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Pahapill NK, Monahan PF, Graefe SB, Gallo RA. Preoperative Antidepressant Prescriptions Are Associated With Increased Opioid Prescriptions and Health Care Use but Similar Rates of Secondary Surgery Following Primary Anterior Cruciate Ligament Reconstruction in a Young Adult Population. Arthroscopy 2024; 40:2246-2253.e1. [PMID: 38190947 DOI: 10.1016/j.arthro.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To compare adverse events, postoperative opioid-prescribing patterns, health care use, and secondary anterior cruciate ligament reconstruction (ACLR) surgery rates of patients undergoing primary ACLR with a preoperative antidepressant prescription (ADP) against a propensity-matched group with no preoperative antidepressant prescription (NADP) using the TriNetX Diamond Network. METHODS Patients undergoing primary ACLR between ages 18 and 35 years of age were queried from the database using International Classification of Diseases, Tenth Revision/Current Procedural Terminology codes. Patients with an ADP were propensity matched in a 1:1 ratio to patients with NADP based on 11 patient characteristics. Postoperative rates of adverse events, emergency department (ED) visits, in-patient hospitalizations, outpatient services, physical therapy evaluations, postoperative opioid prescriptions, and secondary ACLR were compared at various time points. RESULTS In total, 3,736 patients with an ADP with an average age of 21.4 ± 4.5 years undergoing primary ACLR were propensity matched to patients with NADP. A significantly greater percentage of patients with an ADP received opioid prescriptions at 2 weeks (ADP 21%, NADP 11.3%, odds ratio [OR] 2.08), 6 weeks (ADP 25.5%, NADP 13.9%, OR 2.13), 3 months (ADP 27.6%, NADP 15.6%, OR 2.07), 6 months (ADP 30.5%, NADP 17.2%, OR 2.1), and 1 year (ADP 35.3%, NADP 20.2%, OR 2.16) postoperatively (P <.0001 for each time point). Patients with ADP had greater rates of ED visits (ADP 9.7%, NADP 7.1%, P < .0001, OR 1.39) and outpatient appointments (ADP 28.3%, NADP 21.8%) P < .0001, OR 1.42) at 3 months' postoperatively. Secondary surgery rates at 1 and 2 years were nonsignificant (P = .381 and P = .062, respectively). CONCLUSIONS Following ACLR, patients with ADP had a significant increase in postoperative opioid prescriptions at all time points and used more ED resources and outpatient services compared with patients with NADP at 3 months' postoperatively. Thirty-day postoperative adverse events and both 1- and 2-year secondary ACL surgery rates demonstrated no significant differences between the groups. LEVEL OF EVIDENCE Level III, retrospective comparative case series.
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Affiliation(s)
- Natalie K Pahapill
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, U.S.A..
| | - Peter F Monahan
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Steven B Graefe
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Robert A Gallo
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania, U.S.A
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202
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Nyffeler RW, Raass I, Haupt-Bertschy B. Posterior shoulder dislocation with acromion fracture: a case that illustrates a possible mechanism of posterior shoulder instability. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:536-539. [PMID: 39157215 PMCID: PMC11328993 DOI: 10.1016/j.xrrt.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Richard W. Nyffeler
- Orthopädie Sonnenhof, Bern, Switzerland
- Campus Stiftung Lindenhof Bern (Campus SLB), Bern, Switzerland
| | - Iina Raass
- Orthopädie Sonnenhof, Bern, Switzerland
- Campus Stiftung Lindenhof Bern (Campus SLB), Bern, Switzerland
| | - Bettina Haupt-Bertschy
- Institute of Physiotherapy, Insel Group, Inselspital, University Hospital, Bern, Switzerland
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203
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Ahmed AS, Clifton T, Subbiah K, Spasojevic M, Young A, Cass B, Marmen A, Yu R, Burton C, Smith MM, Hughes J. Midterm follow-up of the Nexel total elbow arthroplasty. J Shoulder Elbow Surg 2024; 33:1699-1708. [PMID: 38522777 DOI: 10.1016/j.jse.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Aseptic loosening is one of the most common complications of total elbow arthroplasty (TEA). Modern implants, such as the Nexel, have been designed in an attempt to decrease loosening. The present study aims to report implant survivorship, radiographic assessment of loosening and lucency, and patient-reported outcome measures (PROMs) in patients treated with the Nexel TEA at midterm follow-up. METHODS Consecutive series of adult patients underwent TEA using the Nexel by a single surgeon via standardized technique. Patients with minimum 3-year follow-up with radiographic and PROM data were included. Survivorship was defined by the absence of revision. Loosening was assessed via the Wrightington method by 3 independent fellowship-trained shoulder and elbow surgeons. Lucency was analyzed across individual radiographic zones on orthogonal radiographs. PROMs included the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Patient-Rated Elbow Evaluation (PREE), and EuroQoL-5 Dimensions (EQ-5D). RESULTS Thirty-eight consecutive patients (22 female, 16 male) with a mean age of 67 years underwent TEA via a triceps-sparing isolated medial window approach. Mean follow-up was 5.5 years (range 3-9). Primary diagnoses were as follows: 19 osteoarthritis (OA), 9 rheumatoid arthritis (RA), 9 post-traumatic arthritis (PA), and 1 conversion of elbow arthrodesis. Overall survivorship was 97.4%, with 1 patient undergoing revision for infection. Loosening was found in 5.3% of elbows, averaged across 3 observers. Lucency was most pronounced at the level of the humeral condyles. PROMs demonstrated significant and clinically meaningful improvements in 76%, 92%, and 73% of patients for QuickDASH, PREE, and EQ-5D, respectively. No significant correlations were found between patient age, gender, loosening, lucency, and PROMs. CONCLUSION At midterm follow-up, the Nexel TEA demonstrated excellent overall survivorship and low rate of implant loosening. The single failure requiring revision for infection was conversion of a prior elbow arthrodesis. PROMs overall exhibited marked and consistent improvement from preoperative to final postoperative follow-up. Although promising, these results should be interpreted with some caution as long-term data regarding this prosthesis are still lacking.
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Affiliation(s)
- Adil Shahzad Ahmed
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - Thomas Clifton
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | | | - Milos Spasojevic
- Rockhampton Department of Orthopaedic Surgery, University of Queensland, Queensland, QLD, Australia
| | - Allan Young
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Benjamin Cass
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | | | - Raymond Yu
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Codey Burton
- Department of Orthopaedic Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Jeffery Hughes
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
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204
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Gauthier CW, Bakaes YC, Kern EM, Kung JE, Hopkins JS, Hamilton CA, Bishop BC, March KA, Jackson JB. Total Joint Arthroplasty Outcomes in Eligible Patients Versus Patients Who Failed to Meet at Least 1 Eligibility Criterion: A Single-Center Retrospective Analysis. J Arthroplasty 2024; 39:1974-1981.e2. [PMID: 38403078 DOI: 10.1016/j.arth.2024.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND This study looks to investigate how not meeting eligibility criteria affects postoperative outcomes following total joint arthroplasty surgery. METHODS A retrospective review was conducted of total joint arthroplasty patients at a single academic institution. Demographics, laboratory values, and complications were recorded. Continuous and categorical variables were compared using the Student's T-test and the Chi-Square test, respectively. Multivariable analysis was used to control for confounding variables. RESULTS Our study included 915 total hip and 1,579 total knee arthroplasty patients. For total hip and total knee arthroplasty, there were no significant differences in complications (P = .11 and .87), readmissions (P = .83 and .2), or revision surgeries (P = .3 and 1) when comparing those who met all criteria to those who did not. Total hip arthroplasty patients who did not meet two criteria had 16.1 higher odds (P = .02) of suffering a complication. There were no differences in complications (P = .34 and .41), readmissions (P = 1 and .55), or revision surgeries (P = 1 and .36) between ineligible patients treated by total joint arthroplasty surgeons and those who were not. Multivariable analysis demonstrated no eligibility factors were associated with outcomes for both total hip and knee arthroplasty. CONCLUSIONS There was no significant difference in outcomes between those who met all eligibility criteria and those who did not. Not meeting two criteria conferred significantly higher odds of suffering a complication for total hip arthroplasty patients. Total joint arthroplasty surgeons had similar outcomes to non-total joint surgeons, although their patient population was more complex. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chase W Gauthier
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Yianni C Bakaes
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Elizabeth M Kern
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Justin E Kung
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Jeffrey S Hopkins
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Corey A Hamilton
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Braxton C Bishop
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - Kyle A March
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
| | - J Benjamin Jackson
- Prisma Health Department of Orthopedic Surgery, Columbia, South Carolina
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205
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Pasqualini I, Turan O, Emara AK, Ibaseta A, Xu J, Chiu A, Piuzzi NS. Outpatient Total Hip Arthroplasty Volume up Nearly 8-Fold After Regulatory Changes With Expanding Demographics and Unchanging Outcomes: A 10-Year Analysis. J Arthroplasty 2024; 39:2074-2081. [PMID: 38401607 DOI: 10.1016/j.arth.2024.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND With the removal of total hip arthroplasty (THA) from the inpatient-only (IPO) lists, the orthopedic landscape across the United States has changed rapidly. Thus, this study aimed to: 1) characterize the change in THA volume for outpatient and inpatient surgeries; 2) elucidate demographical differences before and after removal from the IPO list; and 3) analyze 30-day complications, readmissions, and reoperations. METHODS The National Surgical Quality Improvement Program database was queried for primary THAs between January 2010 and December 2021. The primary outcome was the annual volume of outpatient and inpatient THAs. Secondary outcomes involved 30-day complications, readmissions, and reoperations. The variables between cohorts were analyzed using goodness-of-fit Chi-square tests with summary statistics. RESULTS Of the 332,423 THAs between 2010 and 2021, 88% were inpatient THAs (n = 292,974) and 12% were outpatient THAs (n = 39,449). From 2019 to 2021, the volume of inpatient THA decreased by 55% (42,779 to 19,075), while outpatient THA increased by 751% (2,518 to 21,424). Patients who had a THA after 2019 were older (P < .001), more commonly women (P < .001), white (P < .001), and more likely American Society of Anesthesiologists Class III (P < .001). The outpatient cohort had fewer 30-day complications, readmissions, and reoperations. The length of stay for both cohorts decreased until 2019, before increasing in 2020 and 2021 for inpatient THAs, while home discharge and operative time increased for both. CONCLUSIONS The volume of outpatient THA increased almost eightfold after its removal from the IPO lists in 2020. Despite expanding eligibility with older patients and more comorbidities, 30-day complications, readmissions, and reoperations remain low. These findings support the safe transition to outpatient THA with appropriate patient selection and optimization.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oguz Turan
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alvaro Ibaseta
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Xu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Austin Chiu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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206
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Rezaee M, Roshandel H, Rahimibarghani S, Rihani TSS, Mohammadyahya E. Predictors of pain intensity in carpal tunnel syndrome: Development and validation of a model. Clin Neurol Neurosurg 2024; 243:108395. [PMID: 38936177 DOI: 10.1016/j.clineuro.2024.108395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Pain often accompanies carpal tunnel syndrome and affects patients' health-related quality of life. The aim was to develop and validate a predictive model for the pain intensity of carpal tunnel syndrome using demographic, clinical, electrophysiological, and ultrasound findings. METHODS We conducted a secondary analysis of data from a large sample of patients (May 2017 to December 2022) with carpal tunnel syndrome. A total of 520 (53.0 %) mild, 276 (28.1 %) moderate, and 186 (18.9 %) severe syndromes were included in the complete data set of 982 hands (61.1 % female). The mean age was 57.8 (10.7) years and the median duration [interquartile range] of the symptoms was 4 [2,10] months. A regression model was developed and validated to predict pain intensity on a numerical rating scale using a tree-based machine learning algorithm. RESULTS The validation of the regression model showed good performance with a root mean squared error, R-squared, and mean absolute error of 1.35, 0.42, and 1.05, respectively. Overall, the top significant predictors of pain intensity were compound motor nerve action potential latency, nocturnal pain, and thenar weakness. These were followed by the cross-sectional area of the median nerve, sensory nerve action potential, bowing of the flexor retinaculum, disease duration, and body mass index. We did not find strong associations between the median nerve transcarpal latency, age, sex, and diabetes with the pain intensity of carpal tunnel syndrome. CONCLUSION Our model showed good performance in predicting the subjective pain intensity of carpal tunnel syndrome, even in the context of non-linear relations.
