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Muthu S, Viswanathan VK, Sakthivel M, Thabrez M. Does progress in microfracture techniques necessarily translate into clinical effectiveness? World J Orthop 2024; 15:266-284. [DOI: 10.5312/wjo.v15.i3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/21/2023] [Accepted: 01/23/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND Multitudinous advancements have been made to the traditional microfracture (MFx) technique, which have involved delivery of various acellular 2nd generation MFx and cellular MFx-III components to the area of cartilage defect. The relative benefits and pitfalls of these diverse modifications of MFx technique are still not widely understood.
AIM To comparatively analyze the functional, radiological, and histological outcomes, and complications of various generations of MFx available for the treatment of cartilage defects.
METHODS A systematic review was performed using PubMed, EMBASE, Web of Science, Cochrane, and Scopus. Patients of any age and sex with cartilage defects undergoing any form of MFx were considered for analysis. We included only randomized controlled trials (RCTs) reporting functional, radiological, histological outcomes or complications of various generations of MFx for the management of cartilage defects. Network meta-analysis (NMA) was conducted in Stata and Cochrane’s Confidence in NMA approach was utilized for appraisal of evidence.
RESULTS Forty-four RCTs were included in the analysis with patients of mean age of 39.40 (± 9.46) years. Upon comparing the results of the other generations with MFX-I as a constant comparator, we noted a trend towards better pain control and functional outcome (KOOS, IKDC, and Cincinnati scores) at the end of 1-, 2-, and 5-year time points with MFx-III, although the differences were not statistically significant (P > 0.05). We also noted statistically significant Magnetic resonance observation of cartilage repair tissue score in the higher generations of microfracture (weighted mean difference: 17.44, 95% confidence interval: 0.72, 34.16, P = 0.025; without significant heterogeneity) at 1 year. However, the difference was not maintained at 2 years. There was a trend towards better defect filling on MRI with the second and third generation MFx, although the difference was not statistically significant (P > 0.05).
CONCLUSION The higher generations of traditional MFx technique utilizing acellular and cellular components to augment its potential in the management of cartilage defects has shown only marginal improvement in the clinical and radiological outcomes.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
- Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore 641021, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur 639004, Tamil Nadu, India
| | | | - Manoharan Sakthivel
- Department of Orthopaedics, Government Medical College, Karur 639004, Tamil Nadu, India
| | - Mohammed Thabrez
- Department of Medical Oncology, Aster Medcity Hospital, Kochi 682034, India
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Zhanaspayev A, Bokembayev N, Zhanaspayev M, Tlemissov A, Aubakirova S, Prokazyuk A. Correction method for moderate and severe degrees of hallux valgus associated with transfer metatarsalgia. World J Orthop 2024; 15:238-246. [DOI: 10.5312/wjo.v15.i3.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/07/2024] [Accepted: 02/29/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND Hallux valgus (HV) is a common foot deformity that manifests with increasing age, especially in women. The associated foot pain causes impaired gait and decreases quality of life. Moderate and severe HV is a deformity that is characterized by the involvement of lesser rays and requires complex surgical treatment. In this study, we attempted to develop a procedure for this condition.
AIM To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.
METHODS We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems. This method included a modified Lapidus procedure, M2M3 tarsometatarsal arthrodesis, intermetatarsal fusion of the M4 and M5 bases, and the use of an original external fixation apparatus to enhance correction power. Preoperative, postoperative, and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared, and P values < 0.05 were considered to indicate statistical significance.
RESULTS The study included 28 females (93.3%) and 2 males feet (6.7%), 20 (66.7%) of whom had a moderate degree of HV and 10 (33.3%) of whom had severe deformity. M2 and M3 metatarsalgia was observed in 21 feet, and 9 feet experienced pain only at M2. The mean follow-up duration was 11 months. All patients had good correction of the HV angle [preoperative median, 36.5 degrees, interquartile range (IQR): 30-45; postoperative median, 10 degrees, IQR: 8.8-10; follow-up median, 11.5 degrees, IQR: 10-14; P < 0.01]. At follow-up, metatarsalgia was resolved in most patients (30 vs 5). There was a clinically negligible decrease in the corrected angles at the final follow-up, and the overall AOFAS score was significantly better (median, 65 points, IQR: 53.8-70; vs 80 points, IQR: 75-85; P < 0.01).
CONCLUSION The developed method showed good sustainability of correction power in a small sample of patients at the one-year follow-up. Randomized clinical trials with larger samples, as well as long-term outcome assessments, are needed in the future.
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Affiliation(s)
- Amangasy Zhanaspayev
- Department of Traumatology and Orthopaedics, The National Scientific Center of Traumatology and Orthopaedics Named after Academician Batpenov ND, Astana 010000, Kazakhstan
| | - Nurlan Bokembayev
- Department of Traumatology and Paediatric Surgery, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey 071400, Kazakhstan
| | - Marat Zhanaspayev
- Department of Traumatology and Paediatric Surgery, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey 071400, Kazakhstan
| | - Aidos Tlemissov
- Department of Habilitation and Rehabilitation, Center of Habilitation and Rehabilitation of Persons with Disabilities of the Abai Region, Semey 071400, Kazakhstan
| | - Sabina Aubakirova
- Department of Traumatology and Paediatric Surgery, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey 071400, Kazakhstan
| | - Alexander Prokazyuk
- Department of Anaesthesiology and Resuscitation, Center of Nuclear Medicine and Oncology, Semey 071400, Kazakhstan
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Nogueira DMB, Rosso MPDO, Buchaim DV, Zangrando MSR, Buchaim RL. Update on the use of 45S5 bioactive glass in the treatment of bone defects in regenerative medicine. World J Orthop 2024; 15:204-214. [DOI: 10.5312/wjo.v15.i3.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
Bone regeneration is a critical area in regenerative medicine, particularly in orthopedics, demanding effective biomedical materials for treating bone defects. 45S5 bioactive glass (45S5 BG) is a promising material because of its osteoconductive and bioactive properties. As research in this field continues to advance, keeping up-to-date on the latest and most successful applications of this material is imperative. To achieve this, we conducted a comprehensive search on PubMed/MEDLINE, focusing on English articles published in the last decade. Our search used the keywords “bioglass 45S5 AND bone defect” in combination. We found 27 articles, and after applying the inclusion criteria, we selected 15 studies for detailed examination. Most of these studies compared 45S5 BG with other cement or scaffold materials. These comparisons demonstrate that the addition of various composites enhances cellular biocompatibility, as evidenced by the cells and their osteogenic potential. Moreover, the use of 45S5 BG is enhanced by its antimicrobial properties, opening avenues for additional investigations and applications of this biomaterial.
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Affiliation(s)
- Dayane Maria Braz Nogueira
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | | | - Daniela Vieira Buchaim
- Medical School, University Center of Adamantina, Adamantina 17800-000, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marília, Marília 17525-902, Brazil
| | | | - Rogério Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
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Wu X, Gao B. Meta-analysis of the clinical efficacy of the Gamma3 nail vs Gamma3U-blade system in the treatment of intertrochanteric fractures. World J Orthop 2024; 15:285-292. [DOI: 10.5312/wjo.v15.i3.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures. Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence. However, comparative studies between the Gamma3U-blade and Gamma3 systems are limited; hence, this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.
AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.
METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed, Cochrane, CNKI, Wanfang, and VIP databases. The search keywords were gamma 3, gamma 3 U blade, and intertrochanteric fracture. Additionally, literature tracking was performed on the references of published literature. The data were analyzed using Revman 5.3 software. Two individuals checked the inputs for accuracy. Continuous variables were described using mean difference and standard deviation, and outcome effect sizes were expressed using ratio OR and 95% confidence interval (CI). High heterogeneity was considered at (P < 0.05, I2 > 50%), moderate heterogeneity at I2 from 25% to 50%, and low heterogeneity at (P ≥ 0.05, I2 < 50%).
RESULTS Following a comprehensive literature search, review, and analysis, six articles were selected for inclusion in this study. This selection comprised five articles in English and one in Chinese, with publication years spanning from 2016 to 2022. The study with the largest sample size, conducted by Seungbae in 2021, included a total of 304 cases. Statistical analysis: A total of 1063 patients were included in this meta-analysis. The main outcome indicators were: Surgical time: The Gamma3U blade system had a longer surgical time compared to Gamma3 nails (P = 0.006, I2 = 76%). Tip-apex distance: No statistical significance or heterogeneity was observed (P = 0.65, I2 = 0%). Harris Hip score: No statistical significance was found, and low heterogeneity was detected (P = 0.26, I2 = 22%). Union time: No statistical significance was found, and high heterogeneity was detected (P = 0.05, I2 = 75%).
CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures. Both surgical methods proved to be safe and effective for this patient group. These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.
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Affiliation(s)
- Xuan Wu
- Department of Orthopedic, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Bo Gao
- Department of Orthopedic, The Affiliated Taizhou Second People's Hospital of Yangzhou University, Taizhou 225500, Jiangsu Province, China
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Öztürk R. Cyclops syndrome following anterior cruciate ligament reconstruction: Can relapse occur after surgery? World J Orthop 2024; 15:201-203. [DOI: 10.5312/wjo.v15.i3.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/26/2024] [Accepted: 02/29/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
Symptomatic cyclops lesions are complications that can be seen at rates of up to approximately 10% after anterior cruciate ligament reconstruction. However, recurrent cyclops lesions have rarely been documented. There are case rare series in the literature regarding the treatment of recurrent cyclops lesion. Future large studies are needed to investigate factors contributing to the development of cyclops lesions and syndrome and treatment options.
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Affiliation(s)
- Recep Öztürk
- Department of Orthopedic Oncology, University Hospital Essen, Essen 45143, Germany
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Hamans B, de Waard S, Kaarsemaker S, Janssen ERC, Sierevelt IN, Kerkhoffs GMMJ, Haverkamp D. Mid-term survival of the Optimys short stem: A prospective case series of 500 patients. World J Orthop 2024; 15:257-265. [DOI: 10.5312/wjo.v15.i3.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND In recent years, there has been an increase in the number of total hip arthroplasty procedures in the younger patient population. This active group has higher expectations of their prosthesis in comparison to the older population, and there is a greater physical demand for the prosthesis. Short femoral stems were introduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population. Currently, the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.
AIM To determine the 5-year survival of the Optimys hip stem.
METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands. All patients received the Optimys short stem (Mathys Ltd, Bettlach, Switzerland). The primary outcome measure was survival of the hip stem, with revision as the endpoint. The secondary outcome measurements included patient-reported outcome measures (PROMs). Kaplan-Meier analysis was used to calculate the 5-year survival rate. Log-minus-log transformation was performed to calculate the 95% confidence interval (95%CI). Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery. Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.
RESULTS The mean age of the total 500 patients was 62.3 years (standard deviation: 10.6) and 202 were male (40%). At a median follow-up of 5.5 years (interquartile range: 4.5-6.7), 7 patients were deceased and 6 revisions were registered, for infection (n = 3), subsidence (n = 2) and malposition (n = 1). This resulted in an overall 5-year survival of 98.8% (95%CI: 97.3-99.5). If infection was left out as reason for revision, a stem survival of 99.4% (95%CI: 98.1-99.8) was seen. Baseline questionnaires were completed by 471 patients (94%), 317 patients (63%) completed the 1-year follow-up questionnaires and 233 patients (47%) completed the 2-year follow-up. Both outcome measures significantly improved across all domains in the 1st year after the operation (P < 0.03 for all domains). In the 2nd year after surgery, no significant changes were observed in any domain in comparison to the 1-year follow-up.
CONCLUSION The Optimys stem has a 5-year survival of 98.8%. Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.
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Affiliation(s)
- Bryan Hamans
- Department of Orthopaedic Surgery, Xpert Clinic, Amsterdam 1101EA, Netherlands
| | - Sheryl de Waard
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam 1105 AZ, Netherlands
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, Viecuri Medisch Centrum, Venlo 5912 BL, Netherlands
| | - Esther R C Janssen
- Department of Orthopaedic Surgery, Viecuri Medisch Centrum, Venlo 5912 BL, Netherlands
| | - Inger N Sierevelt
- Centre for Orthopaedic Research, Spaarne Ziekenhuis, Hoofddorp 2134 TM, Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
| | - Daniël Haverkamp
- Department of Orthopedic Surgery, Xpert Orthopedic Surgery Clinic, Amsterdam 1101 EA, Netherlands
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Wu CJ, Penrose C, Ryan SP, Bolognesi MP, Seyler TM, Wellman SS. Subsequent total joint arthroplasty: Are we learning from the first stage? World J Orthop 2024; 15:230-237. [DOI: 10.5312/wjo.v15.i3.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedures.
