in patients with knee osteoarthritis physiotherapists or manual therapists might consider adding manual mobilisation to optimise supervised active exercise programs
|
0 |
"Not always a straight path": patients' perspectives following anterior cruciate ligament rupture and reconstruction
|
DoD PRF (Psychosocial RF)
|
PURPOSE: To explore patients' perspectives following anterior cruciate ligament rupture and subsequent reconstructive surgery.
METHODS: A qualitative study design was employed, using validated questionnaires, interviews and general inductive methodology. Semi-structured interviews were conducted with five men and four women who had undergone an anterior cruciate ligament reconstruction in the past 6-36 months. Participants completed the Knee Osteoarthritis Outcome Score and the Tegner Activity Score. Descriptive statistics were used to analyze quantitative data. Interviews were recorded, transcribed and analyzed using the general inductive approach to develop key themes.
RESULTS: Participants had not returned to pre-injury knee-related activity levels (Tegner score: 7 pre-injury; 4 current). The theme of a disruptive "journey" emerged with two sub-themes of "loss of identity" and "life at the present," influenced positively and negatively by "support systems" and experience with the "care pathway." This unequivocally negative experience resulted in irrevocable changes to their lives, reflected by current lower knee-related quality of life.
CONCLUSIONS: Anterior cruciate ligament injury and rehabilitation thereof have a profound influence in the individual's identity. The results imply that a broader approach is needed within the rehabilitation process to address psychosocial factors, in addition to physical impairments and function. Implications for rehabilitation Anterior cruciate ligament rupture has a profound influence on patients' understanding of their individual identity. Support systems the patients have in place influence the patients' experience of the care pathway. Understanding psychosocial responses and implementing appropriate strategies and interventions for these may be critical for rehabilitation of these patients.
|
0 |
Opioid Prescribing Habits for Common Arthroscopic Procedures in Opioid Naïve Patients
|
AMP (Acute Meniscal Pathology)
|
Background: With the opioid epidemic and the increasing number of opioid-related deaths, there is growing awareness in the medical community regarding the dangers of opioid overprescription. As a result, there is a willingness among physicians to abandon old norms and adopt new data-driven prescribing practices. Purpose: To demonstrate patient-reported consumption data of opioid medications after anterior cruciate ligament (ACL) reconstructions (ACLRs), knee arthroscopies, and rotator cuff repairs to provide data-driven guidelines for prescribing opioids after these procedures. Study Design: Case series; Level of evidence, 4. Methods: Included in the study were 168 patients who underwent an ACLR, knee arthroscopy, or arthroscopic rotator cuff repair over a 17-month period. Patients were excluded if they had an opioid allergy, had preexisting opioid use, had an acute postoperative complication requiring further surgery, required hospitalization, exhibited drug-seeking behaviors, or were lost to follow-up. Medical records were reviewed to determine the number of opioid pills prescribed and the number of pills taken postoperatively. Prescribing was standardized in that 15 hydrocodone/acetaminophen pills (5/325 mg) were prescribed for all knee arthroscopy procedures and 40 hydrocodone/acetaminophen pills were prescribed for all ACL and rotator cuff procedures. The mean number of pills consumed and percentage of prescribed pills taken were analyzed in association with specific procedures and patient demographics. Results: Overall, the mean (±SD) reported opioid consumption overall was 13.5 ± 13.0 pills, with a utilization rate of 45.6% of the prescription. The mean reported opioid consumption for ACLRs, knee arthroscopies, and rotator cuff repairs was 19.1 ± 15.4, 7.2 ± 5.4, and 17.2 ± 14.3 pills, respectively (P <.001). This represented a utilization rate of 48%, 47%, and 41%, respectively. Conclusion: This study provides important information regarding opioid utilization after common arthroscopic procedures. For ACLRs, knee arthroscopies, and rotator cuff repairs, by respectively prescribing 20, 10, and 20 pills postoperatively, the amount of unused medications would decrease by 60%, 47%, and 64%, respectively. We recommend prescribing no more than 20, 10, and 20 hydrocodone/acetaminophen pills (5/325 mg) for ACLRs, knee arthroscopies, and arthroscopic rotator cuff repairs, respectively.
|
1 |
Incidence of complex regional pain syndrome type I after fractures of the distal radius
|
DoD PRF (Psychosocial RF)
|
Aim of this study was to analyse the incidence CRPS-I after a fracture of the distal radius and to analyse risk factors. Patients who visited the Emergency Unit of the University Hospital, with a fracture of distal radius were asked to participate. As risk factors for CRPS-I, number of repositions (with or without local anaesthesia), additional cast changes and pain during the cast period, were assessed. In a structured interview social life events (SLEs) and psychological and/or psychiatric history were assessed. The patients filled out the Symptom Checklist-90 (SCL-90). In total 88 patients participated in the study. One female (1%, 95% CI: 0.2 to 6%), age 69 years with the following characteristics developed CRPS-I: one set of local anaesthetics, one repositioning attempt, no additional cast changes, average pain scores, no life events and her total score on the SCL-90 of 117, was slightly above average. Based on the results of this study it is concluded that the incidence of CRPS-I may be low (1%, 95% CI: 0.2 to 6%) after fractures of the distal radius. Further the risk factors described in literature play a minor role in the development of CRPS-I. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
|
0 |
The effect of a stem on the tibial component of knee arthroplasty. A roentgen stereophotogrammetric study of uncemented tibial components in the Freeman-Samuelson knee arthroplasty
|
Surgical Management of Osteoarthritis of the Knee CPG
|
We studied the effect of a metal tray with an intramedullary stem on the micromotion of the tibial component in total knee arthroplasty. Of 32 uncemented Freeman-Samuelson knee arthroplasties performed in London and Gothenburg, nine had a metal backing and stem added to the tibial component. Micromotion of the tibial components, expressed as migration and inducible displacement, was analysed using roentgen stereophotogrammetric analysis up to two years follow-up. The addition of a metal back and a 110 mm stem to the standard polyethylene component significantly reduced both migration over two years and inducible displacement
|
0 |
Correlation between complication rate and tissue resection volume in inferior pedicle reduction mammaplasty: a retrospective study
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: The inferior pedicle technique is the most common breast reduction procedure performed in the United States today. Traditionally, it has been recommended that pedicle techniques not be used for large volume breast reduction (>1000 gm/breast), as the complication rate may be unacceptably high.
OBJECTIVE: We conducted a retrospective study to determine whether any correlation could be found between complication rate and tissue resection volume in breast reduction procedures when the inferior pedicle technique was used.
METHODS: One hundred twenty-two patients underwent inferior-pedicle reduction mammaplasty by a single surgeon between January 1998 and December 2001. Patients were divided into 2 groups according to the average quantity of tissue resection: 500- to 1000-gm breast reduction, and >1000-gm breast reduction. Complications were analyzed. Rates in each group were determined and assessed for statistical significance.
RESULTS: The average reduction was 673 gm/breast (range, 502-964 gm) in the small volume group (n = 73), and 1326 gm/breast (range, 1005-2175 gm) in the large-volume group (n = 49). Twenty-nine complications occurred. No patient experienced more than 1 complication. Eight different complications were identified. Hypertrophic scarring was most common, occurring in 11 patients. One major complication, an expanding hematoma, occurred. There were no cases of nipple-areolar complex or skin flap necrosis. The overall complication rate was 23.7%. There were 18 complications in the >1000-gm group (24.6%) and 11 complications in the <1000-gm group (22.4%). This difference was not statistically significant (P = .77).
CONCLUSIONS: The inferior pedicle technique can be safely used in reduction mammaplasty for resection volume exceeding 1000 gm/breast, without added complications.
|
0 |
Intermittent negative pressure wound therapy with instillation for the treatment of persistent periprosthetic hip infections: a report of two cases
|
PJI DX Updated Search
|
Intermittent negative pressure wound therapy with instillation (NPWTi) is starting to be used successfully to treat early periprosthetic infections of endoprostheses. However, few articles have reported the outcome of treatment with intermittent NPWTi for late persistent periprosthetic infections of the hip. In this study, we report two cases who underwent several rounds of radical wound debridement for the treatment of a late persistent periprosthetic infection of the hip. Intermittent NPWTi was used in both cases. Patients were treated successfully and there was no recurrence after 3 and 1 years of follow-up, respectively
|
1 |
Cosmesis with bilateral mammoreduction for conservative breast cancer treatment
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
Over 7 years, 57 women with breast cancer underwent lumpectomy and bilateral mammoreduction. Physical complaints about large or lax breast shape were the predominate rationale. Two patients were immediately lost to follow-up, 55 patients remained and were followed every 3 months for an average of 1.6 years. This is the largest series traceable by computer and literature search. Chart review and patient examination in this retrospective review were utilized as the basis for data within the article. Collated notes from patients'doctors were assessed, as well as documented patient responses to the procedure. Pictures without head/face for identifiers were taken of the patients. Chart data were collected by clinicians, but were reviewed blindly by a statistician. The overall control and cosmesis rates as well as alleviation of heavy breast problems were noted. Only 6% of women had fair to poor cosmetic results; the majority (82%) had excellent to good results. Women with very large breasts or markedly relaxed breast tissue of concern to the patients proved optimal candidates for lumpectomy of cancer and bilateral mammoreduction in the conservative treatment of these cancers. There was a significant reduction in the physical complaints of the patients as well. For women with very pendulous or extremely large breasts, lumpectomy and bilateral mammoreduction may prove to be the optimal course of action. © 2005 Blackwell Publishing, Inc.
|
0 |
Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets: A Placebo-controlled Single Practice Cohort Study
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: Capsular contracture is the most common complication following primary augmentation mammoplasty. It remains poorly understood but is attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The infectious theory of contracture has lead to the practice of irrigating implant pockets with a triple antibiotic solution. The purpose of this study was to determine if antibiotic irrigation reduced the incidence and severity of capsular contracture compared with saline irrigation.
METHODS: A cohort study enrolling all patients having undergone primary augmentation mammoplasty performed by surgeon A and surgeon B between 2011 and 2012 for all women satisfying inclusion and exclusion criteria was conducted. The only difference in surgical technique was the use of antibiotic irrigation by surgeon B. A chi-square test and analysis of variance with predetermined 95% confidence intervals were performed.
RESULTS: Fifty-five patients were operated on. Twenty-eight of surgeon A's patients were included, ranging in age from 22 to 50 with a mean follow-up time of 1.8 years. Twenty-seven of surgeon B's patients were included, ranging in age from 22 to 56 with a mean follow-up time of 1.6 years. Rate of capsular contracture was 3.6% (surgeon A) and 3.7% (surgeon B). Chi-square statistic was found to be 0.0014 (P = 0.97) and analysis of variance F value was 1 (P = 0.39).
CONCLUSIONS: Triple antibiotic breast irrigation is not associated with a significant reduction in the incidence or severity of capsular contracture compared with sterile saline when high-quality surgical technique is used.
|
0 |
Factors affecting the achievement of Japanese-style deep knee flexion after total knee arthroplasty using posterior-stabilized prosthesis with high-flex knee design
|
OAK 3 - Non-arthroplasty tx of OAK
|
Background: Achievement of very deep knee flexion after total knee arthroplasty (TKA) can play a critical role in the satisfaction of patients who demand a floor-sitting lifestyle and engage in high-flexion daily activities (e.g., seiza-sitting). Seiza-sitting is characterized by the knees flexed >145º and feet turned sole upwards underneath the buttocks with the tibia internally rotated. The present study investigated factors affecting the achievement of seiza-sitting after TKA using posterior-stabilized total knee prosthesis with high-flex knee design. Methods: Subjects comprised 32 patients who underwent TKA with high-flex knee prosthesis and achieved seiza-sitting (knee flexion >145º) postoperatively. Another 32 patients served as controls who were capable of knee flexion >145º preoperatively, but failed to achieve seiza-sitting postoperatively. Accuracy of femoral and tibial component positions was assessed in terms of deviation from the ideal position using a two-dimensional to three-dimensional matching technique. Accuracies of the component position, posterior condylar offset ratio and intraoperative gap length were compared between the two groups. Results: The proportion of patients with >3º internally rotated tibial component was significantly higher in patients who failed at seiza-sitting (41 %) than among patients who achieved it (13 %, p = 0.021). Comparison of intraoperative gap length between patient groups revealed that gap length at 135º flexion was significantly larger in patients who achieved seiza-sitting (4.2 ± 0.4 mm) than in patients who failed at it (2.7 ± 0.4 mm, p = 0.007). Conversely, no significant differences in gap inclination were seen between the groups. Conclusions: From the perspective of surgical factors, accurate implant positioning, particularly rotational alignment of the tibial component, and maintenance of a sufficient joint gap at 135º flexion appear to represent critical factors for achieving >145º of deep knee flexion after TKA.
