151
|
An YS, Gil JW, Lee SK, Oh T, Seo SY. Is arthritis an associated risk factor for trigger finger occurrence after carpal tunnel release? A nationwide, population-based study in Korea. Int Orthop 2024; 48:1065-1070. [PMID: 38165448 DOI: 10.1007/s00264-023-06079-z] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE We hypothesized that increased friction between the flexor tendon and surrounding structures due to hand arthritis is an important risk factor for trigger finger (TF) after carpal tunnel release (CTR). Therefore, we compared TF development according to the presence or absence of arthritis in carpal tunnel syndrome (CTS) patients treated with CTR. METHODS This retrospective study was based on data collected from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in the Republic of Korea between January 1, 2002, and December 31, 2015. Patients diagnosed with TF between one month and one year after the CTR date or with a history of surgery were included in the study. During subsequent follow-up, the patients were divided into subgroups of those (1) with TF and (2) without TF. Sex, age, arthritis, and TF-related comorbidities were compared between the subgroups. RESULTS The subgroup with TF had a higher proportion of women (9.43% vs 90.57%), the highest age range between 50 and 59 years, more cases of arthritis (32.55% vs 16.79%), and a higher proportion of patients with hypothyroidism (10.85% vs 4.60%) than the group without TF. The association between arthritis and TF after CTR was examined using a multivariate logistic regression model, showing arthritis to be a significant risk factor for TF after CTR (odds ratio, 1.35; P = 0.049). CONCLUSIONS We identified arthritis as an important risk factor for the development of TF after CTR.
Collapse
Affiliation(s)
- Young Sun An
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Korea
| | - Jong Won Gil
- Division of Medical Radiation, Bureau of Healthcare Safety and Immunization, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Sang Ki Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Korea.
| | - Taeho Oh
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon, 35233, Korea
| | - Sun Youl Seo
- Department of Radiological Science, Hallym Polytechnic University, Chuncheon, Republic of Korea
| |
Collapse
|
152
|
Addai D, Zarkos J, Pettit M, Lützner C, Wronka K, Stiehler M. The Effect of Waiting for a Primary Total Hip Arthroplasty on the Overall Hip Function and Quality of Life. J Arthroplasty 2024; 39:974-978.e1. [PMID: 37863273 DOI: 10.1016/j.arth.2023.10.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The primary aim was to determine whether time spent awaiting primary total hip arthroplasty (THA) affects patient-reported outcome measures (PROMs) using the Oxford Hip score, Harris Hip Score, and visual analogue scale (VAS) pain. The secondary aim was to assess whether patients have worsening HRQoL, while awaiting THA using the European Quality of Life Five Dimension (EQ-5D) index and EQ-5D health VAS. METHODS This was a single center cross-sectional study of 190 patients awaiting THA. Patients were divided into waiting "more than 6 months" and "less than 6 months." Baseline and current scores were compared. Multivariate regression analyses were performed to identify predictors of PROM change. RESULTS No significant intergroup differences were observed for change in preoperative Oxford Hip score, Harris Hip Score, and VAS pain from index consultation to time of study. The EQ-5D index and EQ-5D health VAS decreased significantly further in patients waiting more than 6 months (P = .043, P = .004). Time awaiting THA was significantly associated with a decrease in EQ-5D index and EQ-5D health VAS in multivariate regression (P = .013, P < .001). CONCLUSIONS Waiting more than 6 months is not associated with a decrease in hip-specific PROMs and longer waiting times are not associated with changes in hip-specific PROMs. Waiting time was associated with a decrease in health-related quality of life and patients waiting more than 6 months had significantly higher decreases in EQ-5D scores. This suggests that living longer with hip osteoarthritis leads to a decrease in QoL, not necessarily through perceived osteoarthritis progression. LEVEL OF EVIDENCE Level III cross-sectional study.
Collapse
Affiliation(s)
- Daniel Addai
- West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, England; University Centre for Orthopaedics, Trauma & Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | - Jacqueline Zarkos
- West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, England
| | - Matthew Pettit
- St George's University Hospitals, NHS Foundation Trust, London, England
| | - Cornelia Lützner
- University Centre for Orthopaedics, Trauma & Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | - Konrad Wronka
- West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, England
| | - Maik Stiehler
- University Centre for Orthopaedics, Trauma & Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
153
|
Zhang J, Guo S, Tao M, Yu D, Cheng CK. Automatic planning and geometric analysis of the drilling path in core decompression surgery for osteonecrosis of the femoral head. Comput Methods Programs Biomed 2024; 247:108059. [PMID: 38382305 DOI: 10.1016/j.cmpb.2024.108059] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Core decompression surgery is an effective treatment method for patients with pre-collapse osteonecrosis of the femoral head (ONFH). The treatment relies on accurately predrilling the wire into the necrotic lesion. However, the surgical planning of this drilling path remains unclear. This paper aims to develop a framework to automatically plan the drilling path and analyze its geometric parameters. METHODOLOGY The proposed system consists of two stages. The first stage is to detect the key points. Besides the entry point and target point for the drilling path, the center of the femoral head (FH) and the boundary points of the necrotic lesion are also detected for the subsequent geometric analysis. In the second stage, the geometric parameters of the drilling path are analyzed, including the size of the necrotic lesion, the length from the entry point to the target point, the relative location between the FH center and the necrosis center, and the angular range of the drilling path in the anterior-posterior (AP) direction and superior-inferior (SI) direction. RESULTS All of the drilling paths designed by the proposed system were considered successful, starting from the proximal subtrochanteric region, terminating at the center of the necrotic lesion, and remaining within the femoral neck. The relative coordinates of the centers of the femoral head and necrotic lesion were (-0.89,5.14,2.63) mm for the left femurs and (1.55,5.92,2.63) mm for the right femurs, on average. The angular range of the drilling path was 39.99±29.58 degrees in the SI direction and 46.18±40.73 degrees in the AP direction. CONCLUSION This study develops a framework that allows for automatic planning and geometric analysis of the drilling path in core decompression surgery. The target point of the drilling path primarily resides in the lateral-anterior-superior region relative to the femoral head center. Surgeons and researchers can benefit from our unified framework while still maintaining the flexibility to adapt to variations in surgical cases.
Collapse
Affiliation(s)
- Jiping Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Sijia Guo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Mingzhu Tao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Degang Yu
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai 20030, China.
| |
Collapse
|
154
|
Randsborg PH, Brinchmann JE, Owesen C, Engebretsen L, Birkenes T, Hanvold HA, Benth JŠ, Årøen A. Autologous Chondrocyte Implantation Is Not Better Than Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: Two-Year Results From a Randomized-Controlled Trial. Arthrosc Sports Med Rehabil 2024; 6:100909. [PMID: 38495635 PMCID: PMC10943062 DOI: 10.1016/j.asmr.2024.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose To compare the functional and patient-reported outcome measures after autologous chondrocyte implantation (ACI) and arthroscopic debridement (AD) in symptomatic, isolated cartilage injuries larger than 2 cm2 in patients aged 18 to 50 years. Methods Twenty-eight patients were included and randomized to ACI (n = 15) or AD (n = 13) and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale. Results The mean age at inclusion was 34.1 (standard deviation [SD] 8.5) years. There were 19 (68%) male patients. The mean size of the lesion was 4.2 (SD 1.7) cm2. There was a statistically significant and clinically meaningful improvement in patient-reported outcome measures from baseline to 2 years in both groups. The improvement from baseline to final follow-up for the primary endpoint (the KOOS QoL subscale) was larger for the AD group (39.8, SD 9.4) compared with the ACI group (23.8, SD 6.7), but this difference was not statistically significant (P = .17). However, according to a mixed linear model there were statistically significantly greater scores in the AD group for several KOOS subscales at several time points, including KOOS QoL, KOOS pain, and KOOS sport and recreation at 2 years. Conclusions This study indicates that AD followed by supervised physiotherapy is equal to or better than ACI followed by supervised physiotherapy in patients with isolated cartilage lesions of the knee larger than 2 cm2. The improvement in KOOS QoL score from baseline to 2 years was clinically meaningful for both groups (23.8 points for ACI and 39.8 points AD), and larger for the AD group by 16 points. Level of Evidence Level I, prospective randomized controlled trial.
Collapse
Affiliation(s)
- Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Jan E. Brinchmann
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christian Owesen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Lars Engebretsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thomas Birkenes
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Sports Traumatology and Arthroscopy Research Group, Bergen, Norway
| | | | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Asbjørn Årøen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| |
Collapse
|
155
|
Swallow J, Seidler K, Barrow M. The mechanistic role of curcumin on matrix metalloproteinases in osteoarthritis. Fitoterapia 2024; 174:105870. [PMID: 38423225 DOI: 10.1016/j.fitote.2024.105870] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/02/2024]
Abstract
A systematic mechanistic review was performed to determine mechanistic evidence for curcumin on pro-inflammatory matrix metalloproteinases and Osteoarthritis to understand the underlying pathophysiology, and to evaluate available human intervention evidence to inform clinical decision making. The systematic literature search was performed in 3 tranches (reviews, mechanistic, intervention studies) using PubMed, with no date limitations and using specific search terms. 65 out of 393 screened papers were accepted based on detailed inclusion and exclusion criteria. The mechanistic search was divided into three searches and the intervention searches were subdivided into four searches. Curcumin demonstrated significant inhibition of matrix metalloproteinases linked to cartilage degradation in Osteoarthritis through reduced activation of the nuclear factor kappa-B signaling pathway via suppressing phosphorylation of Iκβa and p65 nuclear translocation. Mechanistic evidence implicated matrix metalloproteinases in Osteoarthritis by decreasing Type II collagen, leading to cartilage damage. As a potential nutritional intervention for Osteoarthritis, curcumin could reduce inflammatory markers and improve pain and function scores. The evidence indicates most formulations of turmeric extract and curcumin extract, bio-enhanced and non-bio-enhanced, are effective at improving inflammatory markers and pain and function to a greater or lesser extent. Due to the high heterogeneity of the formulations, dosage, and duration of the studies, further research is needed to fully understand curcumin's potential as a promising non-pharmaceutical intervention for Osteoarthritis. This mechanism review identifies a gap in current research for the mechanism by which Type II collagen is mediated.
Collapse
Affiliation(s)
- Jennifer Swallow
- Centre for Nutrition Education and Lifestyle Management (CNELM), Chapel Garden, 14 Rectory Road, Wokingham, Berkshire RG40 1DH, UK.
| | - Karin Seidler
- Centre for Nutrition Education and Lifestyle Management (CNELM), Chapel Garden, 14 Rectory Road, Wokingham, Berkshire RG40 1DH, UK.
| | - Michelle Barrow
- Centre for Nutrition Education and Lifestyle Management (CNELM), Chapel Garden, 14 Rectory Road, Wokingham, Berkshire RG40 1DH, UK.
| |
Collapse
|
156
|
Cornell DJ, Gnacinski SL, Ebersole KT. Changes in Dynamic Balance Ability Among Firefighter Recruits: A Longitudinal Cohort Study. J Strength Cond Res 2024; 38:734-741. [PMID: 38513179 DOI: 10.1519/jsc.0000000000004670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT Cornell, DJ, Gnacinski, SL, and Ebersole, KT. Changes in dynamic balance ability among firefighter recruits: A longitudinal cohort study. J Strength Cond Res 38(4): 734-741, 2024-It has been suggested that enhanced balance ability may mitigate the high musculoskeletal injury (MSKI) rate among firefighters, but the longitudinal changes in dynamic balance ability within this tactical athlete population have yet to be characterized. The purpose of this study was to examine the changes in dynamic balance ability of a cohort population of firefighter recruits completing a training academy and their probationary period as active-duty firefighters. Twenty-seven male firefighter recruits completed the modified Star Excursion Balance Test (mSEBT) at the beginning (W1) and at the end of their training academy (W14) and after completing their probationary period as active-duty firefighters (W38). After controlling for age and changes in body fat (BF) over time, significant changes in mSEBTANT ( p < 0.001), mSEBTPL ( p = 0.015), mSEBTPM ( p < 0.001), and mSEBTCOMP ( p = 0.003) were observed across time. Although mSEBTPL performance significantly increased ( p = 0.033) in from W1 to W14, significant decreases in all mSEBT reach directions were observed from W14 to W38 ( p < 0.05), with mSEBTANT ( p < 0.001) and mSEBTCOMP ( p = 0.002) also significantly decreasing from W1 to W38. However, the frequency of right vs. left asymmetries (>4 cm) did not significantly change over time in any mSEBT reach direction ( p > 0.05). Irrespective of age or changes in BF, minimal changes in the dynamic balance ability of firefighter recruits were observed during their training academy, but significant decreases in balance ability were noted by the end of their probationary period.