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Affiliation(s)
- Mehdi Rezaee
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Islamic Republic of Iran
| | - Hamid Roshandel
- Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Sarvenaz Rahimibarghani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Tayebeh Sadat Salehi Rihani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Elham Mohammadyahya
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
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207
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Radtke LE, Matheson DJ, Woychik MJ, Blackburn BE, Anderson LA, Gililland JM, Peters CL. Staged Bilateral Total Knee Arthroplasty: Differing Results Comparing the First and Second Knees. J Arthroplasty 2024; 39:S86-S94. [PMID: 38604283 DOI: 10.1016/j.arth.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Patients often prefer one knee over the other following staged bilateral total knee arthroplasty (BTKA). Our study compared patient-reported outcomes scores of each knee following BTKA and identified factors that may contribute to the identified discrepancies. METHODS All patients who underwent staged BTKA between July 2014 and August 2022 were identified. The patient-reported outcomes were collected preoperatively and at 2 weeks, 6 weeks, 1 year, and 2 years postoperatively. Each knee's results were compared using paired t-tests and McNemar tests. Preoperative Kellgren-Lawrence Grade (KLG), postoperative range of motion (ROM), reoperation rates, and manipulations under anesthesia (MUAs) were collected. Results were stratified based on time between TKAs (< 3 months, 3 to 12 months, 1 to 2 years, and > 2 years). RESULTS There were 911 patients who underwent staged BTKA, with a mean 4.1-year follow-up. The ROM, patient satisfaction, MUAs, and reoperations were not significantly different between knees. Comparing the KLG of the first and second knees, 71% had the same KLG for both knees, 21% had a lower KLG, and 7% of the second knees had a higher KLG. The first knee had greater pain reduction (-10.6 at 2 weeks, -27.4 at 6 weeks) compared to the second (9.3 at 2 weeks, -8.1 at 6 weeks) (P < .0001) and better improvement in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) score (8.5 at 2 weeks, 16.9 at 6 weeks) compared to the second (-5.8 at 2 weeks, 5.0 at 6 weeks) (P < .0001). The 1-year outcomes between first and second knees, or recovery curves, were not different when stratifying by time between TKAs. CONCLUSIONS The second knee in a staged BTKA has less delta improvement in KOOS JR and pain scores at early follow-up, likely due to higher starting KOOS JR and Patient-Reported Outcomes Measurement Information System scores, despite similar final patient satisfaction and clinical outcome measures. Lower KLG in the second total knee arthroplasty (TKA) may contribute to these findings. An MUA after the first TKA is highly predictive of an MUA after the second TKA.
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Affiliation(s)
- Logan E Radtke
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Derek J Matheson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Mia J Woychik
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Brenna E Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Muthu S, Ramanathan K, Alagar Yadav S, Jha SK, Ranjan R. Increased Cellular Dosage of Bone Marrow Aspiration Concentrate Does Not Translate to Increased Clinical Effectiveness in Knee Osteoarthritis: A Phase I Dose Escalation Study. Indian J Orthop 2024; 58:1001-1008. [PMID: 39087042 PMCID: PMC11286881 DOI: 10.1007/s43465-024-01197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/31/2024] [Indexed: 08/02/2024]
Abstract
Introduction Knee osteoarthritis (KOA), a chronic degenerative disease, significantly impairs quality of life due to pain and mobility limitations. Traditional treatments focus on symptom management without addressing the underlying disease progression, leading to a growing interest in regenerative medicine approaches. Bone marrow aspirate concentrate (BMAC), rich in mesenchymal stem cells and growth factors, has shown potential for cartilage repair and symptom relief in KOA. Despite promising outcomes, the optimal BMAC dosage for knee OA treatment remains undetermined. This study aims to evaluate the clinical efficacy and safety of varying BMAC dosages in knee OA treatment. Methods This prospective controlled dose-escalation study involved 75 patients with early-stage knee OA, categorized into three groups based on BMAC dosage administered 10 × 106 cells (low-dose group), 50 × 106 cells (medium-dose group), or 100 × 106 cells (high-dose group). All the patients underwent a single intra-articular injection of BMAC and were monitored over a year. The primary outcomes include Visual Analog Scale (VAS) for pain and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for joint function recorded at baseline, 1, 3, 6, and 12 months post-intervention. Adverse events were also documented. Results Significant clinical improvements in VAS and KOOS scores were noted across all groups at all time points compared to the baseline. However, these improvements did not significantly differ between dosage groups throughout the follow-up period. Adverse effects were minimal and primarily consisted of transient post-injection pain and effusion, with no dose-dependent increase in complications. Conclusion BMAC treatment for knee OA is safe and demonstrates potential for significant pain relief and functional improvement, irrespective of the dosage administered within the tested range. The lack of significant differences among varying dosages suggests a plateau in therapeutic efficacy beyond a certain threshold. Further research is necessary on the long-term outcomes to optimize the dosing strategy.
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Affiliation(s)
- Sathish Muthu
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh 201310 India
- Department of Orthopaedics, Government Medical College, Dindigul, Tamil Nadu 624001 India
| | - Karthikraja Ramanathan
- Department of Orthopaedics, Government Medical College, Dindigul, Tamil Nadu 624001 India
| | - Sangilimuthu Alagar Yadav
- Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu 641021 India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh 201310 India
- Department of Zoology, Kalindi College, University of Delhi, New Delhi, 110008 India
| | - Rajni Ranjan
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh 201310 India
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209
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Anderson JA, Laucis N, Symanski J, Blankenbaker D. Imaging of Disease and Normal Variant Patterns in Pediatric Hips. Semin Musculoskelet Radiol 2024; 28:447-461. [PMID: 39074727 DOI: 10.1055/s-0044-1786153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
The pediatric hip undergoes significant changes from infancy through adolescence. Proper maturation is crucial for the development of a stable and functional hip joint. Imaging interpretation of the pediatric hip requires distinguishing normal variants and maturation patterns from pathology. We review femoral ossification centers, variants, and conditions that affect the proximal femur, such as Legg-Calvé-Perthes disease; the acetabulum, such as developmental hip dysplasia; the acetabular labrum, such as femoroacetabular impingement; and synovial pathology in children through adolescence. Understanding the spectrum of hip conditions and using advanced imaging techniques are essential for the accurate diagnosis and effective management of pediatric hip disorders.
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Affiliation(s)
- Jade A Anderson
- Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Nicholas Laucis
- Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - John Symanski
- Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Donna Blankenbaker
- Department of Radiology, Musculoskeletal Imaging and Intervention, UW Health: University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
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210
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Noble DM, Dacus AR, Chhabra AB. Advances in the Treatment of Hand and Wrist Injuries in the Elite Athlete. J Hand Surg Am 2024; 49:779-787. [PMID: 38775759 DOI: 10.1016/j.jhsa.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 08/05/2024]
Abstract
Caring for hand and wrist injuries in the elite athlete brings distinct challenges, with case-by-case decisions regarding surgical intervention and return-to-play. Metacarpal fractures, thumb ulnar collateral ligament tears, and scaphoid fractures are common upper-extremity injuries in the elite athlete that can be detrimental to playing time and future participation. Treatment should therefore endure the demand of accelerated rehabilitation and return-to-activity without compromising long-term outcomes. Fortunately, the literature has supported emerging management options that support goals specific to the athlete. This review examined the advances in surgical and perioperative treatment of metacarpal fractures, thumb ulnar collateral ligament injuries, and scaphoid fractures in the elite athlete.
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Affiliation(s)
- David Matthew Noble
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Angelo Rashard Dacus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Abhinav Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
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Pinelli E, Baroncini I, Serafino F, Ricci L, Rucci P, Lullini G, Simoncini L, Bragonzoni L. Evaluation of the feasibility and acceptability of a home-based supervised exercise programme in individuals with spinal cord injuries: SCI-HOME-ACTIVE study protocol. BMJ Open Sport Exerc Med 2024; 10:e002088. [PMID: 39104378 PMCID: PMC11298722 DOI: 10.1136/bmjsem-2024-002088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 08/07/2024] Open
Abstract
Physical activity is essential to a healthy lifestyle for adults with spinal cord injuries (SCI). Although exercise is recognised as an important tool for improving the well-being and independence of people with SCI, most individuals do not engage in physical exercise. Traditional exercise programmes often require participation in rehabilitation centres or specialised facilities, making them less accessible for individuals with chronic SCI. Many people with SCI live in rural communities and other geographically isolated areas where access to fitness facilities and outdoor recreational areas involves long commutes or expensive transportation, which is one of the most common barriers to exercise reported by people with physical disabilities. Consequently, exercise remains an underused intervention for improving health and function in people with SCI despite its proven effects in reducing pain, fatigue, fall risk and other secondary health conditions. This pilot study evaluates the feasibility and acceptability of a home-based supervised exercise programme for individuals with chronic SCI. The study will be an interventional and prospective pilot study. People with SCI will participate in a 3-month home-based exercise programme. Primary outcomes will include adherence to the exercise programme, while secondary outcomes will encompass quality of life, functional capacity, musculoskeletal health and clinical parameters. The programme will be structured into 1-hour sessions, held twice weekly for 3 months, conducted online and in small groups. The results of this study could be relevant for future indications of the best setting and strategy to ensure adherence to physical activity.
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Affiliation(s)
- Erika Pinelli
- Department of Life Science Quality, University of Bologna, Bologna, Italy
| | | | | | - Lucia Ricci
- Montecatone Rehabilitation Institute, Imola, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | - Laura Bragonzoni
- Department of Life Science Quality, University of Bologna, Bologna, Italy
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Pearsall C, Chen AZ, Abdelaziz A, Saltzman BM, Piasecki DP, Popkin CA, Redler LH, Levine WN, Ahmad CS, Trofa DP. Patient Preferences for Graft Selection in Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2024; 12:23259671241258429. [PMID: 39157023 PMCID: PMC11328237 DOI: 10.1177/23259671241258429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 08/20/2024] Open
Abstract
Background Selecting an appropriate graft for anterior cruciate ligament (ACL) reconstruction requires consideration of a patient's preferences, goals, age, and physical demands alongside the risks and benefits of each graft choice. Purpose To determine the most popular ACL reconstruction grafts among patients and the most important factors influencing their decisions. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients undergoing ACL reconstruction between October 2022 and April 2023 completed a survey either before (nonconsult group) or after (consult group) speaking with their surgeon, who provided an evidence-based description of the pros and cons of an allograft and the following autografts: bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT). Patient characteristics, graft choice, information influencing their graft choice, and surgeon recommendation were collected and compared between the groups. Results Among the 100 included patients, 59.0% were male, and the mean age was 28.3 ± 10.4 years. The most popular grafts were the BPTB (56.0%), followed by the QT (29.0%), HT (8.0%), and allograft (7.0%). No significant difference was observed in the graft selection between the consult group (n = 60; BPTB, 46.7%; QT, 38.3%; HT, 8.3%; allograft, 6.7%) and nonconsult group (n = 40; BPTB, 70.0%; QT, 15.0%; HT, 7.5%; allograft, 7.5%) (P = .0757). In the consult group, 81.7% of patients selected the graft recommended to them by their surgeon. The top 2 graft selection reasons were usage in professional athletes and failure rates, while the top 2 ACL surgery concerns were returning to their desired level of athletics and graft failure risk. Among the 93 patients who researched their ACL graft options before their visit, the most popular information source was some form of media (72.0% [67/93]). Conclusion The study findings underscore the importance of patient preference and surgeon recommendation in a patient's graft selection and highlight the need to be cognizant of the information sources available to patients when researching their graft options.