|
0 |
A self-compensated spin-locking scheme for quantitative R1? dispersion MR imaging in ordered tissues
|
AMP (Acute Meniscal Pathology)
|
Purpose: To propose a self-compensated spin-locking (SL) method for quantitative R1? dispersion imaging in ordered tissues. Methods: Two pairs of antiphase rotary-echo SL pulses were proposed in a new scheme with each pairs sandwiching one refocusing RF pulse. This proposed SL method was evaluated by Bloch simulations and experimental studies relative to three prior schemes. Quantitative R1?R dispersion imaging studies with constant SL duration (TSL = 40 ms) were carried out on an agarose (1–4% w/v) phantom and one in vivo human knee at 3 T, using six SL RF strengths ranging from 50 to 1000 Hz. The performances of these SL schemes were characterized with an average coefficient of variation (CV) of the signal intensities in agarose gels and the sum of squared errors (SSE) for quantifying in vivo R1? dispersion of the femoral and tibial cartilage. Results: The simulations demonstrate that the proposed SL scheme was less prone to B0 and B1 field inhomogeneities. This theoretical prediction was supported by fewer image banding artifacts and less signal fluctuation signified by a reduced CV (%) on the phantom without R1? dispersion (i.e., 4.04 ± 1.36 vs. 18.87 ± 4.46 or 6.66 ± 2.92 or 5.71 ± 2.05 for others), and further by mostly decreased SSE (*10–3) for characterizing R1? dispersion of the femoral (i.e., 0.3 vs. 1.2 or 0.4 or 0.1) and tibial (i.e., 0.4 vs. 7.2 or 3.2 or 2.8) cartilage. Conclusion: The proposed SL scheme is less sensitive to B0 and B1 field artifacts for a wide range of SL RF strengths and thus more suitable for quantitative R1? dispersion imaging in ordered tissues.
|
0 |
The problem of post-traumatic varization of the distal end of the humerus remaining after the recovery of a supracondylar fracture
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
We aimed to determine whether the distal end of the humerus had the capacity of spontaneous realignment of the remaining deformity following an inadequate reposition of the supracondylar fracture. The results in 56 children with a supracondylar humerus fracture were analysed. In 45 patients (80%), manual repositioning was performed along with transcutaneous fixation, whereas in 11 patients (20%), only manual repositioning and immobilization in plaster cast was applied. Immobilization was removed and physical therapy was started in all patients on the 21st day following the intervention. Anteroposterior and left-lateral radiography was performed and Baumann's angle was determined. Follow-up radiograph of the elbow of the traumatized and healthy extremity was performed at an interval of 5-15 years (median 9.4). There was no statistically significant difference between the relationship of Baumann's angle of the injured arm measured on the 21st day after the reduction of fragments on the one hand and the carrying angle of the injured and healthy arm measured at the long-term follow-up on the other (t=0.48, P=0.63). Similarly, there was no statistically significant difference between the relationship of Baumann's angle of the injured arm measured at the long-term follow-up and the findings of the carrying angle of both the injured and the healthy arm obtained on the same examination (t=0.78, P=0.44). On the basis of our experience, we conclude that there is no biological capacity to rectify a possible remaining postreduction varus deformity by spontaneous remodelling
|
0 |
Comparison of a novel muscle training device with conventional rehabilitation training in motor dysfunction of lower limb patients: A pilot study
|
Hip Fx in the Elderly 2019
|
Background: Postoperative functional training for fracture or osteoarthritis is mainly focused on functional self-exercise, which aims to recover the function of the lower limbs. Purpose: To compare the function and life quality recovery in patients with fracture or arthritis treated with novel muscle training device (NMT) or conventional rehabilitation training (CRT) following surgery. Patients and Methods: A total of 32 fracture patients were randomly divided into the NMT or the CRT groups. The evaluation was performed on the first and 7th day after surgery. The outcome measurements included the incidence of foot drop, Deep Vein Thrombosis and pressure ulcers, Hospital for Special Surgery knee score (HSS scores), pain scores for the Visual Analogue Scale (Pain scores for VAS), Zung self-rating anxiety scale (SAS), Pittsburgh sleep quality index (PSQI) and the Barthel Index score. Results: The comparison of the change scores between the two groups indicated significant differences on day 7 following surgery in the Barthel Index score (P<0.01). The Pain scores for VAS between the two groups indicated a significant difference (P<0.05, U=20.0). The HSS scores between the two groups indicated a significant difference (P<0.05, U=19.0). The HSS scores exhibited a highly significant difference in the NMT group (P<0.01). The Mann– Whitney test was used to analyze the various components of the HSS scores. The comparison of the change scores on the function between the two groups indicated a significant difference (P<0.05). The Range of Motion difference between groups exhibited highly significant differences (P<0.01). Conclusion: The novel muscle training device positively influenced the decrease in pain score, which resulted in a range increase of knee joint movement and a significant overall improvement in motion.
|
0 |
Bone regeneration therapy of atraumatic necrosis of femoral head
|
BMAC (Bone Marrow Aspirate Concentrate)
|
Femoral head necrosis is a mobility disorder and till now no satisfactory solution has been reported. The principal contributing factor in the pathogenesis of the disease is insufficient blood supply to the femoral head resulting in necrosis of the femoral head. Various preventive measures required to treat femoral head necrosis include revascularization, adequate supply of osteogenic cells and establishing enough strength to avoid collapse. Among all, cell transplantation therapy is considered the most favourable treatment strategy for femoral head necrosis. However, the results merely depend on the etiology and the clinical stage of femoral head necrosis. Thus, it is better to make a treatment plan according to the epidemiology, disease status and stage. The main objective of this communication is to study the treatment of femoral head necrosis with cell replacement therapy and also its effects by focusing on the disease stages.
|
0 |
Pneumococcal meningitis and etanercept-chance or association?
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Rheumatoid arthritis is a severe deforming chronic disease which has major implications for mortality and quality of life. Agents with anti-tumour necrosis factor alpha (TNF(alpha)) activity are a new modality of therapy, which can significantly reduce the acute inflammation in this condition. However, TNF(alpha) is a cytokine involved in initiating the protective immune response; consequently, patients receiving this therapy are at increased risk of infection. Etanercept is a recombinant form of the p75 TNF receptor (TNF-RII) dimerised by fusion with a portion of the human IgG1 Fc tail with anti-TNF(alpha) activity. We report the first case of a patient with rheumatoid arthritis who developed pneumococcal meningitis whilst on etanercept, suggesting a possible association between etanercept and this severe life threatening infection. (copyright) 2004 The British Infection Society. Published by Elsevier Ltd. All rights reserved
|
0 |
Consensus document on controversial issues in the diagnosis and treatment of prosthetic joint infections
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
BACKGROUND: Joint replacement surgery has been on the increase in recent decades and prosthesis infection remains the most critical complication. Many aspects of the primary prevention and clinical management of such prosthesis infections still need to be clarified. CONTROVERSIAL ISSUES: The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group - a panel of multidisciplinary experts - was to define recommendations for the following controversial issues: (1) Is a conservative surgical approach for the management of prosthetic joint infections effective? (2) Is the one-stage or the two-stage revision for the management of prosthetic joint infections more effective? (3) What is the most effective treatment for the management of prosthetic joint infections due to methicillin-resistant staphylococci? Results are presented and discussed in detail. METHODS: A systematic literature search using the MEDLINE database for the period 1988 to 2008 of randomized controlled trials and/or non-randomized studies was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence and strength of recommendation was applied
|
0 |
Distal radius fracture malunion: Importance of managing injuries of the distal radio-ulnar joint
|
Distal Radius Fractures
|
BACKGROUND: Distal radius malunion is a major complication of distal radius fractures, reported in 0 to 33% of cases. Corrective osteotomy to restore normal anatomy usually provides improved function and significant pain relief. We report the outcomes in a case-series with special attention to the potential influence of the initial management.
MATERIAL AND METHODS: This single-centre retrospective study included 12 patients with a mean age of 35years (range, 14-60years) who were managed by different surgeons. There were 8 extra-articular fractures, including 3 with volar angulation, 2 anterior marginal fractures, and 2 intra-articular T-shaped fractures; the dominant side was involved in 7/12 patients. Initial fracture management was with an anterior plate in 2 patients, Kapandji intra-focal pinning in 5 patients, plate and pin fixation in 2 patients, and non-operative reduction in 3 patients. The malunion was anterior in 10 patients, including 2 with intra-articular malunion, and posterior in 2 patients. Corrective osteotomy of the radius was performed in all 12 patients between 2005 and 2012. In 11/12 patients, mean time from fracture to osteotomy was 168days (range, 45-180days). The defect was filled using an iliac bone graft in 7 patients and a bone substitute in 4 patients. No procedures on the distal radio-ulnar joint were performed.
RESULTS: All 12 patients were evaluated 24months after the corrective osteotomy. They showed gains in ranges not only of flexion/extension, but also of pronation/supination. All patients reported improved wrist function. The flexion/extension arc increased by 40degree (+21degree of flexion and +19degree of extension) and the pronation/supination arc by 46degree (+13degree of pronation and +15degree of supination). Mean visual analogue scale score for pain was 1.7 (range, 0-3). Complications recorded within 2years after corrective osteotomy were complex regional pain syndrome type I (n=1), radio-carpal osteoarthritis (n=3), and restricted supination due to incongruity of the distal radio-ulnar joint surfaces (n=3). This last abnormality should therefore receive careful attention during the management of distal radius malunion.
DISCUSSION: In our case-series study, 3 (25%) patients required revision surgery for persistent loss of supination. The main error in these patients was failure to perform a complementary procedure on the distal radio-ulnar joint despite postoperative joint incongruity. This finding and data from a literature review warrant a high level of awareness that distal radio-ulnar joint congruity governs the outcome of corrective osteotomy for distal radius malunion.
|
0 |
Resilience and quality of life: An investigation of Kumpferâ??s resilience model with persons with spinal cord injuries
|
DoD PRF (Psychosocial RF)
|
The construct of resilience is key to understanding adaptation to disability from a strengths-based perspective. The objective of this study was to examine the impact of factors identified in Kumpferâ??s resilience model on quality of life (QOL) outcomes for adults with spinal cord injury (SCI), specifically taking into account injury characteristics, self-efficacy, resiliency characteristics, and social support using hierarchical regression analysis. Participants included 255 adults with SCI. Findings revealed that the overall model accounted for 75% of the variance in QOL outcomes. In particular, coexisting pain, participation self-efficacy, core self-evaluation, resiliency characteristics, cognitive strength, general health, and social support independently contributed to the variance in QOL scores. Implications of these findings for developing theory-driven, strengths-based approaches for improving rehabilitation outcomes for individuals with SCI are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
|
0 |
The impact of glucocorticoid therapy on trabecular bone score in older women
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
Summary: We propose that trabecular bone score could be a useful tool for the study of glucocorticoid-associated bone effects. Trabecular bone score alone and lumbar spine bone mineral density (BMD) used in combination with trabecular bone score, but not lumbar spine BMD alone was able to discriminate between glucocorticoid-treated and glucocorticoid-naïve women. Introduction: Glucocorticoids result in rapid bone loss and an increase in fracture risk that cannot be fully explained by changes in BMD. Trabecular bone score (TBS) correlates with three-dimensional bone micro-architectural parameters and can be derived from grey-level variations within dual energy X-ray absorptiometry (DXA) scans. We propose that TBS could be a useful tool for the study of glucocorticoid-associated bone effects. Methods: We assessed the ability of lumbar spine BMD (LS-BMD), TBS, and LS-BMD with TBS (LS-BMD + TBS) to discriminate between healthy women and (i) glucocorticoid-treated women, and (ii) glucocorticoid-naïve women with recent fractures. Older women (n = 484, ages 55â??79 years) who had (i) taken prednisolone â?¥5 mg/day for >3 months (n = 64), (ii) sustained a recent fracture of the distal forearm (n = 46), proximal humerus (n = 37), vertebra (n = 30) or proximal femur (n = 28), or (iii) were healthy population-based women (n = 279) were recruited. LS-BMD was measured by DXA and TBS values were derived. Results: Compared to healthy, population-based women, women with recent fractures had lower LS-BMD (â??0.34 to â??1.38) and TBS (â??0.38 to â??1.04) Z-scores. Glucocorticoid-treated women had lower TBS Z-scores than glucocorticoid-naïve women (â??0.80 versus 0) but their LS-BMD Z-scores did not differ (â??0.13 versus 0). TBS alone (area under the receiver operating characteristic curve (AUC) = 0.721) and LS-BMD + TBS (AUC = 0.721), but not LS-BMD alone (AUC = 0.572) was able to discriminate between glucocorticoid-treated and glucocorticoid-naïve women. Conclusions: TBS provides additional information regarding glucocorticoid-associated alterations in bone quality. We conclude that TBS may be a useful tool for the further study of glucocorticoid-induced osteoporosis.