Collapse
Affiliation(s)
- David J Cornell
- Health Assessment Laboratory, University of Massachusetts Lowell, Lowell, Massachusetts
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, Massachusetts
| | | | - Kyle T Ebersole
- Human Performance and Sport Physiology Laboratory, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
- School of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| |
Collapse
|
157
|
Doğu H, Abdallah A. A novel guide device for pedicle screw insertion using three-dimensional preoperative planning in open lumbar spinal surgery: a comparative retrospective study. Neurol Res 2024:1-11. [PMID: 38557428 DOI: 10.1080/01616412.2024.2328486] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 03/03/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Pedicle screw stabilization (PSS) surgeries for spinal instability are still the most effective treatment approach. The use of preoperative planning can minimize the complications related to transpedicular screw (TPS) misplacement. The study aimed to evaluate the surgical outcomes of a guide device developed to improve the accuracy of the free-hand technique using three-dimensional planning in PSS. PATIENTS AND METHODS Patients with degenerative spinal diseases who underwent open PSS between 2019 and 2022 were evaluated retrospectively. FG group included patients who were operated on using the fluoroscopy alone with preoperative two-dimensional planning. AFG group included patients who were operated on using a guide advice-assisted technique with preoperative 3DP. Between-group comparisons were performed. RESULTS A total of 143 patients with a mean age of 59.6 years were included in the study. 71 patients were assessed in the FG group and 72 patients in the AFG group. Between-group comparisons regarding demographics, etiologies, radiation exposure, and functional improvements showed no significant differences (p > 0.05). Although the accuracy of TPSs positioning was 94.2% and 96.5% in the 2DG and 3DG, the difference between the groups was not statistically significant. The statistically significant differences regarding the upper-level facet joint violation and pedicle breach rates were lower in the AFG group (p < 0.0001; X2 = 19.57) and (p < 0.0001; X2 = 25.3), respectively. CONCLUSION Using a guide device associated with preoperative 3PD reduced the upper-level facet joint violation and pedicle breach rates in open PSS surgeries performed by free-hand technique for degenerative spinal diseases.
Collapse
Affiliation(s)
- Hüseyin Doğu
- Department of Neurosurgery, Atlas University-Medicine Hospital, Istanbul, Bağcılar, Turkey
| | - Anas Abdallah
- Department of Neurosurgery, University of Health Sciences-Istanbul Training and Research Hospital, Istanbul, Samatya, Turkey
| |
Collapse
|
158
|
Sasi A, Chitikela S, Ganguly S, Biswas B, Pushpam D, Kumar A, Khan SA, Kumar VS, Kale SS, Biswas A, Barwad A, Mridha AR, Thulkar S, Bakhshi S. Treatment outcomes in patients with Ewing sarcoma of the spine in a resource-challenged setting: 17-year experience from a single center in India. Pediatr Hematol Oncol 2024; 41:211-223. [PMID: 38189167 DOI: 10.1080/08880018.2023.2296949] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
Ewing sarcoma (ES) of the spine is a rare childhood cancer with sparse literature on treatment outcomes. We aimed to describe survival outcomes and prognostic factors in patients with spinal ES treated at a single institute in a resource-challenged setting. We conducted a retrospective analysis of patients with spinal ES registered at a tertiary care oncology center between 2003-2019. Clinical patient data was retrieved from hospital records. Cox regression analysis was used to identify the association of baseline clinical parameters with event free survival (EFS) and overall survival (OS). A cohort of 85 patients was analyzed including 38 (45%) patients with metastatic disease. The median age was 15 years with 73% being male. Local therapy was administered in 62 (72.9%) patients with surgery alone in 8 (9.4%), radiotherapy alone in 36 (42.4%) and both in 18 (21.2%) patients. A higher proportion of males received local therapy than females (80.3% versus 59.1%; p = 0.049). The median EFS and OS were 20.1 and 28.6 months, respectively. On univariable analysis, age ≤ 15 years, female sex, serum albumin ≤3.5 g/dL and hemoglobin ≤11 g/dL were associated with inferior EFS while younger age, female sex, hypoalbuminemia and metastatic disease were associated with inferior OS. On multivariable analysis, only hypoalbuminemia was predictive for inferior EFS (HR:2.41; p = 0.005) while hypoalbuminemia (HR:2.06;p = 0.033) and female sex (HR:1.83; p = 0.046) were associated with inferior OS. We concluded that hypoalbuminemia confers poor prognosis in ES spine. Survival outcomes are poorer in females treated in our setting, possibly due to prevailing sex-based biases.
Collapse
Affiliation(s)
- Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Centre, Kolkata, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, National Cancer Institute, Jhajjar, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
159
|
Valenti J, Posner K, Nadeau N, Bakus C, Richards S. Comments on the Article "Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions": To the Editor. Clin Orthop Surg 2024; 16:342-345. [PMID: 38562633 PMCID: PMC10973630 DOI: 10.4055/cios23323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/12/2023] [Indexed: 04/04/2024] Open
Affiliation(s)
| | - Kevin Posner
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | | | | | - Sean Richards
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| |
Collapse
|
160
|
Berk AN, Cregar WM, Rao AJ, Trofa DP, Schiffern SC, Hamid N, Saltzman BM. Anatomic total shoulder arthroplasty with inlay glenoid component: A systematic review. Shoulder Elbow 2024; 16:119-128. [PMID: 38655412 PMCID: PMC11034471 DOI: 10.1177/17585732231154850] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/14/2023] [Indexed: 04/26/2024]
Abstract
Background A total shoulder arthroplasty (TSA) system utilizing an inlay glenoid component has been proposed as a means of reducing glenoid component loosening while still providing patients with desirable functional and clinical outcomes. The purpose of this study was to systematically review current outcomes literature on TSA using an inlay glenoid component. Methods A literature search was conducted using PubMed/MEDLINE, Cochrane Database of Systematic Reviews, and Web of Science databases. Studies comparing pre- and postoperative functional and clinical outcomes were included. Results Five studies with 148 shoulders (133 patients) were included. Patient-reported outcomes improved, including the American Shoulder and Elbow Surgeons score (mean change 34.1 to 80.6), Penn Shoulder Score (mean change 43.3 to 85.5), Single Assessment Numeric Evaluation score (mean change 34.1 to 80.6), and visual analog scale-pain (mean change 6.9 to 1.6). Range of motion improved for forward elevation (mean change 109.6 to 156.2) and external rotation (mean change 21.5 to 50.8). Glenoid component loosening occurred in one shoulder (0.68%). Two revision surgeries (1.35%) were performed. Discussion The use of an inlay glenoid component is associated with improvements in postoperative pain, function, and satisfaction while minimizing rates of glenoid component loosening and the need for revision surgery over short-term follow-up. Level of evidence systematic review, level IV.
Collapse
Affiliation(s)
- Alexander N. Berk
- OrthoCarolina—Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health—Musculoskeletal Institute,Charlotte, NC, USA
| | - William M. Cregar
- OrthoCarolina—Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Allison J. Rao
- University of Minnesota Physicians, University of Minnesota—Department of Orthopedic Surgery, Minneapolis, MN, USA
| | - David P. Trofa
- New York Presbyterian, Columbia University Medical Center—Department of Orthopaedics, New York, NY, USA
| | - Shadley C. Schiffern
- OrthoCarolina—Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Nady Hamid
- OrthoCarolina—Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Bryan M. Saltzman
- OrthoCarolina—Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health—Musculoskeletal Institute,Charlotte, NC, USA
| |
Collapse
|
161
|
Setliff JC, Paulus PF, Yamamoto T, Yang S, Hogan MV, Anderst WJ. Ankle and hindfoot motion of healthy adults during running revealed by dynamic biplane radiography: Side-to-side symmetry, sex-specific differences, and comparison with walking. Med Eng Phys 2024; 126:104151. [PMID: 38621840 DOI: 10.1016/j.medengphy.2024.104151] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024]
Abstract
This study aimed to characterize ankle and hindfoot kinematics of healthy men and women during overground running using biplane radiography, and to compare these data to those previously obtained in the same cohort during overground walking. Participants ran across an elevated platform at a self-selected pace while synchronized biplane radiographs of their ankle and hindfoot were acquired. Motion of the tibia, talus, and calcaneus was tracked using a validated volumetric model-based tracking process. Tibiotalar and subtalar 6DOF kinematics were obtained. Absolute side-to-side differences in ROM and kinematics waveforms were calculated. Side-to-side and sex-specific differences were evaluated at 10 % increments of stance phase with mixed model analysis. Pearson correlation coefficients were used to assess the relationship between stance-phase running and walking kinematics. 20 participants comprised the study cohort (10 men, mean age 30.8 ± 6.3 years, mean BMI 24.1 ± 3.1). Average absolute side-to-side differences in running kinematics waveforms were 5.6°/2.0 mm or less at the tibiotalar joint and 5.2°/3.2 mm or less at the subtalar joint. No differences in running kinematics waveforms between sides or between men and women were detected. Correlations were stronger at the tibiotalar joint (42/66 [64 %] of correlations were p < 0.05), than at the tibiotalar joint (38/66 [58 %] of correlations were p < 0.05). These results provide a normative reference for evaluating native ankle and hindfoot kinematics which may be informative in surgical or rehabilitation contexts. Sex-specific differences in ankle kinematics during overground running are likely not clinically or etiologically significant. Associations seen between walking and running kinematics suggest one could be used to predict the other.
Collapse
Affiliation(s)
- Joshua C Setliff
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.
| | - Paige F Paulus
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tetsuya Yamamoto
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumeng Yang
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh, Foot and Ankle Injury Research [F.A.I.R] Group, USA
| | - William J Anderst
- Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
162
|
Danieli MV, Fernandes Guerreiro JP. Extraarticular infection 9 years after anterior cruciate ligament reconstruction. Case report. J ISAKOS 2024; 9:211-214. [PMID: 38081388 DOI: 10.1016/j.jisako.2023.12.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Abstract
Extraarticular infection after anterior cruciate ligament reconstruction (ACLr) is a rare condition with challenging diagnosis because the symptoms are milder and more insidious when compared to septic arthritis. When late (>2 months after surgery), it tends to be associated with osteomyelitis, requiring more extensive surgical debridement and hardware removal. We report a case of extraarticular infection after ACLr, in the acute phase affecting the tibial site and 9 years after index surgery affecting around the femur site. There was no progression to osteomyelitis at any of the sites. The infection developed a large posterolateral encapsulated abscess, with the endobutton plate loose inside it with its loop intact. In addition to the absence of osteomyelitis progression, there was no sinus tract formation, graft or joint involvement. With open debridement and antibiotic therapy, the patient returned to his activities without limitations. The reported case highlights that extraarticular infection after ACLr, while rare, can be challenging to diagnose and treat. However, with appropriate treatment, it can lead to good results with no functional limitations.
Collapse
Affiliation(s)
- Marcus Vinicius Danieli
- Unort.E Hospital de Ortopedia, Av. Higienópolis nº 2600, Londrina, PR CEP 86050-000, Brazil; Pontifícia Universidade Católica PUC, Paraná - Campus de Londrina, Av. Jockey Club, 485, Hípica, Londrina, PR CEP 86067-000, Brazil.
| | - João Paulo Fernandes Guerreiro
- Unort.E Hospital de Ortopedia, Av. Higienópolis nº 2600, Londrina, PR CEP 86050-000, Brazil; Pontifícia Universidade Católica PUC, Paraná - Campus de Londrina, Av. Jockey Club, 485, Hípica, Londrina, PR CEP 86067-000, Brazil.
| |
Collapse
|
163
|
Richards DP, Miller DL, MacDonald ED, Stewart QF, Miller SD. Rotator Cuff Tears Are Related to the Side Sleeping Position. Arthrosc Sports Med Rehabil 2024; 6:100886. [PMID: 38328528 PMCID: PMC10847686 DOI: 10.1016/j.asmr.2024.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose To determine whether there was a relationship between sleep position and symptomatic partial- and full-thickness rotator cuff tears. Methods A consecutive series of patients that met the inclusion/exclusion criteria (n = 58) were in seen in clinic between July 2019 and December 2019. All of these individuals had a significant partial-thickness (> 50%) or full-thickness rotator cuff tear determined by either ultrasound, magnetic resonance imaging, or both. All patients in this series either had an insidious onset of shoulder pain or their symptoms were related to the basic wear and tear of daily activities. Traumatic rotator cuff tears (those associated with a significant traumatic event such as shoulder instability, motor vehicle accidents, sports related injuries, etc.) were excluded. Previous shoulder surgery, recurrent rotator cuff tears, and worker's compensation cases also were excluded from this series. As part of the history-taking process, the patients were asked what was their preferred sleeping position-side sleeper, back sleeper, or stomach sleeper. A χ2 test was conducted to determine the relationship between rotator cuff pathology and sleep position. Results Of the 58 subjects, 52 of the patients were side sleepers, 4 were stomach sleepers, 1 was a back sleeper, and 1 preferred all 3 positions. Statistical analysis, using the χ2 test (P < .0001), demonstrated that rotator cuff tears were most often seen in side sleepers. Conclusions In our study, there appeared to be a relationship between the preference of being a side sleeper and the presence of a rotator cuff tear. Level of Evidence Level IV, prognostic case series.