AIM To determine if both physicians and patients learn from the patient’s initial arthroplasty, resulting in improved outcomes following the second procedure.
METHODS The institutional database was retrospectively queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients with only unilateral THA or TKA, and patients undergoing same-day bilateral TJA, were excluded. Patient demographics, comorbidities, and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery. Outcome metrics evaluated included operative time, length of stay (LOS), disposition, 90-d readmissions and emergency department (ED) visits.
RESULTS A total of 642 patients, including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA, were analyzed. There was no significant difference in demographics or comorbidities between the first and second procedure, which were separated by a mean of 285 d. For THA and TKA, LOS was significantly less for the second surgery, with 66% of patients having a shorter hospitalization (P < 0.001). THA patients had significantly decreased operative time only when the same sized implant was utilized (P = 0.025). The vast majority (93.3%) of patients were discharged to the same type of location following their second surgery. However, when a change in disposition was present from the first surgery, patients were significantly more likely to be discharged to home after the second procedure (P = 0.033). There was no difference between procedures for post-operative readmissions (P = 0.438) or ED visits (P = 0.915).
CONCLUSION After gaining valuable experience recovering from the initial surgery, a patient’s perioperative outcomes are improved for their second TJA. This may be the result of increased confidence and decreased anxiety, and it supports the theory that enhanced patient education pre-operatively may improve outcomes. For the surgical team, the second procedure of a staged THA is more efficient, although this finding did not hold for TKA.
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Affiliation(s)
- Christine Jiang Wu
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Colin Penrose
- Department of Orthopaedic Surgery, Midwest Center for Joint Replacement, Indianapolis, IN 46241, United States
| | - Sean Patrick Ryan
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Michael Paul Bolognesi
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Thorsten Markus Seyler
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Samuel Secord Wellman
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
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Sakellariou E, Alevrogiannis P, Alevrogianni F, Galanis A, Vavourakis M, Karampinas P, Gavriil P, Vlamis J, Alevrogiannis S. Single-center experience with Knee+™ augmented reality navigation system in primary total knee arthroplasty. World J Orthop 2024; 15:247-256. [DOI: 10.5312/wjo.v15.i3.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years, as they enhance precision compared to conventional hardware. The expansion of computer assistance is evolving with the employment of augmented reality. Yet, the accuracy of augmented reality navigation systems has not been determined.
AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty (TKA), utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.
METHODS From May 2021 to December 2021, 30 patients, 25 women and five men, underwent a primary unilateral TKA. Revision cases were excluded. A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment. All patients were operated on by the same team, without a tourniquet, utilizing three distinct prostheses with the assistance of the Knee+™ augmented reality navigation system in every operation. Postoperatively, the same radiographic exam protocol was executed to evaluate the implants’ position, orientation and coronal plane alignment. We recorded measurements in 3 stages regarding femoral varus and flexion, tibial varus and posterior slope. Firstly, the expected values from the Augmented Reality system were documented. Then we calculated the same values after each cut and finally, the same measurements were recorded radiologically after the operations. Concerning statistical analysis, Lin’s concordance correlation coefficient was estimated, while Wilcoxon Signed Rank Test was performed when needed.
RESULTS A statistically significant difference was observed regarding mean expected values and radiographic measurements for femoral flexion measurements only (Z score = 2.67, P value = 0.01). Nonetheless, this difference was statistically significantly lower than 1 degree (Z score = -4.21, P value < 0.01). In terms of discrepancies in the calculations of expected values and controlled measurements, a statistically significant difference between tibial varus values was detected (Z score = -2.33, P value = 0.02), which was also statistically significantly lower than 1 degree (Z score = -4.99, P value < 0.01).
CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized. Augmented reality navigation systems can bolster orthopaedic surgeons’ accuracy in achieving precise axial alignment. However, further research is required to further evaluate their efficacy and potential.
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Affiliation(s)
- Evangelos Sakellariou
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Panagiotis Alevrogiannis
- The 1st Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, Attikon General Hospital, Athens 14561, Greece
| | - Fani Alevrogianni
- Department of Anesthesiology, KAT General Hospital, Athens 14561, Greece
| | - Athanasios Galanis
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Michail Vavourakis
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Panagiotis Karampinas
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Panagiotis Gavriil
- The 1st Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, Attikon General Hospital, Athens 14561, Greece
| | - John Vlamis
- The 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens 14561, Greece
| | - Stavros Alevrogiannis
- Department of Robotic Hip & Knee Orthopaedic Surgery, Metropolitan General Hospital, Athens 14561, Greece
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Fang C, Premchand AXR, Park DH, Toon DH. Peri-articular elbow fracture fixations with magnesium implants and a review of current literature: A case series. World J Orthop 2024; 15:215-229. [DOI: 10.5312/wjo.v15.i3.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND In recent years, the use of Magnesium alloy implants have gained renewed popularity, especially after the first commercially available Conformité Européenne approved Magnesium implant became available (MAGNEZIX® CS, Syntellix) in 2013.
AIM To document our clinical and radiographical outcomes using magnesium implants in treating peri-articular elbow fractures.
METHODS Our paper was based on a retrospective case series design. Intra-operatively, a standardized surgical technique was utilized for insertion of the magnesium implants. Post – operatively, clinic visits were standardized and physical exam findings, functional scores, and radiographs were obtained at each visit. All complications were recorded.
RESULTS Five patients with 6 fractures were recruited (2 coronoid, 3 radial head and 1 capitellum). The mean patient age and length of follow up was 54.6 years and 11 months respectively. All fractures healed, and none exhibited loss of reduction or complications requiring revision surgery. No patient developed synovitis of the elbow joint or suffered electrolytic reactions when titanium implants were used concurrently.
CONCLUSION Although there is still a paucity of literature available on the subject and further studies are required, magnesium implants appear to be a feasible tool for fixation of peri-articular elbow fractures with promising results in our series.
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Affiliation(s)
- Christopher Fang
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
| | - Antony Xavier Rex Premchand
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
| | - Derek Howard Park
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
| | - Dong Hao Toon
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, National Healthcare Group, Singapore 768828, Singapore
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Daher M, Haykal G, Aoun M, Moussallem M, Ghoul A, Tarchichi J, Sebaaly A. Pulsed lavage in joint arthroplasty: A systematic review and meta-analysis. World J Orthop 2024; 15:293-301. [DOI: 10.5312/wjo.v15.i3.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND Knee and hip osteoarthritis affects millions of people around the world and is expected to rise even more in frequency as the population ages. Joint arthroplasty is the surgical management of choice in these articulations. Heterotopic ossification and radiolucent lines formation are two frequent problems faced in hip and knee replacements respectively. Some studies show that the usage of pulsed lavage may prevent their formation.
AIM To compare pulsed lavage to standard lavage in joint arthroplasty.
METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched till December 2023. Only comparative studies were included. The clinical outcomes evaluated were the heterotopic ossification formation in hip replacements, radiolucent lines formation, and functional knee scores in knee replacements.
RESULTS Four studies met the inclusion criteria and were included in this meta-analysis. Pulsed lavage was shown to reduce the formation of radiolucent lines (P = 0.001). However, no difference was seen in the remaining outcomes
CONCLUSION Pulsed lavage reduced the formation of radiolucent lines in knee replacements. No difference was seen in the remaining outcomes. Furthermore, the clinical significance of these radiolucent lines is poorly understood. Better conducted randomized controlled studies and cost-effectivity studies are needed to reinforce these findings.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Gaby Haykal
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Marven Aoun
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Marc Moussallem
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Ali Ghoul
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Jean Tarchichi
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
| | - Amer Sebaaly
- Department of Orthopedics, Saint Joseph University, Beirut 1001, Lebanon
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Noguchi T, Sakamoto A, Kakehi K, Matsuda S. New method of local adjuvant therapy with bicarbonate Ringer’s solution for tumoral calcinosis: A case report. World J Orthop 2024; 15:302-309. [DOI: 10.5312/wjo.v15.i3.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/06/2024] [Accepted: 01/24/2024] [Indexed: 03/15/2024] [Imported: 03/15/2024] Open
Abstract
BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues, occurring in hemodialysis patients. Calcium phosphate crystals are mainly composed of hydroxyapatite, which is highly infiltrative to tissues, thus making complete resection difficult. An adjuvant method to remove or resolve the residual crystals during the operation is necessary.
CASE SUMMARY A bicarbonate Ringer’s solution with bicarbonate ions (28 mEq/L) was used as the adjuvant. After resecting calcium phosphate deposits of tumoral calcinosis as much as possible, while filling with the solution, residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field. A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders, bilateral hip joints, and the right foot. A shoulder lesion was resected, but the calcification remained and early re-deposition was observed. Considering the difficulty of a complete rection, we devised a bicarbonate dissolution method and excised the foot lesion. After resection of the calcified material, the residual calcified material was washed away with bicarbonate Ringer’s solution.
CONCLUSION The bicarbonate dissolution method is a new, simple, and effective treatment for tumoral calcinosis in hemodialysis patients.
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Affiliation(s)
- Takashi Noguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Kensaku Kakehi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Katzman JL, Habibi AA, Haider MA, Cardillo C, Fernandez-Madrid I, Meftah M, Schwarzkopf R. Mid-term outcomes of a kinematically designed cruciate retaining total knee arthroplasty. World J Orthop 2024; 15:118-128. [PMID: 38464356 PMCID: PMC10921185 DOI: 10.5312/wjo.v15.i2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty (TKA) outcomes. A cruciate retaining (CR) TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament. Limited research exists that has examined clinical outcomes or patient reported outcome measures (PROMs) of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant. It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores. AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design. METHODS A retrospective, multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System (JOURNEY™ II CR; Smith and Nephew, Inc., Memphis, TN) at an urban, academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon. Patient demographics, surgical information, clinical outcomes, and PROMs data were collected via query of electronic medical records. The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and Patient-Reported Outcomes Measurement Information System (PROMIS®) scores. The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests. RESULTS Of the 255 patients, 65.5% were female, 43.8% were White, and patients had an average age of 60.6 years. Primary osteoarthritis (96.9%) was the most common primary diagnosis. The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home (92.5%). There were 18 emergency department (ED) visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%, including a 2.4% orthopedic-related ED visit rate and a 4.7% non-orthopedic-related ED visit rate. There were three (1.2%) hospital readmissions within 90 d postoperatively. With a mean time to latest follow-up of 3.3 years, four patients (1.6%) required revision, two for arthrofibrosis, one for aseptic femoral loosening, and one for peri-prosthetic joint infection. There were significant improvements in KOOS JR, PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Mobility, and PROMIS Physical Health from preoperative scores to six month and two-year postoperative scores. CONCLUSION The evaluated implant is an effective, novel design offering excellent outcomes and low complication rates. At a mean follow up of 3.3 years, four patients required revisions, three aseptic and one septic, resulting in an overall implant survival rate of 98.4% and an aseptic survival rate of 98.8%. The results of our study demonstrate the utility of this kinematically designed implant in the setting of primary TKA.
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Affiliation(s)
- Jonathan L Katzman
- Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY 10010, United States
| | - Akram A Habibi
- Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY 10010, United States
| | - Muhammad A Haider
- Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY 10010, United States
| | - Casey Cardillo
- Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY 10010, United States
| | - Ivan Fernandez-Madrid
- Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY 10010, United States
| | - Morteza Meftah
- Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY 10010, United States
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY 10010, United States
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Feng H, Feng ML, Cheng JB, Zhang X, Tao HC. Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty. World J Orthop 2024; 15:180-191. [PMID: 38464355 PMCID: PMC10921178 DOI: 10.5312/wjo.v15.i2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a mature procedure recommended for correcting knee osteoarthritis deformity, relieving pain, and restoring normal biomechanics. Although TKA is a successful and cost-effective procedure, patient dissatisfaction is as high as 50%. Knee pain after TKA is a significant cause of patient dissatisfaction; the most common location for residual pain is the anterior region. Between 4% and 40% of patients have anterior knee pain (AKP). AIM To investigate the effect of various TKA procedures on postoperative AKP. METHODS We searched PubMed, EMBASE, and Cochrane from January 2000 to September 2022. Randomized controlled trials with one intervention in the experimental group and no corresponding intervention (or other interventions) in the control group were collected. Two researchers independently read the title and abstract of the studies, preliminarily screened the articles, and read the full text in detail according to the selection criteria. Conflicts were resolved by consultation with a third researcher. And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software. RESULTS There were 25 randomized controlled trials; 13 were comparative studies with or without patellar resurfacing. The meta-analysis showed no significant difference between the experimental and control groups (P = 0.61). Six studies were comparative studies of circumpatellar denervation vs non-denervation, divided into three subgroups for meta-analysis. The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups (P = 0.31, P = 0.50). One subgroup meta-analysis showed a significant difference between the experimental and control groups (P = 0.001). Two studies compared fixed-bearing TKA and mobile-bearing TKA; the results meta-analysis showed no significant difference between the experimental and control groups (P = 0.630). Two studies compared lateral retinacular release vs non-release; the meta-analysis showed a significant difference between the experimental and control groups (P = 0.002); two other studies compared other factors. CONCLUSION Patellar resurfacing, mobile-bearing TKA, and fixed-bearing TKA do not reduce the incidence of AKP. Lateral retinacular release can reduce AKP; however, whether circumpatellar denervation can reduce AKP is controversial.