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Affiliation(s)
- Christian Pearsall
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Aaron Z. Chen
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Abed Abdelaziz
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Charles A. Popkin
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren H. Redler
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - William N. Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher S. Ahmad
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - David P. Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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de Souza HCM, Pessoa MF, Clemente RDS, da Silva AV, Cardoso PRG, Fernandes J, Dornelas de Andrade A. Effects of 12 weeks of inspiratory muscle training and whole body vibration on the inflammatory profile, BDNF and muscular system in pre-frail elderly women: A randomized controlled trial. Arch Gerontol Geriatr 2024; 123:105421. [PMID: 38593699 DOI: 10.1016/j.archger.2024.105421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
AIM to investigate the effects of the whole body vibration (WBV) and inspiratory muscle training (IMT) on the inflammatory profile and in muscle mass and strength in pre-frail older women. METHODS this study was a randomized double-blind trial. Forty two older women aged 60-80 years were randomly allocated to IMT + WBV (G1), IMTsham + WBV (G2) or Sham groups (G3). During 12 weeks G1 received both trainings, whereas G2 received WBV alone and G3 received IMT with a low fixed load and were positioned at the vibratory platform without therapeutic effect. Participants were evaluated before and after the intervention for the following outcomes: Brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers (IB), respiratory (RT) and quadriceps thickness (QT) and diaphragmatic mobility (DM) using muscle ultrasound, body composition (BC) using a bioelectrical impedance scale and inspiratory muscle strength (IMS). RESULTS after the training, G1 (114.93 ± 21.29) improved IMS (p<0.005) compared with G2 (91.29 ± 23.10) and G3 (85.21 ± 27.02). There was also a significant improve on time of the DM (p<0.001) and RT (p=0.006) for G1 (8.59 ± 3.55 and 11.11 ± 12.66) compared with G2 (1.05 ± 3.09 and 1.10 ± 10.60) and G3 (0.40 ± 2.29 and -1.85 ± 7.45). BDNF, IB, QT and BC were similar between groups. CONCLUSIONS IMT associated with WBV is effective to improve in increasing IMS, RT and DM in pre-frail older women. However, these interventions do not modify BDNF, IB, QT or BC in this population.
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Affiliation(s)
- Helga Cecília Muniz de Souza
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Hospital das Clínicas de Pernambuco - Empresa Brasileira de Serviços Hospitalares (HCPE-EBSERH), Federal University of Pernambuco, Recife, Brazil; Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil.
| | - Maíra Florentino Pessoa
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
| | - Rafaela Dos Santos Clemente
- Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
| | - Alanna Vasconcelos da Silva
- Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
| | | | - Juliana Fernandes
- Laboratory of Physiotherapy and Collective Health, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil
| | - Arméle Dornelas de Andrade
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Laboratory of Cardiopulmonary Physiotherapy, Department of Physiotherapy, Federal University of Pernambuco, Recife, Brazil.
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214
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Chanbour H, Zeoli T, Zuckerman SL. Commentary: Neural Arch Preservation-Posterior Vertebral Column Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 27:247-248. [PMID: 38648853 DOI: 10.1227/ons.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Tyler Zeoli
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
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215
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Morgan DF, Elangovan SM, Meyers AB. Pediatric Foot: Development, Variants, and Related Pathology. Semin Musculoskelet Radiol 2024; 28:490-504. [PMID: 39074731 DOI: 10.1055/s-0044-1779246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Pediatric foot development throughout childhood and adolescence can present a diagnostic dilemma for radiologists because imaging appearances may be confused with pathology. Understanding pediatric foot development and anatomical variants, such as accessory ossification centers, is essential to interpret musculoskeletal imaging in children correctly, particularly because many of these variants are incidental but others can be symptomatic. We first briefly review foot embryology. After describing common accessory ossification centers of the foot, we explain the different patterns of foot maturation with attention to irregular ossification and bone marrow development. Common pediatric foot variants and pathology are described, such as tarsal coalitions and fifth metatarsal base fractures. We also discuss pediatric foot alignment and various childhood foot alignment deformities.
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Affiliation(s)
- Daniel F Morgan
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stacey M Elangovan
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arthur B Meyers
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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216
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Tsirikos AI, Ahuja K, Jordan B, Fisher K. Management Principles in a Case of True-positive Loss of Neuromonitoring Signals during Scoliosis Surgery: A Case Report. J Orthop Case Rep 2024; 14:110-116. [PMID: 39157486 PMCID: PMC11327700 DOI: 10.13107/jocr.2024.v14.i08.4666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/20/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Multimodal intraoperative neuromonitoring (IOM) is essential in scoliosis surgery. This is affected by misplaced instrumentation, cord trauma, hemodynamic instability, and anesthesia. We present an irreversible loss of IOM without identifiable intra-operative cause to highlight its occurrence and discuss post-operative investigations and management. Case Report A 14-year-old girl with adolescent idiopathic scoliosis, no co-morbidities, and normal spinal magnetic resonance imaging (MRI) underwent posterior spinal fusion. During screw placement, bilateral motor evoked potentials (MEPs) and right somatosensory evoked potentials (SSEPs) were lost in the legs. All screws were removed with no evidence of cortical breach. Left leg responses gradually improved, but there was no recovery of right leg SSEPs or MEPs. Subsequently, the procedure was abandoned. The patient had reduced right leg strength (3/5) and sensation with the left leg was normal. Immediate post-operative spinal MRI identified no abnormality. Computed tomography (CT) showed no cortical breach with satisfactory pedicle screw tracts. Repeat MRI (day 7) showed high T2-signal within the cord at T11 indicating ischemia. Gradual neurological recovery occurred and on day 15, repeat neurophysiology found reproducible SSEPs and MagStim MEPs. The patient underwent revision posterior fusion with single rod correction without complication and IOM was maintained. By day 24, the patient had 5/5 power and normal sensation in both legs. Good scoliosis correction was achieved and maintained at 3-year follow-up. Conclusion This patient represents a vascular event affecting the lower spinal cord and highlights the role of sequential imaging and pre-operative neurophysiology including MagStim in deciding when to proceed with revision surgery while reducing risk using conservative techniques.
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Affiliation(s)
- Athanasios I Tsirikos
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Kaustubh Ahuja
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Brian Jordan
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Katie Fisher
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK
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217
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Trovato B, Sortino M, Petrigna L, Roggio F, Musumeci G. The influence of static and dynamic warm-up on knee temperature: infrared thermography insights before and after a change of direction exercise. Front Physiol 2024; 15:1393804. [PMID: 39148745 PMCID: PMC11324587 DOI: 10.3389/fphys.2024.1393804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/17/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Infrared thermography is gaining attention in the field of sports medicine and performance. This study investigated the effects of static and dynamic warm-ups and a 90° change of direction (COD) exercise on the thermal response of the knee. Methods Thermograms were collected using the FlIR E54 Imaging Camera from 85 healthy young adults, 46 men and 39 women, aged 20-31 years. The participants were divided in two groups, static and dynamic warm-up. Four thermograms were taken: baseline (T0), warm-up (T1), COD (T2), and rest (T3). Four regions of interest (ROIs) of the knee were analyzed: anterior upper half (AUH), anterior lower half (ALH), posterior upper half (PUH), and posterior lower half (PLH). Mixed ANOVA with the Bonferroni-Holm test and independent t-test were used for pairwise comparison and to spot differences between the right and left knees at T1 and T2 and at T0 between men and women, respectively. Results The mixed ANOVA was significant for time points (p< 0.001) in all the ROIs and for the stretching/temperature interaction with different levels of significance. The t-test results for the right and left knees at T1 and T2 were not significant. The temperature in the static warm-up group followed a decrease at T1, a subsequent decrease at T2, and a recovery similar to the baseline at T3, in the ALH in men and women and in the PUH only in men. Conclusion Static stretching was more suitable for preparing the knee for the COD exercise than the dynamic one in terms of the thermal response.
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Affiliation(s)
- Bruno Trovato
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Catania, Italy
| | - Martina Sortino
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Catania, Italy
| | - Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Catania, Italy
| | - Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Catania, Italy
- Research Center on Motor Activities (CRAM), University of Catania, Catania, Italy
- Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, United States
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218
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D'Ambrosi R, Kambhampati SB, Meena A, Milinkovic DD, Abermann E, Fink C. The "Golden Age" of quadriceps tendon grafts for the anterior cruciate ligament: a bibliometric analysis. J ISAKOS 2024; 9:672-681. [PMID: 38492850 DOI: 10.1016/j.jisako.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/25/2023] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
IMPORTANCE Bibliometric research is a statistical analysis of publications to measure the scientific output in a specific field in order to highlight medical developments or knowledge gaps and to direct future scientific research. The quantity of orthopedic papers on the internet is astounding and is steadily growing as a result of recent advancements in technology and medicine. This is why choosing the right information is essential. AIM The purpose of this study was to analyze the current literature for trends in publications regarding quadriceps tendon (QT) grafting of the anterior cruciate ligament (ACL). EVIDENCE REVIEW PubMed was searched on August 28, 2023. References were collected from PubMed, and trends were analyzed using this information. This search retrieved 405 articles regarding human and animal studies. We analyzed the top 10 authors and journals in terms of publication numbers, citation numbers, and citations per year. The PubMed-by-year feature was used to compare the number of publications regarding ACL reconstruction by quadriceps grafting with all publications in PubMed. FINDINGS The number of yearly publications averaged 10 or less up to 2018, starting from 1982 when the first paper on the QT was published. However, the number of publications increased from 2018. While the total number of publications on this topic was 405, 260 were published from 2018 alone. The number of citations was 8262 in total overall years. It is expected that the last five years' publications, especially those for the last year, will be low in number, as it takes time for citations to accrue. The journal Arthroscopy published the most articles on this topic, with 57 papers and 1884 citations, followed by the American Journal of Sports Medicine, with 39 articles and 1576 citations. The top three journals on this topic were Arthroscopy, AmericanJournalofSportsMedicine, and KneeSurgery, SportsTraumatology, Arthroscopy. The most published author was Musahl V (with 24 articles), and the most cited author was Xerogeanes JW (with 570 citations). CONCLUSIONS AND RELEVANCE Global trend analysis suggests that research on anterior cruciate ligament reconstruction with the quadriceps has significantly increased in the last 5 years and that the number of papers on this topic is increasing steadily. We found that the publications and citations are exhibiting a rising trend, Arthroscopy is the most impactful journal, and Musahl V is the most impactful author on the topic. Xerogeanes JW is the author with the most citations on the topic. The promising clinical results of anterior cruciate ligament reconstruction with the QT have attracted the most research interest. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, 20161, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, 20133, Italy.
| | - Srinivas Bs Kambhampati
- Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, 520008, India.
| | - Amit Meena
- Division of Orthopedics, Shalby Multi-Specialty Hospital, Jaipur, 302021, India; Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria.
| | - Danko Dan Milinkovic
- Department of Orthopedic and Trauma Surgery, Arcus Sportclinic, Pforzheim, 75179, Germany.
| | - Elisabeth Abermann
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria.
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, 6020, Austria; Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, 6060, Austria.
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219
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Evsyukov A, Kosimshoev M, Kubetskyi Y, Nikitenko E, Rzaev J. Surgical treatment of a patient with Gorham-Stout disease of craniovertebral junction: case report and literature review. Br J Neurosurg 2024; 38:972-977. [PMID: 34585642 DOI: 10.1080/02688697.2021.1981244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
The paper discusses a case of a 58-year-old male suffering from a destructive process affecting the cranial bone and craniovertebral junction. A pathological fracture of the axial vertebrae led to a progressing atlantoaxial dislocation combined with pain syndrome and orthopedic disturbances. After symptom assessment, he was diagnosed to have developed the Gorham-Stout disease (GSD), a rare syndrome accompanied by massive osteolysis. The paper considers GSD etiology and observes the main pathogenetic theories.
