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Farooq H, Oetojo W, Bajwa S, Brown NM. Patellar resurfacing in contemporary total knee arthroplasty: Frequency of complications in a matched cohort. J Orthop 2025; 60:25-28. [PMID: 39345676 PMCID: PMC11437602 DOI: 10.1016/j.jor.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 09/05/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction Optimum patient selection and outcomes following patellar resurfacing are ongoing debates amongst the arthroplasty community. This study compared the outcomes of patients who had a total knee arthroplasty (TKA) with patellar resurfacing to those left with their native patella. Methods A retrospective review of 1941 TKAs performed between 2016 and 2020 was conducted. 41 TKAs without patellar resurfacing and with 2-years of minimum follow-up were identified. Of these, 38 TKAs were matched on age (exact), sex (exact), and body mass index (±10) to 38 TKAs that had patellar resurfacing. The indications for patella resurfacing were subjective based upon the surgeon preference and assessment of cartilage quality. Paired t-tests and chi-square tests were used for analysis. Results There was 1 major patellofemoral complication in both the resurfaced group (patellar fracture) and the non-resurfaced group (patellar tendon tear), requiring nonoperative management and revision surgery, respectively. However, in the non-resurfaced group there were 4 cases of subjective patellofemoral pain compared to none in the resurfaced group (p = 0.37). Additionally, 3 non-resurfaced patients required manipulation under anesthesia (MUA) compared to none in the resurfaced group (p = 0.44). Discussion There was no difference in the frequency of major patella-specific complications between the groups. However, there was a non-statistically significant trend towards increased patellofemoral pain and MUA in the non-resurfaced group. Based on this study both methods of treatment remain viable options, but the trend towards increased pain and stiffness should continue to be closely evaluated.
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Affiliation(s)
- Hassan Farooq
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, 60153, USA
| | - William Oetojo
- Stritch School of Medicine, Loyola University, Maywood, IL, 60153, USA
| | - Safi Bajwa
- Stritch School of Medicine, Loyola University, Maywood, IL, 60153, USA
| | - Nicholas M. Brown
- Loyola University Health System, Department of Orthopaedic Surgery and Rehabilitation, Maywood, IL, 60153, USA
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Gordon D, Cardenas JM, Fawley D, Kitziger KJ, Gladnick BP. Mitigating calcar fracture risk with automated impaction during total hip arthroplasty. J Orthop 2025; 59:64-67. [PMID: 39351264 PMCID: PMC11439554 DOI: 10.1016/j.jor.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/30/2024] [Accepted: 08/04/2024] [Indexed: 10/04/2024] Open
Abstract
Background Automated broaching has recently been introduced for total hip arthroplasty (THA), with the goal of improving surgical efficiency and reducing surgeon workload. While studies have suggested that this technique may improve femoral sizing and alignment, little has been published regarding its safety, particularly with regard to calcar fractures. The purpose of our study was to evaluate the risk of calcar fracture during automated broaching, and to determine if this risk can be mitigated. Methods We queried our prospective institutional database and identified 1596 unilateral THAs performed by the senior author using automated impaction between 2019 and 2023. We identified the incidence of calcar fracture with automated impaction, and whether the fracture occurred during broaching or stem insertion. We additionally determined calcar fracture incidence within two consecutive subgroups of patients using different stem insertion techniques; subgroup (1): automated broaching with automated stem insertion for all patients; versus subgroup (2): automated broaching with automated stem insertion ONLY if a cushion of cancellous bone separated the broach from the calcar, otherwise the stem was placed manually. Continuous and categorical variables were analyzed with Student's t-test and Fisher's exact test, respectively. Results Seventeen calcar fractures occurred intraoperatively (1.1 %). Only two fractures occurred during automated broaching (0.1 %), while fifteen occurred during final stem impaction (0.9 %) (p = 0.007). Four calcar fractures (1.4 %) occurred in subgroup 1, compared to two in subgroup 2 (0.6 %) (p = 0.28). Conclusions Our study found a calcar fracture incidence of 1.1 % using automated impaction, consistent with historically reported rates of 0.4-3.7 %. We found that calcar fractures are more likely to occur during stem insertion than during femoral broaching. We recommend that if any part of the final broach is in direct contact with the calcar, the final stem should be impacted manually to minimize fracture risk.
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Affiliation(s)
- Dan Gordon
- Baylor University Medical Center, 3500 Gaston Ave, 6th Floor Hoblitzelle, Dallas, TX 75246, USA
| | - Justin M. Cardenas
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Tower I, Suite 400, Dallas, TX, 75231, USA
| | - David Fawley
- DePuy Synthes, Clinical Research, 700 Orthopedic Drive, Warsaw, IN, 46582, USA
| | - Kurt J. Kitziger
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Tower I, Suite 400, Dallas, TX, 75231, USA
| | - Brian P. Gladnick
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Tower I, Suite 400, Dallas, TX, 75231, USA
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Ghandour M, AL Salloum D, Jaber MH, Abou Orm G, Ghosn A, Jaber S, Abd El Nour H, Chalfoun A, Dagher T, Hanna B. A comparative meta-analysis of the efficacy and safety of arthroscopic versus open surgery in patients with lateral epicondylitis. J Orthop 2025; 59:41-50. [PMID: 39351266 PMCID: PMC11439539 DOI: 10.1016/j.jor.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 10/04/2024] Open
Abstract
Background Lateral epicondylitis frequently necessitates surgical management when non-surgical treatments are ineffective. Anecdotal evidence suggests comparable efficacy between arthroscopic and open surgical repair; however, it is limited by the scarcity of data. This meta-analysis compares between both procedures regarding functional recovery, pain intensity, complications, and return-to-work time. Methods A detailed systematic review and meta-analysis of research published until February 2024 were performed, comparing arthroscopic and open surgery methods for lateral epicondylitis. The studies were sourced from PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. The included studies examined outcomes such as functional recovery, pain intensity, complication rates, and time to return to work. The risk of bias was evaluated using the Cochrane tool for randomized studies and the ROBINS-I tool for non-randomized studies. Results The meta-analysis included 19 studies with a total of 20,409 participants. The analysis found no significant differences in postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores (Mean Difference [MD] = 0.06; 95 % Confidence Interval [CI]: 0.81 to 0.94; P = 0.89) or Mayo Elbow Performance Scores (MD = 0.31; 95 % CI: 2.33 to 2.95; P = 0.80) between the arthroscopic and open surgical methods. The rates of good-to-excellent recovery, surgical failures, and complications were similar across both techniques. Nevertheless, arthroscopic surgery was associated with a significantly shorter return-to-work period (MD = -1.64 months; 95 % CI: 2.60 to -0.68; P = 0.001) and a temporary increase in grip strength six months after surgery (MD = -1.50 kg; 95 % CI: 2.67 to -0.33; P = 0.012). Conclusions Arthroscopic and open release techniques for lateral epicondylitis provide similar functional outcomes and complication rates. However, arthroscopic surgery may allow for a quicker return to work, suggesting a potential advantage in the early postoperative period. These findings highlight the need for individualized surgical decision-making based on patient-specific factors and surgeon expertise.