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Affiliation(s)
- Hui Feng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ming-Li Feng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing-Bo Cheng
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiang Zhang
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hai-Cheng Tao
- Department of Orthopaedic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Pace V, Bronzini F, Novello G, Mosillo G, Braghiroli L. Review and update on the management of triangular fibrocartilage complex injuries in professional athletes. World J Orthop 2024; 15:110-117. [PMID: 38464359 PMCID: PMC10921179 DOI: 10.5312/wjo.v15.i2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
Triangular fibrocartilage complex injuries are common in amateur and professional sports. These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist, particularly on the ulnar side and in association with rotations or radial/ulnar deviations. In order to treat professional athletes, a detailed specific knowledge of the pathology is needed. Moreover, the clinician should fully understand the specific and unique environment and needs of the athletes, their priorities and goals, the type of sport, the time of the season, and the position played. An early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon. A compromise between conservative vs surgical indications, athletes' needs and expectations, and financial implications should be achieved. Arthroscopic procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same time. Conservative measures are often used as first line treatment when possible. Peripheral lesions are treated by arthroscopic repair, whilst central lesions are treated by arthroscopic debridement. Further procedures (such as the Wafer procedure, ulnar osteotomies, etc.) have specific indications and great implications with regard to rehabilitation.
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Affiliation(s)
- Valerio Pace
- Department of Trauma and Orthopaedics, AOSP Terni, Terni 05100, Italy
| | - Francesco Bronzini
- Department of Trauma and Orthopaedics, University of Perugia, Perugia 06100, Italy
| | - Giovanni Novello
- Department of Trauma and Orthopaedics, University of Perugia, Perugia 06100, Italy
| | - Giuseppe Mosillo
- Department of Trauma and Orthopaedics, Hand Unit, AOSP Terni, Terni 05100, Italy
| | - Luca Braghiroli
- Department of Trauma and Orthopaedics, Hand Unit, AOSP Terni, Terni 05100, Italy
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Okoro T, Wan M, Mukabeta TD, Malev E, Gross M, Williams C, Manjra M, Kuiper JH, Murnaghan J. Assessment of the effectiveness of weight-adjusted antibiotic administration, for reduced duration, in surgical prophylaxis of primary hip and knee arthroplasty. World J Orthop 2024; 15:170-179. [PMID: 38464351 PMCID: PMC10921182 DOI: 10.5312/wjo.v15.i2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of post-operative surgical site infections (SSI) in orthopaedic surgery. The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed, for the duration of the operation, the minimum inhibitory concentration of the likely organisms that are encountered. Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4% and 8% to between 1% and 3%. Controversy, however, still surrounds the optimal frequency and dosing of antibiotic administration. AIM To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime, combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty. METHODS Following ethical approval, patients undergoing primary total hip arthroplasty (THA)/total knee arthroplasty (TKA) with the old regime (OR) of a preoperative dose [cefazolin 2 g intravenously (IV)], and two subsequent doses (2 h and 8 h), were compared to those after a change to a new regime (NR) of a weight-adjusted preoperative dose (cefazolin 2 g IV for patients < 120 kg; cefazolin 3g IV for patients > 120 kg) and a post-operative dose at 2 h. The primary outcome in both groups was SSI rates during the 2 years post-operatively. RESULTS A total of n = 1273 operations (THA n = 534, TKA n = 739) were performed in n = 1264 patients. There was no statistically significant difference in the rate of deep (OR 0.74% (5/675) vs NR 0.50% (3/598); fishers exact test P = 0.72), nor superficial SSIs (OR 2.07% (14/675) vs NR 1.50% (9/598); chi-squared test P = 0.44) at 2 years post-operatively. With propensity score weighting and an interrupted time series analysis, there was also no difference in SSI rates between both groups [RR 0.88 (95%CI 0.61 to 1.30) P = 0.46]. CONCLUSION A weight-adjusted regime, with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.
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Affiliation(s)
- Tosan Okoro
- Department of Arthroplasty, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, United Kingdom
- School of Medicine, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - Michael Wan
- St Joseph’s Health Centre, Unity Health Toronto, Toronto M6R 1B5, Canada
| | - Takura Darlington Mukabeta
- Department of Arthroplasty, The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, United Kingdom
| | - Ella Malev
- Department of Arthroplasty, Sunnybrook Holland Orthopaedic and Arthritis Centre, Toronto M4Y 1H1, Canada
| | - Marketa Gross
- Department of Arthroplasty, Sunnybrook Holland Orthopaedic and Arthritis Centre, Toronto M4Y 1H1, Canada
| | - Claudia Williams
- Department of Arthroplasty, Sunnybrook Holland Orthopaedic and Arthritis Centre, Toronto M4Y 1H1, Canada
| | - Muhammad Manjra
- Department of Arthroplasty, Sunnybrook Holland Orthopaedic and Arthritis Centre, Toronto M4Y 1H1, Canada
| | - Jan Herman Kuiper
- Institute for Science and Technology in Medicine, Keele University, Staffordshire ST5 1BG, United Kingdom
| | - John Murnaghan
- Department of Arthroplasty, Sunnybrook Holland Orthopaedic and Arthritis Centre, Toronto M4Y 1H1, Canada
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Anastasio AT, Baumann AN, Walley KC, Hitchman KJ, O’Neill C, Kaplan J, Adams SB. Academic productivity correlates with industry earnings in foot and ankle fellowship programs in the United States: A retrospective analysis. World J Orthop 2024; 15:129-138. [PMID: 38464357 PMCID: PMC10921177 DOI: 10.5312/wjo.v15.i2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships. Utilizing metrics like the H-index and Open Payments Database (OPD) data, it addresses a gap in understanding the relationship between scholarly achievements and financial outcomes, providing a basis for further exploration in this specialized medical field. AIM To elucidate the trends between academic productivity and industry earnings across foot and ankle orthopedic surgery fellowship programs in the United States. METHODS This study is a retrospective analysis of the relationship between academic productivity and industry earnings of foot and ankle orthopedic surgery fellowships at an individual faculty and fellowship level. Academic productivity was defined via H-index and recorded from the Scopus website. Industry earnings were recorded from the OPD. RESULTS Forty-eight foot and ankle orthopedic surgery fellowships (100% of fellowships) in the United States with a combined total of 165 physicians (95.9% of physicians) were included. Mean individual physician (n = 165) total life-time earnings reported on the OPD website was United States Dollar (USD) 451430.30 ± 1851084.89 (range: USD 25.16-21269249.85; median: USD 27839.80). Mean physician (n = 165) H-index as reported on Scopus is 14.24 ± 12.39 (range: 0-63; median: 11). There was a significant but weak correlation between individual physician H-index and individual physician total life-time earnings (P < 0.001; Spearman's rho = 0.334) and a significant and moderate positive correlation between combined fellowship H-index and total life-time earnings per fellowship (P = 0.004, Spearman's rho = 0.409). CONCLUSION There is a significant and positive correlation between academic productivity and industry earnings at foot and ankle orthopedic surgery fellowships in the United States. This observation is true on an individual physician level as well as on a fellowship level.
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Affiliation(s)
- Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, United States
| | - Kempland C Walley
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Kyle J Hitchman
- School of Osteopathic Medicine, Campbell University, Lillington, NC 27546, United States
| | - Conor O’Neill
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Jonathan Kaplan
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC 27710, United States
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Mishra A, Barakat A, Mangwani J, Kazda J, Tiwatane S, Shaikh SMA, Houchen-Wolloff L, Kaushik V. Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery. World J Orthop 2024; 15:163-169. [PMID: 38464352 PMCID: PMC10921181 DOI: 10.5312/wjo.v15.i2.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss, improve visualization in the surgical field, and to potentially reduce surgical time. There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure, placement site, and duration of use. There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery. AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery. METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken. Intraoperative tourniquet duration, tourniquet pressure and site, and postoperative pain scores using Visual Analogue Score were collected in immediate recovery, at six hours and at 24 h post-op. Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure, duration, site, and pain scores using Pearson correlation coefficient. RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh. There was no correlation between the site of the tourniquet and pain scores in recovery, at six hours and after 24 h. There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op (r = 0.14, P = 0.04) but not at six or 24 h post-operatively. CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure, site and post-op pain in patients undergoing foot and ankle surgery. The choice of using a tourniquet is based on the surgeon's preference, with the goal of minimizing the duration of its application at the operative site.
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Affiliation(s)
- Ashish Mishra
- Department of Trauma and Orthopedics, University Hospitals Leicester, Leicester LE1 5WW, United Kingdom
| | - Ahmed Barakat
- Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, Leicester LE1 5WW, Leicestershire, United Kingdom
| | - Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
| | - Jakub Kazda
- Department of Anaesthesia, York & Scarborough Teaching Hospitals NHS Foundation Trust, North Yorkshire YO31 8HE, United Kingdom
| | - Sagar Tiwatane
- Department of Anaesthesia, Royal Free London NHS Trust, London NW3 2QG, United Kingdom
| | | | - Linzy Houchen-Wolloff
- Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
| | - Vipul Kaushik
- Department of Anasthesia, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom
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Hussain A, Lee C, Hu E, Amirouche F. Deep learning automation of radiographic patterns for hallux valgus diagnosis. World J Orthop 2024; 15:105-109. [PMID: 38464350 PMCID: PMC10921175 DOI: 10.5312/wjo.v15.i2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
Artificial intelligence (AI) and deep learning are becoming increasingly powerful tools in diagnostic and radiographic medicine. Deep learning has already been utilized for automated detection of pneumonia from chest radiographs, diabetic retinopathy, breast cancer, skin carcinoma classification, and metastatic lymphadenopathy detection, with diagnostic reliability akin to medical experts. In the World Journal of Orthopedics article, the authors apply an automated and AI-assisted technique to determine the hallux valgus angle (HVA) for assessing HV foot deformity. With the U-net neural network, the authors constructed an algorithm for pattern recognition of HV foot deformity from anteroposterior high-resolution radiographs. The performance of the deep learning algorithm was compared to expert clinician manual performance and assessed alongside clinician-clinician variability. The authors found that the AI tool was sufficient in assessing HVA and proposed the system as an instrument to augment clinical efficiency. Though further sophistication is needed to establish automated algorithms for more complicated foot pathologies, this work adds to the growing evidence supporting AI as a powerful diagnostic tool.