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Affiliation(s)
- Aleksey Evsyukov
- Federal State Budgetary Institution "National Ilizarov Medical Research Centre for Traumatology and Ortopaedics" Ministry Healthcare, Novosibirsk, Russian Federation
| | - Murodzhon Kosimshoev
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
| | - Yuliy Kubetskyi
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
| | - Evgeniy Nikitenko
- Autonomous Non-profit Organization Regional Center of High Medical Technologies, Novosibirsk, Russian Federation
| | - Jamil Rzaev
- "Federal Center of Neurosurgery", The Ministry of Health, Novosibirsk, Russian Federation
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220
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Cruz JP, Michaud JB, Van Rysselberghe NL, Walsh D, Svetgoff R, Bailey R, Pirkle SB, Megerian MF, Harbison GJ, Becerra JA, Sakka B, Vega A, Bohlen HL, Holloway A, Finlay A, Scolaro JA, Patterson JT, Campbell ST, Hebert-Davies J, Warner SJ, Goodnough LH, Bishop JA, Gardner MJ. Outcomes of isolated medial tibial plateau fractures by fracture morphology. Injury 2024; 55:111662. [PMID: 38897069 DOI: 10.1016/j.injury.2024.111662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/18/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To identify a cohort of isolated medial tibial plateau fractures treated with surgical fixation and to categorize them by Moore and Wahlquist classifications in order to determine the rate of complications with each fracture morphology and the predictive value of each classification system. We hypothesized there would be high rates of neurovascular injury, compartment syndrome, and complications overall with a higher incidence of neurovascular injury in Moore type III rim avulsion fractures and Wahlquist type C fractures that enter the plateau lateral to the tibial spines. METHODS Patients who presented to six Level I trauma centers between 2010 and 2021 who underwent surgical fixation for isolated medial tibial plateau fractures were retrospectively reviewed. Data including demographics, radiographs, complications, and functional outcomes were collected. RESULTS One hundred and fifty isolated medial tibial plateau fractures were included. All patients were classified by the Wahlquist classification of medial tibial plateau fractures, and 139 patients were classifiable by the Moore classification of tibial plateau fracture-dislocations. Nine percent of fractures presented with neurovascular injury: 5 % with isolated vascular injury and 6 % with isolated nerve injury. There were no significant differences in neurovascular injury by fracture type (Wahlquist p = 0.16, Moore p = 0.33). Compartment syndrome developed in two patients (1.3 %). The average final range of motion was 0.8-122° with no difference by Wahlquist or Moore classifications (p = 0.11, p = 0.52). The overall complication rate was 32 % without differences by fracture morphology. The overall rate of return to the operating room (OR) was 25 %. CONCLUSIONS Isolated medial tibial plateau fractures often represent fracture-dislocations of the knee and should receive a meticulous neurovascular exam on presentation with a high suspicion for neurovascular injury. No specific fracture pattern was found to be predictive of neurovascular injuries, complications, or final knee range of motion. Patients should be counseled pre-operatively regarding high rates of return to the OR after the index surgery.
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Affiliation(s)
| | - Jack B Michaud
- Stanford University (Primary/Coordinating Site), United States
| | | | - Daniel Walsh
- University of Texas Health Science Center at Houston, United States
| | - Reese Svetgoff
- University of Texas Health Science Center at Houston, United States
| | - Ryan Bailey
- University of Texas Health Science Center at Houston, United States
| | | | | | | | | | | | | | | | | | - Andrea Finlay
- Stanford University (Primary/Coordinating Site), United States
| | | | | | | | | | - Stephen J Warner
- University of Texas Health Science Center at Houston, United States
| | | | - Julius A Bishop
- Stanford University (Primary/Coordinating Site), United States
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221
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Radler C, Calder P, Eidelman M, Horn J, Kold S, Langendörfer M, Manner HM, Sedki I, Vogt B. What's new in pediatric lower limb reconstruction? J Child Orthop 2024; 18:349-359. [PMID: 39100980 PMCID: PMC11295377 DOI: 10.1177/18632521241258351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/15/2024] [Indexed: 08/06/2024] Open
Abstract
The last years brought many advances relevant to lower limb reconstruction. It feels like guided growth has been looked at from every angle, and still there are new emerging concepts like rotational guided growth waiting to be validated. New hexapod external devices are more accurate and easier to use, and new unilateral fixators allow for more versatile and stable fixation and lengthening. Intramedullary nail lengthening has found its place as a standard procedure for various diagnoses in children and young adults. First results of new and exciting approaches like extramedullary implantable nail lengthening and lengthening plates have been reported. Pharmaceutical treatment has changed the course of certain diseases and must be integrated and considered when making a reconstructive treatment plan. As reconstructive surgery is rapidly advancing so are the technical options for prosthetic fitting, which makes it difficult for caregivers as well as for parents to make the decision between reconstruction and amputation surgery for the most severe cases of congenital deficiencies. This review is highlighting new developments of lower limb reconstruction and is reviewing the current literature.
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Affiliation(s)
- Christof Radler
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
| | | | - Mark Eidelman
- Ruth Children’s Hospital, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Joachim Horn
- Section of Children’s Orthopaedics and Reconstructive Surgery, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Søren Kold
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Micha Langendörfer
- Department of Paediatric Orthopaedics, Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Hans Michael Manner
- Department of Paediatric Orthopaedics, Schulthess Clinic, Zurich, Switzerland
| | - Imad Sedki
- Royal National Orthopaedic Hospital, London, UK
| | - Bjoern Vogt
- Paediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany
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Rivera RJ, Karasavvidis T, Pagan C, Haffner R, Ast MP, Vigdorchik JM, Debbi EM. Functional assessment in patients undergoing total hip arthroplasty. Bone Joint J 2024; 106-B:764-774. [PMID: 39084648 DOI: 10.1302/0301-620x.106b8.bjj-2024-0142.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims Conventional patient-reported surveys, used for patients undergoing total hip arthroplasty (THA), are limited by subjectivity and recall bias. Objective functional evaluation, such as gait analysis, to delineate a patient's functional capacity and customize surgical interventions, may address these shortcomings. This systematic review endeavours to investigate the application of objective functional assessments in appraising individuals undergoing THA. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Eligible studies of THA patients that conducted at least one type of objective functional assessment both pre- and postoperatively were identified through Embase, Medline/PubMed, and Cochrane Central database-searching from inception to 15 September 2023. The assessments included were subgrouped for analysis: gait analysis, motion analysis, wearables, and strength tests. Results A total of 130 studies using 15 distinct objective functional assessment methods (FAMs) were identified. The most frequently used method was instrumented gait/motion analysis, followed by the Timed-Up-and-Go test (TUG), 6 minute walk test, timed stair climbing test, and various strength tests. These assessments were characterized by their diagnostic precision and applicability to daily activities. Wearables were frequently used, offering cost-effectiveness and remote monitoring benefits. However, their accuracy and potential discomfort for patients must be considered. Conclusion The integration of objective functional assessments in THA presents promise as a progress-tracking modality for improving patient outcomes. Gait analysis and the TUG, along with advancing wearable sensor technology, have the potential to enhance patient care, surgical planning, and rehabilitation.
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Affiliation(s)
- Richard J Rivera
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Cale Pagan
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Rowan Haffner
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Guo Y, Jiang S, Li H, Xie G, Pavel V, Zhang Q, Li Y, Huang C. Obesity induces osteoimmunology imbalance: Molecular mechanisms and clinical implications. Biomed Pharmacother 2024; 177:117139. [PMID: 39018871 DOI: 10.1016/j.biopha.2024.117139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
The notion that obesity can be a protective factor for bone health is a topic of ongoing debate. Increased body weight may have a positive impact on bone health due to its mechanical effects and the production of estrogen by adipose tissue. However, recent studies have found a higher risk of bone fracture and delayed bone healing in elderly obese patients, which may be attributed to the heightened risk of bone immune regulation disruption associated with obesity. The balanced functions of bone cells such as osteoclasts, osteoblasts, and osteocytes, would be subverted by aberrant and prolonged immune responses under obese conditions. This review aims to explore the intricate relationship between obesity and bone health from the perspective of osteoimmunology, elucidate the impact of disturbances in bone immune regulation on the functioning of bone cells, including osteoclasts, osteoblasts, and osteocytes, highlighting the deleterious effects of obesity on various diseases development such as rheumatoid arthritis (RA), osteoarthritis (AS), bone fracture, periodontitis. On the one hand, weight loss may achieve significant therapeutic effects on the aforementioned diseases. On the other hand, for patients who have difficulty in losing weight, the osteoimmunological therapies could potentially serve as a viable approach in halting the progression of these disease. Additional research in the field of osteoimmunology is necessary to ascertain the optimal equilibrium between body weight and bone health.
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Affiliation(s)
- Yating Guo
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
| | - Shide Jiang
- The Central Hospital of Yongzhou, Yongzhou 425000, China
| | - Hengzhen Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Guangyang Xie
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Xiangya School of Medicine, Central South University, Changsha, Hunan 410083, China
| | - Volotovski Pavel
- Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk 220024, Belarus
| | - Qidong Zhang
- Department of Orthopeadics, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Yusheng Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Cheng Huang
- Department of Orthopeadics, China-Japan Friendship Hospital, Beijing 100029, China.
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224
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Gahr P, Schleese L, Mittlmeier T. [Surgical treatment of forefoot and midfoot fractures : Minimally invasive fixation of metatarsal fractures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:211-222. [PMID: 39073454 DOI: 10.1007/s00064-024-00853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Minimally invasive stabilization of metatarsal fractures to enable adequate fracture healing in a correct position to restore anatomy and biomechanics of the foot. INDICATIONS A. Dislocated diaphyseal and subcapital fractures of the second to fifth metatarsal (> 3 mm, > 10° dislocation). B. Fifth metatarsal fracture at the metadiaphyseal junction (Lawrence and Botte type III). CONTRAINDICATIONS High grade soft tissue damage or infection at the implant insertion site. SURGICAL TECHNIQUE A. Fluoroscopically assisted closed reduction and antegrade intramedullary fixation of diaphyseal and subcapital fractures of the second to fifth metatarsal. B. Fluoroscopically assisted wire-guided intramedullary screw fixation of fifth metatarsal fractures at the metadiaphyseal junction. POSTOPERATIVE MANAGEMENT A. Mobilization with partial weight bearing (20 kg) for 6 weeks wearing a stiff sole; implant removal under local anesthesia after 6-8 weeks, followed by a free range of movement and weight-bearing as tolerated (WBAT). B. Early mobilization with weight-bearing as tolerated (WBAT); removal of the orthosis after 6 weeks, implant removal optional. RESULTS A. Antegrade nailing of subcapital and shaft fractures of metatarsals II-V achieves good clinical results with low complication rates both when using prepared Kirschner wires or elastically stable intramedullary nails (ESIN). B. According to current literature, intramedullary screw osteosynthesis of proximal metatarsal V fractures of zone II and III according to Lawrence and Botte leads to faster bony healing with a lower nonunion rate compared with conservative treatment. It is recommended especially, but not only, for active athletes.
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Affiliation(s)
- Patrick Gahr
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - Lennart Schleese
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - Thomas Mittlmeier
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
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225
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Kim JH, Weon YS, Kwon OY. Comparison of wrist range of motion and muscle strength in assembly workers with and without lateral epicondylitis. Work 2024:WOR230725. [PMID: 39093103 DOI: 10.3233/wor-230725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Lateral epicondylitis (LE), also called tennis elbow, is a common musculoskeletal disorder that causes pain in the elbow area and is highly prevalent in assembly workers who repeatedly move their wrists. OBJECTIVE The purpose of this study was to compare the wrist ROM and muscle strength of assembly workers with and without LE. METHODS Forty-five male assembly line workers (23 with LE) participated in the study. Participants had their wrist range of motion (flexion, extension, ulnar deviation, and radial deviation) and strength (wrist flexors, extensors, and hand grip) measured using Smart KEMA sensors. RESULTS Workers with LE showed significantly reduced wrist extension and radial deviation ROM compared to workers without LE, with no significant differences in wrist flexion and ulnar deviation ROM between groups. Workers with LE had significantly lower wrist extensor strength compared to workers without LE, and there was no significant difference in wrist flexor and grip strength between the two groups. CONCLUSIONS For workers with LE, the difference in wrist ROM and muscle strength will be useful for planning intervention and evaluating treatment outcomes for assembly workers with LE.