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Affiliation(s)
- Maher Ghandour
- Department of Orthopedic Surgery, CHU Grenoble Alpes, Grenoble, France
| | - Diaa AL Salloum
- Department of Orthopedic Surgery, CHU Grenoble Alpes, Grenoble, France
| | | | - Ghadi Abou Orm
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Ali Ghosn
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Sadek Jaber
- Department of Orthopedic Surgery, Saint Georges University Medical Center, Beirut, Lebanon
| | - Hicham Abd El Nour
- Department of Orthopedic Surgery, Saint Georges University Medical Center, Beirut, Lebanon
| | - Anthony Chalfoun
- Department of Orthopedic Surgery, Saint Georges University Medical Center, Beirut, Lebanon
| | - Tanios Dagher
- Department of Orthopedic Surgery, Hopital Ambroise-Paré, Paris, France
| | - Bashour Hanna
- Orthopaedic Department, CHU Grenoble Alpes, Grenoble, France
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Dubin JA, Bains SS, Remily E, Salem H, Sax O, Hameed D, Nace J, McClure PK, Delanois RE. The current epidemiology of vascular injuries associated with knee dislocation in the United States from 2010 to 2022. J Orthop 2025; 59:8-12. [PMID: 39351265 PMCID: PMC11439528 DOI: 10.1016/j.jor.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/15/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Despite the recognized importance of managing vascular injury associated with knee dislocation, studies have been limited by small patient sizes, data older than five years, and lack of inclusion of newer procedural and diagnoses codes. This has been reflected in the reported frequency of knee dislocation associated with vascular injury ranging from 1.6 % to 64 %. As such, we sought to determine: (1) the frequency of knee dislocations associated with vascular injuries; (2) the frequency of knee dislocations associated with vascular injuries that required repair; as well as (3) independent risk factors for knee dislocation with vascular injury that require repair, across different age groups, sexes, and United States geographic regions. Methods A national, all-payer database was queried from January 1, 2010 to June 31, 2022. The frequency of a vascular injury was calculated by dividing the number of vascular injuries within 30 days of all knee dislocations by the total number of knee dislocations in each category. The frequency of a vascular injury that required repair was calculated by dividing the number of vascular injuries that required repair associated with knee dislocation by the total number of vascular injuries associated with knee dislocations. Patients were categorized by year of diagnosis, age, sex, and US geographic region. Multivariable logistic regressions were calculated to determine independent risk factors for knee dislocation with vascular injury. Results From 2010 to 2022, there were 99,688 knee dislocations. Of the total knee dislocations, there were 1066 (1.1 %) vascular injuries associated with knee dislocations, 96,530 (96.8 %) were closed dislocations, and 3158 (2.2 %) were open dislocations. Of the 1066 vascular injuries associated with knee dislocations, 262 (24.6 %) vascular injuries required repair. Male sex (P < 0.001), Elixhauser Comorbidity Index (ECI) > 3 (P < 0.001), alcohol abuse (P = 0.006), congestive heart failure (P = 0.01), hypothyroidism (P = 0.003), and obesity (P < 0.001), were independent risk factors for knee dislocation with vascular injuries. Conclusion Our study provides a refined understanding of the historically low incidence of knee dislocation with vascular injury as well as an increase in vascular injuries requiring repair from 2010 to 2022. Given the large expense of irreversible injury in these patients, vulnerable patient populations identified in our study, such as obese patients with additional comorbidities, should be a focus of future intervention. These findings can guide physicians in a clinical setting to appropriately manage the expectations of patients as well as minimize the morbidity and mortality associated with this presentation.
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Affiliation(s)
- Jeremy A. Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ethan Remily
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Hytham Salem
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Oliver Sax
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Philip K. McClure
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Alashek WA, Ali SA. Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review. Libyan J Med 2024; 19:2301829. [PMID: 38197179 PMCID: PMC10783830 DOI: 10.1080/19932820.2024.2301829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024] Open
Abstract
Background: Telemedicine became a fundamental part of healthcare provision during COVID-19 pandemic. An evaluation of telemedicine-associated satisfaction helps the service develop more viable applications. This review evaluated the satisfaction of healthcare users and providers and their willingness to use this modality in future.Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search on empirical articles published between March 2020 and December 2022 was performed on 'PubMed' and 'Scopus' databases. Findings that reported on satisfaction of patients, families and caregivers as well as clinicians were extracted and analysed. Quality of included studies was assessed. After applying inclusion and exclusion criteria, the review included 27 eligible studies.Results: Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare. Almost all studies were undertaken within the NHS. There were many tools that measured satisfaction. Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%. Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information. Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people. In general, willingness to use telemedicine in future was high in the recipients as well as the providers of healthcare.Conclusion: COVID-19 pandemic has transformed healthcare in the UK and promoted a revolution in telemedicine applications. Satisfaction was high among both recipient and provider of healthcare. Telemedicine managed to provide a continued care throughout the pandemic while maintaining social distance. The current review presented commendable evidence to encourage different specialities to engage in telemedicine application.
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Affiliation(s)
- WA. Alashek
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - SA. Ali
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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6
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Costello LF, McMenamin PG, Quayle MR, Bertram JF, Adams JW. Applying 3D surface scanning technology to create photorealistic three-dimensional printed replicas of human anatomy. Future Sci OA 2024; 10:2381956. [PMID: 39135497 PMCID: PMC11323862 DOI: 10.1080/20565623.2024.2381956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/12/2024] [Indexed: 08/16/2024] Open
Abstract
Aim: To describe advances in 3D data capture and printing that allow photorealistic replicas of human anatomical specimens for education and research, and discuss advantages of current generation printing for replica design and manufacture. Materials & methods: We combine surface scanning and computerized tomography datasets that maximize precise color and geometric capture with ultra violet (UV) curable resin printing to replicate human anatomical specimens. Results: We describe the process for color control, print design and translation of photorealistic 3D meshes into 3D prints in durable resins. Conclusion: Current technologies allow previously unachievable ability to capture and reproduce anatomical specimens, and provide a platform for a new generation of 3D printed teaching materials to be designed and used in anatomy education environments.