|
0 |
Risedronate Rapidly Reduces the Risk for Nonvertebral Fractures in Women with Postmenopausal Osteoporosis
|
Management of Hip Fractures in the Elderly
|
Prevention of nonvertebral fractures, which account for a substantial proportion of osteoporotic fractures, is an important goal of osteoporosis treatment. Risedronate, a pyridinyl bisphosphonate, significantly reduces clinical vertebral fracture incidence within 6 months. To determine the effect of risedronate on osteoporosis-related nonvertebral fractures, data from four large, randomized, double-blind, placebo-controlled, Phase III studies were pooled and analyzed. The population analyzed consisted of postmenopausal women, with and without vertebral fractures, who had low bone mineral density (lumbar spine T-score < -2.5). Patients received placebo (N = 608) or risedronate 5 mg daily (N = 564) for 1 to 3 years. At baseline, 58% had at least one prevalent vertebral fracture, and the mean lumbar spine T-score was -3.4. Among placebo-treated patients, the presence of prevalent vertebral fractures did not increase the risk of incident nonvertebral fractures overall, although fractures of the humerus and hip and pelvis were more common in patients who had prevalent vertebral fractures than in those who did not. Risedronate 5 mg significantly reduced the incidence of nonvertebral fractures within 6 months compared with control. After 1 year, non-vertebral fracture incidence was reduced by 74% compared with control (P = 0.001), and after 3 years, the incidence was reduced by 59% (P = 0.002). The results indicate that risedronate significantly reduces the incidence of osteoporosis-related nonvertebral fractures within 6 months
|
0 |
Antibiotic Spacer Arthroplasty for Revision MTP Arthrodesis: A Novel Means to Build the Implant: A Case Report
|
PJI DX Updated Search
|
Metatarsophalangeal (MTP) joint osteoarthritis (OA), also known as hallux rigidus (HR), is the most common degenerative arthropathy of the foot and is often the result of trauma. There are multiple methods of addressing the patient's pain and limited function. Arthrodesis is the gold standard to manage severe MTP arthritis with a highly significant union rate. With various techniques of arthrodesis available, ranging from cannulated screw fixation, Kirschner wires, as well as plate and screw fixation, the orthopedic surgeon has multiple modalities to address this ailment; however, when these fail due to infection, the armament is limited. Through the idea of articulating antibiotic spacers in other regions of the body such as the knee and hip, we present a novel technique to the creation of an antibiotic spacer in the setting of a failed infected MTP arthrodesis
|
1 |
Early complications after high tibial osteotomy: a comparison of two techniques
|
Non-Arthroplasty Treatment of Osteoarthritis of the Knee AUC
|
This prospective cohort study compared opening wedge high tibial osteotomy with use of the Puddu plate and the Vitoss synthetic cancellous bone versus closing wedge high tibial osteotomy with use of the AO/ASIF L-plate, focusing on complications (nonunions, infections, loss of correction, reoperations) and patient satisfaction (visual linear analog scale). During a 10-month period, we performed high tibial osteotomy for 40 patients experiencing medial knee osteoarthritis and a varus deformity. The average follow-up was 11 months. The complication rate in patients treated with the opening wedge technique was significantly higher regarding tibial nonunion, loss of correction, and material failure. Patients in the closing wedge group were more satisfied with the postoperative result. This study found that the Puddu plate, despite 6 weeks of non-weight bearing facilitating the osseous consolidation with Vitoss cement, was not able to maintain the correction during the time required for bone healing
|
0 |
Preoperative chlorhexidine preparation and the incidence of surgical site infections after hip arthroplasty
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
The purpose of this study was to evaluate effectiveness of an advance, at-home chlorhexidine-impregnated skin preparation cloth in decreasing the incidence of deep periprosthetic hip arthroplasty infections. Arthroplasty surgeons at the senior author's institution provided their patients with chlorhexidine-impregnated single-use cloths for use at home the night before and the morning of surgery. Between January 2007 and December 2009, the compliance of this practice, as well as the incidence of periprosthetic infections, was monitored for all patients who underwent hip arthroplasty. Of the 1134 patients who underwent hip arthroplasty, 157 patients completely complied with the preoperative chlorhexidine preparation protocol. There were 14 infections in the group that was not compliant (1.6% infection rate), and there were no infections in the compliant patient population. Based on the results of this study, at-home preoperative patient skin preparation appears to be a simple and cost-effective method to reduce periprosthetic hip infection rates
|
0 |
Outcome of Islanded Gastrocnemius Musculocutaneous Flap in Orthopaedic Practice
|
DoD SSI (Surgical Site Infections)
|
<b>Introduction:</b> Large wounds in the leg require combination of local flaps or free flap for wound coverage. Gastrocnemius musculocutaneous flap (GMCF) allows a large wound to be covered by a single local flap. However, the conventional GMCF is often associated with donor site morbidity where the exposed soleus raphe causes poor uptake of the skin graft. Islanding the skin on the muscles allows the donor site to be closed primarily, thus avoiding the donor site morbidity. <b>Materials and Methods:</b> Medical records of twelve patients who underwent islanded GMCF surgery from 2004 till 2018 were reviewed retrospectively.
|
0 |
Biomechanical Response to Osteoarthritis Pain Treatment May Impair Long-Term Efficacy
|
OAK 3 - Non-arthroplasty tx of OAK
|
Pain has an important physiologic role and acts with or stimulates motor system adaptations to protect tissue from threats of damage. Although clinically beneficial, removing the protective pain response may have negative consequence in osteoarthritis, a mechanically mediated disease. We hypothesize motor system adaptations to joint pain and its treatment may impact osteoarthritis progression, thereby limiting efficacy of pain therapies.
|
0 |
Local Treatment with Adjuvant Therapy for Central Atypical Cartilaginous Tumors in the Long Bones: Analysis of Outcome and Complications in One Hundred and Eight Patients with a Minimum Follow-up of Two Years
|
MSTS 2022 - Metastatic Disease of the Humerus
|
BACKGROUND: A central atypical cartilaginous tumor (ACT)--formerly known as chondrosarcoma grade 1 (CS1)--is a tumor of intermediate-type malignancy, often treated with surgery. The extent of surgery remains controversial, as some advocate resection and others favor local treatment by curettage. Because of the low prevalence of ACT/CS1, the available data are limited and generally not uniform. The purpose of this study was to present the outcome for a large cohort of patients with ACT/CS1 in the long bones who were treated with curettage and adjuvant phenolization and followed for a minimum of two years according to national guidelines.
METHODS: A retrospective study was designed to analyze data from 108 patients treated for central ACT/CS1 in the long bones between 2006 and 2012. All patients were treated with curettage and adjuvant phenolization, and defects were filled with polymethylmethacrylate, bone graft, or bone substitutes. The primary end point was local recurrence or residual tumor. Secondary end points included the type and rate of complications and reoperations.
RESULTS: All patients were free from local recurrence at a mean follow-up of 48.7 months (range, 24.3 to 97.5 months). Residual tumor was suspected in five patients, leading to a 95.4% disease-free survival rate. A fracture occurred in eleven patients (10.2%). Other complications were osseous penetration during the surgery (two patients), wound infection (one patient), arthrofibrosis (one patient), and skin necrosis (one patient). Tumor volume was related neither to the risk of fracture nor to the occurrence of residual tumor.
CONCLUSIONS: In our experience, curettage of ACT/CS1 in the long bones with adjuvant phenolization is safe, even with large tumors of up to 100 cm(3). Most worrisome is the risk of fracture, which occurred in 10.2% of our patients. Considering the relatively mild behavior of ACT/CS1, less aggressive treatment, by observation or by minimally invasive surgery, could be the next step that should be evaluated prospectively.
|
0 |
Generating hypotheses about care needs of high utilizers: lessons from patient interviews
|
DoD PRF (Psychosocial RF)
|
Informed by a largely secondary and quantitative literature, efforts to improve care and outcomes for complex patients with high levels of emergency and hospital-based health care utilization have offered mixed results. This qualitative study identifies psychosocial factors and life experiences described by these patients that may be important to their care needs. Semi-structured interviews were conducted with 19 patients of the Camden Coalition of Healthcare Providers' Care Management Team. Investigators coded transcripts using a priori and inductively-derived codes, then identified 3 key themes: (1) Early-life instability and traumas, including parental loss, unstable or violent relationships, and transiency, informed many participants' health and health care experiences; (2) Many "high utilizers" described a history of difficult interactions with health care providers during adulthood; (3) Over half of the participants described the importance to their well-being of positive and "caring" relationships with primary health care providers and the outreach team. Additionally, the transient and vulnerable nature of this complex population posed challenges to follow-up, both for research and care delivery. These themes illuminate potentially important hypotheses to be explored in more generalizable samples using robust and longitudinal methods. Future work should explore the prevalence and impact of adverse childhood experiences among "high utilizers," and the different types of relationships they have with providers. Investigators should test new modes of care delivery that attend to patients' trauma histories. This qualitative study was well suited to provide insight into the life stories of these complex, vulnerable patients, informing research questions for further investigation.
|
1 |
Hip muscle strength and protection against structural worsening and poor function and disability outcomes in knee osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
Objective: Examine associations of hip abductor strength with (1) cartilage damage worsening in the tibiofemoral and patellofemoral compartments 2 years later, and (2) poor function and disability outcomes 5 years later. Methods: Participants had knee osteoarthritis (K/L â?¥ 2) in at least one knee. Hip abductor strength was measured using Biodex Dynamometry. Participants underwent 3.0T MRI of both knees at baseline and 2 years later. Baseline-to-2-year cartilage damage progression, defined as any worsening of WORMS cartilage damage score, was assessed at each tibiofemoral and patellofemoral surface. LLFDI (Late-Life Function and Disability Instrument) and Chair-Stand-Rate were recorded at baseline and 5-year follow-up; outcomes analyzed using quintiles. Poor outcomes were defined as remaining in the same low-function quintiles or being in a worse quintile at 5-year follow-up. We analyzed associations of baseline hip abductor strength with cartilage damage worsening and function and disability outcomes using multivariable log-binomial models. Results: 275 knees from 164 persons [age = 63.7 (SD = 9.8) years, 79.3% women] comprised the structural outcome sample, and 187 persons [age = 64.2 (9.7), 78.6% women] the function and disability outcomes sample. Greater baseline hip abductor strength was associated with reduced risks of baseline-to-2-year medial patellofemoral and lateral tibiofemoral cartilage damage worsening [adjusted relative risks (RRs) range: 0.80â??0.83) and with reduced risks of baseline-to-5-year poor outcomes for Chair-Stand-Rate and LLFDI Basic Lower-Extremity Function and Disability Limitation (adjusted RRs range: 0.91â??0.94). Conclusion: Findings support a beneficial role of hip abductor strength for disease modification and for function and disability outcomes, and as a potential therapeutic target in managing knee osteoarthritis.
|
0 |
Trochanteric bone grafts in foot and ankle surgery
|
Management of Hip Fractures in the Elderly
|
Eighty-five patients who underwent trochanteric bone graft harvest in association with foot and ankle surgery were studied retrospectively by patient questionnaire. The average follow-up was 49 months (range, 14-101 months). Ninety-five percent of the patients expressed satisfaction with the procedure, in that they would choose to accept the trochanteric bone graft again if required to make the choice. However, 31% of the patients acknowledged some degree of hip discomfort and 4% reported some daily pain. Nineteen of 85 patients (22%) were treated for trochanteric pain. Most patients responded to strengthening/stretching and heat/ice. Four patients (5%) had failed or delayed union of the arthrodesis in which trochanteric bone graft was utilized. The greater trochanter may be considered as an alternative for major bone graft when the iliac bone is not available and when weightbearing is restricted for at least 6 weeks after surgery. As with the use of iliac bone graft, patients should be alerted to the possibility of postoperative discomfort. Surgical details should be followed to minimize the risk of peritrochanteric fracture
|
0 |
Hope versus hype: what can additive manufacturing realistically offer trauma and orthopedic surgery?
|
PJI DX Updated Search
|
Additive manufacturing (AM) is a broad term encompassing 3D printing and several other varieties of material processing, which involve computer-directed layer-by-layer synthesis of materials. As the popularity of AM increases, so to do expectations of the medical therapies this process may offer. Clinical requirements and limitations of current treatment strategies in bone grafting, spinal arthrodesis, osteochondral injury and treatment of periprosthetic joint infection are discussed. The various approaches to AM are described, and the current state of clinical translation of AM across these orthopedic clinical scenarios is assessed. Finally, we attempt to distinguish between what AM may offer orthopedic surgery from the hype of what has been promised by AM
|
0 |
The functional outcome of lower-extremity fractures with vascular injury
|
DoD SSI (Surgical Site Infections)
|
Salvage of lower-extremity Gustilo type IIIC fractures is difficult, time-consuming for the patients and physicians, and not universally successful because of poor functional outcomes. Even if successful with limb salvage, the functional result may be unsatisfactory because of mutilating injuries to muscle and nerve, bone loss, and the presence of chronic infection. From July 1991 until July 1994, revascularizations of open IIIC fractures were attempted for wounds with Mangled Extremity Severity Score (MESS) < or = 10. The functional results were evaluated at 2 years after injury. Thirty-six lower-extremity revascularizations were performed on 34 patients, including 1 patient with bilateral distal tibial IIIC fractures and a child with IIIC femoral fracture accompanied by ipsilateral distal tibial amputation. Excluded were patients with below-ankle IIIC fractures as well as patients who underwent immediate amputation at admission. After the revascularization, seven patients with IIIC fractures (7 of 36, 19.4%) underwent secondary amputation within 1 week. At the 2-year follow-up, the overall secondary amputation rate was 25% (9 of 36) and the salvage rate was 75% (27 of 36). Those were no deaths. Of the 29 salvaged limbs among these 27 patients, 23 limbs (23 of 29, 79.3%) required secondary coverage procedures that included 12 free flap transfers (12 of 29, 41.4%). Every patient needed subsequent reconstructive surgery to achieve an acceptable functional result. In this series, MESS was able to predict the secondary amputation rate and the functional result. Sixteen of the 17 limb-salvaged patients with MESS < or = 7 were able to achieve minimal functional requirements, whereas 3 of the 10 patients with MESS = 8 to 10 failed to achieve minimal functional requirements at the 2-year follow-up. Using statistical analysis, we found that the salvaged limbs with MESS < or = 9 exhibited a significant difference in achieving adequate function compared with limbs with MESS > 9. Using our protocol for treatment for IIIC fractures, the threshold for immediate amputation can be raised from MESS = 7 to MESS = 9. Our conclusions are (1) more severely injured limbs have poor functional results, (2) every patient needs subsequent reconstructive surgery, and (3) the MESS may be helpful in decision-making.