Collapse
Affiliation(s)
- David P. Richards
- West Virginia University – Eastern Division – Charles Town, West Virginia, U.S.A
- Rocky Mountain Health – Calgary, Alberta, Canada
| | | | | | | | | |
Collapse
|
164
|
Guevara-Alvarez A, Valencia-Ramon EA, Bothorel H, Collin P, Zbinden J, Guizzi A, Lädermann A. Traumatic and Atraumatic Rotator Cuff Tears Have the Same Rates of Healing. Arthrosc Sports Med Rehabil 2024; 6:100867. [PMID: 38379596 PMCID: PMC10877195 DOI: 10.1016/j.asmr.2023.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024] Open
Abstract
Background To examine whether traumatic rotator cuff repairs (RCRs) differ in postoperative rotator cuff tendon integrity and functional outcomes from degenerative RCRs. Methods RCRs performed by a single surgeon were retrospectively identified. The inclusion criteria were repairable Goutallier grades 0 to 2 full-thickness rotator cuff tears. Demographic and clinical data as well as radiological results were compared. A multivariate logistic regression of the of patient acceptable symptom state for American Shoulder and Elbow Surgeons (ASES) score was performed to evaluate whether the origin of tear led to a different relative risk (RR) independently from tear and surgical characteristics. Results A total of 616 consecutive shoulders (304 traumatic and 312 degenerative) were finally included. Traumatic ruptures presented a greater distribution of male (72% vs 51%, P < .001) and younger patients (53 vs 57 years, P < .001), as well as earlier onset of symptoms (3 vs 15 months, P < .001), reduced range of motion in preoperative assessment for forward elevation (130° vs 150°, P < .001), and slightly greater preoperative ASES (46.5 ± 19.7 vs 50.0 ± 18.0, P = .022) and Constant (47.0 ± 20.2 vs 52.0 ± 18.9, P = .001) scores. Degenerative tears presented a lower proportion of grade 3 tendon coronal retraction (11% vs 18%, P = .031). Postoperative tendon integrity at 6 months was comparable for both groups, predominantly Sugaya types 1 and 2 (91% traumatic; 92% degenerative, P = .371). Both groups exhibited favorable outcomes in range of motion and postoperative functional scores at last follow-up. The multivariate regression confirmed that the tear origin was not significantly associated with patient acceptable symptom state achievement (P = .201) but rather with greater preoperative ASES score (RR, 1.01), men (RR, 1.16) and workers' compensation (RR, 0.65) (P < .05). Conclusions Traumatic cases were frequent, involved younger patients, more frequently affected the anterior rotator cuff, and were associated with more severe tendon retraction. Traumatic and degenerative RCRs lead to comparable clinical and radiologic results. Level of Evidence Level III, retrospective comparative study.
Collapse
Affiliation(s)
| | | | - Hugo Bothorel
- Research Department, La Tour Hospital, Meyrin, Switzerland
| | | | - Jeanni Zbinden
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Alberto Guizzi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia (BS), Italy
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
165
|
Varela-Margolles D, Milani A, Kamel SI. Percutaneous Interventions for Injuries in Athletes: Implications on Return to Play. Semin Musculoskelet Radiol 2024; 28:146-153. [PMID: 38484767 DOI: 10.1055/s-0043-1778026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
For nonsurgical musculoskeletal (MSK) injuries in athletes, image-guided percutaneous intervention may aid in recovery and decrease return to play (RTP) time. These interventions fall into two major categories: to reduce inflammation (and therefore alleviate pain) or to promote healing. This review describes the risks and benefits of the various percutaneous interventions in MSK athletic injury and surveys the literature regarding the implication of these interventions on RTP.
Collapse
Affiliation(s)
- Diana Varela-Margolles
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ava Milani
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah I Kamel
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
166
|
Cauley CE, Samost-Williams A, Philpotts L, Brindle M, Cooper Z, Ritchie CS. Geriatric Assessment in Colorectal Surgery: A Systematic Review. J Surg Res 2024; 296:720-734. [PMID: 38367523 DOI: 10.1016/j.jss.2023.12.055] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The prevalence of colorectal surgery among older adults is expected to rise due to the aging population. Geriatric conditions (e.g., frailty) are risk factors for poor surgical outcomes. The goal of this systematic review is to examine how current literature describes geriatric assessment interventions in colorectal surgery and associated outcomes. METHODS Systematic searches of Ovid MEDLINE, Cochrane Library, CINAHL, Embase, and Web of Science were completed. Review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered in PROSPERO, the international prospective register of systematic reviews in health and social care. All cohort studies and randomized trials of adult colorectal surgery patients where geriatric assessment was performed were included. Geriatric assessment with/without management interventions were identified and described. RESULTS Seven-hundred ninety-three studies were identified. Duplicates (197) were removed. An additional 525 were excluded after title/abstract review. After full-text review, 20 studies met the criteria. Reference list review increased final total to 25 studies. All 25 studies were cohort studies. No randomized clinical trials were identified. Heterogeneous assessments were organized into geriatrics domains (mind, mobility, medications, matters most, and multi-complexity). Incomplete evaluations across geriatric domains were performed with few studies describing the use of assessments to impact management decisions. CONCLUSIONS There are no randomized trials assessing the impact of geriatric assessment to tailor management strategies and improve outcomes in colorectal surgery. Few studies performed assessments to evaluate the geriatric domain matters most. These findings represent a gap in evidence for the efficacy of geriatric assessment and management strategies in colorectal surgical care.
Collapse
Affiliation(s)
- Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts; Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, Massachusetts.
| | - Aubrey Samost-Williams
- Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Brindle
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Ariadne Labs, Brigham and Women's Hospital, Harvard. T.H. School of Public Health, Boston, Massachusetts
| | - Zara Cooper
- The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Marcus Institute for Aging Research, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine S Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts; Division of Palliative Care & Geriatrics, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
167
|
Ozawa Y, Takegami Y, Osawa Y, Asamoto T, Tanaka S, Imagama S. Anti-sclerostin antibody therapy prevents post-ischemic osteonecrosis bone collapse via interleukin-6 association. Bone 2024; 181:117030. [PMID: 38309414 DOI: 10.1016/j.bone.2024.117030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
Osteonecrosis of the femoral head (ONFH) is a debilitating condition characterized by subchondral bone necrosis, which frequently culminates in joint destruction. Although total hip arthroplasty is conventionally practiced to remediate ONFH, for patients under the age of 60, the outcomes can be suboptimal. Chronic inflammation, particularly that mediated by interleukin-6 (IL-6), has been conjectured to be a potential mechanism underlying the etiology of ONFH. This study aimed at exploring the interplay between IL-6, the canonical Wnt signaling pathway, and ONFH to provide insights for potential therapeutic interventions. Human ONFH specimens depicted an elevation in β-catenin expression in the transitional layer, while IL-6 levels were pronounced in the same region. Subsequently, mouse models of ischemic osteonecrosis were treated with an anti-sclerostin antibody to assess its effects on bone metabolism and cellular processes. Histological analysis revealed that the administration of anti-sclerostin antibodies effectuated early recovery from bone necrosis, reduced empty lacunae, and suppressed IL-6 expression. The treatment evidently initiated the activation of the Wnt/β-catenin signaling pathway, presenting a potential mechanism associated with IL-6-mediated inflammation. Furthermore, the antibody upregulated osteoblast formation, downregulated osteoclast formation, and increased bone volume. Micro-CT imaging demonstrated increased bone volume, prevented epiphyseal deformity, and improved compression strength. Therefore, this study yields significant findings, indicating the potency of anti-sclerostin antibodies in effectively modulating the Wnt/β-catenin pathway, associating with IL-6 expression, and preventing post-ONFH bone collapse. Additionally, this preclinical investigation in mouse models offers an avenue for prospective research on potential therapeutic interventions against human ONFH.
Collapse
Affiliation(s)
- Yuto Ozawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, 8 Showa-ku, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, 8 Showa-ku, Nagoya, Japan.
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, 8 Showa-ku, Nagoya, Japan
| | - Takamune Asamoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, 8 Showa-ku, Nagoya, Japan
| | - Shinya Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, 8 Showa-ku, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, 8 Showa-ku, Nagoya, Japan
| |
Collapse
|
168
|
Ganta A, Merrell LA, Adams J, Konda SR, Egol KA. Retention of Antibiotic Cement Delivery Implants in Orthopedic Infection Associated With United Fractures Does Not Increase Recurrence Risk. J Orthop Trauma 2024; 38:190-195. [PMID: 38206770 DOI: 10.1097/bot.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To evaluate whether retention of antibiotic cement delivery devices after resolution of orthopaedic infection is associated with recurrence. METHODS DESIGN Retrospective cohort. SETTING Academic medical center. PATIENT SELECTION CRITERIA Patients with a fracture definitively treated with internal fixation that went on to unite and develop a confirmed fracture-related infection or osteomyelitis after a remote fracture surgery and had implantation of antibiotic-impregnated cement for infection management. OUTCOME MEASURES AND COMPARISONS Patients were divided into whom the antibiotic implants were retained (Retained Cohort) and whom the antibiotic implants were removed (Removed Cohort). Outcome measures included clinical infection resolution, infection recurrence, time to resolution of infection signs, symptoms and laboratory values, reoperation and readmission rates, and need for soft tissue coverage (local flap vs. free tissue transfer) because of recurrence. RESULTS Of 98 patients treated for fracture-related infection in united fractures or osteomyelitis after a remote fracture surgery, 39 (39.8%) underwent implantation of antibiotic-impregnated cement delivery devices: 21 (21.4%) beads, 7 (7.1%) rods, and 11 (11.2%) blocks. Twenty patients (51.3%) comprised the Retained Cohort and 19 patients (48.7%) comprised the Removed Cohort. There were few differences in demographics ([American Society of Anesthesiology Score, P = 0.026] and [diabetes, P = 0.047]), infection location, and pathogenic profiles. The cohorts demonstrated no difference in eventual resolution of infection (100% in the Retained Cohort, 95% in the Removed Cohort, P = 0.487) and experienced similar time to clinical infection resolution, based on signs, symptoms, and laboratory values ( P = 0.360). There was no difference in incidence of subsequent infection recurrence after clinical infection resolution (1 recurrence Retained vs. 2 recurrences Removed, P = 0.605) for those considered "cured." Compared with the Retained Cohort, the Removed Cohort underwent more reoperations (0.40 vs. 1.84 reoperations, P < 0.001) and admissions after implantation ( P < 0.001). CONCLUSIONS Retention of antibiotic-impregnated cement delivery devices in patients with orthopaedic infection after fractured bones that have healed was not associated with infection recurrence. Additional surgical intervention with the sole purpose of removing antibiotic delivery devices may not be warranted. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Lauren A Merrell
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Jack Adams
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| |
Collapse
|
169
|
Koutp A, Hauer G, Leitner L, Kaltenegger L, Fischerauer S, Clar C, Reinbacher P, Schittek G, Leithner A, Sadoghi P. Less Induction Time and Postoperative Pain Using Spinal Anesthesia Versus General Anesthesia With or Without the Use of Peripheral Nerve Blocks in Total Knee Arthroplasty. J Arthroplasty 2024; 39:904-909. [PMID: 37852447 DOI: 10.1016/j.arth.2023.10.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Our aim was to analyze anesthetic induction time and postoperative pain using spinal anesthesia versus general anesthesia with or without the use of peripheral nerve blocks (PNBs) in total knee arthroplasty. The hypothesis was that spinal anesthesia would be beneficial with respect to induction time and postoperative pain and that PNBs would complement this effect. METHODS Patients were stratified according to demographics, American Society of Anesthesiologists physical status classification system (ASA), and opioid intake and divided into: (A) general anesthesia without PNB; (B) general anesthesia with PNB; (C) spinal anesthesia without PNB; and (D) spinal anesthesia with PNB. Endpoints were anesthetic induction time, opioid consumption, and pain. Of 559 patients, 348 (62.3%) received general anesthesia (consisting of group A with 46 and group B with 302 patients), and 211 (37.7%) spinal anesthesia (consisting of group C with 117 and group D with 94 patients). RESULTS We observed significantly lower total opioid intake 48 hours postoperative when applying spinal anesthesia by 2.08 mg (P < .05) of intravenous morphine-equivalent, and a reduction of 7.0 minutes (P < .05) until skin incision. The application of a PNB achieved a reduction of piritramide intake of 3.59 mg (P < .05) 48 hours postoperative and lengthened induction time by 8.5 minutes (P < .05). CONCLUSIONS Statistically shorter anesthetic induction times without clinical relevance, but lower postoperative opioid dosages with clinical relevance were observed for patients undergoing total knee arthroplasty with spinal anesthesia. The additional application of PNBs led to a lower need for opioids and lower pain levels in the early postoperative phase.