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Affiliation(s)
- Lucy F Costello
- Centre for Human Anatomy Education, Department of Anatomy & Developmental Biology, Monash University, Clayton, Victoria, 3800, Australia
- Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Paul G McMenamin
- Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Michelle R Quayle
- Centre for Human Anatomy Education, Department of Anatomy & Developmental Biology, Monash University, Clayton, Victoria, 3800, Australia
- Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - John F Bertram
- Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Justin W Adams
- Centre for Human Anatomy Education, Department of Anatomy & Developmental Biology, Monash University, Clayton, Victoria, 3800, Australia
- Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
- Geosciences, Museums Victoria, Melbourne, Victoria, 3000, Australia
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7
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He C, Shi X, Lin H, Li Q, Xia F, Shen G, Feng J. The combination of HSI and NMR techniques with deep learning for identification of geographical origin and GI markers of Lycium barbarum L. Food Chem 2024; 461:140903. [PMID: 39178543 DOI: 10.1016/j.foodchem.2024.140903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/17/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024]
Abstract
Lycium barbarum L. (L. barbarum) is renowned worldwide for its nutritional and medicinal benefits. Rapid and accurate identification of L.barbarum's geographic origin is essential because its nutritional content, medicinal efficacy, and market price significantly vary by region. This study proposes an innovative method combining hyperspectral imaging (HSI), nuclear magnetic resonance (NMR), and an improved ResNet-34 deep learning model to accurately identify the geographical origin and geographical indication (GI) markers of L.barbarum. The deep learning model achieved a 95.63% accuracy, surpassed traditional methods by 6.26% and reduced runtime by 29.9% through SHapley Additive exPlanations (SHAP)-based feature selection. Pearson correlation analysis between GI markers and HSI characteristic wavelengths enhanced the interpretability of HSI data and further reduced runtime by 33.99%. This work lays the foundation for portable multispectral devices, offering a rapid, accurate, and cost-effective solution for quality assurance and market regulation of L.barbarum products.
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Affiliation(s)
- Chengcheng He
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| | - Xin Shi
- Ningxia Institute of Quality Standards and Testing Technology for Agricultural Products, Yinchuan 750002, China
| | - Haifeng Lin
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| | - Quanquan Li
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| | - Feng Xia
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| | - Guiping Shen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| | - Jianghua Feng
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China.
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Chang YT, Huang KC, Pranata R, Chen YL, Chen SN, Cheng YH, Chen RJ. Evaluation of the protective effects of chondroitin sulfate oligosaccharide against osteoarthritis via inactivation of NLRP3 inflammasome by in vivo and in vitro studies. Int Immunopharmacol 2024; 142:113148. [PMID: 39276449 DOI: 10.1016/j.intimp.2024.113148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/12/2024] [Accepted: 09/08/2024] [Indexed: 09/17/2024]
Abstract
Osteoarthritis (OA) is the most prevalent degenerative arthritis disease linked to aging, obesity, diet, and accumulation of octacalcium phosphate (OCP) crystals in joints. Current research has focused on inflammation and chondrocytes apoptosis as underlying OA mechanisms. Inflammatory cytokines like IL-1β activate matrix metalloproteinase-13 (MMP-13) and aggrecanase (the member of A Disintegrin and Metalloproteinase with Thrombospondin motifs family, ADAMTS), leading to cartilage matrix degradation. The NLRP3 inflammasome also contributes to OA pathogenesis by maturing IL-1β. Natural products like chondroitin sulfate oligosaccharides (oligo-CS) show promise in OA treatment by inhibiting inflammation. Our study evaluates the protective effects of oligo-CS against OA by targeting NLRP3 inflammation. Stimulating human SW1353 chondrocytes and human mononuclear macrophage THP-1 cells with OCP showed increased NLRP3 inflammation initiation, NF-κB pathway activation, and the production of inflammatory cytokines (IL-1β, IL-6) and the metabolic index (MMP-13, ADAMTS-5), leading to cartilage matrix degradation. However, oligo-CS treatment significantly reduced inflammation. In a 28-day in vivo study with C57BL/6 female mice, OCP was injected into their right knee and oligo-CS was orally administered. The OCP group exhibited significant joint space narrowing and chondrocyte loss, while the oligo-CS group maintained cartilage integrity. Oligo-CS groups also regulated gut microbiota composition to a healthier state. Taken together, our findings suggest that oligo-CS can be considered as a protective compound against OA.
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Affiliation(s)
- Yu-Ting Chang
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Ching Huang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Hospital, Liouying District, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Rosita Pranata
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Lin Chen
- Bioresource Collection and Research Center (BCRC), Food Industry Research and Development Institute, Hsinchu 300, Taiwan.
| | - Ssu-Ning Chen
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Hsuan Cheng
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Rong-Jane Chen
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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DeRogatis MJ, Pellegrino AN, Wang N, Higgins M, Dubin J, Issack P, Sokunbi G, Brogle P, Konopitski A. Enhancing recovery and reducing readmissions: The impact of remote monitoring on acute postoperative care in outpatient total joint arthroplasty. J Orthop 2024; 58:111-116. [PMID: 39114426 PMCID: PMC11301234 DOI: 10.1016/j.jor.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Outpatient total joint arthroplasty (TJA) is gaining popularity in the United States. With a shift towards value-based healthcare and bundled payment models, the importance of safe discharge after TJA is pertinent in reducing readmissions and subsequent cost of care. However, many acute issues or complications may not occur until after discharge which can result in emergency department visits and readmission. Our study aims to characterize the effect of remote monitoring devices on acute postoperative recovery in TJA discharged within 24 h. We hypothesized there would be a decreased readmission rate in the remote home monitoring cohort. Methods This prospective cohort compared 50 outpatient TJAs (primary total hip and total knee replacements) defined as discharged within 24 h with a remote home monitoring device to 50 outpatient TJAs who did not receive remote monitoring. Demographics, hospital length of stay, American Society of Anesthesiology scores, and Charlson Comorbidity Index were compared with no significant difference observed between cohorts (p > 0.05). Patients' vital signs were transmitted to a virtual response center for up to 48 h after discharge. An on-call medical team reviewed the transmissions and if prompted, would contact the patient to troubleshoot and triage. Primary outcome was 30-day hospital readmissions rates, while 30-day ED visits and patient satisfaction scores for the remote home monitoring were measured as secondary outcomes. Results Within the remote monitoring cohort there was a 20 % incidence (10 patients) of abnormal vitals captured and 2 patients visited the ED, however there were no readmissions attributed to this group. Readmission rates and ED visits in the control non-monitored group were significantly higher at 12 % (p = 0.03), secondary to syncope, uncontrolled postoperative pain, cellulitis, hip dislocations, and postoperative fever. Of the patients who received remote monitoring, 14 % had trouble connecting the device to their smartphone, 44 % felt home monitoring helped in their care while recovering at home, 52 % made them feel safer, and 70 % would recommend this program. Conclusions Remote home monitoring with a virtual response team after outpatient TJA is a feasible way to mitigate readmissions in the acute postoperative period and increase patient satisfaction. Efforts to minimize costs should not be implemented at the expense of patients' health outcomes with a goal to find an appropriate balance between both agendas. Level of evidence Therapeutic Level III.