|
0 |
Mapping tibiofemoral gonarthrosis: an MRI analysis of non-traumatic knee cartilage defects
|
OAK 3 - Non-arthroplasty tx of OAK
|
OBJECTIVE: Arthroscopy is "the gold standard" for the diagnosis of knee cartilage lesions. However, it is invasive and expensive, and displays all the potential complications of an open surgical procedure. Ultra-high-field MRI now offers good opportunities for the indirect assessment of the integrity and structural changes of joint cartilage of the knee. The goal of the present study is to determine the site of early cartilaginous lesions in adults with non-traumatic knee pain.
METHODS: 3-T MRI examinations of 200 asymptomatic knees with standard and three-dimensional double-echo steady-state (3D-DESS) cartilage-specific sequences were prospectively studied for early degenerative lesions of the tibiofemoral joint. Lesions were classified and mapped using the modified Outerbridge and modified International Cartilage Repair Society classifications.
RESULTS: A total of 1437 lesions were detected: 56.1% grade I, 33.5% grade II, 7.2% grade III and 3.3% grade IV. Cartographically, grade I lesions were most common in the anteromedial tibial areas; grade II lesions in the anteromedial L5 femoral areas; and grade III in the centromedial M2 femoral areas.
CONCLUSION: 3-T MRI with standard and 3D-DESS cartilage-specific sequences demonstrated that areas predisposed to early osteoarthritis are the central, lateral and ventromedial tibial plateau, as well as the central and medial femoral condyle.
ADVANCES IN KNOWLEDGE: In contrast with previous studies reporting early cartilaginous lesions in the medial tibial compartment and/or in the medial femoral condyle, this study demonstrates that, regardless of grade, lesions preferentially occur at the L5 and M4 tibial and L5 and L2 femoral areas of the knee joint.
|
1 |
Pulseless arm in association with totally displaced supracondylar fracture
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
Seven children (3-10 years of age) were treated for a type III supracondylar fracture of the humerus. All fractures were reduced and pinned. Closed reduction was performed in four patients; three required open reduction. Before reduction six of the seven patients did not have a distal palpable pulse in the involved forearm. After reduction of the fractures all patients had a pulseless arm and a seemingly viable hand. Doppler pulses were absent or greatly diminished compared with the normal side in all involved extremities. Six patients underwent immediate antecubital fossa exploration of the brachial artery without arteriogram; one patient, referred to us from another facility, underwent angiography followed by immediate exploration. In three patients the brachial artery was directly damaged or transected and was repaired via saphenous vein graft, with reestablishment of distal pulses in each case. In the other four patients the brachial artery was kinked or entrapped at the fracture site, necessitating microdissection to mobilize the vessel and reestablish pulses in each case. At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. Immediate exploration of the antecubital fossa should be considered if an extremity remains pulseless (to palpation and Doppler) after reduction and stabilization of significantly displaced supracondylar fractures of the humerus
|
0 |
The initial effects of knee joint mobilization on osteoarthritic hyperalgesia
|
OAK 3 - Non-arthroplasty tx of OAK
|
Physiotherapists often employ lower limb joint mobilization to reduce pain and increase function. However, there is little experimental data confirming its efficacy. The purpose of this study was to investigate the initial effects of accessory knee joint mobilization on measures of pain and function in individuals with knee osteoarthritis. The study employed a doubleâ?blind, controlled, withinâ?subjects repeatedâ?measures design. Thirtyâ?eight subjects with mild to moderate knee pain participated. The effects of a 9â?min, nonâ?noxious, AP mobilization of the tibioâ?femoral joint were compared with manual contact and noâ?contact interventions. Pressure pain threshold (PPT) and 3â?m 'up and go' time were measured immediately before and after each intervention. Results demonstrated a significantly greater mean (95% CI) percentage increase in PPT following knee joint mobilization (27.3% (20.9â?33.7)) than after manual contact (6.4% (0.4â?12.4)) or noâ?contact (â?9.6% (â?20.7 to 1.6)) interventions. Knee joint mobilization also increased PPT at a distal, nonâ?painful site and reduced 'up and go' time significantly more (â?5% (â?9.3 to 0.8)) than manual contact (â?0.4% (â?4.2 to 3.5)) or noâ?contact control (+7.9% (2.6â?13.2)) interventions. This study therefore provides new experimental evidence that accessory mobilization of an osteoarthritic knee joint immediately produces both local and widespread hypoalgesic effects. It may therefore be an effective means of reducing pain in this population.
|
0 |
Repair of distal biceps tendon rupture using a suture anchor: Description of a new endoscopic procedure
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Background: Repair of a distal biceps tendon rupture is a challenging procedure and, to date, there is no consensus as to which technique should be used because of the specific complications reported for each. Purpose: A new endoscopic technique is described that uses a suture anchor to repair distal biceps tendon ruptures. Study Design: Case series; Level of evidence, 4. Methods: The results of a cohort of 23 patients (25 elbows) are reported with a median follow-up of 26 months. All patients were male and their median age was 44 years (range, 30-58). Ten of the patients (12 ruptures) were professional athletes or had a high level of physical activity. All repairs were performed via a 3-cm incision made in the "safe area? of the anterior crease of the forearm. The whole procedure was performed within the tendon sheath. The tendon was reinserted using a single anchor. Results: Of the 23 patients, 22 were satisfied and 20 patients returned to their preinjury sports and jobs. There was a mean loss of 8.6(degrees) of pronation and 5(degrees) of supination. A single severe neurologic complication, which required a second surgical procedure, was reported. There were also 2 ectopic ossifications without clinical consequences and a transitory radial nerve paralysis. Conclusions: This study clearly demonstrated that endoscopic repair of the ruptured distal biceps tendon is safe, effective, and reproducible. It provides good functional outcome and early recovery with few complications. Postoperative median nerve palsy due to edema is a possible concern for patients involved in athletic activity and with a history of nerve entrapment; thus this technique should be used with caution in this group of patients. (copyright) 2009 American Orthopaedic Society for Sports Medicine
|
0 |
Autologous platelet gel for tissue regeneration in degenerative disorders of the knee
|
AMP (Acute Meniscal Pathology)
|
Background. The refinement of the use of platelet-derived growth factors that has occurred over the last decade has led to a broadening of the fields of use, in particular for new treatments in orthopaedics aimed at improving tissue regeneration. Materials and methods. Twenty-seven patients, aged between 18 and 81 years, with a diagnosis of degenerative joint disease lasting for more than 1 year were treated. The patients were divided into two groups, one with arthritis of the knee, the other with degenerative cartilage disease of the knee. Both groups were treated with a therapeutic protocol consisting of a cycle of three infiltrations of platelet-rich plasma at weekly intervals. The extemporaneous preparation was made from a sample of about 8 mL of venous whole blood collected into a specific Fibrin Polymer 2 test-tube from RegenLab® and centrifuged before addition of calcium gluconate. During the initial pre-treatment evaluation, specific questionnaires were administered, the Numerical Rating Scale (NRS) for subjective measurement of pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); these assessments were repeated 7 days after the end of the treatment and at 6 months during the follow-up. Results. The parameters evaluated improved in both groups after treatment and there was a further improvement after 6 months of follow-up; furthermore, there was a substantial decrease in pain right after the first infiltration. Discussion. The patients were treated on an out-patient basis by a specifically created multidisciplinary team comprising a transfusion specialist, an orthopaedist and a radiologist, who collaborate in a symbiotic manner. The out-patient protocol exploits the regenerative properties of platelet-rich plasma, which is a low cost treatment; in practice, a diagnostic-therapeutic programme of lower intensity, but of high technical and professional quality is created. The strategy also reduces both the number of hospital services and the pharmacological support required, thereby optimising the use of health care resources. © SIMTI Servizi Srl.
|
0 |
Calcium phosphate bone cement for treatment of distal radius fractures: a preliminary report
|
Distal Radius Fractures
|
Distal radius fractures in osteoporotic patients are often complicated with a residual deformity and a subsequent stiff and painful wrist. The aim of this study was to evaluate the usefulness of calcium phosphate bone cement (CPC95) in the treatment of these fractures. Seven Colles type fractures in seven patients (all female; average age, 58 years) were treated. After a closed reduction, the fractures were fixed either by percutaneous pinning or by external skeletal fixation. The CPC95 was then injected into the cancellous bone defect through a small dorsal incision. The functional and radiological results were evaluated for up to 1 year. All patients were graded as good or excellent within 3 months, and all were graded as excellent at the final follow-up. The average duration of immobilization was 3.5 weeks. The overall shortening of the radius was 2.3 mm. In one patient, CPC95 extruded into the extensor tendon sheath and was surgically removed. Injection of CPC95 is a promising augmentation of osteosynthesis for distal radius fractures, although a prospective control study is mandatory to prove the usefulness of this material. The equipment and surgical technique should be refined to avoid the extrusion of CPC95.
|
1 |
Medium-long-term radiographic and clinical outcomes after surgical treatment of intra-articular tibial pilon fractures by three different techniques
|
DoD SSI (Surgical Site Infections)
|
Introduction. The goal of this retrospective, observational, case series study was to evaluate the medium-long-term clinical and radiographic results of the three most common surgical osteosynthesis techniques used for the treatment of articular tibial pilon fractures: ORIF, MIPO, and EF. Materials and Methods. A consecutive series of patients with articular pilon fractures who underwent surgery at our institution were enrolled in this study. Fractures were classified according to the Müller AO classification system. Overall outcomes took the following into account: radiographic quality of reduction, evaluated using Ovadia and Beals’ criteria; clinical assessment, evaluated using the AOFAS questionnaire; and general health, evaluated with the SF36-v2 Health Survey. Results. A total of 94 articular pilon fractures (34 type 43-B and 60 43-C) were evaluated with a mean follow-up of 56.34 months (range 33–101). The techniques used were ORIF, MIPO, and EF in 63 (67%), 17 (18.9%), and 14 cases (14.1%), respectively. According to Ovadia and Beals’ criteria, good, fair, and poor results were reported in 61 (64.89%), 26 (27.66%), and 7 (7.45%) cases, respectively. The mean AOFAS score was 82.41 for MIPO, 79.83 for ORIF, and 50.57 for EF, respectively. Thirty-nine patients (41.49%) presented early and/or late complications. Conclusion. Satisfactory outcomes using the three different techniques were reported. In particular, the radiographic outcomes were inversely proportional to the fracture comminutions and statistically different between internal and external osteosynthesis, but comparable between ORIF and MIPO techniques. On the other hand, the clinical outcomes were closely related to the soft tissue conditions and the anatomical reconstruction of the joint.