Collapse
Affiliation(s)
- Amir Koutp
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lucas Kaltenegger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Stefan Fischerauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Clemens Clar
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gregor Schittek
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| |
Collapse
|
170
|
Franchini M, Focosi D, Pezzo MP, Mannucci PM. How we manage a high D-dimer. Haematologica 2024; 109:1035-1045. [PMID: 37881856 PMCID: PMC10985443 DOI: 10.3324/haematol.2023.283966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
D-dimer, a soluble fibrin degradation product that originates from plasmin-induced degradation of cross-linked fibrin, is an important biomarker of coagulation activation and secondary fibrinolysis that is routinely used to rule out venous thromboembolism (VTE), and to evaluate the risk of VTE recurrence, as well as the optimal duration of anticoagulant therapy. Besides VTE, D-dimer may be high due to physiologic conditions, including aging, pregnancy, and strenuous physical activity. In addition, several disorders have been associated with increased D-dimer levels, ranging from disseminated intravascular coagulation to infectious diseases and cancers. Thus, it is far from unusual for hematologists to have to deal with ambulatory individuals with increased D-dimer without signs or symptoms of thrombus formation. This narrative review is dedicated to the management of these cases by the hematologist.
Collapse
Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
| | | | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico and University of Milan, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
| |
Collapse
|
171
|
Wei Z, Ye H, Li Y, Li X, Liu Y, Chen Y, Yu J, Wang J, Ye X. Mechanically tough, adhesive, self-healing hydrogel promotes annulus fibrosus repair via autologous cell recruitment and microenvironment regulation. Acta Biomater 2024; 178:50-67. [PMID: 38382832 DOI: 10.1016/j.actbio.2024.02.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
Annulus fibrosus (AF) defect is an important cause of disc re-herniation after discectomy. The self-regeneration ability of the AF is limited, and AF repair is always hindered by the inflammatory microenvironment after injury. Hydrogels represent one of the most promising materials for AF tissue engineering strategies. However, currently available commercial hydrogels cannot withstand the harsh mechanical load within intervertebral disc. In the present study, an innovative triple cross-linked oxidized hyaluronic acid (OHA)-dopamine (DA)- polyacrylamide (PAM) composite hydrogel, modified with collagen mimetic peptide (CMP) and supplied with transforming growth factor beta 1 (TGF-β1) (OHA-DA-PAM/CMP/TGF-β1 hydrogel) was developed for AF regeneration. The hydrogel exhibited robust mechanical strength, strong bioadhesion, and significant self-healing capabilities. Modified with collagen mimetic peptide, the hydrogel exhibited extracellular-matrix-mimicking properties and sustained the AF cell phenotype. The sustained release of TGF-β1 from the hydrogel was pivotal in recruiting AF cells and promoting extracellular matrix production. Furthermore, the composite hydrogel attenuated LPS-induced inflammatory response and promote ECM synthesis in AF cells via suppressing NFκB/NLRP3 pathway. In vivo, the composite hydrogel successfully sealed AF defects and alleviated intervertebral disk degeneration in a rat tail AF defect model. Histological evaluation showed that the hydrogel integrated well with host tissue and facilitated AF repair. The strategy of recruiting endogenous cells and providing an extracellular-matrix-mimicking and anti-inflammatory microenvironment using the mechanically tough composite OHA-DA-PAM/CMP/TGF-β1 hydrogel may be applicable for AF defect repair in the clinic. STATEMENT OF SIGNIFICANCE: Annulus fibrosus (AF) repair is challenging due to its limited self-regenerative capacity and post-injury inflammation. In this study, a mechanically tough and highly bioadhesive triple cross-linked composite hydrogel, modified with collagen mimetic peptide (CMP) and supplemented with transforming growth factor beta 1 (TGF-β1), was developed to facilitate AF regeneration. The sustained release of TGF-β1 enhanced AF cell recruitment, while both TGF-β1 and CMP could modulate the microenvironment to promote AF cell proliferation and ECM synthesis. In vivo, this composite hydrogel effectively promoted the AF repair and mitigated the intervertebral disc degeneration. This research indicates the clinical potential of the OHA-DA-PAM/CMP/TGF-β1 composite hydrogel for repairing AF defects.
Collapse
Affiliation(s)
- Zhenyuan Wei
- Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Center for Spinal Minimally Invasive Research, Shanghai Jiao Tong University, Shanghai 200336, China; Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Han Ye
- Department of Ophthalmology and Vision Science, Shanghai Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - Yucai Li
- Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Center for Spinal Minimally Invasive Research, Shanghai Jiao Tong University, Shanghai 200336, China; Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Xiaoxiao Li
- Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Center for Spinal Minimally Invasive Research, Shanghai Jiao Tong University, Shanghai 200336, China; Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Yi Liu
- Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Center for Spinal Minimally Invasive Research, Shanghai Jiao Tong University, Shanghai 200336, China; Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Yujie Chen
- Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Center for Spinal Minimally Invasive Research, Shanghai Jiao Tong University, Shanghai 200336, China; Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Jiangming Yu
- Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Center for Spinal Minimally Invasive Research, Shanghai Jiao Tong University, Shanghai 200336, China; Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
| | - Jielin Wang
- Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Center for Spinal Minimally Invasive Research, Shanghai Jiao Tong University, Shanghai 200336, China; Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
| | - Xiaojian Ye
- Laboratory of Key Technology and Materials in Minimally Invasive Spine Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Center for Spinal Minimally Invasive Research, Shanghai Jiao Tong University, Shanghai 200336, China; Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
| |
Collapse
|
172
|
Parikh HB, Stanley M, Tseng CC, Kulber DA, Kuschner SH. Lateral Epicondylitis: Treatment Preferences from the Potential Patient Perspective. Plast Reconstr Surg Glob Open 2024; 12:e5706. [PMID: 38596580 PMCID: PMC11000778 DOI: 10.1097/gox.0000000000005706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024]
Abstract
Background Knowing the questions and concerns that patients have regarding treatment options for lateral epicondylitis may allow for shared-decision making and potentially superior patient outcomes and satisfaction. In the present study, we aimed to further delineate patient preferences with treatment of lateral epicondylitis. Methods An online, survey-based, descriptive study was conducted through Amazon Mechanical Turk. Survey participants were presented with a clinical scenario regarding lateral epicondylitis and asked four questions regarding treatment preferences for nonoperative treatment, whether they would consider platelet-rich plasma (PRP) injection, and whether they would consider surgical intervention for recalcitrant symptoms. A Likert scale was used for responses. McNemar chi-square test was used for paired nominal data for statistical analysis. Results A total of 238 survey responses were included. A majority (63%) of respondents elected to proceed with formal physical therapy. When given additional information regarding corticosteroid injections, 50.8% of respondents reported preferring physical therapy. There were no differences between groups for questions 1 and 2 (P = 0.90). Of the respondents, 75.2% were "likely" or "extremely likely" to consider PRP injection. When asked about surgical intervention, 74.8% of respondents were "likely" or "extremely likely" to proceed with continued symptoms. Conclusions It is important to include patient preferences in treatment discussions of lateral epicondylitis. Survey respondents preferred formal physical therapy for initial treatment. A surprising majority of respondents were likely to consider a PRP injection. With prolonged symptoms, respondents were interested in discussions of surgical intervention and thus, it should continue to be offered to patients with recalcitrant symptoms.
Collapse
Affiliation(s)
- Harin B Parikh
- From the Department of Hand Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Mackinzie Stanley
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Cassie C Tseng
- Department of Outpatient Rehabilitation, University of Southern California, Los Angeles, Calif
| | - David A Kulber
- From the Department of Hand Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Stuart H Kuschner
- From the Department of Hand Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| |
Collapse
|
173
|
Delbrück H, Lambertz E, Migliorini F, Berger N, Hildebrand F. Influence of COVID-19 pandemic on hospitalisations at a paediatric traumatology department during 2020: a single-centre observational study and comprehensive literature review. Eur J Trauma Emerg Surg 2024; 50:591-601. [PMID: 38286949 PMCID: PMC11035450 DOI: 10.1007/s00068-024-02453-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024]
Abstract
PURPOSE The study investigates changes in the injury characteristics of hospitalised children in a paediatric trauma centre during the COVID-19 pandemic. METHODS Data from injured children from the pre-pandemic year 2019 were compared to the pandemic year 2020 using Pearson's chi-squared test and the Mann-Whitney U test. The period of highly restrictive regulations (HRP) was evaluated separately. A comprehensive literature review with defined search terms resulted in a descriptive data synthesis. RESULTS Data from 865 patients indicated reductions in admissions of 5.6% and 54.4% during the HRP. In 2020, the hospitalisation time was longer (2.2 ± 2.7 days in 2019 vs. 2.4 ± 2.6 in 2020, p = 0.045); the proportions of wounds requiring surgical therapy (p = 0.008) and of observational treatments, primarily for mild brain injuries (p = 0.046), were higher; and conservative treatments, primarily for contusions, were lower (p = 0.005). There were no significant changes in age, location of lesions, or frequency of surgical therapy; nor were there differences in the HRP, except for fewer injuries in school and kindergarten (p < 0.001). The literature review summarises the main results of 79 studies. CONCLUSION Limited resources did not alter the indications for surgical therapy. Further studies should examine whether the more common injuries sustained at home were caused by excessive work/childcare demands on parents. Reduced inpatient conservative treatment implies that hospital resources possibly were overused previously. The literature offers answers to many detailed questions regarding childhood injuries during a pandemic and more efficient safe treatment. Registration Ethical committee of RWTH Aachen University EK 22-320; Center for Translational & Clinical Research RWTH Aachen University (CTC-A) 21-430.
Collapse
Affiliation(s)
- Heide Delbrück
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Ellen Lambertz
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
| | - Nina Berger
- Department of Neuromuscular and Paediatric Orthopaedics, Klinikum Dritter Orden München - Nymphenburg, Menzinger Strasse 44, 80638, München, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| |
Collapse
|
174
|
Malhotra K, Colta R, Jani P, Haldar A, Patel S, Welck M, Cullen N. Talar neck rotation angle in adults with clubfoot deformity: Observed values and intra- and inter-observer reliability using weightbearing CT. Foot Ankle Surg 2024; 30:263-267. [PMID: 38216337 DOI: 10.1016/j.fas.2024.01.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Adults presenting with symptomatic clubfoot represent a challenging cohort of patients. An appreciation of the location and degree of deformities is essential for management. Talar anatomy is often abnormal with varus within the talar neck, however, there are few reproducible methods which quantify talar neck deformity in adults. We describe a technique of assessing talar neck deformity, and report on observed values and intra- / inter-observer reliability. METHODS This was a single-centre, retrospective study including 96 feet from 56 adult patients with clubfeet (82 feet had clubfoot deformity, 14 were normal). Mean age was 34.3 ± 16.9 years and 31 (55.3%) were male. Weight-bearing CT scans captured as part of routine clinical care were analysed. Image reformats were oriented parallel to the long axis of the talus in the sagittal plane. In the corresponding axial plane two lines were drawn (on separate slices): 1) a line perpendicular to the intermalleolar axis, 2) a line connecting the midpoints of the talar head and narrowest part of the talar neck. The talar neck rotation angle (TNR angle) was the angle formed between these lines. Intraclass correlation coefficients (ICC) were performed for intra- and inter-observer reliability. RESULTS Mean TNR angle in clubfeet was 27.6 ± 12.2 degrees (95%CI = 25.0 to 30.2 degrees). Mean TNR angle in normal feet was 18.7 ± 5.1 degrees (95%CI = 16.0 to 21.4 degrees) (p < 0.001). The ICC for clubfeet was 0.944 (95%CI = 0.913 to 0.964) for intra-observer agreement, and 0.896 (95%CI = 0.837 to 0.932) for inter-observer agreement. CONCLUSION This measurement technique demonstrated excellent intra- and inter-observer agreement. It also demonstrated that compared to normal feet, clubfeet had about 9 degrees of increased varus angulation of the talar neck. This technique and data may be used for future research into clubfoot deformity and in planning treatment. LEVEL OF CLINICAL EVIDENCE 3.