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Affiliation(s)
- Michael J. DeRogatis
- St. Luke's University Health Network, PPHP 2, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Anna Ng Pellegrino
- St. Luke's University Health Network, PPHP 2, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Nigel Wang
- St. Luke's University Health Network, PPHP 2, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Margaret Higgins
- St. Luke's University Health Network, PPHP 2, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Jeremy Dubin
- Rubin Institute for Advanced Orthopaedics, 2401 W Belvedere Ave 2nd Floor, Baltimore, MD, 21215, USA
| | - Paul Issack
- New York Presbyterian Lower Manhattan Hospital, 170 William Street, 8th Floor, New York, NY, 10028, USA
| | - Gbolabo Sokunbi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, 535 E 70th St, New York, NY, USA
| | - Patrick Brogle
- St. Luke's University Health Network, PPHP 2, 801 Ostrum Street, Bethlehem, PA, 18015, USA
| | - Andrew Konopitski
- St. Luke's University Health Network, PPHP 2, 801 Ostrum Street, Bethlehem, PA, 18015, USA
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10
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Qiu C, Li Z, Peng P. Human umbilical cord mesenchymal stem cells protect MC3T3-E1 osteoblasts from dexamethasone-induced apoptosis via induction of the Nrf2-ARE signaling pathway. Regen Ther 2024; 27:1-11. [PMID: 38476629 PMCID: PMC10926296 DOI: 10.1016/j.reth.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/29/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
Objective To investigate the protective effect human umbilical cord mesenchymal stem cells (hUC-MSCs) have on Dexamethasone (Dex)-induced apoptosis in osteogenesis via the Nrf2-ARE signaling pathway. Methods Glucocorticoid-induced osteonecrosis of the femoral head (GC-ONFH) was developed in rats through the administration of lipopolysaccharide and methylprednisolone. The incidence of femoral head necrosis, cavity notch, apoptosis of osteoblasts, and bone density were observed by HE staining, TUNEL staining, and Micro-CT. HUC-MSCs were co-cultured with mouse pre-osteoblast MC3T3-E1. The survival rate of osteoblasts was determined by CCK8, and apoptosis and ROS levels of osteoblasts were determined by flow cytometer. The viability of antioxidant enzymes SOD, GSH-Px, and CAT was analyzed by biochemistry. Nrf2 expression levels and those of its downstream proteins and apoptosis-related proteins were analyzed by Western blotting. Results In rats, hUC-MSCs can reduce the rates of empty bone lacuna and osteoblast apoptosis that are induced by glucocorticoids (GCs), while reducing the incidence of GC-ONFH. hUC-MSCs can significantly improve the survival rate and antioxidant SOD, GSH-Px, and CAT activity of MC3T3-E1 cells caused by Dex, and inhibit apoptosis and oxidative stress levels. In addition, hUC-MSCs can up-regulate the expression of osteoblast antioxidant protein Nrf2 and its downstream protein HO-1, NQO-1, GCLC, GCLM, and apoptosis-related protein bcl-2, while also down-regulating the expression of apoptosis-related protein bax, cleaved caspase-3, cleaved caspase-9, and cytochrome C in MC3T3-E1 cells. hUC-MSCs improve the ability of MC3T3-E1 cells to mineralize to osteogenesis. However, the promoting effects of hUC-MSCs were abolished following the blocking of the Nrf2-ARE signaling pathway for osteoblasts. Conclusion The results reveal that hUC-MSCs can reduce Dex-induced apoptosis in osteoblasts via the Nrf2-ARE signaling pathway.
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Affiliation(s)
- Chen Qiu
- Department of Sports Medicine, The Affiliated Hospital of Wuhan Sports University, Wuhan, 430000, China
| | - Zhaowen Li
- Department of Sports Medicine, The Affiliated Hospital of Wuhan Sports University, Wuhan, 430000, China
| | - Puji Peng
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, China
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11
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Coletti C, Naaktgeboren R, Tourais J, Van De Steeg-Henzen C, Weingärtner S. Generalized inhomogeneity-resilient relaxation along a fictitious field (girRAFF) for improved robustness in rotating frame relaxometry at 3T. Magn Reson Med 2024; 92:2373-2391. [PMID: 39046914 DOI: 10.1002/mrm.30219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 06/07/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To optimize Relaxation along a Fictitious Field (RAFF) pulses for rotating frame relaxometry with improved robustness in the presence ofB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ field inhomogeneities. METHODS The resilience of RAFF pulses againstB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities was studied using Bloch simulations. A parameterized extension of the RAFF formulation was introduced and used to derive a generalized inhomogeneity-resilient RAFF (girRAFF) pulse. RAFF and girRAFF preparation efficiency, defined as the ratio of the longitudinal magnetization before and after the preparation (M z ( T p ) / M 0 $$ {M}_z\left({T}_p\right)/{M}_0 $$ ), were simulated and validated in phantom experiments.T RAFF $$ {T}_{\mathrm{RAFF}} $$ andT girRAFF $$ {T}_{\mathrm{girRAFF}} $$ parametric maps were acquired at 3T in phantom, the calf muscle, and the knee cartilage of healthy subjects. The relaxation time maps were analyzed for resilience against artificially induced field inhomogeneities and assessed in terms of in vivo reproducibility. RESULTS Optimized girRAFF preparations yielded improved preparation efficiency (0.95/0.91 simulations/phantom) with respect to RAFF (0.36/0.67 simulations/phantom).T girRAFF $$ {T}_{\mathrm{girRAFF}} $$ preparations showed in phantom/calf 6.0/4.8 times higher resilience toB 0 $$ {\mathrm{B}}_0 $$ inhomogeneities than RAFF, and a 4.7/5.3 improved resilience toB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities. In the knee cartilage,T girRAFF $$ {T}_{\mathrm{girRAFF}} $$ (53± $$ \pm $$ 14 ms) was higher thanT RAFF $$ {T}_{\mathrm{RAFF}} $$ (42± $$ \pm $$ 11 ms). Moreover, girRAFF preparations yielded 7.6/4.9 times improved reproducibility acrossB 0 $$ {\mathrm{B}}_0 $$ /B 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneity conditions, 1.9 times better reproducibility across subjects and 1.2 times across slices compared with RAFF. Dixon-based fat suppression led to a further 15-fold improvement in the robustness of girRAFF to inhomogeneities. CONCLUSIONS RAFF pulses display residual sensitivity to off-resonance and pronounced sensitivity toB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities. Optimized girRAFF pulses provide increased robustness and may be an appealing alternative for applications where resilience against field inhomogeneities is required.