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Affiliation(s)
- Jun-Hee Kim
- Department of Physical Therapy, Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Young-Soo Weon
- Department of Physical Therapy, Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, Yeonsedae-gil, Maeji-ri, Heungeop-myeon, Wonju-si, Gangwon-do, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
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226
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DeBaun MR, Vanderkarr M, Holy CE, Ruppenkamp JW, Parikh A, Vanderkarr M, Coplan PM, Pean CA, McLaurin TM. Persistent racial disparities in postoperative management after tibia fracture fixation: A matched analysis of US medicaid beneficiaries. Injury 2024; 55:111696. [PMID: 38945078 DOI: 10.1016/j.injury.2024.111696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Racial and ethnic disparities in orthopaedic surgery are well documented. However, the extent to which these persist in fracture care is unknown. This study sought to assess racial disparities in the postoperative surgical and medical management of patients after diaphyseal tibia fracture fixation. METHODS Patients with surgically treated tibial shaft fractures from October 1, 2015, to December 31, 2020, were identified in the MarketScan® Medicaid Database. Exclusion criteria included concurrent fractures or amputation. Outcomes included 2-year postoperative complications, reoperation rates, and filled prescriptions. Surgically-treated Black and White cohorts were propensity-score matched using nearest-neighbor matching on patient demographics, comorbidities, fracture pattern and severity, and fixation type. Chi-square tests and survival analyses (Kaplan-Meier and Cox proportional hazard models) were conducted. RESULTS 5,472 patients were included, 2,209 Black and 3,263 White patients. After matching, 2,209 were retained in each cohort. No significant differences in complication rates were observed in the matched Black vs White cohorts. Rates of reoperation, however, were significantly lower in Black as compared to White patients (28.5 % vs. 35.5 % rate, risk difference = 7.0 % (95 % confidence interval (CI): 4.2 % to 9.7 %)). Implant removal was also significantly lower in Black (17.9 %) vs. White (25.1 %) patients (Risk difference = 7.2 %, (95 %CI: 4.8 % to 9.6 %)). The adjusted hazard ratio comparing the reoperation rate in Black versus White patients was 0.77 (95 %CI: 0.69-0.82, p < 0.0001). Significantly lower proportions of Black vs White patients filled at least one prescription for benzodiazepine, antidepressants, strong opiates, or antibiotics at every time point post-index. DISCUSSION Fewer resources were used in post-operative management after surgical treatment of tibial shaft fractures for Black versus White Medicaid-insured patients. These results may be reflective of the undertreatment of complications after tibia fracture surgery for Black patients and highlight the need for further interventions to address racial disparities in trauma care.
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Affiliation(s)
- Malcolm R DeBaun
- Duke University School of Medicine, Orthopedic Surgery, Durham, NC 27710, USA.
| | - Mari Vanderkarr
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Chantal E Holy
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Jill W Ruppenkamp
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | | | | | - Paul M Coplan
- Johnson & Johnson MedTech Epidemiology, New Brunswick, NJ 08901, USA
| | - Christian A Pean
- Duke University School of Medicine, Orthopedic Surgery, Durham, NC 27710, USA
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227
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Walter SG, Gaisendrees C, Kernich N, Weber M, Scheyerer MJ, Eysel P, Siewe J, Zarghooni K. Epidemiology of Surgically Treated Spinal Tumors: A Multicenter Surveillance Study of 9686 Patients from the German Spine Registry (DWG Register). ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:403-409. [PMID: 37308096 DOI: 10.1055/a-2077-7155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Tumors of the spine are challenging in terms of diagnoses and interdisciplinary treatment. This study was conducted to evaluate and characterize a large multicenter cohort of surgically treated spine tumor patients.Data of the German Spine Society (DWG) were used to characterize a cohort of all surgically treated spine tumor cases that were registered between 2017 and 2021. Subgroup analysis was performed for tumor entity, tumor localization, height of most severely affected segments, surgical treatment, and demographic parameters.In total, there were 9686 cases, of which 6747 were "malignant", 1942 were "primary benign", 180 were "tumor-like lesions", and 488 were "other" spinal tumors. Subgroups showed differences in number of affected segments as well as localization. There were further significant differences in surgical complication rates (p = 0.003), age (p < 0.001), morbidity (p < 0.001), and duration of surgery (p = 0.004).This is a representative study on spinal tumors from a large spine registry and allows for the epidemiological characterization of surgically treated tumor subgroups and quality control of registry data.
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Affiliation(s)
- Sebastian G Walter
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Germany
| | | | - Nikolaus Kernich
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Maximilian Weber
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Max J Scheyerer
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Germany
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peer Eysel
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Jan Siewe
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Germany
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Kourosh Zarghooni
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Germany
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228
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Giusto JD, Cohen D, Dadoo S, Grandberg C, Lott A, Hughes JD, Ayeni OR, Musahl V. Lateral extra-articular tenodesis may be more cost-effective than independent anterolateral ligament reconstruction: A systematic review and economic analysis. J ISAKOS 2024; 9:689-698. [PMID: 38604570 DOI: 10.1016/j.jisako.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
IMPORTANCE Anterolateral augmentation during primary anterior cruciate ligament (ACL) reconstruction (ACLR) may lower rates of ACL graft failure. However, differences in costs between two techniques, lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR), are unclear. OBJECTIVE To perform a systematic review and subsequent cost-effectiveness analysis comparing LET versus ALLR in the setting of primary ACLR. The hypothesis was that LET is more cost-effective than ALLR. EVIDENCE REVIEW A systematic review was conducted on studies in which patients underwent primary ACLR with a concomitant LET or ALLR with minimum 24 months follow-up published between January 2013 and July 2023. Primary outcomes included ACL graft failure rates and Knee Injury and Osteoarthritis Outcome Survey-Quality of Life (KOOS-QoL) subscale scores, which were used to determine health utilities measured by quality-adjusted life years (QALYs) gained. A decision tree model with one-way and two-way sensitivity analyses compared the cost of primary ACLR with a concomitant LET, independent autograft ALLR, or independent allograft ALLR. Costs were estimated using a combination of QALYs, institution prices, literature references, and a survey sent to 49 internationally recognized high-volume knee surgeons. FINDINGS A total of 2505 knees undergoing primary ACLR with concomitant LET (n=1162) or ALLR (n=1343) were identified from 22 studies. There were 77 total ACL graft failures with comparable failure rates between patients receiving LET versus ALLR (2.9% vs. 3.2%, P=0.690). The average QALYs gained was slightly higher for those who received LET (0.77) compared to ALLR (0.75). Survey results revealed a 5 minute longer median self-reported operative time for ALLR (20 min) than LET (15 min). The estimated costs for LET, autograft ALLR, and allograft ALLR were $1,015, $1,295, and $3,068, respectively. CONCLUSIONS AND RELEVANCE Anterolateral augmentation during primary ACLR with LET is more cost-effective than independent autograft and allograft ALLR given the lower costs and comparable clinical outcomes. Surgeons may utilize this information when determining the optimal approach to anterolateral augmentation during primary ACLR, although differences in preferred technique and health care systems may influence operative efficiency and material costs. LEVEL OF EVIDENCE Systematic review; Level of evidence, IV.
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Affiliation(s)
- Joseph D Giusto
- Department of Orthopaedic Surgery, Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Dan Cohen
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Camila Grandberg
- Department of Orthopaedic Surgery, Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ariana Lott
- Department of Orthopaedic Surgery, Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Volker Musahl
- Department of Orthopaedic Surgery, Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
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Qiu S, Wang Y, Xing G, Pu Q, Zhao Z, Zhao L. Precise and efficient measurement of tibial slope on magnetic resonance imaging (MRI): two novel autonomous pipelines by traditional and deep learning algorithms. Quant Imaging Med Surg 2024; 14:5304-5320. [PMID: 39144010 PMCID: PMC11320518 DOI: 10.21037/qims-23-1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 06/15/2024] [Indexed: 08/16/2024]
Abstract
Background The measurement of posterior tibial slopes (PTS) can aid in the screening and prevention of anterior cruciate ligament (ACL) injuries and improve the success rate of some other knee surgeries. However, the circle method for measuring PTS on magnetic resonance imaging (MRI) scans is challenging and time-consuming for most clinicians to implement in practice, despite being highly repeatable. Currently, there is no automated measurement scheme based on this method. To enhance measurement efficiency, consistency, and reduce errors resulting from manual measurements by physicians, this study proposes two novel, precise, and computationally efficient pipelines for autonomous measurement of PTS. Methods The first pipeline employs traditional algorithms with experimental parameters to extract the tibial contour, detect adhesions, and then remove these adhesions from the extracted contour. A cyclic process is employed to adjust the parameters adaptively and generate a better binary image for the following tibial contour extraction step. The second pipeline utilizes deep learning models for classifying MRI slice images and segmenting tibial contours. The incorporation of deep learning models greatly simplifies the corresponding steps in pipeline 1. Results To evaluate the practical performance of the proposed pipelines, doctors utilized MRI images from 20 patients. The success rates of pipeline 1 for central, medial, and lateral slices were 85%, 100%, and 90%, respectively, while pipeline 2 achieved success rates of 100%, 100%, and 95%. Compared to the 10 minutes required for manual measurement, our automated methods enable doctors to measure PTS within 10 seconds. Conclusions These evaluation results validate that the proposed pipelines are highly reliable and effective. Employing these tools can effectively prevent medical practitioners from being burdened by monotonous and repetitive manual measurement procedures, thereby enhancing both the precision and efficiency. Additionally, this tool holds the potential to contribute to the researches regarding the significance of PTS, particularly those demanding extensive and precise PTS measurement outcomes.
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Affiliation(s)
- Shi Qiu
- Multi-Disciplinary Research Division, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- Minzu University of China, Beijing, China
| | - Yaoting Wang
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Gengyan Xing
- Department of Orthopedic, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qiumei Pu
- Minzu University of China, Beijing, China
| | - Zhe Zhao
- Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lina Zhao
- Multi-Disciplinary Research Division, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
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Arnold SC, Lagazzi E, Wagner RK, Rafaqat W, Abiad M, Argandykov D, Hoekman AH, Panossian V, Nzenwa IC, Cote M, Hwabejire JO, Schipper IB, Ly TV, Velmahos GC. Two big bones, one big decision: When to fix bilateral femur fractures. Injury 2024; 55:111610. [PMID: 38861829 DOI: 10.1016/j.injury.2024.111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE For polytrauma patients with bilateral femoral shaft fractures (BFSF), there is currently no consensus on the optimal timing of surgery. This study assesses the impact of early (≤ 24 h) versus delayed (>24 h) definitive fixation on clinical outcomes, especially focusing on concomitant versus staged repair. We hypothesized that early definitive fixation leads to lower mortality and morbidity rates. METHODS The 2017-2020 Trauma Quality Improvement Program was used to identify patients aged ≥16 years with BFSF who underwent definitive fixation. Early definitive fixation (EDF) was defined as fixation of both femoral shaft fractures within 24 h, delayed definitive fixation (DDF) as fixation of both fractures after 24 h, and early staged fixation (ESF) as fixation of one femur within 24 h and the other femur after 24 h. Propensity score matching and multilevel mixed effects regression models were used to compare groups. RESULTS 1,118 patients were included, of which 62.8% underwent EDF. Following propensity score matching, 279 balanced pairs were formed. EDF was associated with decreased overall morbidity (12.9% vs 22.6%, p = 0.003), lower rate of deep venous thrombosis (2.2% vs 6.5%, p = 0.012), a shorter ICU LOS (5 vs 7 days, p < 0.001) and a shorter hospital LOS (10 vs 15 days, p < 0.001). When compared to DDF, early staged fixation (ESF) was associated with lower rates of ventilator acquired pneumonia (0.0% vs 4.9%, p = 0.007), but a longer ICU LOS (8 vs 6 days, p = 0.004). Using regression analysis, every 24-hour delay to definitive fixation increased the odds of developing complications by 1.05, postoperative LOS by 10 h and total hospital LOS by 27 h. CONCLUSION Early definitive fixation (≤ 24 h) is preferred over delayed definitive fixation (>24 h) for patients with bilateral femur shaft fractures when accounting for age, sex, injury characteristics, additional fractures and interventions, and hospital level. Although mortality does not differ, overall morbidity and deep venous thrombosis rates, and length of hospital and intensive care unit stay are significantly lower. When early definitive fixation is not possible, early staged repair seems preferable over delayed definitive fixation.
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Affiliation(s)
- Suzanne C Arnold
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA; Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Emanuele Lagazzi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA; Department of Surgery, Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, Italy
| | - Robert K Wagner
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Wardah Rafaqat
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - May Abiad
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Dias Argandykov
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Anne H Hoekman
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA; Department of Surgery, Division of Trauma & Emergency Surgery, Amsterdam University Medical Center Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Vahe Panossian
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Ikemsinachi C Nzenwa
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Mark Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Thuan V Ly
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114, USA.