Collapse
Affiliation(s)
- Karan Malhotra
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - Raul Colta
- Ortopedicum, 40-44 Banu Andronache Str, Bucharest, Romania
| | - Priyanka Jani
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
| | - Anil Haldar
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
| | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
| | - Matthew Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
| | - Nicholas Cullen
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
| |
Collapse
|
175
|
Pereverzev VS, Kolesov SV, Kazmin AI, Panteleev AA. Comparison of long-term results of anterior surgical correction of Lenke type 5 idiopathic scoliosis using dynamic and rigid fixation in patients with complete or near-complete skeletal maturity. World Neurosurg X 2024; 22:100324. [PMID: 38469387 PMCID: PMC10926199 DOI: 10.1016/j.wnsx.2024.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Vladimir S. Pereverzev
- Department of Spine Pathology, The Head of Department of Spine Pathology, N. N. Priorov National Medical Research Center, Moscow, Russia
| | - Sergey V. Kolesov
- Department of Spine Pathology, The Head of Department of Spine Pathology, N. N. Priorov National Medical Research Center, Moscow, Russia
| | - Arkadii I. Kazmin
- Department of Spine Pathology, The Head of Department of Spine Pathology, N. N. Priorov National Medical Research Center, Moscow, Russia
| | - Andrey A. Panteleev
- Department of Traumatology and Orthopedics, Russian Children's Clinical Hospital (RCCH), Leninsky Pr-t, 117, 119571, Moscow, Russia
| |
Collapse
|
176
|
Sax AJ. Osseous Stress Injuries: Treatment Algorithms and Return to Play. Semin Musculoskelet Radiol 2024; 28:130-138. [PMID: 38484765 DOI: 10.1055/s-0043-1778030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Osseous stress injuries are common in athletes. Specifically, lower extremity injuries are prevalent in running athletes and upper extremity injuries are prevalent in throwing athletes. Such injuries are suspected when there is focal bone tenderness and increased pain with the inciting activity. In elite athletes, osseous stress injuries are a relatively common culprit in lost play time. Thus rapid diagnosis and treatment is imperative to expedite return to play (RTP). The radiologist's role in these cases is not only for diagnosis, but also to grade the injury, which has implications in determining a treatment regimen. The high sensitivity and specificity of magnetic resonance imaging is thus the preferred imaging modality. This article discusses common osseous stress injuries, the imaging findings, and how different treatment regimens affect RTP.
Collapse
Affiliation(s)
- Alessandra J Sax
- The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|
177
|
Baxter SN, Brennan JC, Johnson AH, Chapa L, Robbins S, Turcotte JJ, King PJ. Non-White Race and Concomitant Orthopedic Conditions Are Risk Factors for Failure to Achieve Clinically Relevant Improvement After Total Knee Arthroplasty. J Arthroplasty 2024; 39:927-934. [PMID: 37852453 DOI: 10.1016/j.arth.2023.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Data from the American Joint Replacement Registry demonstrate that 1-year minimal clinically important difference (MCID) achievement rates after total knee arthroplasty (TKA) are substantially lower when using general patient reported outcome measures, such as Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), than joint specific measures. The purpose of this study was to evaluate patient characteristics and outcomes associated with MCID achievement after TKA using the PROMIS-PF measure. METHODS A retrospective review of 263 patients undergoing TKA with preoperative and 1-year postoperative PROMIS-PF scores from March 12, 2020 to February 8, 2022 was performed. Three multivariate models were built to evaluate predictors of MCID achievement. Preoperative predictors evaluated included demographics, comorbidities, history of spine and knee surgery, and baseline PROMIS-PF. Postoperative clinical outcomes evaluated included lengths of stay, discharge statuses, complications, and utilizations of other orthopaedic services. RESULTS There were 109 patients (41%) who achieved an MCID at 1-year postoperatively. Non-white patients had 2.17 times lower odds of achieving MCID. No clinical outcomes assessed were independently predictive of MCID achievement. During the 1-year postoperative period, 63% of patients sought care for another orthopaedic condition. Patients requiring postoperative injections on another joint had a 2.27 times lower odds of achieving MCID. Those seen for spine conditions postoperatively had a 2.44 lower odds of achieving MCID. CONCLUSIONS Race, postoperative injections, and treatment for spine conditions after TKA were independent predictors of failure to achieve MCID. These results may guide preoperative patient consultation and risk-adjustment in future studies using PROMIS-PF as an endpoint for evaluation of TKA outcomes.
Collapse
Affiliation(s)
- Samantha N Baxter
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Jane C Brennan
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Andrea H Johnson
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Lauren Chapa
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Shayla Robbins
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Justin J Turcotte
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Paul J King
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| |
Collapse
|
178
|
Dekhne MS, Fontana MA, Pandey S, Driscoll DA, Lyman S, McLawhorn AS, MacLean CH. Defining Patient-relevant Thresholds and Change Scores for the HOOS JR and KOOS JR Anchored on the Patient-acceptable Symptom State Question. Clin Orthop Relat Res 2024; 482:688-698. [PMID: 37773026 PMCID: PMC10936968 DOI: 10.1097/corr.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/15/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND When evaluating the results of clinical research studies, readers need to know that patients perceive effect sizes, not p values. Knowing the minimum clinically important difference (MCID) and the patient-acceptable symptom state (PASS) threshold for patient-reported outcome measures helps us to ascertain whether our interventions result in improvements that are large enough for patients to care about, and whether our treatments alleviate patient symptoms sufficiently. Prior studies have developed the MCID and PASS threshold for the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) anchored on satisfaction with surgery, but to our knowledge, neither the MCID nor the PASS thresholds for these instruments anchored on a single-item PASS question have been described. QUESTIONS/PURPOSES (1) What are the MCID (defined here as the HOOS/KOOS JR change score associated with achieving PASS) and PASS threshold for the HOOS JR and KOOS JR anchored on patient responses to the single-item PASS instrument? (2) How do patient demographic factors such as age, gender, and BMI correlate with MCID and PASS thresholds using the single-item PASS instrument? METHODS Between July 2020 and September 2021, a total of 10,970 patients underwent one primary unilateral THA or TKA and completed at least one of the three surveys (preoperative HOOS or KOOS JR, 1-year postoperative HOOS or KOOS JR, and 1-year postoperative single-item anchor) at one large, academic medical center. Of those, only patients with data for all three surveys were eligible, leaving 13% (1465 total; 783 THAs and 682 TKAs) for analysis. Despite this low percentage, the overall sample size was large, and there was little difference between completers and noncompleters in terms of demographics or baseline patient-reported outcome measure scores. Patients undergoing bilateral total joint arthroplasty or revision total joint arthroplasty and those without all three surveys at 1 year of follow-up were excluded. A receiver operating characteristic curve analysis, leveraging a 1-year, single-item PASS (that is, "Do you consider that your current state is satisfactory?" with possible answers of "yes" or "no") as the anchor was then used to establish the MCID and PASS thresholds among the 783 included patients who underwent primary unilateral THA and 682 patients who underwent primary unilateral TKA. We also explored the associations of age at the time of surgery (younger than 65 years or 65 years and older), gender (men or women), BMI (< 30 or ≥ 30 kg/m 2 ), and baseline Patient-Reported Outcome Measure Information System-10 physical and mental component scores (< 50 or ≥ 50) for each of the MCID and PASS thresholds through stratified analyses. RESULTS For the HOOS JR, the MCID associated with the PASS was 23 (95% CI 18 to 31), with an area under the receiver operating characteristic curve of 0.75, and the PASS threshold was 81 (95% CI 77 to 85), with an area under the receiver operating characteristic curve of 0.81. For the KOOS JR, the MCID was 16 (95% CI 14 to 18), with an area under the receiver operating characteristic curve of 0.75, and the PASS threshold was 71 (95% CI 66 to 73) with an area under the receiver operating characteristic curve of 0.84. Stratified analyses indicated higher change scores and PASS threshold for younger men undergoing THA and higher PASS thresholds for older women undergoing TKA. CONCLUSION Here, we demonstrated the utility of a single patient-centered anchor question, raising the question as to whether simply collecting a postoperative PASS is an easier way to measure success than collecting preoperative and postoperative patient-reported outcome measures and then calculating MCIDs and the substantial clinical benefit. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Mihir S. Dekhne
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mark A. Fontana
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sohum Pandey
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA
| | - Daniel A. Driscoll
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Stephen Lyman
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA
| | | | - Catherine H. MacLean
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
179
|
Rossi M, Terreri S, Battafarano G, Rana I, Buonuomo PS, Di Giuseppe L, D'Agostini M, Porzio O, Di Gregorio J, Cipriani C, Jenkner A, Gonfiantini MV, Bartuli A, Del Fattore A. Analysis of circulating osteoclast and osteogenic precursors in patients with Gorham-Stout disease. J Endocrinol Invest 2024:10.1007/s40618-024-02365-8. [PMID: 38556572 DOI: 10.1007/s40618-024-02365-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Gorham-Stout disease is a very rare disorder characterized by progressive bone erosion and angiomatous proliferation; its etiopathogenesis is still unknown, and diagnosis is still performed by exclusion criteria. The alteration of bone remodeling activity has been reported in patients; in this study, we characterized circulating osteoclast and osteogenic precursors that could be important to better understand the osteolysis observed in patients. METHODS Flow cytometry analysis of PBMC (Peripheral Blood Mononuclear Cells) was performed to characterize circulating osteoclast and osteogenic precursors in GSD patients (n = 9) compared to healthy donors (n = 55). Moreover, ELISA assays were assessed to evaluate serum levels of bone markers including RANK-L (Receptor activator of NF-κB ligand), OPG (Osteoprotegerin), BALP (Bone Alkaline Phosphatase) and OCN (Osteocalcin). RESULTS We found an increase of CD16-/CD14+CD11b+ and CD115+/CD14+CD11b+ osteoclast precursors in GSD patients, with high levels of serum RANK-L that could reflect the increase of bone resorption activity observed in patients. Moreover, no significant alterations were found regarding osteogenic precursors and serum levels of BALP and OCN. CONCLUSION The analysis of circulating bone cell precursors, as well as of RANK-L, could be relevant as an additional diagnostic tool for these patients and could be exploited for therapeutic purposes.
Collapse
Affiliation(s)
- M Rossi
- Bone Physiopathology Research Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - S Terreri
- Bone Physiopathology Research Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - G Battafarano
- Bone Physiopathology Research Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - I Rana
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - P S Buonuomo
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - L Di Giuseppe
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - M D'Agostini
- Clinical Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - O Porzio
- Clinical Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - J Di Gregorio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - A Jenkner
- Pediatric Palliative Care Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M V Gonfiantini
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Bartuli
- Rare Diseases and Medical Genetic Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Del Fattore
- Bone Physiopathology Research Unit, Translational Pediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy.
| |
Collapse
|
180
|
Yang M, Zhang Y. Epidemiological features of 1,332 cases of hip fracture in Shanghai, China (2015-2020). Arthroplasty 2024; 6:18. [PMID: 38556902 PMCID: PMC10983753 DOI: 10.1186/s42836-024-00236-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/09/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE This study aimed to analyze the epidemiological characteristics of hip fracture in all age groups in Shanghai, and to evaluate the hospitalization cost of patients with hip fracture. METHODS A total of 1,332 hip fracture patients admitted to a tertiary general hospital between January 2015 and May 2020 in Shanghai were included. Age, sex, diagnosis, cause of injury and site, fracture type, comorbidities, length of stay, treatment, outcomes (at discharge) and hospitalization expenses were recorded. The epidemiological characteristics of hip fracture were analyzed by using SPSS 26.0 software. RESULTS The average age of hip fracture was 77.24 ± 12.66 years, and 69.0% of the patients were female. Overall, 886 patients had femoral neck fracture, and 446 patients suffered from intertrochanteric fracture. Most of the fractures caused by falls at the same level and falls from a height occurred in those aged 81-90 years; and traffic accident injuries mostly took place in patients aged 50-60. Among the 1,302 hip fracture patients who underwent surgical treatment, hip replacement was the major choice for femoral neck fracture, accounting for 49.2%. Internal fixation was the main treatment choice for intertrochanteric fracture, making up 97.8%. The median length of hospital stay lasted 8 days and at cost of hospitalization was ¥49,138.18 RMB. CONCLUSION This epidemiological study found that patients with hip fracture had certain distribution characteristics in age, sex, type of fracture, injury season, cause of injury, mode of operation, length of stay, cost, and so on. Proper medical management, social preventive measures, and prevention of falls are needed to reduce the risk of hip fracture and the socioeconomic burden.
Collapse
Affiliation(s)
- Miaomiao Yang
- Department of Nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Ying Zhang
- Department of Nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| |
Collapse
|
181
|
Sönmez DZ, Taşcı S. The Effect of St. John's Wort Oil (Hypericum Perforatum L.) in Knee Osteoarthritis: A Randomized Controlled and Qualitative Study. Pain Manag Nurs 2024; 25:e115-e125. [PMID: 38242739 DOI: 10.1016/j.pmn.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/07/2023] [Accepted: 12/10/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Reducing pain and improving physical function are critical in the treatment of osteoarthritis. Although individuals use St. John's Wort oil to relieve pain due to osteoarthritis, no scientific research has been found investigating its effectiveness. AIM This study investigated the effect of St. John's Wort oil on pain intensity and physical functions in people with knee osteoarthritis. METHODS This study adopted a single-blind, randomized, placebo-controlled, and qualitative mixed design. The sample consisted of 60 patients randomized into intervention (n = 30) and placebo control (n=30) groups. The experimental group participants were treated with topically St. John's Wort oil three times a week for 3 weeks, and the placebo control group participants were treated with olive oil three times a week for 3 weeks. Quantitative data were collected using a patient identification form, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Visual Analogue Scale. Qualitative data were collected through semi-structured interviews. RESULTS The experimental group had a significantly lower mean Visual Analog Scale score in the first, third, and fourth follow-ups than the control group. The experimental group had significantly lower mean WOMAC-pain, WOMAC-stiffness, and WOMAC-physical function subscale scores in the last follow-up than in the first follow-up. The qualitative data agreed with the quantitative data. CONCLUSIONS The results show that St. John's Wort oil helps people with knee osteoarthritis feel less pain and become physically more active. Additional research is warranted to better understand the effect of St. John's Wort oil on pain intensity and physical functions in people with knee osteoarthritis.