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Affiliation(s)
- Angela Hussain
- Department of Orthopaedic Surgery, University of Illinois College of Medicine, Chicago, IL 60612, United States
| | - Cadence Lee
- Department of Orthopaedic Surgery, University of Illinois College of Medicine, Chicago, IL 60612, United States
| | - Eric Hu
- Department of Orthopaedic Surgery, University of Illinois College of Medicine, Chicago, IL 60612, United States
| | - Farid Amirouche
- Department of Orthopaedics Surgery, University of Illinois at Chicago, Chicago, IL 60612, United States
- Department of Orthopaedic Surgery, Northshore University Health System, Skokie, IL 6007, United States
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Nyring MRK, Olsen BS, Amundsen A, Rasmussen JV. High rate of clinically relevant improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis. World J Orthop 2024; 15:156-162. [PMID: 38464358 PMCID: PMC10921174 DOI: 10.5312/wjo.v15.i2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
BACKGROUND The minimal clinically important difference (MCID) is defined as the smallest meaningful change in a health domain that a patient would identify as important. Thus, an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient. AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis. METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital, Denmark. The patients were evaluated preoperatively and 3 months, 6 months, 12 months, and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), Oxford Shoulder Score (OSS) and Constant-Murley Score (CMS). The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID. Based on previous literature, MCID for WOOS, OSS, and CMS were defined as 12.3, 4.3, and 12.8 respectively. RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis. Mean age at the time of surgery was 66 years (range 49.0-79.0, SD: 8.3) and 65% were women. One patient was revised within the two years follow-up. The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points [95% confidence interval (95%CI): 39.7-53.3, P < 0.005] for WOOS, 18.2 points (95%CI: 15.5-21.0, P < 0.005) for OSS and 37.8 points (95%CI: 31.5-44.0, P < 0.005) for CMS. Two years postoperatively, 41 patients (87%) had an improvement in WOOS that exceeded the MCID, 45 patients (94%) had an improvement in OSS that exceeded the MCID, and 42 patients (88%) had an improvement in CMS that exceeded the MCID. CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90% of patients has a clinically relevant improvement. This is a clear message when informing patients about their prognosis.
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Affiliation(s)
- Marc Randall Kristensen Nyring
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark
| | - Bo Sanderhoff Olsen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark
| | - Alexander Amundsen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark
| | - Jeppe Vejlgaard Rasmussen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Denmark
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AlOmran AK, Alosaimi N, Alshaikhi AA, Bakhurji OM, Alzahrani KJ, Salloot BZ, Alabduladhem TO, AlMulhim AI, Alumran A. Burden of routine orthopedic implant removal a single center retrospective study. World J Orthop 2024; 15:139-146. [PMID: 38464354 PMCID: PMC10921180 DOI: 10.5312/wjo.v15.i2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures, sparking ongoing discourse over whether to retain or remove asymptomatic implants. Achieving consensus on this matter is paramount for orthopedic surgeons. This study aims to quantify the impact of routine implant removal on patients and healthcare facilities. A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University (KFHU) was conducted and subjected to statistical scrutiny. Among these cases, 44% necessitated hospitalization exceeding one day, while 56% required only a single day. Adults exhibited a 55% need for extended hospital stays, contrasting with 22.8% among the pediatric cohort. The complication rate was 6%, with all patients experiencing at least one complication. Notably, 34.1% required sick leave and 4.8% exceeded 14 d. General anesthesia was predominant (88%). Routine implant removal introduces unwarranted complications, particularly in adults, potentially prolonging hospitalization. This procedure strains hospital resources, tying up the operating room that could otherwise accommodate critical surgeries. Clearly defined institutional guidelines are imperative to regulate this practice. AIM To measure the burden of routine implant removal on the patients and hospital. METHODS This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU, a tertiary hospital in Saudi Arabia. Data were collected in the orthopedic department at KFHU from February 2016 to August 2022, which includes routine asymptomatic implant removal cases across all age categories. Nonroutine indications such as infection, pain, implant failure, malunion, nonunion, restricted range of motion, and prominent hardware were excluded. Patients who had external fixators removed or joints replaced were also excluded. RESULTS Between February 2016 and August 2022, 360 implants were retrieved; however, only 167 of those who met the inclusion criteria were included in this study. The remaining implants were rejected due to exclusion criteria. Among the cases, 44% required more than one day in the hospital, whereas 56% required only one day. 55% of adults required more than one day of hospitalization, while 22.8% of pediatric patients required more than one day of inpatient care. The complication rate was 6%, with each patient experiencing at least one complication. Sick leave was required in 34.1% of cases, with 4.8% requiring more than 14 d. The most common type of anesthesia used in the surgeries was general anesthesia (88%), and the mean (SD) surgery duration was 77.1 (54.7) min. CONCLUSION Routine implant removal causes unnecessary complications, prolongs hospital stays, depletes resources and monopolizing operating rooms that could serve more critical procedures.
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Affiliation(s)
- Ammar K AlOmran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Nader Alosaimi
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed A Alshaikhi
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Omar M Bakhurji
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Khalid J Alzahrani
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Basil Ziyad Salloot
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Tamim Omar Alabduladhem
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed I AlMulhim
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology Department, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
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21
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Sun JY, Li C, Du FY. Adenylate cyclase activates the cAMP signalling pathway to enhance platelet-rich plasma-treated Achilles tendon disease, a theoretical bioinformatics-based study. World J Orthop 2024; 15:192-200. [PMID: 38464349 PMCID: PMC10921184 DOI: 10.5312/wjo.v15.i2.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
The effectiveness of platelet-rich plasma (PRP) for the treatment of Achilles tendon disorders still needs to be evaluated through a series of prospective studies, but genomic analysis can reveal the existence of complementary PRP treatment options. Based on the 96 platelet activation-related genes in the Kyoto Encyclopedia of Genes and Genomes (KEGG) database, we performed Gene Ontology functional enrichment analysis and KEGG enrichment analysis, pathway correlation analysis, and enrichment mapping to determine the enrichment results of the gene set enrichment analysis and found that the cAMP signalling pathway may be the key to enhancing the effectiveness of PRP treatment. The cAMP signalling pathway interacts with the Rap1 signalling pathway and cGMP-PKG signalling pathway to mediate the entire pathophysiological process of Achilles tendon disease. Moreover, ADCY1-9 may be the key to the activation of the cAMP signalling network. Further based on the data in the Gene Expression Omnibus database, it was found that ADCY4 and ADCY7 may be the players that play a major role, associated with the STAT4-ADCY4-LAMA5 axis and the GRbeta-ADCY7-SEMA3C axis, which is expected to be a complementary target for enhancing the efficacy of PRP in the treatment of Achilles tendon disease.
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Affiliation(s)
- Jing-Yi Sun
- College of Basic Medical Science, Qilu Medical University, Zibo 255300, Shandong Province, China
| | - Cai Li
- College of Basic Medical Science, Qilu Medical University, Zibo 255300, Shandong Province, China
| | - Feng-Ying Du
- Department of Gastroenterological Surgery, Shandong Provincial Hospital of Shandong First Medical University, Jinan 250021, Shandong Province, China
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22
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Wu JJ, Xian HM, Yang DW, Yang F. Mitochondrial dysfunction in type 2 diabetes: A neglected path to skeletal muscle atrophy. World J Orthop 2024; 15:101-104. [PMID: 38464360 PMCID: PMC10921183 DOI: 10.5312/wjo.v15.i2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
Over the course of several decades, robust research has firmly established the significance of mitochondrial pathology as a central contributor to the onset of skeletal muscle atrophy in individuals with diabetes. However, the specific intricacies governing this process remain elusive. Extensive evidence highlights that individuals with diabetes regularly confront the severe consequences of skeletal muscle degradation. Deciphering the sophisticated mechanisms at the core of this pathology requires a thorough and meticulous exploration into the nuanced factors intricately associated with mitochondrial dysfunction.
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Affiliation(s)
- Jian-Jun Wu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Hui-Min Xian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Da-Wei Yang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Fan Yang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 30000, China
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23
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Hoveidaei AH, Niakan R, Hosseini-Asl SH, Annasamudram A, Conway JD. Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States: An analysis of geographical distribution, academic, leadership, and demographic characteristics. World J Orthop 2024; 15:147-155. [PMID: 38464353 PMCID: PMC10921176 DOI: 10.5312/wjo.v15.i2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/25/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] [Imported: 02/07/2024] Open
Abstract
BACKGROUND The Limb Lengthening and Reconstruction Society (LLRS) is a premier orthopedic specialty organization that promotes limb reconstruction for all ages. LLRS membership characteristics, however, are poorly reported. This study delineates orthopedic surgeon LLRS members' demographic traits, academic achievement, leadership attainment, and geographical distribution across the United States. AIM To inform aspiring orthopedic professionals, as well as to promote growth and diversity in both the LLRS organization and overarching field. METHODS This cross-sectional study examined United States LLRS members' academic, leadership, demographic, and geographical attributes. After reviewing the 2023 LLRS member directory, Google search results were matched to the listings and appended to the compiled data. Sex and ethnicity were evaluated visually utilizing retrieved images. The Hirsch index (H-index) of academic activity, residency and fellowship training, other graduate degrees, leadership positions, practice type (academic or non-academic), and spoken languages were categorized. LLRS members per state and capita determined geographic distribution. The Mann-Whitney U test was applied to compare H-index between males and females, as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities. RESULTS The study included 101 orthopedic surgeons, 78 (77.23%) Caucasian and 23 (22.77%) non-Caucasian, 79 (78.22%) male and 22 (21.78%) female. Surgeons with DO degrees comprised only 3.96% (4) of the cohort, while the vast majority held MDs [96.04% (97)]. Mean H-index was 10.55, with male surgeons having a significantly higher score (P = 0.002). Most orthopedic surgeons (88.12%,) practiced in academic centers. Of those professionals who occupied leadership positions, 14% were women, while 86% were men. Additionally, 19 (37.25%) United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon. Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people. CONCLUSION Over 21% of LLRS members are women, surpassing prior benchmarks noted in orthopedic faculty reporting. LLRS members' high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space. Gender disparities in leadership remain, however, necessitating greater equity efforts. A low rate of LLRS representation per capita must be addressed geographically as well, to affect improvements in regional care access. This study can serve to support aspiring orthopedic professionals, inform diversity, leadership, and field advancement strategies, and maintain the continued goal of enhanced patient care worldwide.
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Affiliation(s)
- Amir Human Hoveidaei
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
| | - Reza Niakan
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 73, Iran
| | | | - Abijith Annasamudram
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
| | - Janet D Conway
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
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Klahs KJ, Dertinger JE, Mello GT, Thapa K, Sandler AB, Garcia EJJ, Parnes N. Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study. World J Orthop 2024; 15:52-60. [PMID: 38293264 PMCID: PMC10824061 DOI: 10.5312/wjo.v15.i1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types: Supracondylar (SC), lateral condyle (LC), and medial epicondyle (ME) fractures. AIM To evaluate the epidemiology of pediatric distal humerus fractures (SC, LC, and ME) from an American insurance claims database. METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC, LC and ME fractures based on the IBM Truven MarketScan® Commercial and IBM Truven MarketScan Medicare Supplemental databases. Patients from 2015 to 2020 were queried for treatments, patient age, sex, length of hospitalization, and comorbidities. RESULTS A total of 1133 SC, 154 LC, and 124 ME fractures were identified. SC fractures had the highest percentage of operation at 83%, followed by LC (78%) and ME fractures (41%). Male patients were, on average, older than female patients for both SC and ME fractures. CONCLUSION In the insurance claims databases used, SC fractures were the most reported, followed by LC fractures, and finally ME fractures. Age was identified to be a factor for how a pediatric distal humerus fractures, with patients with SC and LC fractures being younger than those with ME fractures. The peak age per injury per sex was similar to reported historic central tendencies, despite reported trends for younger physiologic development.
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Affiliation(s)
- Kyle Jay Klahs
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences-El Paso, El Paso, TX 79905, United States
| | - Jake E Dertinger
- Medical School, California Health Sciences University College of Osteopathic Medicine, Clovis, CA 93611, United States
| | - Grant T Mello
- Medical School, California Health Sciences University College of Osteopathic Medicine, Clovis, CA 93611, United States
| | - Kevin Thapa
- Undergraduate School, Binghampton University, Vestal, NY 13902, United States
| | - Alexis B Sandler
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences-El Paso, El Paso, TX 79905, United States
| | - E'Stephan J Jesus Garcia
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, NY 13619, United States
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25
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Mastrantonakis K, Karvountzis A, Yiannakopoulos CK, Kalinterakis G. Mechanisms of shoulder trauma: Current concepts. World J Orthop 2024; 15:11-21. [PMID: 38293258 PMCID: PMC10824064 DOI: 10.5312/wjo.v15.i1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/08/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
Acute traumatic injuries to the glenohumeral articulation are common. The types of injuries depend on age, muscle strength, bone density, and biomechanics of the traumatic event. Understanding the different mechanisms of trauma and how they affect the functional anatomical structures of the shoulder joint is crucial for the treatment of these lesions. Therefore, when clinicians have knowledge of these mechanisms they can accurately diagnose and treat shoulder pathology and predict distinct injury patterns. Here, we have described the fundamentals of the mechanisms of injury of the glenohumeral dislocation, dislocation with fracture of the humeral head, and the proximal humerus fracture. We have focused on common injury mechanisms and the correlation with radiological diagnostics. Radiological and laboratory findings of distinct types of injury were also discussed.