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Affiliation(s)
- Chiara Coletti
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Roeland Naaktgeboren
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Joao Tourais
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | | | - Sebastian Weingärtner
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
- HollandPTC, Delft, The Netherlands
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12
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Ota M, Motomiya M, Watanabe N, Kitaguchi K, Iwasaki N. Efficacy of superficial femoral artery as a recipient in free flap reconstruction around the knee: Four case reports and a literature review. JPRAS Open 2024; 42:81-96. [PMID: 39308742 PMCID: PMC11414274 DOI: 10.1016/j.jpra.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/11/2024] [Indexed: 09/25/2024] Open
Abstract
Purpose Reconstructing soft tissue defects around the knee with free flaps presents challenges in recipient vessel selection. Although the superficial femoral artery (SFA) offers exposure ease and anatomical stability, concerns arise regarding its distance from the defect site, difficulty in performing anastomosis and potential peripheral ischaemia. This study aimed to reassess the suitability of SFA as a recipient vessel for knee reconstructions by examining our cases and those from previous reports. Methods We reviewed four cases of knee soft tissue defects reconstructed with free flaps using the SFA, detailing surgical techniques and outcomes. Additionally, a comprehensive literature search was conducted for articles on using SFA as a recipient vessel for knee free flaps, using PubMed, Web of Science and EBSCOhost databases. Results In all four cases, latissimus dorsi (LD) flaps were used, with end-to-side anastomosis performed using a large slit-shaped arteriotomy. All flaps demonstrated successful survival without complications. Our analysis included 85 cases, comprising four of our cases and 81 cases from 16 articles. Sarcoma resection was the most common aetiology, followed by total knee prosthesis-related defects, trauma and osteomyelitis. Complete flap necrosis occurred in 5% of cases. The LD flap was the predominant choice, alongside other long-pedicle flaps. The SFA provided coverage for all knee areas except the distal lateral patellar region. Conclusion Despite the limited evidence, the SFA appears to be a reliable recipient vessel for knee soft tissue reconstruction. Comprehensive understanding of the characteristics of the SFA and flaps used enhances the safety and efficacy of soft tissue defect reconstruction around the knee.
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Affiliation(s)
- Mitsutoshi Ota
- Department of Orthopaedic Surgery, Obihiro Kosei hospital Hand Center, Obihiro, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Makoto Motomiya
- Department of Orthopaedic Surgery, Obihiro Kosei hospital Hand Center, Obihiro, Japan
| | - Naoya Watanabe
- Department of Orthopaedic Surgery, Obihiro Kosei hospital Hand Center, Obihiro, Japan
| | - Kazuya Kitaguchi
- Department of Radiological Technology, Obihiro Kosei Hospital, Obihiro, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Ibdah MG, Baraghithi NI, Al-Karaja L, Awida H, Abosleem A, Alwan NA, Salman M, Nasser Q. Spinal schwannoma: Limitations of CT imaging. Radiol Case Rep 2024; 19:6068-6071. [PMID: 39380829 PMCID: PMC11458935 DOI: 10.1016/j.radcr.2024.08.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 10/10/2024] Open
Abstract
Spinal schwannomas are benign lesions that most commonly appear in the lumbar and thoracic regions of the spine. Although computed tomography (CT) scans are often used to assess spinal conditions, they are ineffective at detecting soft tissue abnormalities. This case is for a 49-year-old female who experienced a gradual loss of sensation and strength in her lower extremities, along with increased urinary urgency, over six weeks. In addition, mid-back pain has been present for one year. Initially, a CT scan was done and did not show any significant findings, which suggested the absence of a spinal abnormality. However, magnetic resonance imaging (MRI) revealed an intradural extramedullary lesion causing spinal cord compression. The patient successfully underwent surgery to remove the tumor, and histological analysis confirmed it as spinal schwannoma. This case underlines the diagnostic limitations of CT imaging for spinal lesions and illustrates the superior accuracy of MRI. Thus, a negative CT should not halt further diagnostic evaluation when symptoms persist.
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Affiliation(s)
| | | | - Layth Al-Karaja
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hala Awida
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Abdelrahman Abosleem
- Radiology Department, Al-Makassed Islamic Charitable Hospital, Jerusalem, Palestine
| | | | - Muayad Salman
- Radiology Department, Al-Makassed Islamic Charitable Hospital, Jerusalem, Palestine
| | - Qusai Nasser
- Odessa National Medical University, Odesa, Ukraine
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14
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Choi Y, Han S, Kim YJ, Kim JW, Kim CH. Hearing impairment increases the risk of hip fracture-related mortality and recurrent hip fractures: A propensity score matching analysis. Arch Gerontol Geriatr 2024; 127:105548. [PMID: 38964053 DOI: 10.1016/j.archger.2024.105548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Despite the ongoing rise in hip fractures and the adverse effects of hearing impairment (HI) on increased mortality and morbidity, research addressing the influence of HI on mortality risk or complications in patients with hip fractures remains absent. This study aimed to analyze the effects of HI on mortality and treatment outcomes among patients with hip fracture. METHODS We retrospectively collected data from consecutive patients diagnosed with hip fractures between January 2007 and March 2022 who had auditory examination records. From the initially enrolled 265 patients, data for 58 with HI and 58 without HI (control group) were extracted using a 1:1 propensity score matching. The primary outcome included comparison of mortality rates, and the secondary outcome encompassed the comparison of postoperative medical and surgical complications. RESULTS The 1-year cumulative mortality rate was not significantly different between the HI and control groups, but the overall cumulative mortality rate was significantly higher in the HI than in the control group (63.0 % and 48.6, respectively; P = 0.046) in a follow-up period of up to 16 years. The HI group had a significantly higher incidence of "second hip fractures due to falls" than the control group (P = 0.016), although no differences in other medical and surgical complications were revealed. CONCLUSIONS Awareness of the long-term risk of higher mortality when managing patients with hip fracture and HI is important. To reduce the risk of second hip fractures, paying more attention to fall prevention education and taking a more proactive approach, especially for those with HI.
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Affiliation(s)
- Yeonjoo Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yun Jae Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Banerjee R, Patel D, Farooque K, Gupta D, Seth A, Kochhar KP, Garg B, Jain S, Kumar N, Jain S. Cortical intermittent theta burst stimulation on gait pathomechanics and urinary tract dysfunction in incomplete spinal cord injury patients: Protocol for a randomized controlled trial. MethodsX 2024; 13:102826. [PMID: 39049927 PMCID: PMC11268124 DOI: 10.1016/j.mex.2024.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Gait impairment and neurogenic bladder are co-existing common findings in incomplete spinal cord injury (iSCI). Repetitive transcranial magnetic stimulation (rTMS), evident to be a promising strategy adjunct to physical rehabilitation to regain normal ambulation in SCI. However, there is a need to evaluate the role of Intermittent theta burst stimulation (iTBS), a type of patterned rTMS in restoring gait and neurogenic bladder in SCI patients. The aim of the present study is to quantify the effect of iTBS on spatiotemporal, kinetic, and kinematic parameters of gait and neurogenic bladder dyssynergia in iSCI. After maturing all exclusion and inclusion criteria, thirty iSCI patients will be randomly divided into three groups: Group-A (sham), Group-B (active rTMS) and Group-C (active iTBS). Each group will receive stimulation adjunct to physical rehabilitation for 2 weeks. All patients will undergo gait analysis, as well assessment of bladder, electrophysiological, neurological, functional, and psychosocial parameters. All parameters will be assessed at baseline and 6th week (1st follow-up). Parameters except urodynamics and gait analysis will also be assessed after the end of the 2 weeks of the intervention (post-intervention) and at 12th week (2nd follow-up). Appropriate statistical analysis will be done using various parametric and non-parametric tests based on results.