Collapse
Affiliation(s)
- Deniz Zeynep Sönmez
- From the Osmaniye Korkut Ata University Faculty of Health Sciences Midwifery Department, Osmaniye, Turkey.
| | - Sultan Taşcı
- Erciyes University Faculty of Health Sciences Nursing Department, Erciyes University, Kayseri, Turkey
| |
Collapse
|
182
|
Kim J, Yi Y, Lee WC. Improvement in Clinical and Radiographic Outcomes After Isolated Realignment Surgery in Patients With Large Cystic Osteochondral Lesion of the Talar Shoulder and Concurrent Malalignment. Orthop J Sports Med 2024; 12:23259671241237126. [PMID: 38617889 PMCID: PMC11010760 DOI: 10.1177/23259671241237126] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 04/16/2024] Open
Abstract
Background Malalignment has been suggested as a predisposing factor for the development of osteochondral lesions of the talus (OLTs). Purpose To evaluate the clinical and radiographic outcomes of realignment surgery in patients with a large cystic OLT of the talar shoulder and concurrent malalignment of the foot and ankle. Study Design Case series; Level of evidence, 4. Methods The authors reviewed consecutive patients with large cystic OLTs (diameter, >10 mm) of the talar shoulder and concurrent malalignment of the foot and ankle who underwent realignment surgery between September 2013 and April 2021. The type of realignment procedure was determined based on patient symptoms and findings on plain radiographs and weightbearing computed tomography. Clinical improvement was assessed using pre- and postoperative Foot Function Index (FFI) scores and the visual analog scale (VAS) for pain. The OLT location was categorized according to Raikin zone, and the OLT area and volume were measured and compared pre- and postoperatively. The comparative analysis was performed using the Wilcoxon signed-rank test. Results In total, 27 ankles in 27 patients (mean age, 34.4 ± 11.9 years) were included in the analysis. There were 25 patients with a medial lesion (zone 4 [n = 19], zone 7 [n = 5], and zone 1 [n = 1]), and 2 patients with a lateral lesion (zone 6). Despite OLT location, patients' symptoms varied; 15 (55.6%) patients reported both medial- and lateral-sided pain, 10 (37%) reported lateral-sided pain, and 2 (7%) reported medial-sided pain. Supramalleolar osteotomy was performed in 18 patients, while foot and hindfoot correction without supramalleolar osteotomy was performed in 9 patients. Postoperatively, both the median FFI (from 44.4 [interquartile range (IQR), 35.7-52.2] to 9.1 [IQR, 5.2-13.9]) and median VAS pain score (from 6 [IQR, 5-6] to 1 [IQR, 1-2]) improved significantly (P < .0001 for both), and the median lesion size (from 25.8 mm2 [IQR, 19.3-45.2 mm2] to 13.8 mm2 [IQR, 6.8-26.5 mm2]) and median volume (from 2226.8 mm3 [IQR, 1311-3104 mm3] to 1326.5 mm3 [IQR, 714-2100 mm3]) decreased significantly (P < .0001 for both). During the mean follow-up of 4.1 ± 2.1 years, no subsequent surgery for OLT was necessary. Conclusion The results suggest that realignment procedures can improve the symptoms and radiographic profile of OLTs in patients with large cystic OLTs of the talar shoulder and malalignment of the foot and ankle.
Collapse
Affiliation(s)
- Jaeyoung Kim
- Baylor University Medical Center, Dallas, Texas, USA
| | - Young Yi
- Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
| |
Collapse
|
183
|
Middleton KK, Turner A. Racial and Ethnic Disparities in Sports Medicine and the Importance of Diversity. Clin Sports Med 2024; 43:233-244. [PMID: 38383106 DOI: 10.1016/j.csm.2023.07.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Within orthopedics surgery as a specialty, sports medicine is one of the least diverse surgical subspecialties. Differences in minority representation between patient and provider populations are thought to contribute to disparities in care, access, and outcomes.
Collapse
Affiliation(s)
| | - Alex Turner
- University of Texas Southwestern Medical School, Dallas, TX, USA
| |
Collapse
|
184
|
Palomares Cabeza V, Fahy N, Kiernan CH, Lolli A, Witte-Bouma J, Fahmy Garcia S, Merino A, Kops N, Ridwan Y, Wolvius EB, Brama PAJ, Hoogduijn MJ, Farrell E. Bone formation by human paediatric marrow stromal cells in a functional allogeneic immune system. Biomaterials 2024; 306:122471. [PMID: 38377846 DOI: 10.1016/j.biomaterials.2024.122471] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/22/2024]
Abstract
Allogeneic stem-cell based regenerative medicine is a promising approach for bone defect repair. The use of chondrogenically differentiated human marrow stromal cells (MSCs) has been shown to lead to bone formation by endochondral ossification in immunodeficient pre-clinical models. However, an insight into the interactions between the allogeneic immune system and the human MSC-derived bone grafts has not been fully achieved yet. The choice of a potent source of MSCs isolated from pediatric donors with consistent differentiation and high proliferation abilities, as well as low immunogenicity, could increase the chance of success for bone allografts. In this study, we employed an immunodeficient animal model humanised with allogeneic immune cells to study the immune responses towards chondrogenically differentiated human pediatric MSCs (ch-pMSCs). We show that ch-differentiated pMSCs remained non-immunogenic to allogeneic CD4 and CD8 T cells in an in vitro co-culture model. After subcutaneous implantation in mice, ch-pMSC-derived grafts were able to initiate bone mineralisation in the presence of an allogeneic immune system for 3 weeks without the onset of immune responses. Re-exposing the splenocytes of the humanised animals to pMSCs did not trigger further T cell proliferation, suggesting an absence of secondary immune responses. Moreover, ch-pMSCs generated mature bone after 8 weeks of implantation that persisted for up to 6 more weeks in the presence of an allogeneic immune system. These data collectively show that human allogeneic chondrogenically differentiated pediatric MSCs might be a safe and potent option for bone defect repair in the tissue engineering and regenerative medicine setting.
Collapse
Affiliation(s)
- Virginia Palomares Cabeza
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Niamh Fahy
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Orthopedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Applied Science, Technological University of the Shannon: Midlands Midwest, Limerick, Ireland
| | - Caoimhe H Kiernan
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrea Lolli
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Janneke Witte-Bouma
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Shorouk Fahmy Garcia
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Orthopedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ana Merino
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicole Kops
- Department of Orthopedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Yanto Ridwan
- AMIE Core Facility, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pieter A J Brama
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Martin J Hoogduijn
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eric Farrell
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| |
Collapse
|
185
|
Tucker AM, Madsen PJ, Coyle AM, King H, Zahner C, Lang SS, Taylor JA, Heuer GG. Preprocedural Electrophysiological Monitoring in Craniofacial Surgery for a Patient with Chiari Malformation. Cleft Palate Craniofac J 2024; 61:712-716. [PMID: 36357356 DOI: 10.1177/10556656221135284] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Head and neck positioning is a key element of craniofacial reconstructive surgery and can become challenging when intervention necessitates broad exposure of the calvarium. We present a case of craniosynostosis secondary to Apert's syndrome requiring anterior and posterior cranial vault access during surgical correction. A modified sphinx position was used that required significant neck extension. The patient had concurrent Chiari I malformation with brain stem compression so intraoperative neuromonitoring (IONM) was used to ensure that there were no negative effects on the neural elements with positioning. This highlights benefits of IONM in a setting not typically associated with its use.
Collapse
Affiliation(s)
- Alexander M Tucker
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter J Madsen
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anne M Coyle
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hunter King
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cristina Zahner
- SpecialtyCare Intraoperative Neuromonitoring, Philadelphia, PA, USA
| | - Shih-Shan Lang
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jesse A Taylor
- Division of Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory G Heuer
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
186
|
Mukadam AA, Nayak S, Willems J, Pandey V. Estimating the minimal clinically important difference of shoulder functional scores after arthroscopic rotator cuff repair: a prospective study. Arch Orthop Trauma Surg 2024; 144:1693-1701. [PMID: 38386062 PMCID: PMC10965714 DOI: 10.1007/s00402-024-05222-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The minimal clinically important difference (MCID) is a valuable tool for patient-based outcome analysis, for which limited data is available in the literature, especially after arthroscopic rotator cuff repair (ARCR). Although several studies have reported MCID after ARCR, few have studied the impact of various clinical factors such as Diabetes, pseudoparalysis, type of cuff repair, and retear over MCID. This study attempts to determine the MCID in shoulder functional scores after ARCR and the impact of various factors on MCID. METHODS 144 patients undergoing ARCR were prospectively evaluated at six and 12 months by ASES and UCLA scores. MCID for American Shoulder and Elbow Surgeons (ASES) and the University of California and Los Angeles (UCLA) scores were calculated using an anchor-based and distribution-based approach. MCID was also calculated for diabetic and non-diabetic patients, smokers vs. non-smokers, presence or absence of pseudoparalysis, type of cuff repair (single row vs. suture bridge), and presence of retears. Uni- and multivariate analysis was performed to identify factors affecting the MCID of both scores. RESULTS Mean MCID for ASES score was 13.3 and 16.6 using an anchor-based and distribution-based approach, respectively. For the UCLA score, the mean MCID was 10.0 and 12.6 by anchor-based and 12.6 by distribution-based approach, respectively. Patients with higher pre-operative ASES scores demonstrated lower MCID values. No significant difference was observed in MCID scores of diabetic vs. non-diabetic patients, smoker vs. non-smoker, patients with or without pseudoparalysis, and type of cuff repair. The age, gender, and presence of retear did not affect MCID values. CONCLUSION This study establishes the MCID values of ASES and UCLA scores for rotator cuff repair by anchor and distribution methods. No patient or surgical factors appear to affect the MCID except pre-operative ASES scores. STUDY DESIGN Prospective cohort, Level II.
Collapse
Affiliation(s)
- Aditya A Mukadam
- Department of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India
| | - Shalini Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India
| | - Jaap Willems
- International Knee and Joint Centre, Abu Dhabi, UAE
| | - Vivek Pandey
- Department of Orthopedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, 576104, India.
| |
Collapse
|
187
|
Zeitouni D, Pfortmiller D, Coric D, Kim PK, Smith MD, Dyer EH, Adamson TE, McGirt MJ, Rossi VJ. Does type of bone graft matter? A retrospective review of the use of biological bone grafts in patients undergoing elective 1-3 level spinal interbody fusion. Eur Spine J 2024; 33:1340-1346. [PMID: 38459270 DOI: 10.1007/s00586-023-08108-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/15/2023] [Accepted: 12/15/2023] [Indexed: 03/10/2024]
Abstract
OBJECTIVE There is a lack of strong evidence for use of expensive bone substitutes. This study compares perioperative data and patient reported quality-of-life outcomes across the varied types of bone graft extenders. The study analyzes the existing Quality and Outcomes Database and evaluates patient reported outcomes for 1-3 level lumbar fusion procedures comparing across different types of biologics bone graft. METHODS We retrospectively analyzed a prospectively collected data registry. Bone graft implant data were collected and grouped into the following categories: (1) Autograft with basic allograft (2) Enhanced, synthetic, or cellular allograft (3) Use of BMP. Preoperative and 1 year patient reported outcomes and perioperative data from the prospective collected registry were analyzed. RESULTS There were 384 patients included in this study. There were 168 (43.8%) patients in group 1, 133 (34.6%) patients in group 2, and 83 (21.6%) in group 3. There were no group differences in baseline or 1 year back pain, leg pain, ODI, or EQ-5D. The GLM Repeated Measures results indicate a significant difference within each of the three groups between the preoperative and postoperative measures for back pain, leg pain, ODI, and EQ-5D. The change over time was not significantly different between the groups. CONCLUSIONS Bone graft extenders are a significant contributor to the cost of lumbar fusion. This study demonstrates no difference in preoperative, and 1 year patient reported outcomes between the three groups. There was no significant difference in rate of reoperations across the three groups.
Collapse
Affiliation(s)
- Daniel Zeitouni
- Atrium Health Neurological Surgery, Charlotte, NC, USA.