|
0 |
A Mycobacterium malmoense infection of the hand presenting as carpal tunnel syndrome
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
We report an atypical tuberculous infection by Mycobacterium Malmoense of the synovium of the flexor tendons at the wrist presenting as carpal tunnel syndrome. This is the first time this organism has been described in a site other than the lungs or the cervical lymph nodes
|
0 |
Diffuse and localised visual field defects to automated perimetry in primary open angle glaucoma
|
Upper Eyelid and Brow Surgery
|
The occurrence of generalised or diffuse visual field depression in primary open angle glaucoma (POAG), in contrast to the presence of characteristic localised defects, is controversial. The frequency of diffuse visual field loss to automated static perimetry in the early stages of POAG was determined and compared with the frequency of localised defects. Twenty-five eyes of 25 consecutive POAG patients who met the selection criteria were tested on the Humphrey Visual Field Analyser with the Central 30-2 Threshold Test. Patients' mean age was 68 years. All eyes had visual acuity better than 6/9 with correction, refractive error of less than +/- 7 dioptres, no media opacities and normal pupils (3-6 mm). For all eyes, the frequency of abnormality on the STATPAC Total Deviation (TD) and Pattern Deviation (PD) plots were determined for all individual test points. Mean values and standard deviations were compared. The TD plots represent a composite of both diffuse and localised visual field depression, while PD plots are intended to reflect localised field defects. The frequency of involvement of the test points on the TD plots was higher than on the PD plots (mean +/- SD: 41.5 +/- 11.2% vs 27.5 +/- 10.9%) for all presenting defects. When only deep defects (STATPAC p < 1% and p < 0.5%) were evaluated, TD involvement was still more frequent than the PD (20.1 +/- 9.4% vs 13.2 +/- 7.2%). The topographical pointwise incidence of pure generalised sensitivity loss in the visual field was less frequent when only deep defects were taken into consideration (6.9 +/- 5.7%), and the incidence increased progressively with the inclusion of intermediate and shallow field defects (9.6 +/- 6.8% and 14.0 +/- 8.4% respectively). A component of diffuse sensitivity depression is present at all significant levels of visual field loss in glaucoma. This component of generalised loss decreases as the depth of the field defects increases. This finding suggests that early diffuse field loss converts into well-defined pattern defects at later stages.
|
1 |
Preoperative gabapentin in patients undergoing primary total knee arthroplasty
|
AAHKS (5) Gabapentinoids
|
Background: Patients undergoing total knee arthroplasty usually receive a multimodal analgesic regimen including peripheral nerve blockade, but may still experience significant pain. This study examined whether preoperative gabapentin decreases acute postoperative pain and opioid consumption in this setting. Methods: Retrospective chart review of single institution, hospital-based orthopaedic practice. Consecutive patients undergoing unilateral elective primary knee arthroplasty were evaluated for perioperative gabapentin use. Sixty-one consecutive patients received gabapentin; for each, an age- and gender-matched control was identified. Results: Patients in both groups demonstrated similar demographics, all received lumbar plexus blockade. Catheters were removed on postoperative day 2 (95%). There were no differences in postoperative pain scores or opioid use between groups. Overall, median verbal pain scores (IQR) were 0(1), 0(3), 1(3) and 3(3) in the post-anaesthesia care unit and postoperative days 0, 1 and 2, respectively. Postoperative consumption of other analgesics was not different across groups. Patients in the gabapentin group received a single-injection sciatic nerve block less often than patients in the control group (77% vs. 94%, respectively; p < 0.05). Conclusions: Patients undergoing unilateral total knee arthroplasty experience low pain scores utilizing a multimodal analgesic regimen including continuous lumbar plexus blockade independent of gabapentin use. © 2009 Elsevier B.V. All rights reserved.
|
0 |
Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients
|
AMP (Acute Meniscal Pathology)
|
The incidence of venous thromboembolism after elective knee surgery has previously been studied almost exclusively in patients receiving total knee replacements, in whom the risk of a deep vein thrombosis is approximately 60%. We report the results of ipsilateral ascending venography in 312 patients undergoing a wide variety of elective knee operations under tourniquet ischaemia, none of whom received any specific prophylaxis against thromboembolism. Total knee replacement was confirmed to carry a high risk with ipsilateral deep vein thrombosis in 56.4% and symptomatic pulmonary embolism in 1.9%. By contrast, arthroscopy was associated with a low incidence of venous thrombosis (4.2%). Meniscectomy, arthrotomy, patellectomy, synovectomy and arthrodesis were all high-risk procedures, particularly in patients over 40 years of age, and were associated with deep vein thrombosis rates of 25% to 67%. On the basis of these findings, we advise prophylaxis against venous thromboembolism in all patients over 40 years of age undergoing elective knee surgery other than arthroscopy.
|
0 |
Predicting the risk of deep infections following total knee replacement: A pragmatic, prognostic risk score
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Surgeons and patients need a tool to predict deep infections following total knee replacement. We developed a pragmatic, points-based risk score to predict knee deep infections for clinical decision making. Using a large health care organization's joint replacement registry, we identified deep infections associated with 38,094 primary total knees performed between 2001 and 2009. Infections were validated through chart review according to Centers for Disease Control and Prevention guidelines. Patient characteristics were extracted from the registry and our electronic health record. We observed 241 deep infections, a one-year incidence of 6.4 per 1,000 patients (95% Confidence Interval, 5.7 to 7.3). The risk score, derived from a Cox regression with stratification by region, included the following risk factors: age (less than 55 and greater than 80), male gender, race (black and white versus other), diagnosis other than osteoarthritis, diabetes with complications, and higher body mass index. Agreement (calibration) was adequate for the highest and lowest-risk deciles. Patients in the highest-risk decile were 6.7 times more likely to suffer a deep infection when compared with patients in the lowest-risk decile (2.7 per 1,000). Body mass index is one characteristic that is potentially modifiable through intervention. We believe this risk score is the first of its kind for predicting knee deep infections and may be useful for decision-making by orthopedic surgeons and patients. Additional risk scores are needed for predicting other complications and clinical outcomes in knee replacement surgery
|
0 |
Breast dose reduction for chest CT by modifying the scanning parameters based on the pre-scan size-specific dose estimate (SSDE)
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
Objective: To investigate the usefulness of modifying scanning parameters based on the size-specific dose estimate (SSDE) for a breast-dose reduction for chest CT. Materials and methods: We scanned 26 women with a fixed volume CT dose index (CTDIvol) (15 mGy) and another 26 with a fixed SSDE (15 mGy) protocol (protocol 1 and 2, respectively). In protocol 2, tube current was calculated based on the patient habitus obtained on scout images. We compared the mean breast dose and the inter-patient breast dose variability and performed linear regression analysis of the breast dose and the body mass index (BMI) of the two protocols. Results: The mean breast dose was about 35 % lower under protocol 2 than protocol 1 (10.9 mGy vs. 16.8 mGy, p < 0.01). The inter-patient breast dose variability was significantly lower under protocol 2 than 1 (1.2 mGy vs. 2.5 mGy, p < 0.01). We observed a moderate negative correlation between the breast dose and the BMI under protocol 1 (r = 0.43, p < 0.01); there was no significant correlation (r = 0.06, p = 0.35) under protocol 2. Conclusion: The SSDE-based protocol achieved a reduction in breast dose and in inter-patient breast dose variability. Key Points: � CT scan parameters can be modified based on the pre-scan SSDE. � The pre-scan SSDE is useful for a breast dose reduction. � The fixed SSDE protocol reduced individual variations in the breast dose.
|
0 |
Imaging modalities for identifying the origin of regional musculoskeletal pain
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Regional musculoskeletal pain is one of the most common complaints in daily rheumatological practice. Conventional radiology remains the cornerstone of diagnostic imaging in these patients despite the advent of new, fascinating imaging techniques. Ultrasonography may have a relevant impact on final diagnosis or therapeutic choices. It is highly sensitive to the identification of fine, soft-tissue changes and it should be considered as an integral part of the clinical examination in most patients. Scintigraphy is indicated when multifocal processes have to be excluded and when high sensitivity is required. Computed tomography is an excellent tool for the assessment of osseous based abnormalities. Magnetic resonance has several characteristics of the ideal diagnostic tool. However, its appropriateness in the evaluation of many regional musculoskeletal conditions is a matter for discussion. An appropriate diagnostic programme for patients with regional musculoskeletal pain has to be focused on the strengths and weaknesses of various imaging techniques
|
1 |
Fixator-assisted Technique Enables Less Invasive Plate Osteosynthesis in Medial Opening-wedge High Tibial Osteotomy: A Novel Technique
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: Opening-wedge high tibial osteotomy is a well-established procedure in the management of medial osteoarthritis of the knee and correction of proximal tibia vara. Recently, surgical approaches using less invasive plate osteosynthesis have been used with the goal of minimizing complications from more extensive soft tissue exposures. However, to our knowledge, less invasive fixator-assisted plate osteosynthesis has not been tested in the setting of opening-wedge high tibial osteotomy.
QUESTIONS/PURPOSES: The purposes of this study were (1) to assess the complications associated with use of a fixator-assisted less invasive plate osteosynthesis technique to stabilize an opening-wedge high tibial osteotomy in the treatment of proximal tibial vara; and (2) to evaluate the ability of this technique to achieve correction of the proximal tibial deformity and achieve osseous union.
METHODS: From June 2011 to June 2013, a total of 157 limbs in 83 patients who underwent fixator-assisted high tibial osteotomy for (1) idiopathic genu vara; or (2) osteoarthritis of the knee with proximal tibia vara were initially enrolled. Of these, eight limbs (5%) were excluded on the way; thus, 149 limbs in 77 patients were evaluated. During the period in question, no other techniques were used for proximal tibial osteotomy. The surgical procedures included less preparation of soft tissue, proximal tibial osteotomy, application of a temporary external fixator, correction of alignment, and final fixation with the help of an external fixator. Complications were assessed by chart review and the alignment in both coronal and sagittal planes was compared pre- and postoperatively. Radiographic review to confirm osseous union and alignment was performed by two of the authors not involved in clinical care of the patient. Delayed union was described as union occurring later than 4 months.
RESULTS: Thirty limbs out of 149 tibiae (20%) showed complications, all of which were resolved without leaving any sequela. Twenty-seven limbs out of 149 limbs (18%) showed lateral cortical hinge fracture and three limbs out of 149 limbs (2%) showed soft tissue complications (two superficial infections, one wound hematoma). The overall completeness of reaching the target correction was excellent. In the coronal plane, the difference between the amount of real correction and the amount of target correction was 0.3degree +/- 0.7degree (p < 0.001). In the sagittal plane, the difference between pre- and postoperative posterior proximal tibial angle was -0.1degree +/- 0.2degree (p < 0.001). All osteotomies healed before 4 months.
CONCLUSIONS: Fixator-assisted high tibial osteotomy is a valid option for medial opening-wedge high tibial osteotomy, which enables less invasive surgery with excellent coronal/sagittal/rotational alignment control. However, future studies should compare this approach with other approaches for proximal tibial osteotomy to ascertain whether indeed this procedure is less invasive or more reliable.
LEVEL OF EVIDENCE: Level IV, therapeutic study.
|
0 |
Racial and ethnic disparities in hip and knee joint replacement: a review of research in the Veterans Affairs Health Care System
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Elective total joint arthroplasty is an effective treatment option for end-stage osteoarthritis of the hip and knee. The demand for arthroplasty is anticipated to increase as the proportion of older patients with hip and knee osteoarthritis continues to rise in the United States and worldwide. Studies have documented marked racial and ethnic differences in the utilization rates of hip and knee arthroplasty in the United States. The reasons for these differences are complex and include patient-level factors, such as treatment preference; provider-level factors, such as physician-patient communication style; and system-level factors, such as access to specialist care. Most of the studies on racial and ethnic disparities in joint arthroplasty utilization have been based on data from the Medicare database. However, Veterans Administration-based studies have recently confirmed these findings and have indicated potential patient-level factors, such as patient perception of and familiarity with joint arthroplasty, that may play a role in this disparity
|
0 |
Analysis of polymorphisms in the MATN3 and DOT1L Genes and CTX-II urinary levels in patients with knee osteoarthritis in a northeast mexican-mestizo population
|
OAK 3 - Non-arthroplasty tx of OAK
|
Aims: To investigate the possible roles of the single nucleotide polymorphisms (SNPs) MATN3 (rs77245812) and DOT1L (rs12982744) with susceptibility to knee osteoarthritis (KOA) among mestizos from the northeast region of Mexico. In addition, we analyzed the relationship of their urinary levels of carboxy terminal telopeptide of collagen type II (CTX-II) and the radiological grade of disease. Materials and Methods: A total of 223 individuals from a Northeast Mexico Mestizo population were included in this study: 110 patients with primary KOA and 113 healthy controls. Genotyping of the MATN3 (rs77245812) and DOT1L (rs12982744) SNPs was performed by real-time polymerase chain reaction. Results: No association was found between the polymorphisms MATN3 (rs77245812), DOT1L (rs12982744), and the risk of developing KOA (odds ratio [OR] = 1.33, 95% confidence interval [CI] = 0.42-6.48, p = 0.621) (OR = 2.03, 95% CI = 0.35-11.5, p = 0.422). However, urinary CTX-II levels were considerably higher by radiographic grade. Conclusions: An increase in CTX-II per radiographic grade was observed in the case group, but no association was found between MATN3 and DOT1L genes and the risk of KOA in Mexican mestizos.