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Wang F, Zhang G, Wei X. Effect of patellofemoral joint overstuffing following total knee arthroplasty without patella resurfacing on clinical efficacy and related factors analysis. J Orthop Surg Res 2024; 19:451. [PMID: 39085885 PMCID: PMC11289916 DOI: 10.1186/s13018-024-04899-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVE To analyze the influencing factors for patellofemoral joint (PFJ) overstuffing following total knee arthroplasty (TKA) without patella resurfacing, and explore the effect of PFJ overstuffing on clinical efficacy. METHODS A retrospective analysis was conducted on 168 patients with end-stage knee osteoarthritis who underwent TKA without patella resurfacing at our hospital between Match 2019 and September 2021. The clinical data of these patients were retrospectively analyzed. In this study, PFJ overstuffing was defined as a postoperative PFJ distance greater than 1 mm compared to the preoperative measurement. The occurrence of postoperative PFJ overstuffing was counted. The patients were divided into the overstuffing group (n = 109) and the non-overstuffing group (n = 59) to count the patellar thickness and thickness of femoral anterior condyle in all patients before and after surgery, and analyze the influencing factors for postoperative PFJ overstuffing in such patients. Patients were followed up for 2 years to compare the recovery time of postoperative pain, score of visual analogue scale (VAS) and flexion activity between the two groups. RESULTS There was no significant difference in patellar thickness between preoperative and postoperative measurements of the patients (P > 0.05). However, the thickness of the femoral anterior condyle and the PFJ distance after surgery increased significantly compared with those before surgery (P < 0.05). Among the 168 patients, 109 cases (64.88%) experienced PFJ overstuffing. The risk of PFJ overstuffing was higher in female patients than in male (P < 0.05). The preoperative thickness of the femoral anterior condyle in the overstuffing group was significantly smaller compared to the non-overstuffing group (P < 0.001). Compared with the non-overstuffing group, the overstuffing group had longer recovery time of postoperative pain (P < 0.05), and had lower flexion activity at 2 years after surgery (P < 0.001). However, no significant difference was found in VAS score between the overstuffing group and the non-overstuffing group at 2 years after surgery (P > 0.05). Spearman rank correlation analysis indicated females tend to have a lower preoperative thickness of the femoral anterior condyle (r=-0.424, P < 0.001), as well as a positive postoperative PFJ overstuffing (r = 0.237, P < 0.05). Furthermore, there was a negative correlation between preoperative thickness of the femoral anterior condyle and postoperative PFJ overstuffing (r=-0.540, P < 0.001). CONCLUSION Following TKA without patella resurfacing, there is a high risk of PFJ overstuffing, particularly among female patients and those with a small thickness of the femoral anterior condyle. Therefore, special attention should be given to these high-risk groups during clinical treatment.
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Affiliation(s)
- Feida Wang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan City, 030001, Shanxi Province, China
| | - Guohao Zhang
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan City, 030001, Shanxi Province, China
| | - Xiaochun Wei
- Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan City, 030001, Shanxi Province, China.
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Lesar U, Janse van Rensburg L, Oelofsen S, McCree K, Ackerman C, Davis R. Multiple myeloma in a young female presenting as an aggressive skull-base tumour. SA J Radiol 2024; 28:2883. [PMID: 39114744 PMCID: PMC11304403 DOI: 10.4102/sajr.v28i1.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/21/2024] [Indexed: 08/10/2024] Open
Abstract
Plasma cell neoplasia has a wide presentation of disease (localised or systemic) according to the International Myeloma Working Group. Radiological imaging identifies plasmacytomas as solitary lesions or part of multiple myeloma. We present a rare case of a 21-year-old female who presented with a skull-base tumour. Contribution A head and neck plasmacytoma with further lytic bone lesions was confirmed on imaging. This article presents and discusses the clinical, CT, MRI, positron emission tomography (PET)-CT, histology and laboratory findings.
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Affiliation(s)
- Ursula Lesar
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Leon Janse van Rensburg
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
- Department of Radiology and Diagnostics, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - Siobhan Oelofsen
- Division of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Cape Town, South Africa
| | - Kevin McCree
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Christelle Ackerman
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Razaan Davis
- Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
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Roukis TS, Piraino JA, Hollawell S, Kuruvilla B, Kuruvilla B, McMillen R, Zimmerman M, Hentges MJ, West T. ACFAS Clinical Consensus Statements: Hallux Rigidus. J Foot Ankle Surg 2024:S1067-2516(24)00155-8. [PMID: 39094959 DOI: 10.1053/j.jfas.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024]
Abstract
The following are clinical consensus statements (CCS) on the topic of Hallux Rigidus sponsored by the American College of Foot and Ankle Surgeons. A core panel synthesized the data and divided the topic in to twelve sections, each section contained a variable number of consensus statements, based upon complexity. Overall there were 24 consensus statements synthesized for this subject matter. The 24 statements were provided to the expert panel with all available evidence to come to a consensus utilizing all available evidence.
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Affiliation(s)
- Thomas S Roukis
- Clinical Professor, University of Florida College of Medicine-Jacksonville, Department of Orthopaedic Surgery & Rehabilitation, Division of Foot & Ankle Surgery, Jacksonville, FL, United States
| | - Jason A Piraino
- Associate Professor Chief of Foot and Ankle Surgery, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, United States.
| | - Shane Hollawell
- Orthopaedic Institute of Central Jersey, Wall Township, NJ, United States
| | | | | | - Ryan McMillen
- Faculty, Division of Foot and Ankle Surgery, Jefferson Hospital, Allegheny Health Network, Pittsburgh, PA, United States
| | - Michael Zimmerman
- CHI Health, Creighton University School of Medicine, Omaha, Nebraska, United States of America
| | - Matthew J Hentges
- Attending Faculty of Residency Training Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburg, PA, United States
| | - Tenaya West
- Palo Alto Medical Foundation Mountain View, Department of Podiatry and Orthopedics, Fremont, California, United States of America
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Feng LL, Lu K, Li C, Xu MZ, Ye YW, Yin Y, Shan HQ. Association of apolipoprotein A1 levels with lumbar bone mineral density and β-CTX in osteoporotic fracture individuals: a cross-sectional investigation. Front Med (Lausanne) 2024; 11:1415739. [PMID: 39144661 PMCID: PMC11322117 DOI: 10.3389/fmed.2024.1415739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024] Open
Abstract
Background The relationship between the levels of high-density lipoprotein (HDL) and bone mineral density (BMD) is controversial. Furthermore, the specific role of apolipoprotein A1 (APOA1), a primary HDL component, in regulating BMD remains unclear. This study aimed to elucidate the correlation between APOA1 levels and lumbar BMD in patients with osteoporotic fracture (OPF) for novel insights into potential therapeutic strategies against osteoporosis. Methods This study included 587 OPF patients enrolled at the Kunshan Hospital, Affiliated with Jiangsu University between January 2017 and July 2022. The patient's serum APOA1 levels were determined, followed by the assessment of lumbar BMD and C-terminal telopeptide of type I collagen (β-CTX) as outcome variables. The association of APOA1 levels with lumbar BMD and β-CTX was assessed via Generalized Estimating Equations (GEE) and spline smoothing plot analyses. A generalized additive model (GAM) helped ascertain non-linear correlations. Moreover, a subgroup analysis was also conducted to validate the result's stability. Results It was observed that APOA1 levels were positively correlated with lumbar BMD (β = 0.07, 95% CI: 0.02 to 0.11, p = 0.0045), indicating that increased APOA1 levels were linked with enhanced lumbar BMD. Furthermore, APOA1 levels were negatively related to β-CTX (β = -0.19, 95% CI: -0.29 to -0.09, p = 0.0003), suggesting APOA1 might reduce osteolysis. In addition, these findings were robustly supported by subgroup and threshold effect analyses. Conclusion This study indicated that increased APOA1 levels were correlated with enhanced lumbar BMD and decreased osteolysis in OPF patients. Therefore, APOA1 may inhibit osteoclast activity to prevent further deterioration in osteoporotic patients. However, further research I warranted to validate these conclusions and elucidate the underlying physiologies.
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Blackburn AZ, Katakam A, Amakiri I, Mittal A, Bedair HS, Melnic CM. MCID achievement in staged bilateral total knee arthroplasty: Are both joints created equal? Knee 2024; 50:1-8. [PMID: 39089103 DOI: 10.1016/j.knee.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 06/10/2024] [Accepted: 07/11/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND A notable portion of unilateral total knee arthroplasty (TKA) patients undergo arthroplasty of the contralateral knee. The aims of this study were to describe the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W) in staged bilateral TKAs (BTKAs) and identify factors associated with these outcomes. METHODS Patients with staged BTKA were retrospectively reviewed. Demographics, surgery details, and Patient-Reported Outcome Measurement Information System Physical Function Short Form 10a (PROMIS PF10a) were collected. MCID-I and MCID-W were defined for PROMIS PF10a. Patients were stratified into nine groups based on the MCID achievement of the first and second TKA: (A) MCID-I, MCID- I, (B) MCID-I, Neutral, (C) MCID-I, MCID-W, (D) Neutral, MCID-I, (E) Neutral, Neutral, (F) Neutral, MCID-W, (G) MCID- W, MCID-I, (H) MCID-W, Neutral, (I) MCID-W, MCID-W. Neutral patients did not achieve either MCID-I or MCID-W. RESULTS The final cohort consisted of 59 staged BTKA patients. In patients who achieved MCID-I in the first TKA, 39.1% achieved MCID-I again in the second TKA (A), 39.1% were neutral (B), and 21.7% achieved MCID-W (C) in the second TKA. However, 77.8% of those who achieved MCID-W in the first joint (n = 9) went on to achieve MCID-I (G) in the second TKA. Those who achieved MCID-I after both TKAs (A) had a longer staged interval than those who achieved first MCID-I, then MCID-W (C) (15 months vs 8 months, P = 0.0113). CONCLUSION In staged BTKA, MCID achievement of the first TKA may not be associated with the outcome of the second TKA.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
| | - Ikechukwu Amakiri
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ashish Mittal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
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Davulcu CD, Saruhan S, Bilgin E, Zengin EC. Effect of bone grafting on bone union in exchange nailing for the treatment of femoral shaft nonunions. North Clin Istanb 2024; 11:322-327. [PMID: 39165704 PMCID: PMC11331199 DOI: 10.14744/nci.2023.43410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVE This study aims to investigate the effect of bone grafting on the bone union in exchange nailing (EN) for the treatment of femoral shaft nonunions. METHODS A total of 26 patients (16 male) were included in this study. The mean age of the patients was 36.1±9.3. Bone grafts were used in 8 patients (bone graft group), and EN was performed without bone grafting (no bone graft group) in 18 patients. Etiology, fracture type, location, and classification of the fractures at the time of initial injury were evaluated. The reduction type (open or closed) and locking status of the nails were also noted. Nonunion types were recorded. In the bone grafting group, iliac bone autografts were used in seven patients and a synthetic bone graft was used in one patient. Following EN, the presence and duration of bone union, and the increase in the nails' diameter were analyzed for each group and compared. RESULTS Union rates were 100% and 94.4% in bone grafting and no bone grafting groups, respectively. The mean union period was not significant between the groups (22.5 and 16.5 months, respectively). The mean increase in the nail diameter was 1.88 mm in the bone graft group and 2.00 mm in the no bone graft group (p>0.05). CONCLUSION This study demonstrated that high union rates can be achieved with EN by means of using larger diameter nails with or without bone grafting in the management of femoral shaft nonunions, and bone grafting had no significant effect on union rates and periods.
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Affiliation(s)
- Cumhur Deniz Davulcu
- Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
| | - Sertac Saruhan
- Department of Orthopaedics and Traumatology, Bozyaka Training and Research Hospital, Izmir, Turkiye
| | - Emre Bilgin
- Department of Orthopaedics and Traumatology, Bozyaka Training and Research Hospital, Izmir, Turkiye
| | - Eyup Cagatay Zengin
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkiye
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Gong X, Su L, Huang J, Liu J, Wang Q, Luo X, Yang G, Chi H. An overview of multi-omics technologies in rheumatoid arthritis: applications in biomarker and pathway discovery. Front Immunol 2024; 15:1381272. [PMID: 39139555 PMCID: PMC11319186 DOI: 10.3389/fimmu.2024.1381272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease with a complex pathological mechanism involving autoimmune response, local inflammation and bone destruction. Metabolic pathways play an important role in immune-related diseases and their immune responses. The pathogenesis of rheumatoid arthritis may be related to its metabolic dysregulation. Moreover, histological techniques, including genomics, transcriptomics, proteomics and metabolomics, provide powerful tools for comprehensive analysis of molecular changes in biological systems. The present study explores the molecular and metabolic mechanisms of RA, emphasizing the central role of metabolic dysregulation in the RA disease process and highlighting the complexity of metabolic pathways, particularly metabolic remodeling in synovial tissues and its association with cytokine-mediated inflammation. This paper reveals the potential of histological techniques in identifying metabolically relevant therapeutic targets in RA; specifically, we summarize the genetic basis of RA and the dysregulated metabolic pathways, and explore their functional significance in the context of immune cell activation and differentiation. This study demonstrates the critical role of histological techniques in decoding the complex metabolic network of RA and discusses the integration of histological data with other types of biological data.