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Affiliation(s)
- Rohit Banerjee
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deeksha Patel
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamran Farooque
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwal Preet Kochhar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Jain
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Jain
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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16
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Vaishya R, Vaish A, Schäfer L, Migliorini F. Publications and ranking in orthopaedics and sports medicine of European countries during the last three decades: A bibliometric analysis. J Orthop 2024; 58:96-101. [PMID: 39100540 PMCID: PMC11292423 DOI: 10.1016/j.jor.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction The present investigation examined the trend of publications and ranking in Orthopaedics and Sports Medicine of European countries during the years 1996 to 2022 and compared these with all the regions globally. Methods In September 2023, the SCOPUS data of publications in Orthopaedics and Sports Medicine from the SCImago Journal & Country Rank website were retrieved. All the data from Western and Eastern Europe were extracted from the overall data of the global countries and merged into Excel files, for each of the years 1996-2022 and 2022. Results Western European countries contributed significantly to the global share of publications in Orthopaedics and Sports Medicine with nearly 1/3rd of the total publications. Eastern European countries' contribution was minimal to the global publications and was almost 10 times less than the Western European countries. The total number of publications in the area of Orthopaedics and Sports Medicine from 1996 to 2022 at the European scale was led by the United Kingdom (N = 51510) and has maintained its supremacy until recently, in 2022. Amongst Western European countries, during the cumulative period of 1996-2022, the maximum contributions were made by the United Kingdom (N = 51510), and also in 2022, the United Kingdom contributed maximally (N = 3339). In the cumulative period of 1996-2022, Poland contributed maximally (N = 4049) among the Eastern European countries. In 2022, the maximum contribution from the Eastern European countries came from the Russian Federation (N = 462). Conclusion The European continent is the major contributor to Orthopaedics and Sports Medicine research and publications, with almost 1/3rd of the global share of publications. Western European countries are far ahead in their contributions than Eastern European countries.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Luise Schäfer
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
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Carvalho EO, Fernandes MM, Ivanova K, Rodriguez-Lejarraga P, Tzanov T, Ribeiro C, Lanceros-Mendez S. Multifunctional piezoelectric surfaces enhanced with layer-by-layer coating for improved osseointegration and antibacterial performance. Colloids Surf B Biointerfaces 2024; 243:114123. [PMID: 39079183 DOI: 10.1016/j.colsurfb.2024.114123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 09/17/2024]
Abstract
Implant failure is primarily caused by poor osseointegration and bacterial colonization, which demands readmissions and revision surgeries to correct it. A novel approach involves engineering multifunctional interfaces using piezoelectric polyvinylidene fluoride (PVDF) materials, which mimic bone tissue's electroactive properties to promote bone integration and provide antibacterial functionality when mechanically stimulated. In this study, PVDF films were coated with antibacterial essential oil nanoparticles and antibiofilm enzymes using a layer-by-layer (LBL) approach to ensure antibacterial properties even without mechanical stimulation. The experimental results confirmed the LBL build-up and demonstrated notable antibiofilm properties against Pseudomonas aeruginosa and Staphylococcus aureus while enhancing pre-osteoblast cell proliferation under mechanical dynamic conditions in a bioreactor that replicated the real-life environment of implants within the body. The findings highlight the potential of PVDF-coated surfaces to prevent biofilm formation and boost cell proliferation through the piezoelectric effect, paving the way for advanced implantable devices with improved osseointegration and antibacterial performance.
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Affiliation(s)
- E O Carvalho
- Physics Centre of Minho and Porto Universities (CF-UM-UP) and LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, Braga, 4710-057, Portugal; IB-S - Institute for Research and Innovation on Bio-Sustainability, University of Minho, Braga, 4710-057, Portugal.
| | - M M Fernandes
- LABBELS-Associate Laborator, Braga, Guimarães, Portugal; Centre for MicroElectroMechanics Systems (CMEMS), University of Minho, Guimarães 4710-057, Portugal
| | - K Ivanova
- Group of Molecular and Industrial Biotechnology, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Rambla Sant Nebridi 22, Terrassa 08222, Spain
| | - P Rodriguez-Lejarraga
- BCMaterials, Basque Center Centre for Materials, Applications, and Nanostructures, UPV/EHU Science Park, Leioa 48940, Spain
| | - T Tzanov
- Group of Molecular and Industrial Biotechnology, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Rambla Sant Nebridi 22, Terrassa 08222, Spain
| | - C Ribeiro
- Physics Centre of Minho and Porto Universities (CF-UM-UP) and LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, Braga, 4710-057, Portugal; IB-S - Institute for Research and Innovation on Bio-Sustainability, University of Minho, Braga, 4710-057, Portugal
| | - S Lanceros-Mendez
- Physics Centre of Minho and Porto Universities (CF-UM-UP) and LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, Braga, 4710-057, Portugal; BCMaterials, Basque Center Centre for Materials, Applications, and Nanostructures, UPV/EHU Science Park, Leioa 48940, Spain; Ikerbasque, Basque Foundation for Science, Bilbao 48009, Spain.
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DeMaio EL, Marra G, Suleiman LI, Tjong VK. Global Health Inequities in Orthopaedic Care: Perspectives Beyond the US. Curr Rev Musculoskelet Med 2024; 17:439-448. [PMID: 39240419 DOI: 10.1007/s12178-024-09917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE OF REVIEW The burden of musculoskeletal disease is increasing globally and disproportionately affecting people in low and middle income countries (LMIC). We sought to review global access to orthopaedic care, burden of trauma, research infrastructure, impact of surgical mission trips, implant availability, and the effect of COVID-19 upon the delivery of orthopaedic care worldwide. RECENT FINDINGS The majority of people in LMIC do not have access to safe, quality surgical care, and there are few fellowship-trained orthopaedic traumatologists. Road traffic accidents are the leading cause of long bone fractures in LMIC and result in significant morbidity and mortality. Of the orthopaedic literature published globally in the last 10 years, less than 15% had authors from LMIC. There has been growth in surgical mission trips to LMIC, but few organizations have established bidirectional partnerships. Among the challenges to delivering quality musculoskeletal care in LMIC is timely access to quality orthopaedic implants. Implant options in LMIC are more limited and subjected to less rigorous testing and regulation than high income countries (HIC). The COVID-19 pandemic dramatically reduced elective surgeries but saw the increase in telemedicine utilization which has prevailed in both HIC and LMIC. Awareness of global inequities in orthopaedic care is growing. Much can be learned through collaborations between orthopaedic surgeons from HIC and LMIC to advance patient care worldwide. There is a need for high quality, accurate data regarding incidence and prevalence of musculoskeletal disease, care utilization/availability, and postoperative outcomes so resources can be allotted to make orthopaedic care more equitable globally.
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Affiliation(s)
- Emily L DeMaio
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA.