|
0 |
Bilateral carpal tunnel syndrome and bilateral cubital tunnel syndrome in a patient with cervical disc herniations
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Entrapment neuropathies, cervical spondylosis and disc herniations are all well known, common neuromuscular pathologies. A complicated clinical presentation may emerge incase the forementioned problems overlap. We present a similar patient with bilateral carpal tunnel syndrome, bilateral cubital tunnel syndrome and cervical disc herniations gathering all these challenging problems and discuss the utility of clinical examination, electromyographic evaluations, radiological interventions for the diagnosis - under the scenario of double crush syndrome besides shortly touching upon their management
|
0 |
Regional anesthesia for knee surgery
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Knee surgery may be performed under general anesthesia, preferably, however, under regional anesthesia because of the profound preemptive analgesic effect that is provided by regional anesthetic techniques. Both centroneuraxis (spinal, epidural) as well as peripheral nerve blocks may be used for knee surgery. Although the former may be used less frequently in the near future in knee surgery because of increasing administration of low molecular heparins with resultant epidural hematoma formation, the latter enjoy more and more popularity. Peripheral nerve blocks used mostly for knee surgery include femoral/sciatic nerve blocks and intra-articular injection of local anesthetics and/or opioids into the knee joint. They are devoid of extensive sympathectomy and provide sufficient surgical analgesia and motor block
|
1 |
Endoscopic carpal tunnel release--current status
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Endoscopic carpal tunnel release is one of the most controversial topics in hand surgery today. Many surgeons have reservations in doing carpal tunnel release endoscopically because its merits and demerits have not been clearly defined. This article describes the various techniques now available to perform endoscopic carpal tunnel release. The anatomic basis for a single-portal technique using the Concept Carpal Tunnel Release Kit is described in detail. The results of 100 postoperative cases indicate that endoscopic carpal tunnel release was superior to the open technique in regard to postoperative morbidity and patient satisfaction in 92% of this patient group
|
1 |
Perineuronal morphine: a comparison with epidural morphine
|
Surgical Management of Osteoarthritis of the Knee CPG
|
In a double-blind, randomised controlled cross-over study the effects of perineuronal (perifemoral) injections of morphine were compared with epidural injections with the same amount of morphine in patients after knee surgery. Better pain scores were achieved during treatment with epidural morphine. We have not been able to confirm the hypothesis of neuro-axonal transport of morphine from the periphery to the spinal cord
|
0 |
Operative treatment of displaced fractures of the acetabulum. A meta-analysis
|
DoD SSI (Surgical Site Infections)
|
Over the past 40 years, the management of displaced fractures of the acetabulum has changed from conservative to operative. We have undertaken a meta-analysis to evaluate the classification, the incidence of complications and the functional outcome of patients who had undergone operative treatment of such injuries. We analysed a total of 3670 fractures. The most common long-term complication was osteoarthritis which occurred in approximately 20% of the patients. Other late complications, including heterotopic ossification and avascular necrosis of the femoral head, were present in less than 10%. However, only 8% of patients who were treated surgically needed a further operation, usually a hip arthroplasty, and between 75% and 80% of patients gained an excellent or good result at a mean of five years after injury. Factors influencing the functional outcome included the type of fracture and/or dislocation, damage to the femoral head, associated injuries and co-morbidity which can be considered to be non-controllable, and the timing of the operation, the surgical approach, the quality of reduction and local complications which are all controllable. The treatment of these injuries is challenging. Tertiary referrals need to be undertaken as early as possible, since the timing of surgery is of the utmost importance. It is important at operation, to obtain the most accurate reduction of the fracture which is possible, with a minimal surgical approach, as both are related to improved outcome. © 2005 British Editorial Society of Bone and Joint Surgery.
|
0 |
Calcium, magnesium, zinc and lead concentrations in the structures forming knee joint in patients with osteoarthritis
|
AMP (Acute Meniscal Pathology)
|
The aim of the study was to investigate the relationships between the concentrations of calcium (Ca), magnesium (Mg), zinc (Zn), and lead (Pb) in cartilage, anterior cruciate ligament, and meniscus samples obtained following knee joint surgery in patients with osteoarthritis in northwestern Poland. Furthermore, we examined the relationships between the concentrations of these metals in the studied parts of the knee joint and the influences of gender, age, BMI and hypertension. We found significantly higher concentrations of Ca, Mg, and Zn in the cartilage of men than in women and a significantly higher Pb concentration in the meniscus of the men. We also found a higher concentration of Pb in the cartilage of patients over 65 years of age. There were no differences in the concentrations of the studied metals between patients with and without hypertension. There was no relationship between Ca, Mg, Zn, and Pb levels in analyzed materials and BMI. Furthermore, we noted some new interactions between metals in the studied structures of the knee joint. The results reported in the study shows the influence of age, gender and BMI on the Ca, Mg, Zn and Pb in the studied structures of the knee joint.
|
1 |
Radiographic Study of Humeral Stem in Shoulder Arthroplasty After Lesser Tuberosity Osteotomy or Subscapularis Tenotomy
|
Glenohumeral Joint OA
|
Lesser tuberosity osteotomy (LTO) and subscapularis tenotomy (ST) are used for takedown of the subscapularis during shoulder arthroplasty. LTO offers the theoretical but unproven benefit of improved healing and function of the subscapularis. However, humeral stem subsidence and loosening may be greater when osteotomy is performed, which may compromise functional outcomes. Our hypothesis is that no difference in proximal collar press-fit humeral stem subsidence or loosening exists, with no impairment of functional outcomes using the LTO technique. Radiographs of 39 shoulders from 35 patients who underwent shoulder arthroplasty with a minimum of 1 year of radiographic follow-up were included in the study cohort. All patients received the same press-fit implant (Bigliani-Flatow; Zimmer Biomet). We collected data including demographic information; radiographic measurements, including humeral-acromial distance (HAD); subsidence; subluxation index; the presence of lucent lines >2 mm; and functional outcome scores using the Western Ontario Osteoarthritis of the Shoulder Index, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Constant score. Subsidence was 2.8 +/- 3.1 mm for LTO vs 2.5 +/- 3.1 mm for ST (P = .72). HAD did not differ between the LTO and ST groups preoperatively (9.5 +/- 2.4 mm vs 10.9 +/- 2.7 mm, P = .11). The first postoperative and final follow-up films for HAD for the LTO and ST groups showed a statistically significant difference (first postoperative film, 11.9 +/- 3.7 mm vs 15.9 +/- 4.5 mm, P = .005; final follow-up film, 11.8 +/- 3.2 mm vs 14.5 +/- 3.9 mm, P = .03). We identified no differences in subsidence, lucent lines >2 mm, posterior subluxation, and Constant, and DASH functional outcome scores for patients undergoing total shoulder arthroplasty via the LTO vs ST techniques with the same proximal collar press-fit humeral stem at short-term follow-up.
|
0 |
First Case of Lyme Arthritis Involving a Prosthetic Knee Joint
|
PJI DX Updated Search
|
Borrelia burgdorferi sensu stricto is the most common tick-borne illness in the United States. Arthritis is usually a mani-festation of late dis-ease but has not been associated with cases of periprosthetic joint infections. We report on a patient who was first diagnosed with periprosthetic joint infection and subsequently Lyme arthritis
|
0 |
Fungal periprosthetic joint infection of the hip: a systematic review
|
PJI DX Updated Search
|
Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty with an incidence of approximately 1%. Due to the high risk of persisting infection, successful treatment of fungal PJI is challenging. The purpose of this study was to gain insight into the current management of fungal PJI of the hip and, by systematically reviewing the cases published so far, to further improve the medical treatment of this serious complication of total hip arthroplasty. Thus, we conducted a systematic review of the available literature concerning fungal PJI in total hip arthroplasty, including 45 cases of fungal PJI. At the moment a two-stage revision procedure is favorable and there is an ongoing discussion on the therapeutic effect of antifungal drug loaded cement spacers on fungal periprosthetic infections of the hip. Due to the fact that there is rare experience with it, there is urgent need to establish guidelines for the treatment of fungal infections of total hip arthroplasty
|
0 |
Hidradenitis suppurativa
|
Reconstruction After Skin Cancer
|
BACKGROUND: Hidradenitis suppurativa (HS) is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring. METHODS: We reviewed the literature to identify reliable information regarding epidemiology, pathogenesis, clinical manifestations, evaluation and differential diagnosis, treatment, complications, and prognosis. RESULTS: Hidradenitis suppurativa usually affects young women, with a prevalence of 0.3% to 4% in industrialized countries. Once considered to be "apocrine acne," HS is actually a defect of terminal follicular epithelium. Obesity, chemical irritants, or hyperandrogenism are not consistently associated; bacterial involvement is secondary. Hidradenitis suppurativa should be suspected in young adults with recurrent, deep furuncular lesions in flexural sites, especially when such lesions respond poorly to antibiotic therapy. Clindamycin and isotretinoin may be useful, though wide excision with healing by granulation is considered most efficacious. Anemia, arthropathy, and squamous cell carcinoma are potential complications. CONCLUSIONS: Since spontaneous resolution is rare and progressive disability the rule, early definitive surgical treatment of HS is advisable.
|
1 |
Safety and efficacy of US-approved viscosupplements for knee osteoarthritis: a systematic review and meta-analysis of randomized, saline-controlled trials
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Intra-articular injection of hyaluronic acid is a common, yet controversial, therapeutic option for patients with knee osteoarthritis (OA). The purpose of this research was to determine the safety and efficacy of US-approved viscosupplements for symptomatic knee OA.
METHODS: We searched MedLine and EMBase for randomized, sham-controlled trials evaluating safety and/or clinical efficacy of US-approved viscosupplements in patients with symptomatic knee OA. Knee pain severity and knee joint function were assessed at 4 to 13 weeks and 14 to 26 weeks. Safety outcomes included serious adverse events, treatment-related serious adverse events, patient withdrawal, and adverse event-related patient withdrawal occurring at any time during follow-up.
RESULTS: A total of 29 studies representing 4,866 unique patients (active: 2,673, control: 2,193) were included. All sham-controlled trials used saline injections as a control. Viscosupplementation resulted in very large treatment effects between 4 and 26 weeks for knee pain and function compared to preinjection values, with standardized mean difference values ranging from 1.07 to 1.37 (all P<0.001). Compared to controls, standardized mean difference with viscosupplementation ranged from 0.38 to 0.43 for knee pain and 0.32 to 0.34 for knee function (all P<0.001). There were no statistically significant differences between viscosupplementation and controls for any safety outcome, with absolute risk differences of 0.7% (95% confidence interval [CI]: -0.2 to 1.5%) for serious adverse events, 0% (95% CI: -0.4 to 0.4%) for treatment-related serious adverse events, 0% (95% CI: -1.6 to 1.6%) for patient withdrawal, and 0.2% (95% CI: -0.4 to 0.8%) for adverse event-related patient withdrawal.
CONCLUSION: Intra-articular injection of US-approved viscosupplements is safe and efficacious through 26 weeks in patients with symptomatic knee OA.
|
0 |
The learning curve for adopting hip resurfacing among hip specialists
|
Management of Hip Fractures in the Elderly
|
Patient demand and surgeon interest in hip resurfacing has recently increased, but surgeons in the United States are relatively inexperienced with this procedure. We determined the learning curve associated with hip resurfacing and compared the rate of early complications of the first 650 hip resurfacings between five experienced hip surgeons and a national safety survey database study we previously published, which included 89 surgeons and 537 hip resurfacings. Patient demographics and adverse events were recorded. Specific features on pre- and postoperative radiographs were measured in a blinded fashion by a single observer. There were 13 major complications (2.0%), which is 3.7 times lower than our national safety survey complication rate of 7.4%. All fractures occurred in the first 25 cases performed. The complication rate was higher for the first 25 procedures (5.6%) compared with the second 25 procedures (1.6%). For experienced hip surgeons, the learning curve for avoiding early complications was short, 25 cases or less. The learning curve for achieving the desired component positioning radiographically was much longer, 75 to 100 cases or more. If achieving some ideal component position proves important for long-term function and implant survival, improved instrumentation and surgical techniques would be necessary to shorten the learning curve. Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence
|
0 |
Free vascularized bone transfers for nonunions, segmental gaps, and following tumor resection
|
DoD SSI (Surgical Site Infections)
|
Free vascularized bone transfer is recognized as a valuable technique for skeletal reconstruction and salvage with certain nonunions, skeletal defects, and following tumor resection. This procedure is most often indicated for reconstruction of lengthy skeletal defects or under circumstances where conventional bone grafting techniques are unlikely to succeed. Factors affecting selection of donor bone and technical peculiarities relative to the recipient sites are discussed. The results of 49 cases at the Mayo Clinic for management of nonunion, segmental gaps or following tumor resection suggest a union rate of 82%. The most consistent rate of success was found for reconstruction of defects affecting the tibia, mandible or forearm bones.
|
0 |
Are we any closer to beating the biofilm: Novel methods of biofilm control
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Purpose Of Review: A multidisciplinary approach to the treatment and management of biofilms has resulted from the growing appreciation of the role that biofilms play in modern medicine. Conventional antimicrobial agents are generally ineffective against biofilms, and as a result novel laboratory-based and clinical strategies have emerged. The purpose of this review is to analyse the recent literature relating to novel treatment strategies targeting the growing spectrum of clinically relevant biofilms. Recent Findings: Microscopy and molecular techniques have provided greater insights into identifying the key bacterial and fungal biofilm pathogens. Knowledge of these microorganisms has provided a foundation for the development of specific molecules, often microbial derived, with antimicrobial and/or biofilm disruptive properties, augmenting conventional antibiotics treatments. The validity of some such rationally designed therapeutics has been explored in clinical trials. Summary: Biofilms are inherently difficult to treat, and mechanical disruption is the mainstay of clinical management. With scientific progress in molecular microbiology, there is an abundance of newly discovered molecules and pathways, providing novel therapeutic and prophylactic targets. (copyright) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
|
0 |
Pamidronate induces bone formation in patients with smouldering or indolent myeloma, with no significant anti-tumour effect
|
MSTS 2018 - Femur Mets and MM
|
Twelve patients with smouldering or indolent multiple myeloma (MM) received 12 courses of intravenous pamidronate as a single agent to evaluate both the antitumour and bone metabolism effects. One patient achieved minor response, eight had stable disease, and three - all indolent MM - showed disease progression. Serum interleukin 6 (IL-6), IL-1beta and Oncostatin-M remained stable throughout the study, while tumour necrosis factor-alpha increased. Bone density significantly increased after four and 12 courses compared with baseline. Markers for bone resorption and bone formation decreased with treatment. These results suggest that pamidronate treatment reduces bone turnover in smouldering or indolent MM, but has no significant antitumour effect.
|
1 |
The association between bifid median nerve and carpal tunnel syndrome: Is it really a risk factor?