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Affiliation(s)
- Xiangjin Gong
- Department of Sports Rehabilitation, Southwest Medical University, Luzhou, China
| | - Lanqian Su
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Jinbang Huang
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Jie Liu
- Department of Geriatric, Dazhou Central Hospital, Dazhou, China
| | - Qinglai Wang
- Orthopedics and Traumatology Department of TCM, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Xiufang Luo
- Department of Geriatric, Dazhou Central Hospital, Dazhou, China
| | - Guanhu Yang
- Department of Specialty Medicine, Ohio University, Athens, OH, United States
| | - Hao Chi
- Clinical Medical College, Southwest Medical University, Luzhou, China
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Zhang X, Zheng C, Huang J, Chen H, Lei J, Huang C. Comparison of three different internal fixation methods in the treatment of femoral neck fracture. Heliyon 2024; 10:e34582. [PMID: 39149078 PMCID: PMC11325052 DOI: 10.1016/j.heliyon.2024.e34582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/26/2024] [Accepted: 07/11/2024] [Indexed: 08/17/2024] Open
Abstract
Objective This study aimed to assess the efficacy of three different fixation methods in treating femoral neck fractures in young patients. Methods A retrospective analysis was conducted on 35 young patients with femoral neck fractures who underwent surgical treatment. Among them, 16, 12, and 7 patients underwent fixation with three cannulated compression screws (3CS), the femoral neck system (FNS), and the compound compression system (CCS), respectively. Data, including fracture classification, injury-to-surgery time, surgery duration, intraoperative blood loss, fluoroscopy instances, fracture healing time, complications, and Harris score at the final follow-up, were collected and analyzed to compare clinical outcomes among the three fixation methods. Results All patients were followed for at least 6 months, exhibiting no significant differences in age, gender, injury side, fracture type, or injury-to-operation time among the three groups (P > 0.05). The FNS and CCS groups exhibited shorter operation durations and fewer intraoperative fluoroscopy instances compared to the 3CS group (P < 0.01). Despite the minimally invasive nature of 3CS, the FNS and CCS groups experienced higher intraoperative blood loss (P < 0.01). During follow-up, only one patient with 3CS fixation developed nonunion. Additionally, patients treated with 3CS demonstrated a higher incidence of femoral head necrosis and severe femoral neck shortening than the FNS and CCS groups. Excluding patients with combined nonunion, no significant difference in mean fracture healing time was observed among the three groups (P > 0.05). At the last follow-up, the FNS and CCS groups showed higher Harris scores (P < 0.05). Conclusions Both FNS and CCS are effective internal fixation systems for the treatment of femoral neck fractures in young patients, yielding more satisfactory clinical functional outcomes than 3CS. Comparatively, the CCS system presents a higher risk of iatrogenic rotation of the proximal fracture segment. Therefore, we advocate the insertion of two to three 2.5 mm Kirschner wires from the upper edge of the femoral neck along the axial direction before CCS lag screw insertion to resist iatrogenic rotational stress.
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Affiliation(s)
- Xinzhao Zhang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Changling Zheng
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Jin Huang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Hui Chen
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Jie Lei
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
| | - Cong Huang
- Department of Orthopedics, Ningde Traditional Chinese Medicine Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fujian, Ningde, 352100, China
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Pan H, Li H, Liu T, Xiao C, Li S. Finite element analysis of precise puncture vertebral augmentation in the treatment of different types of osteoporotic vertebral compression fractures. BMC Musculoskelet Disord 2024; 25:599. [PMID: 39080550 PMCID: PMC11287837 DOI: 10.1186/s12891-024-07735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/25/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Osteoporosis vertebral compression fracture (OVCF) secondary to osteoporosis is a common health problem in the elderly population. Vertebral augmentation (VA) has been widely used as a minimally invasive surgical method. The transpedicle approach is commonly used for VA puncture, but sometimes, it is limited by the anatomy of the vertebral body and can not achieve good surgical results. Therefore, we propose the treatment of OVCF with precise puncture vertebral augmentation (PPVA). This study used finite element analysis to explore the biomechanical properties of PPVA in the treatment of osteoporotic vertebral compression fractures (OVCFs) with wedge, biconcave, and collapse deformities. METHOD Three-dimensional finite element models of the fractured vertebral body and adjacent superior and inferior vertebral bodies were established using Computed Tomography (CT) data from patients with OVCF, both before and after surgery. Evaluate the stress changes of the wedged deformed vertebral body, biconcave deformed vertebral body, collapsed deformed vertebral body, and adjacent vertebral bodies before and after PPVA. RESULT In vertebral bodies with wedge deformity and collapsed deformity, PPVA can effectively reduce the stress on the vertebral body but increases the stress on the vertebral body with biconcave deformity. PPVA significantly decreases the stress on the adjacent vertebral bodies of the wedge deformed vertebral body, and decreases the stress on the adjacent superior vertebral body of biconcave deformity and collapsed deformed vertebral bodies, but increases the stress on the adjacent inferior vertebral bodies. PPVA improves the stress distribution of the vertebral body and prevents high-stress areas from being concentrated on one side of the vertebral body. CONCLUSION PPVA has shown positive surgical outcomes in treating wedge deformed and collapsed deformed vertebral bodies. However, its effectiveness in treating biconcave vertebral body is limited. Furthermore, PPVA has demonstrated favorable results in addressing adjacent superior vertebral body in three types of fractures.
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Affiliation(s)
- Hongyu Pan
- Department of Spinal Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Hongtao Li
- Department of Spinal Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Tianzhu Liu
- Neurological Disease Center, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Changming Xiao
- Department of Spinal Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Sen Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
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Liu M, Liang C, Ying M, Ortolani F, Wu B, Liu J, Yang Z, Xiong W, Ding M. Effect of preoperative autologous platelet-rich plasmapheresis on postoperative bleeding in patients undergoing heart valve surgery. J Thorac Dis 2024; 16:4584-4596. [PMID: 39144329 PMCID: PMC11320239 DOI: 10.21037/jtd-24-794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/04/2024] [Indexed: 08/16/2024]
Abstract
Background Cardiovascular surgeries often require deep hypothermic circulatory arrest and cardiopulmonary bypass (CPB), which can disrupt blood clotting and lead to excessive bleeding. Traditional treatments involve transfusing blood and blood products, which can have adverse effects and place significant strain on the global blood supply. Research suggests that autologous platelet-rich plasmapheresis (aPRP) may reduce the need for transfusions by preserving blood components. However, the impact of aPRP on postoperative blood loss and clinical outcomes in cardiovascular surgery remains controversial. This study aimed to examine the effects of aPRP on postoperative blood loss and recovery in patients undergoing heart valve surgery. Methods A total of 183 patients were divided into either aPRP or control groups. The aPRP group received aPRP before CPB, whereas the control group did not. The primary endpoint was postoperative bleeding between the groups. The secondary endpoints were postoperative bleeding risk factors and clinical outcome assessment. Logistic regression analysis with covariate adjustment was used to calculate these risk factors. Results A total of 76 patients (41.5%) in the aPRP group and 107 patients (58.5%) in the control group were included in the analysis. No significant difference was found in the occurrence of postoperative bleeding [odds ratio (OR) =0.53, 95% confidence interval (CI): 0.28-1.00, P=0.05], and the aPRP group had fewer complications than the controls (OR =0.28, 95% CI: 0.10-0.68, P=0.009). However, after adjusting for the New York Heart Association (NYHA) classification, diabetes, arrhythmology, mean activated clotting time (ACTmean), CPB, bleeding, thoracotomy, and body mass index (BMI), there was a significant difference in postoperative bleeding (adjusted OR =0.47, 95% CI: 0.22-0.98, P=0.04) and complications (adjusted OR =0.23, 95% CI: 0.07-0.64, P=0.008) between the two groups. Conclusions Preoperative aPRP can improve postoperative outcomes and reduce complications in patients undergoing heart valve surgery.
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Affiliation(s)
- Manman Liu
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Chao Liang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Meijing Ying
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | | | - Biling Wu
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Jie Liu
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Zhen Yang
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Wanxia Xiong
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Ding
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Christogiannis IF, Mastrokalos DS, Papagelopoulos PJ, Lakiotaki E, Karatrasoglou E, Bami M, Milonaki M, Koulalis D. The addition of mesenchymal stem cells in a bioabsorbable scaffold does not enhance tendon healing after a repair of rotator cuff tear. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39077836 DOI: 10.1002/ksa.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE The purpose of the study is to evaluate the healing potential of a full-thickness tendon defect in the rotator cuff of rabbits using a bioabsorbable scaffold impregnated with bone marrow-mesenchymal stem cells (BM-MSCs) or rotator cuff-derived mesenchymal stem cells (RC-MSCs). METHODS Sixteen adult rabbits were subjected to a full-thickness rotator cuff deficit. Rabbits were randomly assigned to four groups of four animals. In Group 0 (control), the deficit was left untreated. In Group 1, the deficit was treated with a single synthetic scaffold alone. In Group 2, the deficit was treated with the previous scaffold loaded with allogeneic BM-MSCs. In Group 3, the deficit was treated with the previous scaffold loaded with allogenic RC-MSCs. After animal sacrifice, tissue samples were subjected to histological and immunohistochemical analysis. RESULTS Group 1 showed the highest mean tendon maturing score (15.3 ± 0.9) postoperatively, being significantly higher, in comparison to groups 0, 2 and 3 (p = 0.01, 0.02 and 0.01, respectively). Group 1 showed the highest mean collagen I/collagen III ratio (1.4 ± 0.8) postoperatively but without any statistical significance. CONCLUSIONS The utilization of MSCs in rotator cuff repair in a rabbit model has not been associated with an enhancement in tendon healing in 16 weeks postoperatively, in comparison to controls and bioabsorbable scaffolds. The addition of MSCs does not result in better rotator cuff healing. LEVEL OF EVIDENCE Not applicable. This is an animal study.
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Affiliation(s)
- Ioannis F Christogiannis
- 1st Department of Orthopaedic Surgery, School of Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios S Mastrokalos
- 1st Department of Orthopaedic Surgery, School of Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis J Papagelopoulos
- 1st Department of Orthopaedic Surgery, School of Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Lakiotaki
- 1st Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Karatrasoglou
- 1st Department of Oncology, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Myrto Bami
- 'Panayotis N. Soucacos' Orthopaedic Research and Education Center (OREC), Attikon University General Hospital, Athens, Greece
| | - Mandy Milonaki
- 'Panayotis N. Soucacos' Orthopaedic Research and Education Center (OREC), Attikon University General Hospital, Athens, Greece
| | - Dimitrios Koulalis
- 1st Department of Orthopaedic Surgery, School of Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Meng C, Qi B, Luo H, Tang Z, Ren J, Shi H, Li C, Xu Y. Exploring the genetic association between immune cells and susceptibility to osteonecrosis using large-scale population data. Heliyon 2024; 10:e34547. [PMID: 39130408 PMCID: PMC11315082 DOI: 10.1016/j.heliyon.2024.e34547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Objectives Research shows a close association between aberrant immune reactions in osteonecrotic tissues and immune cell infiltration. However, due to limitations in sample size and dataset comprehensiveness, the causal relationship between them is not fully established. This study aims to determine whether there is a causal relationship using a larger and more diverse dataset. Methods We conducted a comprehensive Mendelian Randomization (MR) analysis to investigate the causal relationship between immune cell characteristics and osteonecrosis. Utilizing publicly available genetic data, we explored the causal relationships between 731 immune cell features and 604 cases from the FinnGen Finnish database, as well as 257 cases from the UK Biobank database with osteonecrosis data. The inverse-variance weighted (IVW) method was used for the primary analysis, and we employed sensitivity analyses to assess the robustness of the main results. In addition, considering data from the two databases used in this study, a meta-analysis was conducted on the significant immune cells associated with osteonecrosis (FDR <0.05). Results our findings suggested that specific immune cell signatures, such as CD20- % lymphocytes, CD62L-monocytes, and CD33br HLA DR+ CD14-cells were associated with increased odds of osteonecrosis. In contrast, EM CD4+ activated cells and DP (CD4+ CD8+) T cells were associated with decreased odds. Notably, osteonecrosis was associated with a potential decrease in CD45 on immature MDSC cell content. Conclusion From a genetic perspective, we demonstrated a close association between immune cells and osteonecrosis. These findings significantly enhance our understanding of the interplay between immune cell infiltration and the risk of osteonecrosis, contributing to the potential design of therapeutic strategies from an immunological standpoint.