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Affiliation(s)
| | | | - Christos K Yiannakopoulos
- Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
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26
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Wiik A, Ashdown T, Holloway I. Health economics for intra-capsular hip fractures undertaking fixation. World J Orthop 2024; 15:30-38. [PMID: 38293259 PMCID: PMC10824066 DOI: 10.5312/wjo.v15.i1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/26/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
BACKGROUND Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide. The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation. AIM To determine the most beneficial method of fixation for patients with intra-capsular hip fractures. METHODS A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods. Patient notes, electronic records and clinical codes for cost benefit were evaluated. A validated quality of life measure was collected at least 1 year after surgery. RESULTS A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period. There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age, gender, co-morbidities and fracture configuration. There was no significant difference in blood loss, tip apex distance, radiation exposure, length of stay, radiological union time, collapse, avascular necrosis or re-operation between fixation methods. Logistic regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of 7.25. There were 9 (19%) and 4 (11%) patients respectively, who required re-operation. There was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual analogue scores. CONCLUSION No significant advantage was identified with differing fixation type, but irrespective there were a high number of patients requiring re-operation. This was predicted by initial fracture displacement and patient age. Arthroplasty may need to be carefully considered for health economics and patient benefit.
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Affiliation(s)
- Anatole Wiik
- Department of Surgery, Trauma and Orthopaedics, London North West University Healthcare, London HA1 3UJ, United Kingdom
| | - Thomas Ashdown
- Department of Surgery, Trauma and Orthopaedics, London North West University Hospital, London HA1 3UJ, United Kingdom
| | - Ian Holloway
- Department of Surgery, Trauma and Orthopaedics, London North West University Hospital, London HA1 3UJ, United Kingdom
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27
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Chen ZR, Liao SJ, Yang FC. Surgical treatment of an old avulsion fracture of the ischial tuberosity and ischial ramus: A case report. World J Orthop 2024; 15:94-100. [PMID: 38293263 PMCID: PMC10824063 DOI: 10.5312/wjo.v15.i1.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities. According to previous literature, the most commonly involved sports are soccer, sprinting, and gymnastics, in descending order. Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare. CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip. She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior. Eventually, she underwent surgery and obtained satisfactory treatment results. CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery. For old fractures with nonunion and chronic buttock pain, surgery is a preferred therapeutic choice with good treatment outcomes.
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Affiliation(s)
- Zi-Ru Chen
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shi-Jie Liao
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Fu-Chun Yang
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Nitiwarangkul L, Hongku N, Pattanaprateep O, Rattanasiri S, Woratanarat P, Thakkinstian A. Which approach of total hip arthroplasty is the best efficacy and least complication? World J Orthop 2024; 15:73-93. [PMID: 38293261 PMCID: PMC10824060 DOI: 10.5312/wjo.v15.i1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function. Approaches of the hip have been exhaustively explored about pros and cons. The efficacy and the complications of hip approaches remains inconclusive. This study conducted an umbrella review to systematically appraise previous meta-analysis (MAs) including conventional posterior approach (PA), and minimally invasive surgeries as the lateral approach (LA), direct anterior approach (DAA), 2-incisions method, mini-lateral approach and the newest technique direct superior approach (DSA) or supercapsular percutaneously-assisted total hip (SuperPath). AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials (RCTs). METHODS MAs were identified from MEDLINE and Scopus from inception until 2023. RCTs were then updated from the latest MA to September 2023. This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score (HHS), dislocation, intra-operative fracture, wound complication, nerve injury, operative time, operative blood loss, length of hospital stay, incision length and VAS pain. Data were independently selected, extracted and assessed by two reviewers. Network MA and cluster rank and surface under the cumulative ranking curve (SUCRA) were estimated for treatment efficacy and safety. RESULTS Finally, twenty-eight MAs (40 RCTs), and 13 RCTs were retrieved. In total 47 RCTs were included for reanalysis. The results of corrected covered area showed high degree (13.80%). Among 47 RCTs, most of the studies were low risk of bias in part of random process and outcome reporting, while other domains were medium to high risk of bias. DAA significantly provided higher HHS at three months than PA [pooled unstandardized mean difference (USMD): 3.49, 95% confidence interval (CI): 0.98, 6.00 with SUCRA: 85.9], followed by DSA/SuperPath (USMD: 1.57, 95%CI: -1.55, 4.69 with SUCRA: 57.6). All approaches had indifferent dislocation and intraoperative fracture rates. SUCRA comparing early functional outcome and composite complications (dislocation, intra-operative fracture, wound complication, and nerve injury) found DAA was the best approach followed by DSA/SuperPath. CONCLUSION DSA/SuperPath had better earlier functional outcome than PA, but still could not overcome the result of DAA. This technique might be the other preferred option with acceptable complications.
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Affiliation(s)
- Lertkong Nitiwarangkul
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Orthopaedics Surgery, Police General Hospital, Bangkok 10330, Thailand
| | - Natthapong Hongku
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindrahiraj University, Bangkok 10300, Thailand
| | - Oraluck Pattanaprateep
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sasivimol Rattanasiri
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Patarawan Woratanarat
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ammarin Thakkinstian
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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29
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Zeng JF, Xie YY, Liu C, Song ZQ, Xu Z, Tang ZW, Wen J, Xiao S. Effective time, correction speed and termination time of hemi-epiphysiodesis in children. World J Orthop 2024; 15:1-10. [PMID: 38293262 PMCID: PMC10824067 DOI: 10.5312/wjo.v15.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
In children with asymmetric growth on the medial and lateral side of limbs, if there still remains growth potential, the guided growth technique of hemi-epiphysiodesis on one side of the epiphysis is recognized as a safe and effective method. However, when the hemi-epiphysiodesis start to correct the deformities, how many degrees could hemi-epiphysiodesis bring every month and when to remove the hemi-epiphysiodesis implant without rebound phenomenon are still on debate. This article reviews the current studies focus on the effective time, correction speed and termination time of hemi-epiphysiodesis.
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Affiliation(s)
- Jian-Fa Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Yu-Yin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Can Liu
- Department of Anatomy, Hunan Normal University school of Medicine, Changsha 410003, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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30
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McKenna DP, Price A, McAleese T, Dahly D, McKenna P, Cleary M. Acetabular cup size trends in total hip arthroplasty. World J Orthop 2024; 15:39-44. [PMID: 38293257 PMCID: PMC10824062 DOI: 10.5312/wjo.v15.i1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a common procedure for end stage osteoarthritis. The learning curve for THA is complex and challenging. One of the most difficult skills to master is acetabular reaming. We wish to identify if experience in arthroplasty leads to preservation of more bone stock. AIM To investigate if increasing surgeon experience will predict an ever decreasing acetabular cup size. METHODS A retrospective case series of four attending orthopaedic surgeons was completed. All uncemented elective total hip arthroplasties since appointment were selected for inclusion. The size of acetabular cup used was noted and logistic regression was used to identify if a trend to smaller cups existed. RESULTS A total of 1614 subjects were included with a mean age of 64 years. Overall cups were on average 0.18mm smaller per year (95% confidence interval -0.25 to -0.11, P < 0.001). Individual surgeon trends showed cup sizes to decrease 0.27 mm/year for surgeon A, 0.02 mm/year for surgeon B, 0.15 mm/year for surgeon C and 0.29 mm/year for surgeon D. Three of the four surgeons had a more pronounced trend to smaller cups for male subjects than their female counterparts. CONCLUSION We found increasing surgeon experience to be associated with an ever-decreasing acetabular cup size. Smaller acetabular cup size may act as a surrogate marker of surgical proficiency by virtue of decreased acetabular reaming.
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Affiliation(s)
- Daniel Patrick McKenna
- Department of Trauma and Orthopaedics, University Hospital Waterford, Waterford X91 ER8E, Ireland
| | - Alex Price
- Department of Trauma and Orthopaedics, University Hospital Waterford, Waterford X91 ER8E, Ireland
| | - Timothy McAleese
- Department of Trauma and Orthopaedics, University Hospital Waterford, Waterford X91 ER8E, Ireland
| | - Darren Dahly
- Department of Epidemiology and Public Health, University College Cork, Cork T12 XF62, Ireland
| | - Paul McKenna
- Department of Trauma and Orthopaedics, University Hospital Waterford, Waterford X91 ER8E, Ireland
| | - May Cleary
- Department of Trauma and Orthopaedics, University Hospital Waterford, Waterford X91 ER8E, Ireland
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Charles T, Bloemers N, Kapanci B, Jayankura M. Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures. World J Orthop 2024; 15:22-29. [PMID: 38293256 PMCID: PMC10824065 DOI: 10.5312/wjo.v15.i1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/15/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1% to 17%. This serious complication is associated with increased morbidity and mortality rates. Approaches to this surgery are still debated, with no consensus regarding the superiority of any single approach. AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches (PL) for hip hemiarthroplasty after femoral neck fractures. METHODS This is a comparative, retrospective, single-center cohort study conducted at a university hospital. Between March 2008 and December 2018, 273 patients (a total of 280 hips) underwent bipolar hemiarthroplasties (n = 280) for displaced femoral neck fractures using either the PL (n = 171) or the minimally invasive direct anterior approach (DAA) (n = 109). The choice of approach was related to the surgeons' practices; the implant types were similar and unrelated to the approach. Dislocation rates and other complications were reviewed after a minimum follow-up of 6 mo. RESULTS Both treatment groups had similarly aged patients (mean age: 82 years), sex ratios, patient body mass indexes, and patient comorbidities. Surgical data (surgery delay time, operative time, and blood loss volume) did not differ significantly between the groups. The 30 d mortality rate was higher in the PL group (9.9%) than in the DAA group (3.7%), but the difference was not statistically significant (P = 0.052). Among the one-month survivors, a significantly higher rate of dislocation was observed in the PL group (14/154; 9.1%) than in the DAA group (0/105; 0%) (P = 0.002). Of the 14 patients with dislocation, 8 underwent revision surgery for recurrent instability (posterior group), and one of them had 2 additional procedures due to a deep infection. The rate of other complications (e.g., perioperative and early postoperative periprosthetic fractures and infection-related complications) did not differ significantly between the groups. CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate (< 1%) than the PL.
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Affiliation(s)
- Tatiana Charles
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Nicolas Bloemers
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Bilal Kapanci
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
| | - Marc Jayankura
- Department of Orthopedic Surgery and Traumatology, HUB-Hospital Erasme, Brussels 1070, Belgium
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Jin F, Wang YF, Zhu ZX. Association between serum estradiol level and appendicular lean mass index in middle-aged postmenopausal women. World J Orthop 2024; 15:45-51. [PMID: 38293265 PMCID: PMC10824069 DOI: 10.5312/wjo.v15.i1.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/13/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
BACKGROUND Previous studies investigating the association between loss of estrogen at menopause and skeletal muscle mass came to contradictory conclusions. AIM To evaluate the association between serum estradiol level and appendicular lean mass index in middle-aged postmenopausal women using population-based data. METHODS This study included 673 postmenopausal women, aged 40-59 years, from the National Health and Nutrition Examination Survey between 2013 and 2016. Weighted multivariable linear regression models were used to evaluate the association between serum E2 Level and appendicular lean mass index (ALMI). When non-linear associations were found by using weighted generalized additive model and smooth curve fitting, two-piecewise linear regression models were further applied to examine the threshold effects. RESULTS There was a positive association between serum E2 level and ALMI. Compared to individuals in quartile 1 group, those in other quartiles had higher ALMI levels. An inverted U-shaped curve relationship between serum E2 Level and ALMI was found on performing weighted generalized additive model and smooth curve fitting, and the inflection point was identified as a serum E2 level of 85 pg/mL. CONCLUSION Our results demonstrated an inverted U-shaped curve relationship between serum E2 levels and ALMI in middle-aged postmenopausal women, suggesting that low serum E2 levels play an important in the loss of muscle mass in middle-aged postmenopausal women.