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Objectives: This study aims to determine the bifid median nerve (BMN) frequency in patients with carpal tunnel syndrome (CTS) and to investigate the possible association between CTS and BMN in this patient population. Patients and methods: A total of 194 wrists of 131 patients in whom CTS was diagnosed clinically and electrophysiologically and 73 healthy volunteers without any symptom or sign of CTS were examined with ultrasonography. Results: Bifid median nerve was detected in 22 wrists (11.3%) in CTS group and 15 wrists (10.2%) in the control group. There was no statistically significantly difference in the incidence of BMN among patients with CTS and healthy volunteers (p=0.891). Conclusion: Our study results showed that the incidence of BMN was similar among CTS patients and healthy volunteers. Therefore, we conclude that BMN may not be a predisposing factor for CTS. (copyright) 2014 Turkish League Against Rheumatism. All rights reserved
|
0 |
Trends in total elbow arthroplasty in the Medicare population: a nationwide study of records from 2005 to 2012
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
Background Utilization of total elbow arthroplasty (TEA) has reportedly increased in recent years. Since the introduction of disease-modifying antirheumatic drugs, there has been a reported decline in its use among rheumatoid patients; yet, the shift in indications for TEA remains unclear. This study evaluated trends in TEA utilization from 2005 to 2012 by analyzing the most common indications within the population of Medicare patients. Methods We performed a retrospective review of a comprehensive Medicare patient population database using the PearlDiver supercomputer (Warsaw, IN, USA) for TEA utilization in rheumatoid arthritis (RA), osteoarthritis (OA), distal humerus fracture (DHF), post-traumatic arthritis (PTA), and distal humerus nonunion (DHNU). Total reported incidence of office visits and TEA utilization for each indication was reviewed. Results Utilization of TEA remained unchanged (Pâ??=â??.9530) despite a growing Medicare population (Pâ??=â??.0201). There was a significant decline in annual TEA utilization for RA (Pâ??=â??.002) and DHNU (Pâ??=â??.003). No significant change was found in TEA use for DHF, OA, and PTA. A significant increase was noted in total visits coded for OA, RA, and DHNU (Pâ??<â??.001). A significant, strong negative correlation was found for office visit coding and TEA use in RA (râ??=â??â??0.850; Pâ??=â??.008) and DHNU (râ??=â??â??0.902; Pâ??=â??.002). Conclusion From 2005 to 2012, utilization rates of TEA in the Medicare population remained constant. Despite increases in office visits, TEA use for RA and DHNU has declined, likely secondary to improved medical management with disease-modifying antirheumatic drugs and the surgeon's comfort with improved fracture fixation options.
|
0 |
Return to activities after breast reduction
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
Background: Uncertainty exists in the medical literature about recommendations for return to work or driving after breast reduction surgery. Methods: A survey was sent to 138 plastic surgeons in the United Kingdom enquiring about their recommended timing of return to work or driving a car depending of level of activity. Data was evaluated with univariate ANOVA test and a p<0.05 significance level. Results: Out of 73 surgeons who responded, 13% did not give any specific advice regards to return to work and 30% for return to driving. The remainder suggested to return to work and driving after about 19 days each. Conclusions: Based on this consensus of opinion of plastic surgeons with an interest in breast surgery it appears reasonable to suggest a recovery period of approximately 3 weeks subject to individual variations. Further evidence is needed to comment on the interaction of wound healing and pain and return to driving and work. © 2010 Elsevier Ltd.
|
0 |
Navigated femoral shaft fracture treatment: current status
|
DoD SSI (Surgical Site Infections)
|
Femoral malrotation is a common complication after internal fixation of a femoral shaft fracture. The only valid, objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; unfortunately, this can only be carried out postoperatively. A difference of 15degree compared to the contralateral femur is seen as an indication for revision. With the development of computer-assisted surgery, new possibilities for performing torsion control and correction intraoperatively has been introduced. These methods also allow for navigation-assisted definition of the optimal incision site, intramedullary access, femoral nail and interlocking. The main problem lies in the extra time of surgery, which is due to performing all the steps of the surgery navigated. The solution for this problem is "hybrid navigation", in which the surgeon can select the steps he needs from the navigation system, depending on his experience or surgical technique.
|
0 |
Late results after meniscectomy in children
|
Diagnosis and Treatment of Osteochondritis Dissecans AUC
|
Seventy-five children undergoing 77 meniscectomies have been reviewed from 1 to 30 years (mean 15) after operation in order to determine the late results of meniscectomy. Arthroscopy of the patients with a poor result was performed at the follow-up. In 30 per cent osteoarthrosis was diagnosed, all with follow-up times from 19 to 25 years. Delay in operation resulted in worse results. The younger the patient the worse the result. The benefit of operation was less in girls than in boys. Bucket-handle lesions and peripheral tears produced the best results after meniscectomy. Fifty-eight per cent of men and 26 per cent of women had symptom-free knees at follow-up. Removing a meniscus is not a benign procedure. Only 44 per cent of patients in whom a damaged meniscus and 17 per cent in whom a normal meniscus had been removed were without symptoms. These results stress the need for making an accurate diagnosis by careful examination and arthroscopy before embarking on meniscectomy in children. Efforts to preserve the meniscus in children must be made whenever possible
|
0 |
Sonographic evaluation of the medial aspect of the knee in a population-based cohort study
|
AMP (Acute Meniscal Pathology)
|
PURPOSE: The aim of this study was to evaluate the medial aspect of the knee with ultrasound (US).
METHODS: This study included 71 men and 154 women (450 knees) with a mean age of 65 years. US was used to evaluate the medial joint space of both knees with and without weight-bearing. In each subject, the medial radial displacement of the medial meniscus, the peripheral joint space, and the number of osteophytes were evaluated. The subjects were stratified by age into five groups: 40-49 years, 50-59 years, 60-69 years, 70-79 years, and 80 years and older, and the US findings in each group were compared.
RESULTS: Statistically significant differences were noted between the 60-69 and over-80 age groups in medial radial displacements and peripheral joint spaces (p < 0.01 for both). The number of osteophytes significantly increased after 60 years of age (p < 0.01).
CONCLUSIONS: We believe that US is a useful tool for making a simple evaluation of the intra-articular components in population-based studies.
|
0 |
Bone loss after heart transplant: effect of alendronate, etidronate, calcitonin, and calcium plus vitamin D3
|
Management of Hip Fractures in the Elderly
|
OBJECTIVE: To compare the effects of calcitonin, etidronate, and alendronate in preventing bone loss during the first 2 years after heart transplant. METHODS: A total of 222 heart transplant recipients (mean [SD] age, 52.4 [10] years, 85% male) were evaluated. Patients with normal bone mineral density (reference group, n = 102) received 1000 mg/d calcium plus 800 IU/d vitamin D3. The rest were assigned to 200 IU/d of calcitonin (n=42), 400 mg/d etidronate orally for 14 days quarterly (n = 33), or 10 mg/d alendronate (n = 45). All patients received calcium and vitamin D. Bone mineral density was assessed by dual-energy x-ray absorptiometry in the lumbar spine, the entire femur, and the femoral neck at baseline and 6, 12, and 24 months after transplant. RESULTS: At 2 years after transplant, bone mineral density in the lumbar spine had decreased in the reference group (-3.07%), calcitonin group (-0.93%), and etidronate group (-1.87%) but not in the alendronate group (+4.9%; P <.001). After 2 years, bone mineral density in the entire femur decreased in all groups (-3.2% in the reference group, -3.6% in the calcitonin group, -4.6% in the etidronate group, and -0.5% in the alendronate group) but bone loss was significantly lower in the alendronate group (P <.001). Bone mineral density in the femoral neck also decreased in all groups. The incidence of vertebral fractures did not differ among groups. Adverse events were similar between groups. CONCLUSIONS: Alendronate therapy in heart transplant recipients was associated with a significant increase in bone mineral density in the lumbar spine and less bone loss at the hip
|
0 |
A subacute combined degeneration-like syndrome in the setting of zinc toxicity with normal serum copper
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
OBJECTIVE: To report a subacute combined degeneration-like syndrome with zinc toxicity and normal serum copper. BACKGROUND: Copper deficiency is a well-described cause of myelopathy with prominent sensory ataxia. Zinc overload results in excessive elimination of copper in enterocytes
|
0 |
Biofilm formation mechanisms and targets for developing antibiofilm agents
|
Dental Implant Infection
|
Biofilms are communities of microorganisms that are attached to a surface and play a significant role in the persistence of bacterial infections. Bacteria within a biofilm are several orders of magnitude more resistant to antibiotics, compared with planktonic bacteria. Thus far, no drugs are in clinical use that specifically target bacterial biofilms. This is probably because until recently the molecular details of biofilm formation were poorly understood. Bacteria integrate information from the environment, such as quorum-sensing autoinducers and nutrients, into appropriate biofilm-related gene expression, and the identity of the key players, such as cyclic dinucleotide second messengers and regulatory RNAs are beginning to be uncovered. Herein, we highlight the current understanding of the processes that lead to biofilm formation in many bacteria.
|
0 |
Surgical delay in acute admissions on warfarin: are we doing enough?
|
Management of Hip Fractures in the Elderly
|
Warfarin anti-coagulation can cause significant delay in acute surgical admissions. We reviewed fracture neck of femur patients operated over a period of 4 years in our unit. There was an average delay to surgery of 4.36 days in patients on warfarin as against an average delay of 1.78 days in patients not on warfarin (p < 0.001). The review was followed up with a questionnaire-based survey of consultant haematologists, and a general agreement towards a protocol-based use of vitamin K(1) was noted. The reasons for limited use of vitamin K(1) include the lack of studies and guidelines specifically addressing the pre-operative emergency admissions. We highlight a practical problem shared across different specialities and identify the areas for future studies
|
0 |
Bisphosphonate-induced periprosthetic fracture: a cause of painful total hip arthroplasty
|
PJI DX Updated Search
|
Background. Cases have been reported in the literature of periprosthetic fractures associated with the use of bisphosphonates occurring in the long term following a Total Hip Replacement (THR). We report an interesting case of periprosthetic fracture secondary to bisphosphonate use only a few months after a THR. Case Report. A 72-year-old lady (on bisphosphonates for 10 years) underwent a THR for osteoarthritis. She was pain-free in the first four months postoperatively. Thereafter, she developed spontaneous onset of pain in the lateral aspect of her thigh and groin and found it difficult to weight-bear. X-rays and blood tests were unremarkable. An ultrasound and MRI scan showed no evidence of effusion/collection or periprosthetic fracture. A radionuclide bone scan showed an abnormal appearance of the right femoral shaft. A subsequent CT scan showed an oblique vertical split on the anterior surface of the upper right femoral shaft. This stress fracture was managed nonoperatively with protected weight bearing. She has progressed well with good clinical and radiological signs of fracture healing. Conclusion. This case is an important addition to our knowledge that bisphosphonate-induced periprosthetic stress fractures can be a cause of hip pain only a few months following a THR
|
1 |
Neonatal hip screening
|
Developmental Dysplasia of the Hip CPG
|
CONTEXT: A "missed" case of congenital hip dislocation (CDH) can be a disaster for the patient and the outcome may be poor. Considerable resources are expended on screening programmes to identify appropriate cases early but a recent change in terminology to developmental dysplasia of the hip (DDH) and a realisation that neonatal hip maturation is poorly understood has made it difficult to know who should be screened and why. STARTING POINT: Neonatal hip screening is well established although some experts feel that the effectiveness of clinical let alone ultrasound screening programmes is unproven. Several European countries undertake population screening, while selective screening occurs in 93% of UK units. K Holen and colleagues recently reported (J Bone Joint Surg 2002; 84-B: 886-90) a prospective randomised trial of just over 15 500 newborn babies in which they compare universal and selective screening programmes. With a follow-up of 6-11 years, one late-detected hip dysplasia was seen in the universal group compared with six in the selective group (not statistically significant). These investigators found, on the background of an excellent clinical programme, no additional benefit from universal screening and thus advocate selective screening. WHERE NEXT: The aims of a screening programme must be defined, then evaluated. A consideration of costs can never take into account family pain and distress. The results of the universal screening programme in Coventry, UK, are impressive and significantly better than results from other UK centres. If the Coventry results are the gold standard, then it is necessary to work out how this can be achieved elsewhere rather than worry about whether it is unachievable
|
0 |
Abrogation of TGF beta signaling in mammary carcinomas recruits Gr-1+CD11b+ myeloid cells that promote metastasis
|
MSTS 2018 - Femur Mets and MM
|
Aberrant TGFbeta signaling is common in human cancers and contributes to tumor metastasis. Here, we demonstrate that Gr-1+CD11b+ myeloid cells are recruited into mammary carcinomas with type II TGF beta receptor gene (Tgfbr2) deletion and directly promote tumor metastasis. Gr-1+CD11b+ cells infiltrate into the invasive front of tumor tissues and facilitate tumor cell invasion and metastasis through a process involving metalloproteinase activity. This infiltration of Gr-1+CD11b+ cells also results in increased abundance of TGF beta 1 in tumors with Tgfbr2 deletion. The recruitment of Gr-1+CD11b+ cells into tumors with Tgfbr2 deletion involves two chemokine receptor axes, the SDF-1/CXCR4 and CXCL5/CXCR2 axes. Together, these data indicate that Gr-1+CD11b+ cells contribute to TGFbeta-mediated metastasis through enhancing tumor cell invasion and metastasis.