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA.
| | - Deborah Pfortmiller
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA
| | - Domagoj Coric
- Atrium Health Neurological Surgery, Charlotte, NC, USA
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA
| | - Paul K Kim
- Atrium Health Neurological Surgery, Charlotte, NC, USA
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA
| | - Mark D Smith
- Atrium Health Neurological Surgery, Charlotte, NC, USA
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA
| | - E Hunter Dyer
- Atrium Health Neurological Surgery, Charlotte, NC, USA
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA
| | - Tim E Adamson
- Atrium Health Neurological Surgery, Charlotte, NC, USA
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA
| | - Matthew J McGirt
- Atrium Health Neurological Surgery, Charlotte, NC, USA
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA
| | - Vincent J Rossi
- Atrium Health Neurological Surgery, Charlotte, NC, USA
- Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave, Charlotte, NC, 28203, USA
| |
Collapse
|
188
|
Cabrolier J, Ceballos O, Rieloff F, Hardoy F, Tolosa R, Wevar O. Clinical outcomes of total femoral replacement. First Latin American experience. Surg Oncol 2024; 53:102038. [PMID: 38316087 DOI: 10.1016/j.suronc.2024.102038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION The femur is frequently affected by primary and metastatic bone tumors. In cases with substantial bone loss, Total Femur Replacement (TFR) remains the only viable limb preservation option. This study investigates the clinical outcomes of TFR patients in a Latin American setting, with a minimum 3-year follow-up. METHODS Retrospective review identifying cases of TFR at a single center from 2009 to 2020. Patients who had TFR either due to oncological indications or complications arising from oncology-related surgeries were included. Data on the indications for surgery and post-operative complications were recorded. To assess functional status, the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS) were used. RESULTS Fourteen patients met the inclusion criteria. Diagnoses included eight osteosarcomas, four chondrosarcomas, one Ewing sarcoma, and one giant cell tumor. Ten patients had undergone prior surgeries. Indication for TFR was a complication of a previous surgery in 78.6 % of cases. Post-TFR complications were experienced by 35.7 % of patients, requiring further surgeries. At the 3-year mark, average MSTS and TESS scores were 67.4 % and 70.8 %, respectively. CONCLUSION Total femur replacement serves as a valuable limb salvage solution for patients with significant femoral defects in oncological scenarios, however, there is a significant risk of complications. Given its potential benefits, it is essential for developing countries to consider incorporating TFR into their healthcare systems.
Collapse
Affiliation(s)
- Jorge Cabrolier
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clinica Alemana - Universidad Del Desarrollo, Av Vitacura 5951, 7640745, Vitacura, Region Metropolitana, Chile.
| | - Oscar Ceballos
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clínica Santa Maria, Bellavista 0415, 7520349, Providencia, Región Metropolitana, Chile.
| | - Fabiola Rieloff
- Hospital Santa Cruz, Federico Errazuriz 920, 3130671, Santa Cruz, O'Higgins, Chile.
| | - Francisco Hardoy
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clínica Davila, Avenida Recoleta 464, Recoleta, Región Metropolitana, Chile.
| | - Ricardo Tolosa
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clínica Davila, Avenida Recoleta 464, Recoleta, Región Metropolitana, Chile.
| | - Orlando Wevar
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martin 771, 8340220, Santiago, Región Metropolitana, Chile; Clínica Santa Maria, Bellavista 0415, 7520349, Providencia, Región Metropolitana, Chile.
| |
Collapse
|
189
|
Hapa O, Hevesi M, Lee SH, Trousdale RT, Sierra RJ. Making the cut: a technical note and literature review of Bernese periacetabular osteotomy techniques with special attention to ischial osteotomy initiation and completion with an inside to anterior curved osteotomy. Eur J Orthop Surg Traumatol 2024; 34:1691-1697. [PMID: 38055056 DOI: 10.1007/s00590-023-03787-5] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023]
Abstract
Periacetabular osteotomy includes a fluoroscopy-guided ischial cut without direct visualization. Previously described techniques include a mediolateral ischial cortex cut, which is associated with the risk of injuring nearby nerves. Another drawback of that technique is the difficulty connecting an ischial cortex cut with a retroacetabular cut due to orthogonal nature of the osteotomy. In general, an additional cut from medial to lateral is required. The present study aimed to describe a technique that eliminates those problems due to use of only a central cut of the ischium and the curved nature of the osteotomy.
Collapse
Affiliation(s)
- Onur Hapa
- Department of Orthopedic Surgery, Dokuz Eylül University, İzmir, Turkey.
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sheng-Hsun Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
190
|
Lindh JD, Patrova J, Mannheimer B, Falhammar H. Prevalence and Incidence of Fractures in Patients With Nonfunctional Adrenal Tumors. JAMA Netw Open 2024; 7:e246453. [PMID: 38619841 PMCID: PMC11019395 DOI: 10.1001/jamanetworkopen.2024.6453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/15/2024] [Indexed: 04/16/2024] Open
Abstract
Importance It is unclear whether nonfunctional adrenal tumors (NFATs) are associated with fractures. Objective To analyze fracture frequencies in individuals with NFATs. Design, Setting, and Participants A national retrospective cohort study was conducted in patients with NFATs diagnosed in Sweden between January 1, 2005, and December 31, 2019, and control participants without adrenal tumors followed up until death or the end of 2019. Individuals with a diagnosis of adrenal hormonal excess or previous malignant tumors were excluded. Sensitivity analyses were performed in subgroups of individuals with a combination of gallbladder, biliary tract, and pancreas diseases (for whom it was assumed that controls would also have undergone computed tomography) and 3- and 12-month survival free of malignant tumors after the NFAT diagnosis. The data were analyzed from September to November 2023. Exposures Diagnosis of NFATs. Main Outcomes and Measures Main study outcomes were prevalence and incidence of fractures after adjustment for sex, age, and comorbidities. Secondary outcomes were fragility fractures, fractures with fall on the same level, and fracture locations (distal arm and vertebral and hip fractures). Fracture incidence after adrenalectomy was also studied. Results Among 20 390 patients, 12 120 (59.4%) were women, and the median (IQR) age was 66 (57-73) years; among 125 392 controls, 69 994 (55.8%) were women, and the median (IQR) age was 66 (57-73) years. Previous fractures were more common in patients diagnosed with NFATs compared with controls (4310 of 20 390 [21.1%] vs 20 323 of 125 392 [16.2%]; odds ratio [OR], 1.39; 95% CI, 1.34-1.45; adjusted OR [AOR], 1.27; 95% CI, 1.23-1.33). During the follow-up period (median [IQR], 4.9 [2.2-8.2] years), incident fractures were more common in patients with NFATs (3127 of 20 390 [15.3%] vs 16 086 of 125 392 [12.8%]; hazard ratio [HR], 1.40; 95% CI, 1.34-1.45; adjusted HR [AHR], 1.27; 95% CI, 1.22-1.33). An association between NFATs and vertebral fractures was found (AOR, 1.51; 95% CI, 1.33-1.72; AHR, 1.83; 95% CI, 1.60-2.09). In men younger than 50 years, NFATs were associated with fractures (AOR, 1.45; 95% CI, 1.21-1.74; AHR, 1.48; 95% CI, 1.20-1.82). There was no association among individuals who had undergone adrenalectomy (AHR, 1.12; 95% CI, 0.90-1.38). The association between NFATs and fractures remained significant and of similar magnitude in all sensitivity analyses. Conclusions and Relevance In this cohort study, NFATs were associated with fractures, particularly among younger men; thus, patients with NFATs should have bone health evaluation with appropriate treatment and monitoring, especially in younger men.
Collapse
Affiliation(s)
- Jonatan D. Lindh
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jekaterina Patrova
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Södersjukhuset, Stockholm, Sweden
| | - Buster Mannheimer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Södersjukhuset, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
191
|
J JL, Parasuraman G, Amirtham SM, Francis DV, Livingston A, Goyal A, Ramasamy B, Sathishkumar S, Vinod E. Comparative assessment of chondral defect repair using migratory chondroprogenitors suspended in either gelled or freeze-dried platelet-rich plasma: An in vitro and ex vivo human osteochondral unit model study. Knee 2024; 48:105-119. [PMID: 38565037 DOI: 10.1016/j.knee.2024.03.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Chondroprogenitors, with enhanced chondrogenic potential, have emerged to be a promising alternative for cell-based therapy in cartilage repair. Platelet-rich plasma (PRP), widely used for intra-articular treatment, has a short half-life. Freeze-dried PRP (FD-PRP), with an extended half-life and retained growth factors, is gaining attention. This study compares the efficacy of Migratory Chondroprogenitors (MCPs) in gelled PRP and FD-PRP using in-vitro and ex-vivo models, assessing FD-PRP as a potential off-the-shelf option for effective cartilage repair. METHODOLOGY MCPs were isolated from osteoarthritic cartilage samples (n = 3), characterized through FACS and RT-PCR. For in-vitro analysis, cells were loaded into gelled PRP and FD-PRP scaffolds at a density of 1x106 cells per scaffold. Trilineage differentiation studies and live-dead assays were conducted on MCPs using Calcein AM/Propidium Homodimer-1. In ex-vivo analysis, MCPs of the same density were added to Osteochondral Units (OCU) with chondral defects containing PRP gel and FD-PRP scaffolds, harvested on the 15th and 35th days for histological examination. Controls included cell-free scaffolds. RESULTS Our in-vitro analysis demonstrates the robust viability of MCPs in both scaffolds, with no discernible impact on their differentiation capacity. Ex-vivo analysis of the OCU for cartilage repair showed that the chondrogenic potential characterized by the accumulation of extracellular matrix containing glycosaminoglycans and collagen type II production (with no alteration in collagen type X), was observed to be better with the gel PRP and the gel PRP containing MCP groups. CONCLUSIONS These findings support the preference for gel PRP as a superior synergistic scaffold for chondroprogenitor delivery.
Collapse
Affiliation(s)
- Jeya Lisha J
- Department of Physiology, Christian Medical College, Vellore, India.
| | - Ganesh Parasuraman
- Centre for Stem Cell Research, (A Unit of InStem. Bengaluru), Christian Medical College, Vellore, India.
| | | | | | - Abel Livingston
- Department of Orthopaedics, Christian Medical College, Vellore, India.
| | - Anjali Goyal
- Department of Pathology, Smt NHL Municipal Medical College, Ahmedabad, India.
| | - Boopalan Ramasamy
- Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia.
| | | | - Elizabeth Vinod
- Department of Physiology, Christian Medical College, Vellore, India; Centre for Stem Cell Research, (A Unit of InStem. Bengaluru), Christian Medical College, Vellore, India.
| |
Collapse
|
192
|
Keeling H, Williams EJ, Itasaki N. Consideration of the thoracic phenotype of cerebro-costo-mandibular syndrome. Clin Anat 2024; 37:254-269. [PMID: 37265362 DOI: 10.1002/ca.24054] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
Cerebro-costo-mandibular syndrome (CCMS) is a congenital condition with skeletal and orofacial abnormalities that often results in respiratory distress in neonates. The three main phenotypes in the thorax are posterior rib gaps, abnormal costovertebral articulation and absent ribs. Although the condition can be lethal, accurate diagnosis, and subsequent management help improve the survival rate. Mutations in the causative gene SNRPB have been identified, however, the mechanism whereby the skeletal phenotypes affect respiratory function is not well-studied due to the multiple skeletal phenotypes, lack of anatomy-based studies into the condition and rarity of CCMS cases. This review aims to clarify the extent to which the three main skeletal phenotypes in the thorax contribute to respiratory distress in neonates with CCMS. Despite the posterior rib gaps being unique to this condition and visually striking on radiographic images, anatomical consideration, and meta-analyses suggested that they might not be the significant factor in causing respiratory distress in neonates. Rather, the increase in chest wall compliance due to the rib gaps and the decrease in compliance at the costovertebral complex was considered to result in an equilibrium, minimizing the impact of these abnormalities. The absence of floating ribs is likely insignificant as seen in the general population; however, a further absence of ribs or vestigial rib formation is associated with respiratory distress and increased lethality. Based on these, we propose to evaluate the number of absent or vestigial ribs as a priority indicator to develop a personalized treatment plan based on the phenotypes exhibited.
Collapse
Affiliation(s)
- Holly Keeling
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | | | - Nobue Itasaki
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
193
|
Melman WPR, Ettema HB, Edens MA, Verheyen CCPM. Mid-term results of cemented hip arthroplasties through the direct anterior approach in the lateral decubitus position: a retrospective cohort study. J Orthop Surg Res 2024; 19:206. [PMID: 38561763 PMCID: PMC10983692 DOI: 10.1186/s13018-024-04696-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Reports show a high complication rate when starting with the Direct Anterior Approach (DAA) in a supine position for hip arthroplasty. The DAA with the patient in lateral decubitus position may avoid this problem because it supposedly provides better visibility, especially on the femoral side. However, this approach did show a rather high complication rate during the adoption of the approach at 1 year follow up in our previous report. We were interested what the overall 7 year survival estimate would be and whether improvement could be seen with growing experience. METHODS A cohort of patients undergoing total hip arthroplasty right from the start of applying the DAA in lateral decubitus position was analysed. RESULTS In total 175 hip prostheses (162 patients) were evaluated. The 7-year survival estimate was 95.1%, 95 CI: 91.8-98.4%. In 6 of 8 revisions there was aseptic loosening of the stem. By dividing the cohort into 3 consecutive groups in time we did not see a significantly improving revision rate. CONCLUSIONS In our experience, the adoption of the direct anterior approach in lateral decubitus position caused a relatively low 7-year survival estimate without an apparent decrease with growing experience, however given the low number of cases further research is needed to investigate the long-term risk of adopting a new approach.