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Moffett O, Bloom GB, Barnes CL, Stronach BM, Mears SC, Stambough JB. The Use of General Anesthesia in Revision Joint Arthroplasty. J Arthroplasty 2024; 39:2831-2836. [PMID: 38788812 PMCID: PMC11458356 DOI: 10.1016/j.arth.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Several studies have suggested that spinal anesthesia gives superior outcomes for primary total joint arthroplasty (TJA). However, there is a lack of available data regarding contemporary general anesthesia (GA) approaches for revision TJA utilized at high-volume joint arthroplasty centers. METHODS We retrospectively reviewed a series of 850 consecutive revision TJAs (405 revision total hip arthroplasties and 445 revision total knee arthroplasties) performed over 4 years at a single institution that uses a contemporary GA protocol and reported on the lengths of stay, early recovery rates, perioperative complications, and readmissions. RESULTS Of the revision arthroplasty patients, 74.4% (632 of 850) were discharged on postoperative day 1 and 68.5% (582 of 850) of subjects were able to participate in physical therapy on the day of surgery. Only 6 patients (0.7%) required an intensive care unit stay postoperatively. The 90-day readmission rate over this time was 11.3% (n = 96), while the reoperation rate was 9.4% (n = 80). CONCLUSIONS While neuraxial anesthesia is commonly preferred when performing revision TJA, we have demonstrated favorable safety and efficiency metrics utilizing GA in conjunction with contemporary enhanced recovery pathways. Our data support the notion that modern GA techniques can be successfully used in revision TJA.
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Affiliation(s)
- Olivia Moffett
- University of Arkansas for Medical Sciences, College of Medicine
| | - G. Barnes Bloom
- University of Arkansas for Medical Sciences, Department of Orthopaedic Surgery
| | - C. Lowry Barnes
- University of Arkansas for Medical Sciences, Department of Orthopaedic Surgery
| | | | - Simon C. Mears
- University of Arkansas for Medical Sciences, Department of Orthopaedic Surgery
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Chahrour M, Chamseddine H, Kabbani L, Aboul Hosn M. Regional Anesthesia is Associated with Improved Mortality and Morbidity in Patients with Congestive Heart Failure Undergoing Lower Extremity Amputation. Ann Vasc Surg 2024; 108:206-211. [PMID: 38950851 DOI: 10.1016/j.avsg.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/18/2024] [Accepted: 04/07/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND While existing literature reports variable results of general anesthesia (GA) and regional anesthesia (RA) in patients undergoing lower extremity amputation (LEA), the effect of RA on patients with congestive heart failure (CHF) has not been explored. This study aims to assess whether the choice of anesthesia plays a role in influencing outcomes within this vulnerable population. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program files between 2005 and 2022, all patients receiving LEA were identified, and the subset of patients with CHF was included. Patient characteristics and 30-day outcomes were compared using χ2 or Fischer's exact test as appropriate for categorical variables and the independent t-test or Mann-Whitney U test as appropriate for continuous variables. The association between anesthesia modality and post-operative outcomes was studied using multivariable logistic regression analysis. RESULTS A total of 5,831 patients (4,779 undergoing GA, 1,052 undergoing RA) with a diagnosis of CHF undergoing LEA were identified. On multivariable logistic regression analysis, RA was associated with lower mortality (adjusted odds ratio [aOR] 0.79, 95% CI 0.65-0.97), pneumonia (aOR 0.76, 95% CI 0.58-0.99), septic shock (aOR 0.64, 95% CI 0.47-0.88), post-operative blood transfusion (aOR 0.82, 95% CI 0.70-0.97), and 30-day readmission (aOR 0.79, 95% CI 0.64-0.97). CONCLUSIONS This study demonstrates that RA for LEA in patients with CHF is associated with decreased morbidity and mortality compared to GA. While furthermore research is needed to confirm this association, RA should be at least considered in CHF patients undergoing LEA when feasible.
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Affiliation(s)
- Mohamad Chahrour
- Division of Vascular Surgery, Department of Surgery, University of Iowa Hospital and Clinics, Iowa, IA
| | - Hassan Chamseddine
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI.
| | - Loay Kabbani
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI
| | - Maen Aboul Hosn
- Division of Vascular Surgery, Department of Surgery, University of Iowa Hospital and Clinics, Iowa, IA.
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21
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Szapary HJ, Desai V, Farid A, Franco H, Chen AF, Lange JK, Ready JE. Predictors of Reoperation and Survival Experience (Minimum 1 Year) for Primary Versus Conversion Total Hip Arthroplasty in Young Patients. J Arthroplasty 2024; 39:2793-2799.e3. [PMID: 38797454 DOI: 10.1016/j.arth.2024.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA), including primary and conversion procedures, is commonly used for many types of joint disease in patients aged below 65 years, though few studies have evaluated THA outcomes in young patients (≤ 40 years old). This study examined a large cohort of patients who underwent THA at a young (≤ 40 years old) age to identify predictors of reoperation and compare survivorship between primary and conversion THAs. METHODS A retrospective study was conducted on 497 patients who underwent 612 primary and conversion THAs at 40 years old or younger between 1990 and 2020. Medical records were reviewed to collect patient/surgical data. A multivariable logistic regression model identified independent predictors of reoperation, and Kaplan-Meier analysis with log-rank tests was used to compare survival curves by THA type. RESULTS The median age at surgery (interquartile range) was 31 years (25 to 36). The median follow-up time was 6.6 years (range, 3.8 to 10.5). Conversion THAs had an increased rate of both revisions (12.3 versus 5.6%, P = 0.02) and nonrevision reoperations (8.9 versus 3.2%, P = 0.03) compared to primary THAs. A ceramic-on-ceramic articulation (odds ratio: 5.17; P = 0.03) and a higher estimated blood loss (odds ratio: 1.0007; P = 0.03) were independent predictors of reoperation for primary and conversion THA, respectively. Conversion THAs had a lower 15-year survival (77.8 versus 90.8%, P = 0.009) compared to primary THAs. CONCLUSIONS Patients ≤ 40 years old who underwent primary and conversion THAs demonstrated an impressive 15-year survival comparable to that of older populations (74 to 93%), while conversion procedures had a higher reoperation rate. Although primary THA may be more ideal, there are promising outcomes for patients who need THA at a younger age than typically implemented, especially for those who are very young (≤ 30 years old).
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Affiliation(s)
- Hannah J Szapary
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vineet Desai
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alexander Farid
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Helena Franco
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John E Ready
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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22
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Warneke K, Lohmann LH. Revisiting the stretch-induced force deficit: A systematic review with multilevel meta-analysis of acute effects. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:805-819. [PMID: 38735533 PMCID: PMC11336295 DOI: 10.1016/j.jshs.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/24/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND When recommending avoidance of static stretching prior to athletic performance, authors and practitioners commonly refer to available systematic reviews. However, effect sizes (ES) in previous reviews were extracted in major part from studies lacking control conditions and/or pre-post testing designs. Also, currently available reviews conducted calculations without accounting for multiple study outcomes, with ES: -0.03 to 0.10, which would commonly be classified as trivial. METHODS Since new meta-analytical software and controlled research articles have appeared since 2013, we revisited the available literatures and performed a multilevel meta-analysis using robust variance estimation of controlled pre-post trials to provide updated evidence. Furthermore, previous research described reduced electromyography activity-also attributable to fatiguing training routines-as being responsible for decreased subsequent performance. The second part of this study opposed stretching and alternative interventions sufficient to induce general fatigue to examine whether static stretching induces higher performance losses compared to other exercise routines. RESULTS Including 83 studies with more than 400 ES from 2012 participants, our results indicate a significant, small ES for a static stretch-induced maximal strength loss (ES = -0.21, p = 0.003), with high magnitude ES (ES = -0.84, p = 0.004) for stretching durations ≥60 s per bout when compared to passive controls. When opposed to active controls, the maximal strength loss ranges between ES: -0.17 to -0.28, p < 0.001 and 0.040 with mostly no to small heterogeneity. However, stretching did not negatively influence athletic performance in general (when compared to both passive and active controls); in fact, a positive effect on subsequent jumping performance (ES = 0.15, p = 0.006) was found in adults. CONCLUSION Regarding strength testing of isolated muscles (e.g., leg extensions or calf raises), our results confirm previous findings. Nevertheless, since no (or even positive) effects could be found for athletic performance, our results do not support previous recommendations to exclude static stretching from warm-up routines prior to, for example, jumping or sprinting.