|
0 |
Neck of Femur Fracture in a Patient with a Chronic Osteomyelitis of the Ipsilateral Foot
|
DoD LSA (Limb Salvage vs Amputation)
|
This case report describes a successful two-stage treatment in a 75-year-old male with a displaced neck of femur fracture, also suffering from an active chronic osteomyelitis of the ipsilateral calcaneus. In our case, a below-knee amputation was performed first, followed by total hip arthroplasty two weeks later. At 15-month follow-up, full recovery of the prefracture level of activities of daily living without significant impairment was obtained. Only a few cases of total hip arthroplasty in amputees have been published, but the indication for surgery was mainly traumatic or advanced osteoarthritis. Treating patients with this type of comorbidities is challenging; therapeutic dilemmas can be major. The management in cases like these requires a thorough evaluation and a clear surgical and medical treatment plan, preferably conducted by a multidisciplinary orthogeriatric team.
|
1 |
Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review
|
Trial Systematic Review Project
|
PURPOSE: To report the outcomes and complications of reverse shoulder arthroplasty (RSA) in massive irreparable rotator cuff tears (MIRCT) and cuff tear arthropathy (CTA).
METHODS: A systematic review of the literature contained in Medline, Cochrane, EMBASE, Google Scholar and Ovid databases was conducted on May 1, 2016, according to PRISMA guidelines. The key words "reverse total shoulder arthroplasty" or "reverse total shoulder prostheses" with "rotator cuff tears"; "failed rotator cuff surgery"; "massive rotator cuff tears"; "irreparable rotator cuff tears"; "cuff tear arthropathy"; "outcomes"; "complications" were matched. All articles reporting outcomes and complications of RSA for the management of MIRCT or CTA were included. The comparison between preoperative and postoperative clinical scores, as well as range of motion (ROM), was performed using the Wilcoxon-Mann-Whitney test. P values lower than 0.05 were considered statistically significant.
RESULTS: Seven articles were included in our qualitative synthesis. A statistically significant improvement in all clinical scores and ROM was found comparing the preoperative value with the postoperative value. The degrees of retroversion of the humeral stem of the RSA do not influence the functional outcomes in a statistically significant fashion. There were 17.4% of complications. The most frequent was heterotopic ossification, occurring in 6.6% of patients. Revision surgery was necessary in 7.3% of patients.
CONCLUSIONS: RSA restores pain-free ROM and improves function of the shoulder in patients with MIRCT or CTA. However, complications occur in a high percentage of patients. The lack of level I studies limits the real understanding of the potentials and limitations of RSA for the management of MIRCT and CTA.
|
0 |
Musculoskeletal rehabilitation: current understandings and future directions
|
HipFx Supplemental Cost Analysis
|
This work examines the current state of knowledge regarding the efficacy of rehabilitation for patients with major lower-extremity joint replacements, hip fractures, and amputations. Of particular focus is the use of inpatient rehabilitation strategies for functional restoration. These areas of rehabilitation involve common conditions in the elderly population. Cost-containment pressures have highlighted the focus on the efficacy of inpatient rehabilitation for persons with joint replacements in particular. Medicare's "75% rule" specifically limits persons with elective joint replacements from entering rehabilitation units after their surgeries. This article highlights research relevant to these issues and was written to examine the state of knowledge about these topics with the goal of highlighting areas that need more research attention
|
0 |
Platelet aggregation inhibitors, platelet function testing, and blood loss in hip fracture surgery
|
AAHKS (8) Anesthetic Infiltration
|
Background: The purpose of our prospective study was to analyze how many patients with hip fractures are on treatment with platelet aggregation inhibitors (aspirin and clopidogrel), how many of these patients have impaired platelet function as measured by the PFA-100, and whether there is an association between perioperative blood loss and either intake of platelet inhibitors or platelet function. Methods: Four hundred sixty-two patients with hip fractures were investigated. Surgery (most commonly dynamic screw fixation and hemiarthroplasty) was performed on day 1.3 (in patients on clopidogrel on day 3). Platelet function analysis was performed with the PFA-100, using the collagen and epinephrine closure time. Transfusion requirement and drain blood loss were measured. Results: Ninety-eight patients (21%) were on treatment with aspirin, of those, 64 patients (65%) had impaired platelet function. Twenty-two patients (5%) were on clopidogrel, of those, 15 patients (68%) had impaired platelet function. Of the patients without platelet aggregation inhibitors, 29% had impaired platelet function. Mortality, major bleeding, red blood cell requirement, and drainage blood loss did not correlate with platelet aggregation inhibitor intake or platelet function. Conclusions: It is not possible to predict the platelet function by asking patients about intake of aspirin or clopidogrel. Perioperative blood loss did not correlate with either history of platelet aggregation inhibitor intake or platelet function as determined by PFA-100. Therefore, the measurement of platelet function is of little clinical relevance in patients with hip fractures. In patients treated with aspirin, surgery should not be delayed, and patients on clopidogrel can be operated on 3 days after stopping the drug without increased bleeding risk. Copyright © 2010 by Lippincott Williams & Wilkins.
|
0 |
Covering of calf and foot defects by microsurgical techniques (free flaps)
|
DoD LSA (Limb Salvage vs Amputation)
|
Introduction: The progress seen in the treatment of traumas allows the rescue of the severely lesioned inferior limbs, which used to have primary amputation indication or were considered as lethal. The essential condition for this attitude is the adequate covering with soft tissues in the immediate period after the trauma occurrence, which frequently requires free tissue transfer. Methods: The study has been run on the polytrauma patients with severe defects in the calf and ankle parts (59 cases with free flaps) operated in the Surgery Clinic no. 1 of Cluj, in the Plastic Surgery University Clinic of Recovery Hospital of Cluj, and the Orthopaedics Clinic of Constanţa County Hospital. Results: The main complications appeared after the free transfer were the infections and the microvascular complications, from the mere congestion of the flap, to ischemia / tissue necroses. The flap which managed cover the largest tissue loss was the latissimus flap, that was able to cover the entire posterior compartment of the calf. Conclusions: The aggressive treatment of the acute trauma to the inferior limbs has good results. The protocol should allow the one stage reconstruction, in order to close the wound as soon as possible. Preserve the functionality of the affected foot-calf has been obtained. The sooner the covering takes place, the better are the results. The free microsurgical transfers constitute the election method for complex soft parts defects for calf and foot. Copyright © 2012 Celsius.
|
1 |
Evolving clinical and scientific concepts of upper extremity electrical trauma
|
DOD - Acute Comp Syndrome CPG
|
In conclusion, the pathogenesis of electrical injury is more complex than previously thought. Cellular damage occurs both by heating and electroporation. The relative contributions of heat and electroporation depend on the duration of electric current passage, the orientation of the cells, their location, and other factors. If the contact is brief, nonthermal mechanisms of cell damage may be most important. If the contact is much longer, heat damage will be most destructive. The characteristic time before heat damage predominates is probably a function of the electrical field strength in the tissue. If heat damage predominates, the injury may not be limited just to the plasma membrane but to other cell membranes as well. This is unlikely to be reversible. These parameters should also determine the pattern of injury. Damage by Joule heating is not known to be dependent on cell size, whereas larger cells are more vulnerable to membrane breakdown by electroporation. Cells do survive transient plasma membrane rupture under appropriate circumstances. Thus, if electroporation is the mechanism of damage, injured tissue may be salvageable; the challenge is to identify a technique that promptly reseals the damaged membranes. Current therapy requires a fully staffed and equipped intensive care unit, available operating suites, and the full range of available medical specialists. Major teaching hospitals are usually the prime candidates for operating an electric trauma unit. After initial resuscitation, efforts should be directed primarily toward preventing additional tissue loss mediated through a compartment syndrome. Renal and cardiac failure resulting from the release of intracellular muscle contents into the circulation must be prevented. Attention can then be directed toward maximizing tissue salvage and preventing late skeletal and neuromuscular complications. Finally, complex reconstructive procedures are needed to optimize the functional value of the remaining tissue. The eventual reconstructive goals should be kept in mind throughout the acute care of the patient.
|
1 |
Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
We assessed the efficacy of perioperative antibiotic prophylaxis for surgery in a randomized, double-blind trial of 1218 patients undergoing herniorrhaphy or surgery involving the breast, including excision of a breast mass, mastectomy, reduction mammoplasty, and axillary-node dissection. The prophylactic regimen was a single dose of cefonicid (1 g intravenously) administered approximately half an hour before surgery. The patients were followed up for four to six weeks after surgery. Blinding was maintained until the last patient completed the follow-up and all diagnoses of infection had been made. The patients who received prophylaxis had 48 percent fewer probable or definite infections than those who did not (Mantel-Haenszel risk ratio, 0.52; 95 percent confidence interval, 0.32 to 0.84; P = 0.01). For patients undergoing a procedure involving the breast, infection occurred in 6.6 percent of the cefonicid recipients (20 of 303) and 12.2 percent of the placebo recipients (37 of 303); for those undergoing herniorrhaphy, infection occurred in 2.3 percent of the cefonicid recipients (7 of 301) and 4.2 percent of the placebo recipients (13 of 311). There were comparable reductions in the numbers of definite wound infections (Mantel-Haenszel risk ratio, 0.49), wounds that drained pus (risk ratio, 0.43), Staphylococcus aureus wound isolates (risk ratio, 0.49), and urinary tract infections (risk ratio, 0.40). There were also comparable reductions in the need for postoperative antibiotic therapy, non-routine visits to a physician for problems involving wound healing, incision and drainage procedures, and readmission because of problems with wound healing. We conclude that perioperative antibiotic prophylaxis with cefonicid is useful for herniorrhaphy and certain types of breast surgery.
|
0 |
Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Knee osteoarthritis (OA) is a painful condition causing disability and muscle weakness. Shortwave diathermy (SWD) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice. However, the efficacy of SWD in knee OA is still inconclusive. AIM: The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain, function, muscle strength, quality of life and depression in patients with OA. DESIGN: This was a randomised, controlled clinical trial. SETTING: Inpatient Physiotherapy Department. POPULATION: Forty women aged between 42 and 74 years, with a diagnosis of bilateral primary knee OA. METHODS: Patients were sequentially randomized into two groups. Group 1 (N.=20) received SWD and isokinetic muscular strengthening exercises. Group 2 (N.=20) served as control group and they received isokinetic exercises only. Both of the programs were performed three days a week, for a duration of four weeks, and a total of 12 sessions. Patients were assessed before treatment (BT), after treatment (AT), and at a threeâ?month followâ?up (F). Outcome measures included visual analogue scale, Western Ontario and McMaster University Osteoarthritis Index, six minute walking distance, isokinetic muscle testing, Short Form 36 and Beck depression index. RESULTS: The patients with OA in each group had significant improvements in pain, disability, depression, walking distance, muscle strength, and quality of life AT and F when compared with their initial status (P<0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between ATâ?BT test and Fâ?BT test (P>0.05) except some isokinetic peak torque measurements (Fâ?BT scores of extension right 60°, 120° and flexion right 60°). CONCLUSION: Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain, disability, walking distance, muscle strength, quality of life and depression in patients with knee OA. CLINICAL REHABILITATION IMPACT: Considering the time and cost of combination therapy is now, the isokinetic exercise program, as it is efficient, may be preferable for the treatment of knee OA, alone.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.