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Affiliation(s)
- Fang Jin
- Department of Osteoporosis Care and Control, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Yan-Fei Wang
- Department of Osteoporosis Care and Control, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Zhong-Xin Zhu
- Department of Osteoporosis Care and Control, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou 311200, Zhejiang Province, China
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Phedy P, Dilogo IH, Indriatmi W, Supriadi S, Prasetyo M, Octaviana F, Noor Z. Scoliocorrector Fatma-UI for correction of adolescent idiopathic scoliosis: Development, effectivity, safety and functional outcome. World J Orthop 2024; 15:61-72. [PMID: 38293260 PMCID: PMC10824068 DOI: 10.5312/wjo.v15.i1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024] [Imported: 01/16/2024] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence, high risk, and high cost. One of the aims of the management in scoliosis is to correct the deformity. Many techniques are available to correct scoliosis deformity; however, they are all far from ideal to achieve three-dimensional correction in scoliosis. AIM To develop a set of tools named Scoliocorrector Fatma-UI (SCFUI) to aid three-dimensional correction and to evaluate the efficacy, safety, and functional outcome. METHODS This study consists of two stages. In the first stage, we developed the SCFUI and tested it in finite element and biomechanical tests. The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation (DVR). Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group (n = 23) and SCFUI group (n = 21). Radiological, neurological, and functional outcome was compared between the groups. RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2 - 252 MPa. Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324 ± 633277 MPa. Both groups showed improvement in Cobb angle and sagittal profile, however the rotation angle was lower in the SCFUI group (11.59 ± 7.46 vs 18.23 ± 6.39, P = 0.001). Neurological and functional outcome were comparable in both groups. CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR. The safety and functional outcomes were also similar to DVR.
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Affiliation(s)
- Phedy Phedy
- Doctoral Program in Medical Sciences Faculty of Medicine, University of Indonesia, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Universitas Indonesia, Jakarta 10430, DKI Jakarta, Indonesia
| | - Wresti Indriatmi
- Department of Dermatology and Venereology, Faculty of Medicine, University of Indonesia, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Sugeng Supriadi
- Faculty of Mechanical Engineering, University of Indonesia, Depok 16424, Jawa Barat, Indonesia
| | - Marcel Prasetyo
- Department of Radiology, University of Indonesia, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Fitri Octaviana
- Department of Neurology, Faculty of Medicine, University of Indonesia, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Zairin Noor
- Research Center for Osteoporosis, Department of Orthopaedic and Traumatology, Lambung Mangkurat University, Banjarmasin 70123, Kalimantan Selatan, Indonesia
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De Marchi Neto N, Nesello PFT, Bergamasco JM, Costa MT, Christian RW, Severino NR. Importance of computed tomography in posterior malleolar fractures: Added information to preoperative X-ray studies. World J Orthop 2023; 14:868-877. [PMID: 38173804 PMCID: PMC10758590 DOI: 10.5312/wjo.v14.i12.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 12/15/2023] [Imported: 12/15/2023] Open
Abstract
BACKGROUND Ankle fractures are common lesions of the lower limbs. Approximately 40% of ankle fractures affect the posterior malleolus (PM). Historically, PM osteosynthesis was recommended when PM size in X-ray images was greater than 25% of the joint. Currently, computed tomography (CT) has been gaining traction in the preoperative evaluation of ankle fractures. AIM To elucidate the similarity in dimensions and to correlate PM size in X-ray images with the articular surface of the affected tibial plafond in the axial view on CT (AXCT) of a PM fracture. METHODS Eighty-one patients (mean age: 39.4 ± 13.5 years) were evaluated (54.3% were male). Two independent examiners measured PM size in profile X-ray images (PMXR) and sagittal CT (SAGCT) slices. The correlation of the measurements between the examiners and the difference in the PM fragment sizes between the two images were compared. Next, the PM size in PMXR was compared with the surface of the tibial plafond involved in the fracture in AXCT according to the Haraguchi classification. RESULTS The correlation rates between the examiners were 0.93 and 0.94 for PMXR and SAGCT, respectively (P < 0.001). Fragments were 2.12% larger in SAGCT than in PMXR (P = 0.018). In PMXR, there were 56 cases < 25% and 25 cases ≥ 25%. When PMXR was < 25%, AXCT corresponded to 10.13% of the tibial plafond. When PMXR was ≥ 25%, AXCT was 24.52% (P < 0.001). According to the Haraguchi classification, fracture types I and II had similar PMXR measurements that were greater than those of type III. When analyzing AXCT, a significant difference was found between the three types, with II > I > III (P < 0.001). CONCLUSION PM fractures show different sizes using X-ray or CT images. CT showed a larger PM in the sagittal plane and allowed the visualization of the real dimensions of the tibial plafond surface.
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Affiliation(s)
- Noé De Marchi Neto
- Department of Orthopedics and Traumatology of the São Paulo Mercy Hospital (Santa Casa de São Paulo)-Fernandinho Simonsen Pavillion, Faculdade de Ciências Médicas da Santa Casa de São Paulo-Brazil, São Paulo 01221-020, Brazil
| | - Pietro Felice Tomazini Nesello
- Department of Orthopedics and Traumatology of the São Paulo Mercy Hospital (Santa Casa de São Paulo)-Fernandinho Simonsen Pavillion, Faculdade de Ciências Médicas da Santa Casa de São Paulo-Brazil, São Paulo 01221-020, Brazil
| | - Jordanna Maria Bergamasco
- Department of Orthopedics and Traumatology of the São Paulo Mercy Hospital (Santa Casa de São Paulo)-Fernandinho Simonsen Pavillion, Faculdade de Ciências Médicas da Santa Casa de São Paulo-Brazil, São Paulo 01221-020, Brazil
| | - Marco Tulio Costa
- Department of Orthopedics and Traumatology of the São Paulo Mercy Hospital (Santa Casa de São Paulo)-Fernandinho Simonsen Pavillion, Faculdade de Ciências Médicas da Santa Casa de São Paulo-Brazil, São Paulo 01221-020, Brazil
| | - Ralph Walter Christian
- Department of Orthopedics and Traumatology of the São Paulo Mercy Hospital (Santa Casa de São Paulo)-Fernandinho Simonsen Pavillion, Faculdade de Ciências Médicas da Santa Casa de São Paulo-Brazil, São Paulo 01221-020, Brazil
| | - Nilson Roberto Severino
- Department of Orthopedics and Traumatology of the São Paulo Mercy Hospital (Santa Casa de São Paulo)-Fernandinho Simonsen Pavillion, Faculdade de Ciências Médicas da Santa Casa de São Paulo-Brazil, São Paulo 01221-020, Brazil
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Zanchini F, Catani O, Sergio F, Boemio A, Sieczak A, Piscopo D, Risitano S, Colò G, Fusini F. Role of lateral soft tissues release in percutaneous hallux valgus correction: A medium term retrospective study. World J Orthop 2023; 14:843-852. [PMID: 38173806 PMCID: PMC10758593 DOI: 10.5312/wjo.v14.i12.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/12/2023] [Accepted: 11/17/2023] [Indexed: 12/15/2023] [Imported: 12/15/2023] Open
Abstract
BACKGROUND In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone, the synthesis or not of the metatarsal head, the possible association with lateral soft tissues release (LSTR) and osteotomy of the base of the first phalanx. AIM To evaluate the role of LSTR on percutaneous HV correction, evaluating functional and radiographical results. METHODS From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study. The technique provides no internal fixation (WOS). Patients were divided into the LSTR group and no LSTR group (LSTR N). This surgical procedure (LSTR) was reserved for insufficient HV angle (HVA) correction during fluoroscopic control. Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors (first practitioners). Clinical evaluation was performed before surgery, 6 mo after surgery, and 48 mo follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score was used to evaluate pain and function, and complications were recorded. In addition, the incidence of relapses and the degree of joint range of motion (ROM) with the association with the LSTR (capsule, adductor tendon, phalanx-sesamoid ligament, and the deep transverse metatarsal ligament) were evaluated. Radiological parameters included HVA and intermetatarsal angle (IMA). Patient satisfaction was assessed. Student t-test and Fisher exact test were used to assess statistical analysis. RESULTS From our study it is clear that no differences in term of HVA, VAS, IMA correction, rate of complications, and AOFAS score were found between groups, while a significant improvement of the same variables was found in each group between pre and postoperative values. A significant improvement in ROM at 6 mo (P = 0.018) and 48 mo (P = 0.02) of follow-up was found in LSTR N group. Complications were rare in both groups. CONCLUSION LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.
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Affiliation(s)
- Fabio Zanchini
- Division of Orthopaedics and Traumatology, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Ottorino Catani
- Department of Foot Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Fabrizio Sergio
- Department of Foot an Ankle Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Alessia Boemio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, AOU Luigi Vanvitelli, Napoli 80138, Italy
| | - Angelo Sieczak
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Davide Piscopo
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin 10126, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Alessandria 15121, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Cuneo 12084, Italy
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Allen S, Rashid A, Adjani A, Akram M, Khan FS, Sherwani R, Khalil MT. Efficacy and safety of thermobalancing therapy with Dr Allen's Device for chronic low back pain: A randomised controlled trial. World J Orthop 2023; 14:878-888. [PMID: 38173805 PMCID: PMC10758594 DOI: 10.5312/wjo.v14.i12.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/12/2023] [Accepted: 11/08/2023] [Indexed: 12/15/2023] [Imported: 12/15/2023] Open
Abstract
BACKGROUND Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients' health-related quality of life (HRQoL). Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen's Device can relieve chronic low back pain, there have been no randomised controlled trials for these indications. AIM To evaluate the efficacy of Dr Allen's Device in lumbar disc herniation (LDH) and non-specific low back pain (NSLBP). METHODS A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH (n = 28) or NSLBP (n = 27), out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group. The intervention was treatment with Dr Allen's Device for 3 mo. Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire. RESULTS Thermobalancing therapy with Dr Allen's Device showed a significant reduction in pain in the treatment group (P < 0.001), with no recorded adverse effects. Both pain assessment scales showed a significant improvement in patients' perception of pain indicating improvement in HRQoL. CONCLUSION The out-of-hospital use of Thermobalancing therapy with Dr Allen's Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects, improves the level of activity and HRQoL among patients with LDH and NSLBP. This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.
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Affiliation(s)
- Simon Allen
- Director and Head of Medical Research, Fine Treatment, Oxford OX2 7SL, United Kingdom
| | - Abid Rashid
- Director of Faculty of Medical Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Ariana Adjani
- Senior Researcher, Fine Treatment, Oxford OX2 7SL, United Kingdom
| | - Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Fahad Said Khan
- Faculty of Medical and Health Sciences, University of Poonch Rawalakot, Rawalakot 12350, Pakistan
| | - Rehan Sherwani
- College of Statistical and Actuarial Science, University of the Punjab, Lahore 54000, Pakistan
| | - Muhammad Talha Khalil
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad 38000, Pakistan
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Toro G, Braile A, Conza G, De Cicco A, Abu Mukh A, Placella G, Salini V. Unicompartimental knee arthroplasty metallosis treated with uni-on-uni revision: A case report. World J Orthop 2023; 14:889-896. [PMID: 38173807 PMCID: PMC10758592 DOI: 10.5312/wjo.v14.i12.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/15/2023] [Accepted: 11/09/2023] [Indexed: 12/15/2023] [Imported: 12/15/2023] Open
Abstract
BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response. Metallosis has been reported after total hip and total knee arthroplasty (TKA), but rarely after a unicompartimental knee arthroplasty (UKA). In the context of UKA metallosis, surgeons often opt for revision using a TKA. However, in this paper, the authors successfully treated UKA revising the metal back only. CASE SUMMARY Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA, ten (90.9%) were treated revising using though a TKA. Only one case was managed through a uni-on-uni revision, reporting high knee function. Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation. At 18 mo following surgical debridment and uni-on-uni revision surgery, our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood. CONCLUSION Our study highlights that in case of metallosis after UKA, the treatment may be based on surgical debridement and just revising the mobilized components.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Gianluca Conza
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Assala Abu Mukh
- Department of Orthopaedics and Traumatology, San Raffaele Hospital, Milan 20132, Italy
| | - Giacomo Placella
- Department of Orthopaedics and Traumatology, San Raffaele Hospital, Milan 20132, Italy
| | - Vincenzo Salini
- Department of Orthopaedics and Traumatology, San Raffaele Hospital, Milan 20132, Italy
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Green A, Walsh A, Al-Dadah O. Comparison of clinical outcomes between total hip replacement and total knee replacement. World J Orthop 2023; 14:853-867. [PMID: 38173808 PMCID: PMC10758591 DOI: 10.5312/wjo.v14.i12.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 12/15/2023] [Imported: 12/15/2023] Open
Abstract
BACKGROUND Total hip replacements (THR) and total knee replacements (TKR) are effective treatments for severe osteoarthritis (OA). Some studies suggest clinical outcomes following THR are superior to TKR, the reason for which remains unknown. This study compares clinical outcomes between THR and TKR. AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures (PROMs). METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre- and post-operatively. RESULTS A total of 131 patients were included in the study which comprised the THR group (68 patients) and the TKR group (63 patients). Both groups demonstrated significant post-operative improvements in all PROM scores (P < 0.001). There were no significant differences in post-operative PROM scores between the two groups: Hip and Knee Osteoarthritis Outcome scores (P = 0.140), Western Ontario and McMaster Universities Osteoarthritis Index pain (P = 0.297) stiffness (P = 0.309) and function (P = 0.945), Oxford Hip and Knee Score (P = 0.076), EuroQol-5D index (P = 0.386) and Short-Form 12-item survey physical component score (P = 0.106). Subgroup analyses showed no significant difference (P > 0.05) between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference (P > 0.05) between cemented and uncemented fixation in the THR group. Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR. CONCLUSION Contrary to some literature, THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs. The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome. Obesity had a greater influence on the outcome following TKR than that of THR.