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Affiliation(s)
- Konstantin Warneke
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz 8010, Austria; Institute of Sport Science, Alpen-Adria University of Klagenfurt, Klagenfurt am Wörthersee 9020, Austria.
| | - Lars Hubertus Lohmann
- Institute of Human Movement and Exercise Physiology, University of Jena, Jena 07749, Germany
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Harvey LA, Payne NL, Tan A, Zhang J, Lai YC, Taylor ME, Armstrong E, McVeigh C, Mikolaizak AS, Hairu R, Scott TA, Bishop M, Close J. Variation in mortality following hip fracture across the Asia Pacific region: Systematic review and proportional meta-analysis. Arch Gerontol Geriatr 2024; 126:105519. [PMID: 38941947 DOI: 10.1016/j.archger.2024.105519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/24/2024] [Accepted: 06/02/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To determine country/region-specific mortality (in-hospital, 30-day and 1-year) following hip fracture across the Asia Pacific region. METHODS Five databases MEDLINE, PUBMED, EMBASE, Web of Science and the Cochrane Library were searched to identify studies that reported mortality following hospitalisation for low-trauma hip fracture in adults aged ≥50 years with data from 2010 to 30 September 2021. There were no restrictions on study design or language. Pooled mortality estimates for countries/regions with ≥2 studies were calculated using random-effects models. RESULTS In total 244 studies were included in the meta-analysis. 123 studies (1,382,810 patients, 13 countries/regions) reported in-hospital mortality which ranged from 1.4 % in Japan [95 %CI 1.2-1.7], Singapore [95 %CI 1.0-1.6], China [95 %CI 0.8-2.3] and Hong Kong SAR [95 %CI 0.8-2.6] to 5.5 % [95 %CI 4.1-7.2] in New Zealand. 92 studies (628,450 patients, 13 countries/regions) reported 30-day mortality which ranged from 1.2 % in Japan [95 %CI 0.9-1.5] and Thailand [95 %CI 0.7-2.0] to 7.4 % [95 %CI 7.0-7.8] in Australia. 142 studies (1,139,752 patients, 14 countries/regions) reported 1-year mortality which ranged from 10.8 % [95 %CI 9.6-12.1] in Singapore to 23.3 % [95 %CI 22.3-24.5] in Australia and 23.8 % in New Zealand. CONCLUSION There is substantial variation in mortality across the Asia Pacific region. Short-term mortality rates in Asian countries, notably Japan and Singapore, are up to four-fold lower than for Australia and New Zealand. This difference, although less marked, is sustained at 1-year with a two-fold lower mortality rate in Asia. This meta-analysis is the first to delineate these differences, further studies are required to understand the reasons for this variation.
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Affiliation(s)
- L A Harvey
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia.
| | - N L Payne
- Neuroscience Research Australia, Sydney, Australia
| | - A Tan
- Nepean Hospital, Sydney, Australia
| | - J Zhang
- School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia
| | - Y C Lai
- Khoo Teck Puat Hospital, Singapore
| | - M E Taylor
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - E Armstrong
- Neuroscience Research Australia, Sydney, Australia; School of Population Health, UNSW Medicine & Health, UNSW, Sydney, Australia
| | - C McVeigh
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | | | - R Hairu
- Neuroscience Research Australia, Sydney, Australia; School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
| | - T A Scott
- Prince of Wales Hospital, Sydney, Australia
| | - M Bishop
- Concord Repatriation General Hospital, Sydney, Australia
| | - Jct Close
- Neuroscience Research Australia, Sydney, Australia; School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
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24
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Rudy MD, Grant PJ. The Patient with Hip Fracture. Med Clin North Am 2024; 108:1155-1169. [PMID: 39341619 DOI: 10.1016/j.mcna.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Hip fractures are a frequent cause of hospitalization in the elderly population and can lead to significant morbidity and mortality. As the population continues to age, the incidence of hip fractures is expected to increase. The internist/hospitalist plays a critical role in the care of this population as many patients have multiple medical comorbidities. Management of the fragility hip fracture patient requires knowledge of several perioperative topics including preoperative risk assessment, risk reduction strategies, the optimal timing of surgical repair, venous thromboembolism prevention, and postoperative care considerations such as early mobilization with physical therapy, and osteoporosis treatment.
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Affiliation(s)
- Michael D Rudy
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Paul J Grant
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Srinivasa V, Thirugnanam B, Pai Kanhangad M, Soni A, Kashyap A, Vidyadhara A, Rao SK. Flattening the learning curve - Early experience of robotic-assisted pedicle screw placement in spine surgery. J Orthop 2024; 57:49-54. [PMID: 38973970 PMCID: PMC11225720 DOI: 10.1016/j.jor.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Aims and objectives To determine accuracy of pedicle screws placed by freehand, fluoroscopy-assistance and robotic-assistance with intraoperative image acquisition, and determine the presence of learning curve in robotic spine surgery in a prospective single centre study. Materials and methods In a prospective study, a total of 1120 pedicle screws were placed in Freehand group (n = 175), 1250 screws were placed in fluoroscopy-assisted group (n = 172), and 1225 screws were inserted in Robotic-assisted group(n = 180). Surgical parameters and screw accuracy were analyzed between the three groups. The preoperative plan was overlapped with post operative O-arm scan to determine if the screws were executed as planned. Results The frequency of clinically acceptable screw placement (Gertzbein and Robbins grade A, B) in the Freehand, Fluoroscopy-assisted, and Robotic-assisted groups were 97.7 %, 98.6 %, and 99.34 % respectively. Higher pedicle screw accuracy, and lower blood loss were seen with robotic assistance. There was no significant difference in these parameters between surgeries commencing before and after 2 p.m. We found no statistically significant differences between the planned and executed screw trajectories in robotic assisted group irrespective of surgical experience. Conclusion The third-generation robotic-assisted pedicle screw placement system, used in conjunction with intraoperative 3D O-arm imaging, consistently lowered blood loss and increased accuracy of pedicle screw placement in the thoracolumbar spine. It also has easy adaptability into spine practice with minimal learning curve.
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