Collapse
Affiliation(s)
- Wietse P R Melman
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands.
- Department of Orthopedic Surgery and Traumatology, Saxenburgh Medisch Centrum, Jan Weitkamplaan 4a, Hardenberg, 7772 SE, The Netherlands.
| | - Harmen B Ettema
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands
| | - Mireille A Edens
- Epidemiology Unit, Department Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - Cees C P M Verheyen
- Department of Orthopedic Surgery and Traumatology, Isala Hospital, Zwolle, The Netherlands
| |
Collapse
|
194
|
Chung H, Kim Y, Kook I, Kwak JW, Hwang KT. Comparative Short-Term Outcomes of Femoral Neck System (FNS) and Cannulated Screw Fixation in Patients with Femoral Neck Fractures: A Multicenter Study. Clin Orthop Surg 2024; 16:184-193. [PMID: 38562623 PMCID: PMC10973613 DOI: 10.4055/cios23190] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/21/2023] [Accepted: 11/24/2023] [Indexed: 04/04/2024] Open
Abstract
Background Femoral neck fractures need to be treated in their early stages with accurate reduction and stable fixation to reduce complications. The authors compared the early radiologic outcomes of femoral neck fractures treated with the recently introduced Femoral Neck System (FNS, Depuy-Synthes) with conventional cannulated screws (CS) in a multicenter design. Furthermore, the factors associated with early failure after FNS were analyzed. Methods The FNS group included 40 patients treated between June 2019 and January 2020, and the CS group included 65 patients treated between January 2015 and May 2019. The operation was performed in 3 university hospitals. Patient demographics, fracture classification, postoperative reduction quality, sliding distance of FNS or CS, union and time to union, and complication rates were examined. Logistic regression analysis was performed on candidate factors for early failure of the FNS group. Results The FNS group had a 90% union rate and a mean time to union of 4.4 months, while the CS group had similar results with an 83.1% union rate and a mean time to union of 5.1 months. In the subgroup analysis of Pauwels type III fractures, the union rates were 75.0% and 58.8% in the FNS and CS groups, respectively, and the time to union was significantly shorter in the FNS group with 4.8 months compared to 6.8 months in the CS group. Early failure rate within 6 months of FNS fixation was observed to be 10%, which included 3 reduction failures and 1 excessive sliding with a broken implant. Risk factors for early failure after FNS were identified as displaced fractures (Garden classification type III or IV), poor reduction quality, longer tip-apex distance, greater sliding distance, and 1-hole implants, of which sliding distance was the only significant risk factor in multivariate analysis. Conclusions In femoral neck fractures, FNS and CS did not show significant differences for short-term radiologic results. FNS resulted in shorter operative time than cannulated screw fixation and favorable outcomes in Pauwels type III femoral neck fractures. The FNS could be considered a reliable and safe alternative to CS when treating femoral neck fractures.
Collapse
Affiliation(s)
- HoeJeong Chung
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Youngwoo Kim
- Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Incheol Kook
- Department of Orthopaedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Woong Kwak
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyu Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
195
|
van Erp JHJ, Kuperus JS, Bekkers JEJ, Kruyt MC. Bilateral Slipped Capital Femoral Epiphysis in a Young Girl Treated With Chemotherapy: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00003. [PMID: 38579020 DOI: 10.2106/jbjs.cc.23.00650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
CASE A 1-year-old girl was treated with chemotherapy and hematopoietic stem cell transplantation because of CD40 ligand deficiency. Four years later, she presented with pain in her right leg, diagnosed as atypical acute slipped capital femoral epiphysis, without a clear cause, besides chemotherapy possibly. She was treated with fixation of the epiphysis with a cannulated screw. Two years later, the same diagnosis was made for the left hip and the same surgery was applied. After the 2-year follow-up, clinical outcomes were good. CONCLUSION Chemotherapy may be a risk factor for atypical slipped capital femoral epiphysis, even without the combination with radiotherapy.
Collapse
Affiliation(s)
- J H J van Erp
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands
- Department of Orthopedics, Diakonessenhuis Utrecht, The Netherlands
- Department of Orthopedics, UMC Utrecht, The Netherlands
| | - J S Kuperus
- Department of Orthopedics, UMC Utrecht, The Netherlands
| | - J E J Bekkers
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands
- Department of Orthopedics, Diakonessenhuis Utrecht, The Netherlands
- Department of Orthopedics, UMC Utrecht, The Netherlands
| | - M C Kruyt
- Department of Orthopedics, UMC Utrecht, The Netherlands
| |
Collapse
|
196
|
Veihelmann A, Beck F, Birkenmaier C. HADS and SOMS-2 brief score evaluation can prevent unnecessary minimal invasive spine interventions - a prospective blinded observational clinical trial. Arch Orthop Trauma Surg 2024; 144:1575-1584. [PMID: 38386066 DOI: 10.1007/s00402-024-05257-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION To test the hypothesis, whether HADS/SOMS is practical in a spine surgery consultation setting and that patients with CLBP, but a high-risk of psychic comorbidities using above screenings will not improve after minimal-invasive spine interventions (MIS). METHODS n = 150 completed HADS and SOMS prior to the acquisition of history and examination. Primary outcome was improvement by numeric rating scale (NRS), Pain disability index (PDI) and oswestry disability index (ODI) at baseline and 6 months after intervention. In case of sciatica due to disc herniation epidural neurolysis, for facet or SI-joint-syndrome, radiofrequency and for discogenic pain intradiscal electrothermal therapy (IDET) was performed. RESULTS 6 months after interventions, pat. with a high-risk of anxiety or depression showed no clinically important improvements in NRS, PDI and ODI, whereas in the low-risk group all 3 parameters were significantly reduced. We found a statistically significant difference in the improvement of NRS (p < 0·05), PDI (p < 0·001), ODI (p < 0·001) between high- and low-risk HADS-anxiety and depression groups and in the improvement of NRS and PDI (p < 0·05) between high- and low-risk SOMS-2-subgroups. CONCLUSIONS In this group of CLBP patients, the easy-to-administer HADS/SOMS reliably predicted outcome after MIS due to the detection of somatoform comorbidities. Thus, 30 out of 150 patients were invasively treated without improvement. This is alarming not only because of unnecessary MIS being performed on these individuals, but also because it represents an inefficient allocation of increasingly limited healthcare funds. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Andreas Veihelmann
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany.
- Department for Spine Therapy, Sports Hospital Stuttgart, Stuttgart, Germany.
- SRH Health-center, Bad Herrenalb, Germany.
| | - Florian Beck
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany
- Orthopaedie Centrum 30, Fellbach, Germany
| | - Christof Birkenmaier
- Department of Orthopaedics, Physical Medicine & Rehabilitation, Ludwig-Maximilians- University of Munich, Munich, Germany
| |
Collapse
|
197
|
Leal J, Hones KM, Hao KA, Slaton PT, Roach RP. Arthroscopy and Microfracture for Osteochondritis Dissecans of the Capitellum in Adolescent Athletes Shows Favorable Return to Sport: A Systematic Review. Arthroscopy 2024; 40:1325-1339. [PMID: 37714441 DOI: 10.1016/j.arthro.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To assess return to sport (RTS) in the high-risk young athlete population with capitellar osteochondritis dissecans (OCD) undergoing arthroscopic microfracture (MFX) with or without debridement as well as associated indications, clinical outcomes, radiographic outcomes, and complications. METHODS A literature search of all published literature in the English language from PubMed, EMBASE, Scopus, and Cochrane from database inception to April 4, 2022, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies presented demographics and outcomes for adolescent (<21 years old) patients diagnosed with capitellar OCD who underwent arthroscopic MFX (or drilling/subchondral drilling) or MFX (or drilling/subchondral drilling) with debridement (or loose body removal/chondroplasty). Studies containing multiple surgical techniques that did not distinguish characteristics and outcomes of individual patients by surgical technique were excluded. Additionally, if there was overlap in patient populations between 2 studies, the study with less outcome data was excluded. Extracted data included study properties, patient demographics, lesion characteristics, surgery details, and patient outcomes, including range of motion, outcome scores, and RTS rates. Bias was assessed via the Methodological Index for Non-Randomized Studies (MINORS). RESULTS Nine studies of 136 patients and 138 elbows met criteria. Included articles were published between 2005 and 2020 with MINORS scores of 8 to 14 (50% to 88%). The age ranged from 12.7 to 15.7 years with most patients being involved in baseball or gymnastics and a rate of dominant elbow involvement of 55% to 100%. Patient follow-up ranged from 16 to 138 months. All 9 studies reported RTS, ranging from 65% to 100%. Six of these studies categorized the level to which the patient returned, with patients RTS at the same level of competition ranging from 60% to 100%. Six studies reported complications, with a range rate of 0% to 43%; there were a total of 10 complications, 7 of which required reoperations. CONCLUSIONS Arthroscopic MFX with or without arthroscopic debridement is a safe and effective treatment for OCD lesions of the capitellum in young, athletic patients. Included studies reported improved clinical, radiographic, and patient-reported outcomes. Aside from 1 study reporting an RTS of 65%, the rate of RTS ranged from 86% to 100%. The percentage of patients returning to sport at the same level of competition ranged from 60% to 100% with a time to RTS ranging from 4.1 to 5 months. A single study reported a complication rate of 43%, while remaining studies reported complication rates between 0% and 19%, with loose bodies being the most common complication requiring reoperation. Follow-up ranged from 16 to 138 months. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
Collapse
Affiliation(s)
- Justin Leal
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A..
| | - Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A
| | | | - Ryan P Roach
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, U.S.A
| |
Collapse
|
198
|
Mercer HL, Rodriguez D, Rivas R, Rivenbark E, Mikola E, Mercer D. Management of the Septic Wrist: A Systematic Review of Etiology and Therapeutic Strategies. Orthop Clin North Am 2024; 55:273-283. [PMID: 38403373 DOI: 10.1016/j.ocl.2023.11.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.
Collapse
Affiliation(s)
- Heather L Mercer
- Institute of Microbiology and Infection, School of Biosciences, Univeristy of Birmingham, Edgbaston, B15 2TT, England
| | - Diego Rodriguez
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Rhiana Rivas
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Elizabeth Rivenbark
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Elizabeth Mikola
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Deana Mercer
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA.
| |
Collapse
|
199
|
Marckmann M, Henriksen NA, Krarup PM, Helgstrand F, Vester-Glowinski P, Christoffersen MW, Jensen KK. PROphylactic closed incision Negative-PRESSure treatment in open incisional hernia repair: Protocol for a multicenter randomized trial (PROPRESS study). Contemp Clin Trials Commun 2024; 38:101256. [PMID: 38298916 PMCID: PMC10827677 DOI: 10.1016/j.conctc.2024.101256] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Background Negative Pressure Therapy in closed incisions (ciNPT) after surgery has shown positive effects including reduction of Surgical Site Infection (SSI) incidence. In patients undergoing elective open incisional hernia repair, however, ciNPT is not standard care, perhaps due to high-quality evidence still not provided. This study hypothesizes that this patient group would benefit from ciNPT by reducing wound complications and improving postoperative quality of life. Method This is a multicenter Randomized Controlled Trial (RCT) including a total of 110 patients allocated in a 1:1 ratio with one intervention arm and one active control arm receiving ciNPT (i.e., Prevena™) and standard wound dressing, respectively. The primary outcome is the incidence of SSI at 30 days postoperatively and secondary outcomes are 1) pooled incidence of Surgical Site Occurrence (SSO), 2) patient-reported pain and satisfaction with the scar, and 3) hernia-related quality of life. Conclusion Patients undergoing elective open incisional hernia repair are fragile with a high risk of wound complication development. This multicenter RCT seeks to deliver the high-quality evidence needed to establish the role ciNPT must play for exactly this group with the aim of reducing SSI incidence and health economic costs, and finally improving quality of life. There are no theoretical or clinical experience of unwanted consequences of this treatment.
Collapse
Affiliation(s)
| | - Nadia A. Henriksen
- Dept. of Gastrointestinal and Hepatic Diseases, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | | | | | | | | | - Kristian Kiim Jensen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Denmark
| |
Collapse
|
200
|
Marland H, Barve A, McDonnell JM, Wilson KV, Darwish S, Butler JS. Geriatric Traumatic Spinal Cord Injuries: Should Surgical Intervention Be Delayed? Clin Spine Surg 2024; 37:79-81. [PMID: 38409685 DOI: 10.1097/bsd.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Harry Marland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- School of Medicine, University of Galway, Galway
| | - Arnav Barve
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- School of Medicine, University College Dublin
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- Trinity Centre of Biomedical Engineering, Trinity College Dublin
| | - Kielan V Wilson
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- School of Medicine, University College Dublin
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin
- School of Medicine, University College Dublin
| |
Collapse
|