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Affiliation(s)
- Alexander Green
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside NE34 0PL, United Kingdom
| | - Alex Walsh
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside NE34 0PL, United Kingdom
| | - Oday Al-Dadah
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside NE34 0PL, United Kingdom
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4HH, United Kingdom
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Albrahim IA, AlOmran AK, Bubshait DA, Tawfeeq Y, Alumran A, Alsayigh J, Abusultan A, Altalib A, Alzaid ZA, Alsubaie SS, Alzahrani MM. Time of surgery and surgeon level in supracondylar humerus fractures in pediatric patients: A retrospective study. World J Orthop 2023; 14:791-799. [DOI: 10.5312/wjo.v14.i11.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 11/16/2023] [Imported: 11/16/2023] Open
Abstract
BACKGROUND Supracondylar humerus fractures account for more than 60% of all elbow fractures and about 1/5 of all pediatric fractures. Unfortunately, these fractures can be associated with risk of complications including neurovascular injuries, malunions and limb deformities. Controversy exists regarding the effect of time of surgical intervention and/or level of surgeon performing the surgery on outcome of these fractures.
AIM To determine whether time of surgical intervention and/or surgeon level influence the outcomes of surgically managed pediatric supracondylar humerus fractures.
METHODS We retrospectively studied 155 pediatric patients presenting with a supracondylar humerus fracture in a level 1 trauma center from January 2006 to December 2019. The data extracted included demographic data, fracture characteristics, surgical data, and follow-up outcomes. The collected data was analyzed and P values of < 0.05 were considered statistically significant.
RESULTS Of the cohort, 11% of patients had documented post-operative complications, of which the majority occurred in surgeries performed after day time working hours and in fractures requiring open reduction. While the lowest complication rate was found in surgeries performed by pediatric orthopaedic surgeons, this did not reach statistical significance.
CONCLUSION In pediatric patients undergoing surgery for supracondylar fractures, we found a higher complication rate when surgeries were not performed during working hours. Surgeon level and training had no significant effect on the risk of post-operative complications.
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Affiliation(s)
- Ibrahim A Albrahim
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ammar K AlOmran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Dalal A Bubshait
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Yaser Tawfeeq
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Jaffar Alsayigh
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ammar Abusultan
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Abdulraheem Altalib
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Zaid A Alzaid
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Shayma S Alsubaie
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammad M Alzahrani
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
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Kwolek K, Gądek A, Kwolek K, Kolecki R, Liszka H. Automated decision support for Hallux Valgus treatment options using anteroposterior foot radiographs. World J Orthop 2023; 14:800-812. [DOI: 10.5312/wjo.v14.i11.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] [Imported: 11/16/2023] Open
Abstract
BACKGROUND Assessment of the potential utility of deep learning with subsequent image analysis to automate the measurement of hallux valgus and intermetatarsal angles from radiographs to serve as a preoperative aid in establishing hallux valgus severity for clinical decision-making.
AIM To investigate the accuracy of automated measurements of angles of hallux valgus from radiographs for further integration with the preoperative planning process.
METHODS The data comprises 265 consecutive digital anteroposterior weightbearing foot radiographs. 181 radiographs were utilized for training (161) and validating (20) a U-Net neural network to achieve a mean Sørensen–Dice index > 97% on bone segmentation. 84 test radiographs were used for manual (computer assisted) and automated measurements of hallux valgus severity determined by hallux valgus (HVA) and intermetatarsal angles (IMA). The reliability of manual and computer-based measurements was calculated using the interclass correlation coefficient (ICC) and standard error of measurement (SEM). Inter- and intraobserver reliability coefficients were also compared. An operative treatment recommendation was then applied to compare results between automated and manual angle measurements.
RESULTS Very high reliability was achieved for HVA and IMA between the manual measurements of three independent clinicians. For HVA, the ICC between manual measurements was 0.96-0.99. For IMA, ICC was 0.78-0.95. Comparing manual against automated computer measurement, the reliability was high as well. For HVA, absolute agreement ICC and consistency ICC were 0.97, and SEM was 0.32. For IMA, absolute agreement ICC was 0.75, consistency ICC was 0.89, and SEM was 0.21. Additionally, a strong correlation (0.80) was observed between our approach and traditional clinical adjudication for preoperative planning of hallux valgus, according to an operative treatment algorithm proposed by EFORT.
CONCLUSION The proposed automated, artificial intelligence assisted determination of hallux valgus angles based on deep learning holds great potential as an accurate and efficient tool, with comparable accuracy to manual measurements by expert clinicians. Our approach can be effectively implemented in clinical practice to determine the angles of hallux valgus from radiographs, classify the deformity severity, streamline preoperative decision-making prior to corrective surgery.
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Affiliation(s)
- Konrad Kwolek
- Department of Orthopedics and Traumatology, University Hospital, Kraków 30-688, Małopolska, Poland
| | - Artur Gądek
- Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Kraków 30-688, Małopolska, Poland
| | - Kamil Kwolek
- Department of Spine Disorders and Orthopedics, Gruca Orthopedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Radek Kolecki
- Department of Orthopedics and Traumatology, University Hospital, Kraków 30-688, Małopolska, Poland
| | - Henryk Liszka
- Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Kraków 30-688, Małopolska, Poland
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Jiao Y, Zhao JD, Huang XA, Cai HY, Shen JX. Surgical treatment of atlantoaxial dysplasia and scoliosis in spondyloepiphyseal dysplasia congenita: A case report. World J Orthop 2023; 14:827-835. [DOI: 10.5312/wjo.v14.i11.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023] [Imported: 11/16/2023] Open
Abstract
BACKGROUND Spondyloepiphyseal dysplasia congenita (SEDC) is a rare autosomal dominant hereditary disease caused by COL2A1 mutations. SEDC primarily involves the skeletal system, with typical clinical manifestations, including short stature, hip dysplasia, and spinal deformity. Due to the low incidence of SEDC, there are only a few case reports regarding the surgical treatment of SEDC complicated with spinal deformities.
CASE SUMMARY We report a case of a 16-year-old male patient with SEDC. He presented with typical short stature, atlantoaxial dysplasia, scoliosis, and hip dysplasia. Cervical magnetic resonance imaging showed spinal canal stenosis at the atlas level and cervical spinal cord compression with myelopathy. The scoliosis was a right thoracic curve with a Cobb angle of 65°. He underwent atlantoaxial reduction, decompression, and internal fixation from C1–C2 to relieve cervical myelopathy. Three months after cervical surgery, posterior correction surgery for scoliosis was performed from T3 to L4. Scoliosis was corrected from 66° to 8° and remained stable at 2-year follow-up.
CONCLUSION This is the first case report of a patient with SEDC who successfully underwent surgery for atlantoaxial dysplasia and scoliosis. The study provides an important reference for the surgical treatment of SEDC complicated with spinal deformities.
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Affiliation(s)
- Yang Jiao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jun-Duo Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xu-An Huang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hao-Yu Cai
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jian-Xiong Shen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Wan RW, Luo ZW, Yang YM, Zhang HL, Chen JN, Chen SY, Shang XL. Long head of biceps tendon transposition for massive and irreparable rotator cuff tears: A systematic review and meta-analysis. World J Orthop 2023; 14:813-826. [DOI: 10.5312/wjo.v14.i11.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] [Imported: 11/16/2023] Open
Abstract
BACKGROUND Superior capsular reconstruction (SCR) with long head of biceps tendon (LHBT) transposition was developed to massive and irreparable rotator cuff tears (MIRCTs); however, the outcomes of this technique remain unclear.
AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.
METHODS We performed a systematic electronic database search on PubMed, EMBASE, and Cochrane Library. Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria. Biomechanical studies were assessed for main results and conclusions. Included clinical studies were evaluated for quality of methodology. Data including study characteristics, cohort demographics, and outcomes were extracted. A meta-analysis was conducted of the clinical outcomes.
RESULTS According to our inclusion and exclusion criteria, a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion (ROM) after LHBT transposition for MIRCTs. A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes, consisting of 253 patients. The results indicated that compared to other surgical methods for MIRCTs, LHBT transposition had advantages of more significant improvement in ROM (forward flexion mean difference [MD] = 6.54, 95% confidence interval [CI]: 3.07-10.01; external rotation [MD = 5.15, 95%CI: 1.59-8.17]; the acromiohumeral distance [AHD] [MD = 0.90, 95%CI: 0.21-1.59]) and reducing retear rate (odds ratio = 0.27, 95%CI: 0.15-0.48). No significant difference in American Shoulder and Elbow Surgeons score, visual analogue scale score, and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.
CONCLUSION In general, SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs, both in terms of biomechanical and clinical outcomes, with comparable clinical outcomes, improved ROM, AHD, and reduced the retear rates compared to conventional SCR and other established techniques. More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.
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Affiliation(s)
- Ren-Wen Wan
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yi-Meng Yang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Han-Li Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jia-Ni Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shi-Yi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xi-Liang Shang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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Ahmed M, Abumoawad A, Jaber F, Elsafy H, Alsakarneh S, Al Momani L, Likhitsup A, Helzberg JH. Safety and outcomes of hip and knee replacement surgery in liver transplant recipients. World J Orthop 2023; 14:784-790. [DOI: 10.5312/wjo.v14.i11.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/13/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023] [Imported: 11/16/2023] Open
Abstract
BACKGROUND Liver transplant (LT) is becoming increasingly common with improved life expectancy. Joint replacement is usually a safe procedure; however, its safety in LT recipients remains understudied.
AIM To evaluate the mortality, outcome, and 90-d readmission rate in LT patients undergoing hip and knee replacement surgery.
METHODS Patients with history of LT who underwent hip and knee replacement surgery between 2016 and 2019 were identified using the National Readmission Database.
RESULTS A total of 5046119 hip and knee replacement surgeries were identified. 3219 patients had prior LT. Mean age of patients with no history of LT was 67.51 [95% confidence interval (CI): 67.44-67.58], while it was 64.05 (95%CI: 63.55-64.54) in patients with LT. Patients with history of LT were more likely to have prolonged length of hospital stay (17.1% vs 8.4%, P < 0.001). The mortality rate for patients with no history of LT was 0.22%, while it was 0.24% for patients with LT (P = 0.792). Patients with history of LT were more likely to have re-admissions within 90 d of initial hospitalization: 11.4% as compared to 6.2% in patients without history of LT (P < 0.001). The mortality rate between both groups during readmission was not statistically different (1.9% vs 2%, P = 0.871) respectively.
CONCLUSION Hip and knee replacements in patients with history of LT are not associated with increased mortality; increased re-admissions were more frequent in this cohort of patients. Chronic kidney disease and congestive heart failure appear to predict higher risk of readmission.
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Affiliation(s)
- Mohamed Ahmed
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO 64108, United States
| | - Abdelrhman Abumoawad
- Department of Vascular Medicine, Boston University, Boston, MA 02215, United States
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO 64108, United States
| | - Hebatullah Elsafy
- Department of Pathology, Kansas University, Kansas City, MO 66160, United States
| | - Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO 64108, United States
| | - Laith Al Momani
- Department of Gastroenterology, University of Missouri Kansas City, Kansas City, MO 64110, United States
| | - Alisa Likhitsup
- Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, United States
| | - John H Helzberg
- Department of Gastroenterology, University of Missouri Kansas City, Kansas City, MO 64110, United States
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Kelmer G, Johnson AH, Turcotte JJ, Redziniak DE. Recurrent cyclops lesion after primary anterior cruciate ligament reconstruction using bone tendon bone allograft: A case report. World J Orthop 2023; 14:836-842. [DOI: 10.5312/wjo.v14.i11.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/21/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] [Imported: 11/16/2023] Open
Abstract
BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament (ACL) reconstruction, with symptomatic cyclops syndrome occurring in up to 11% of surgeries. Recurrent cyclops lesions have been rarely documented; this case study documents the successful treatment of a recurrent cyclops lesion.
CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee. Workup and clinical exam revealed an ACL tear, and arthroscopic reconstruction was performed. Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy. Seven months postoperatively, the patient presented with pain, stiffness, and difficulty achieving terminal extension. A smaller recurrent cyclops lesion was diagnosed, and a repeat synovectomy was performed. The patient recovered fully.
CONCLUSION To the best of our knowledge, this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.
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Affiliation(s)
- Grayson Kelmer
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, MD 21401, United States
- Medical School, Campbell University School of Osteopathic Medicine, Lillington, NC 27546, United States
| | - Andrea H Johnson
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, MD 21401, United States
| | - Justin J Turcotte
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, MD 21401, United States
| | - Daniel E Redziniak
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, MD 21401, United States
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Alzahrani MM. Late brachial plexopathy after a mid-shaft clavicle fracture: A case report. World J Orthop 2023; 14:776-783. [PMID: 37970622 PMCID: PMC10642401 DOI: 10.5312/wjo.v14.i10.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023] [Imported: 10/16/2023] Open
Abstract
BACKGROUND Clavicle fractures can rarely be associated with brachial plexus injury. These are commonly caused by tractional injury at the time of trauma, but unfrequently can be caused by compression of the brachial plexus from excessive callus or granulation tissue formation. CASE SUMMARY We report a rare case of an adult male who sustained a mid-shaft clavicle fracture and had a late presentation of brachial plexus palsy due to compression from excessive callus formation. CONCLUSION We reported a case of a rare occurrence of delayed brachial plexus palsy due to compression from excessive callus formation in a midshaft clavicle fracture. Early diagnosis and surgical decompression of the brachial plexus is critical, as when managed efficiently, a full recovery of the brachial plexus palsy can be expected in these patients.
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Affiliation(s)
- Mohammad M Alzahrani
- Department of Orthopaedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
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Jordaan PW, Klumpp R, Zeppieri M. Triggering, clicking, locking and crepitus of the finger: A comprehensive overview. World J Orthop 2023; 14:733-740. [PMID: 37970625 PMCID: PMC10642400 DOI: 10.5312/wjo.v14.i10.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/13/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] [Imported: 10/16/2023] Open
Abstract
Triggering, locking, clicking, and crepitus of the fingers are common symptoms patients present with. Even though crepitus and triggering can occur as part of the same underlying diagnosis, it is important to differentiate between them, as they usually indicate different possible diagnoses. The differential diagnoses that should be considered include trigger finger, metacarpophalangeal joint (MCPJ) arthritis, fractures or dislocations, extensor digitorum communis subluxation or dislocation, locked MCPJ, avascular necrosis of the metacarpal head, and Dupuytren's disease. A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis. Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.
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Affiliation(s)
- Pieter W Jordaan
- Department of Orthopaedic, Garden Route Hand Unit, George 6530, South Africa
| | - Raymond Klumpp
- UOC Ortopedia e Traumatologia, Ospedale Treviglio-Caravaggio ASST, Bergamo Ovest 24047, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Vescio A, Testa G, Caldaci A, Sapienza M, Pavone V. Catania flatfoot score: A diagnostic-therapeutic evaluation tool in children. World J Orthop 2023; 14:755-762. [PMID: 37970624 PMCID: PMC10642399 DOI: 10.5312/wjo.v14.i10.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 10/16/2023] [Imported: 10/16/2023] Open
Abstract
BACKGROUND Flexible flatfoot (FFF) is a very common condition in children, but no evidence-based guidelines or assessment tools exist. Yet, surgical indication is left to the surgeon's experience and preferences. AIM To develop a functional clinical score for FFF [Catania flatfoot (CTF) score] and a measure of internal consistency; to evaluate inter-observer and intra-observer reliability of the CTF Score; to provide a strong tool for proper FFF surgical indication. METHODS CTF is a medically compiled score of four main domains for a total of twelve items: Patient features, Pain, Clinical Parameters, and Functionality. Each item refers to a specific rate. Five experienced observers answered 10 case reports according to the CTF. To assess inter- and intra-observer reliability of the CTF score, the intra-class correlation coefficients' (ICCs) statistics test was performed, as well as to gauge the correlation between the CTF score and the surgical or conservative treatment indication. Values of 75% were chosen as the score cut-off for surgical indication. Sensitivity, specificity, positive likelihood ratio (PLHR), negative likelihood ratio (NLHR), positive predictive value (PPV), and negative predictive value (NPV). RESULTS Overall interobserver reliability ICC was 0.87 [95% confidence interval (CI): 0.846-0.892; P < 0.001]. Overall intra-observer reliability ICC was 0.883 (95%CI: 0.854-0.909; P < 0.001). A direct correlation between the CTF score and surgical treatment indication [Pearson correlation coefficient = 0.94 (P < 0.001)] was found. According to the 75% cut-off, the sensitivity was 100% (95%CI: 83.43%-100%), specificity was 85.71% (95%CI: 75.29%-92.93%), PLHR was 7 (95%CI: 3.94-12.43), NLHR was 0 (95%CI: 0-0), PPV was 75% (95%CI: 62.83%-84.19%) and NPV was 100% (95%CI: 100%-100%). CONCLUSION CTF represents a useful tool for orthopedic surgeons in the FFF evaluation. The CTF score is a quality questionnaire to reproduce suitable clinical research, survey studies, and clinical practice. Moreover, the 75% cut-off is an important threshold for surgical indication and helps in the decision-making process.
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Affiliation(s)
- Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
| | - Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico “Rodolico-San Marco”, University of Catania, Catania 95123, Italy
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Tian CW, Chen XX, Shi L, Zhu HY, Dai GC, Chen H, Rui YF. Machine learning applications for the prediction of extended length of stay in geriatric hip fracture patients. World J Orthop 2023; 14:741-754. [PMID: 37970626 PMCID: PMC10642403 DOI: 10.5312/wjo.v14.i10.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/08/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023] [Imported: 10/16/2023] Open
Abstract
BACKGROUND Geriatric hip fractures are one of the most common fractures in elderly individuals, and prolonged hospital stays increase the risk of death and complications. Machine learning (ML) has become prevalent in clinical data processing and predictive models. This study aims to develop ML models for predicting extended length of stay (eLOS) among geriatric patients with hip fractures and to identify the associated risk factors. AIM To develop ML models for predicting the eLOS among geriatric patients with hip fractures, identify associated risk factors, and compare the performance of each model. METHODS A retrospective study was conducted at a single orthopaedic trauma centre, enrolling all patients who underwent hip fracture surgery between January 2018 and December 2022. The study collected various patient characteristics, encompassing demographic data, general health status, injury-related data, laboratory examinations, surgery-related data, and length of stay. Features that exhibited significant differences in univariate analysis were integrated into the ML model establishment and subsequently cross-verified. The study compared the performance of the ML models and determined the risk factors for eLOS. RESULTS The study included 763 patients, with 380 experiencing eLOS. Among the models, the decision tree, random forest, and extreme Gradient Boosting models demonstrated the most robust performance. Notably, the artificial neural network model also exhibited impressive results. After cross-validation, the support vector machine and logistic regression models demonstrated superior performance. Predictors for eLOS included delayed surgery, D-dimer level, American Society of Anaesthesiologists (ASA) classification, type of surgery, and sex. CONCLUSION ML proved to be highly accurate in predicting the eLOS for geriatric patients with hip fractures. The identified key risk factors were delayed surgery, D-dimer level, ASA classification, type of surgery, and sex. This valuable information can aid clinicians in allocating resources more efficiently to meet patient demand effectively.
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Affiliation(s)
- Chu-Wei Tian
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Xiang-Xu Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Huan-Yi Zhu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Hui Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
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Al-Anii FM, Sadat-Ali M, Al-Tabash KW, AlMulhim AI, AlMousa SA, AlHawas AM. Vancomycin flushing syndrome in orthopaedic practice: A case report. World J Orthop 2023; 14:771-775. [PMID: 37970623 PMCID: PMC10642402 DOI: 10.5312/wjo.v14.i10.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/16/2023] [Accepted: 09/07/2023] [Indexed: 10/16/2023] [Imported: 10/16/2023] Open
Abstract
BACKGROUND Vancomycin flushing syndrome (VFS), also known as red man syndrome, is an allergic reaction to vancomycin. It typically presents as a rash on the face, neck, and upper torso after intravenous administration of vancomycin. VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use. A review of the literature showed that in the last 23 years, 4 such cases have been reported. Here, we add another case of VFS developed after slow local absorption of vancomycin in cement beads. CASE SUMMARY A 44-year-old male with a known case of hypertension, no history of allergies to medications, and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg. The pus culture grew Staphylococcus aureus, which was sensitive to clindamycin and vancomycin. The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate. Three hours postoperatively, the patient developed a pruritic, erythematous, macular rash predominantly on his face, neck, chest, and lower extremities and to a lesser extent his upper extremities. A diagnosis of VFS was made and was successfully treated with cetirizine (10 mg, oral) and methylprednisolone sodium succinate (125 mg, intravenous). The patient continued to have itching with a facial rash for 12 h with gradual improvement. A decision was made to not remove the beads as the patient continued to improve. Gradually, the rash disappeared after 96 h with no further sequela. CONCLUSION VFS can occur not only after rapid intravenous injection of vancomycin but also with local release, as in our case. As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty, they should be aware of such a complication occurring.
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Affiliation(s)
- Fawaz M Al-Anii
- Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, AlKhobar 31952, Saudi Arabia
| | - Mir Sadat-Ali
- Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, AlKhobar 31952, Saudi Arabia
| | - Khalid Waleed Al-Tabash
- Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, AlKhobar 31952, Saudi Arabia
| | - Ahmad I AlMulhim
- Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, AlKhobar 31952, Saudi Arabia
| | - Sulaiman A AlMousa
- Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, AlKhobar 31952, Saudi Arabia
| | - Abdulaziz M AlHawas
- Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, AlKhobar 31952, Saudi Arabia
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50
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Solarino G, Bizzoca D, Dramisino P, Vicenti G, Moretti L, Moretti B, Piazzolla A. Total hip arthroplasty following the failure of intertrochanteric nailing: First implant or salvage surgery? World J Orthop 2023; 14:763-770. [PMID: 37970621 PMCID: PMC10642404 DOI: 10.5312/wjo.v14.i10.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/16/2023] [Accepted: 09/06/2023] [Indexed: 10/16/2023] [Imported: 10/16/2023] Open
Abstract
BACKGROUND Proximal femur fractures, including both intracapsular (femoral neck fractures) and extracapsular fractures (intertrochanteric femoral fractures, IFFs), affect around 1.5 million people per year worldwide. Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty (THA). AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA. METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited. All patients underwent a salvage surgical procedure, i.e., cephalomedullary nail removal and conversion to THA. The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia. All patients underwent clinical and radiographic follow-ups for at least 24 mo. Complications and re-operations were recorded. RESULTS Seventy-four patients met the inclusion criteria (male: 29; female: 45; mean age: 73.8-years-old; range: 65-89) and were included in the current study. The average operative time was 117 min (76-192 min). The average blood loss was 585 mL (430-1720 mL). Among the 74 patients, 43 (58.1%) required transfusion of three or more blood units. Two patients died within the 4th d after surgery because of pulmonary embolism, and 1 patient died 9 mo after surgery due to ischemic myocardial infarction. The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%. In 3 cases out of 71 (4.2%) periprosthetic acetabular fracture was observed during the follow-up. One of these periacetabular fractures occurred intraoperatively. An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71 (7.0%). Four of these patients needed a re-operation to fix the fracture with plates and cerclages; in one of these patients, femoral stem revision was also necessary. In 4 patients out of 71 (5.6%), an early THA dislocation was observed, whereas in 1 case (1.4%) a late THA dislocation was observed. Three patients out of 71 (4.2%) developed a periprosthetic joint infection during the study follow-up. CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.
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Affiliation(s)
| | - Davide Bizzoca
- DiMePre-J, University of Bari Aldo Moro, Bari 70154, Italy
| | | | | | - Lorenzo Moretti
- Orthopaedic and Trauma Unit Policlinico di Bari, Bari 70124, Italy
| | - Biagio Moretti
- DiBraiN, University of Bari Aldo Moro, Bari 70154, Italy
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