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Affiliation(s)
- Chen Meng
- Graduate School of Kunming Medical University, Kunming, Yunnan, China
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, Yunnan, China
| | - Baochuang Qi
- Graduate School of Kunming Medical University, Kunming, Yunnan, China
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, Yunnan, China
| | - Huan Luo
- Graduate School of Kunming Medical University, Kunming, Yunnan, China
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, Yunnan, China
| | - Zhifang Tang
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, Yunnan, China
| | - Junxiao Ren
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, Yunnan, China
| | - Hongxin Shi
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, Yunnan, China
| | - Chuan Li
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, Yunnan, China
- Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Yongqing Xu
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Kunming, Yunnan, China
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Luo D, Gao X, Zhu X, Wu J, Yang Q, Xu Y, Huang Y, He X, Li Y, Gao P. Identification of steroid-induced osteonecrosis of the femoral head biomarkers based on immunization and animal experiments. BMC Musculoskelet Disord 2024; 25:596. [PMID: 39069636 DOI: 10.1186/s12891-024-07707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Steroid-induced osteonecrosis of femoral head (SONFH) is a severe health risk, and this study aims to identify immune-related biomarkers and pathways associated with the disease through bioinformatics analysis and animal experiments. METHOD Using SONFH-related datasets obtained from the GEO database, we performed differential expression analysis and weighted gene co-expression network analysis (WGCNA) to extract SONFH-related genes. A protein-protein interaction (PPI) network was then constructed, and core sub-network genes were identified. Immune cell infiltration and clustering analysis of SONFH samples were performed to assess differences in immune cell populations. WGCNA analysis was used to identify module genes associated with immune cells, and hub genes were identified using machine learning. Internal and external validation along with animal experiments were conducted to confirm the differential expression of hub genes and infiltration of immune cells in SONFH. RESULTS Differential expression analysis revealed 502 DEGs. WGCNA analysis identified a blue module closely related to SONFH, containing 1928 module genes. Intersection analysis between DEGs and blue module genes resulted in 453 intersecting genes. The PPI network and MCODE module identified 15 key targets enriched in various signaling pathways. Analysis of immune cell infiltration showed statistically significant differences in CD8 + t cells, monocytes, macrophages M2 and neutrophils between SONFH and control samples. Unsupervised clustering classified SONFH samples into two clusters (C1 and C2), which also exhibited significant differences in immune cell infiltration. The hub genes (ICAM1, NR3C1, and IKBKB) were further identified using WGCNA and machine learning analysis. Based on these hub genes, a clinical prediction model was constructed and validated internally and externally. Animal experiments confirmed the upregulation of hub genes in SONFH, with an associated increase in immune cell infiltration. CONCLUSION This study identified ICAM1, NR3C1, and IKBKB as potential immune-related biomarkers involved in immune cell infiltration of CD8 + t cells, monocytes, macrophages M2, neutrophils and other immune cells in the pathogenesis of SONFH. These biomarkers act through modulation of the chemokine signaling pathway, Toll-like receptor signaling pathway, and other pathways. These findings provide valuable insights into the disease mechanism of SONFH and may aid in future drug development efforts.
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Affiliation(s)
- Dongqiang Luo
- Nanfang College Guangzhou, Guangzhou, 510970, China
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xiaolu Gao
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xianqiong Zhu
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Jiayu Wu
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Qingyi Yang
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Ying Xu
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Yuxuan Huang
- Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Xiaolin He
- Clifford Hospital, Guangzhou, 511496, China
| | - Yan Li
- Clifford Hospital, Guangzhou, 511496, China
| | - Pengfei Gao
- Nanfang College Guangzhou, Guangzhou, 510970, China.
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Zielli SO, Mazzotti A, Artioli E, Arceri A, Sgubbi F, Langone L, Abdi P, Faldini C. Radiological Landmarks for Joint Line Level in Challenging Total Ankle Arthroplasty. J Clin Med 2024; 13:4451. [PMID: 39124717 PMCID: PMC11312902 DOI: 10.3390/jcm13154451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Although Total Ankle Arthroplasty (TAA) is primarily performed for post-traumatic ankle arthritis with joint disruption, anatomical landmarks for Joint Line (JL) level are typically preserved. However, severe Post-Traumatic Bone Loss (PTBL) or TAA revision may render some landmarks unidentifiable, challenging JL restoration. Methods: Patients undergoing customized TAA for severe PTBL or revision were enrolled. Custom-made implants, based on 3D CT scans, were designed to address bone defects and provide adequate bone support. Evaluated parameters, measured on bilateral ankle weight-bearing radiographs taken preoperatively and 6-8 months postoperatively, included JL Height Ratio (JLHR) and the distances from JL to the Lateral Malleolus apex (LM-JL), the posterior colliculus of the Medial Malleolus (MM-JL), and the Gissane Calcaneal Sulcus (CS-JL). Reproducibility and variability were assessed, and comparisons were made between radiological parameters measured at TAA and those at the contralateral ankle. Results: Thirteen patients were included. Intra- and interobserver reliability demonstrated excellent values. The least variability was observed in the LM-JL distance. Statistically significant correlations were found between CS-JL and MM-JL distances in the operated limb and between the CS-JL of the operated limb and the contralateral ankle. While TAA parameters did not show statistically significant differences compared with the contralateral ankle, a trend toward proximalization of the JL was noted. Conclusions: This study demonstrated good reproducibility of the analyzed parameters for evaluating JL in TAA among patients with severe PTBL or undergoing revision surgery. However, these parameters cannot be deemed fully reliable. Given their potential weaknesses, it is crucial to identify more reproducible values, preferably ratios.
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Affiliation(s)
- Simone Ottavio Zielli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.O.Z.); (A.M.); (A.A.); (P.A.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Antonio Mazzotti
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.O.Z.); (A.M.); (A.A.); (P.A.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.O.Z.); (A.M.); (A.A.); (P.A.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.O.Z.); (A.M.); (A.A.); (P.A.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Federico Sgubbi
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.O.Z.); (A.M.); (A.A.); (P.A.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Laura Langone
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.O.Z.); (A.M.); (A.A.); (P.A.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Pejman Abdi
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.O.Z.); (A.M.); (A.A.); (P.A.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (S.O.Z.); (A.M.); (A.A.); (P.A.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
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Boonchai K, Santipas B, Wilartratsami S, Ruangchainikom M, Korwutthikulrangsri E, Akkarawanit P, Luksanapruksa P. The Magnetic Resonance Imaging of the Psoas Muscle Area as the Prognostic Factor for Survival and Adverse Events in Spinal Metastasis Surgery. Global Spine J 2024:21925682231173366. [PMID: 39069656 DOI: 10.1177/21925682231173366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE This study aimed to evaluate the ability of the mortality and adverse events prediction following metastatic spinal surgery of MRI-based cross-sectional psoas muscle area (PMA). METHODS A retrospective chart review, 120 patients who had undergone metastatic spinal surgery were included. The cross-sectional area identified the PMA under MR-imaging at the L3 or L4 pedicle level, which was classified into 3 tertiles. We used univariate and multivariate cox proportional hazard regression to assess whether PMA was associated with 30-day, 90-day, 1-year, and overall mortality. RESULTS The small psoas tertile group populations had a higher mortality rate than the large psoas tertile group. PMA in T1 and T2 had a probability of a higher 90-d mortality rate than PMA in T3 (T1 VS T3: P = .29 and T2 VS T3: P = .12). The median survival time was 7 months, 9 months, and 10 months in PMA T1, T2, and T3, respectively. PMA in tertile 2 had a significantly higher mortality rate of 38% compared to PMA in tertile 3 (HR 1.38, 95% CI .83-2.32, P = .02). Considering PMA as a continuous variable, every 1 mm2 increment of PMA resulted in the increase survivorship of 1% (HR .99 with 95% CI .99-1). CONCLUSION The MRI-based cross-sectional PMA tends to predict the 90-d mortality rate and overall mortality rate in spinal metastasis patients who underwent spinal surgery. The PMA should be considered one of the prognostic factors in the treatment of metastatic spinal patients.
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Affiliation(s)
- Kitidate Boonchai
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Borriwat Santipas
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirichai Wilartratsami
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Monchai Ruangchainikom
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkapoj Korwutthikulrangsri
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawin Akkarawanit
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panya Luksanapruksa
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abualkhair KA, Sharif AF, Eid H, ElToukhy AG, Ezzat M, Taha MM. Unusual Presentation of Thoracic Chordoma with Spinal Epidural Hematoma: A Rare Case Report and PRISMA-Driven Systematic Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241266099. [PMID: 39081345 PMCID: PMC11287744 DOI: 10.1177/11795476241266099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/12/2024] [Indexed: 08/02/2024]
Abstract
A chordoma is a slow growing, locally invasive, low-grade tumor belonging to the sarcoma family. It mainly affects the sacrum and skull base. We present a case of thoracic chordoma initially presented with epidural hematoma (EDH), which is a rare clinical entity. We reported this case, and also performed a PRISMA-driven systematic review to summary the similar cases in the literature. This review includes the clinical characteristics and outcome of thoracic chordoma. Our case involves a 60-year-old male who, despite no history of trauma, presented with acute paraparesis. An epidural hematoma was identified at T6 level, leading to a surgical intervention involving T4-6 laminectomy and fixation. Six months subsequent to surgery, the patient experienced progressive lower limb weakness and spasticity. Computed tomography (CT) exhibited erosion of T6 and an associated aggressive mass. Magnetic resonance imaging (MRI) revealed a large heterogenous soft tissue mass arising from the vertebral body and right pedicle of D6, protruding in the epidural space and compressing the spinal cord focally at this level. The mass measured approximately 5 × 4 × 3.5 cm. Magnetic resonance myelography indicated a filling defect at T5-6 level, confirming the intraspinal location of the soft tissue lesion. Complete excision of the mass confirmed the diagnosis of thoracic chordoma. Postoperative follow-up demonstrated notable improvement in the lower limb spasticity and paraparesis, and the patient started adjuvant radiotherapy. This case underscores the importance of maintaining a high index of suspicion when evaluating presentations resembling EDH.
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Affiliation(s)
| | - Asmaa F. Sharif
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta university, Egypt
| | - Hadeel Eid
- Department of Diagnostic Imaging, Menoufia University Hospitals, Menoufia, Egypt
| | - Ahmed G ElToukhy
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Ezzat
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud M Taha
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Toleikis JR, Pace C, Jahangiri FR, Hemmer LB, Toleikis SC. Intraoperative somatosensory evoked potential (SEP) monitoring: an updated position statement by the American Society of Neurophysiological Monitoring. J Clin Monit Comput 2024:10.1007/s10877-024-01201-x. [PMID: 39068294 DOI: 10.1007/s10877-024-01201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 07/16/2024] [Indexed: 07/30/2024]
Abstract
Somatosensory evoked potentials (SEPs) are used to assess the functional status of somatosensory pathways during surgical procedures and can help protect patients' neurological integrity intraoperatively. This is a position statement on intraoperative SEP monitoring from the American Society of Neurophysiological Monitoring (ASNM) and updates prior ASNM position statements on SEPs from the years 2005 and 2010. This position statement is endorsed by ASNM and serves as an educational service to the neurophysiological community on the recommended use of SEPs as a neurophysiological monitoring tool. It presents the rationale for SEP utilization and its clinical applications. It also covers the relevant anatomy, technical methodology for setup and signal acquisition, signal interpretation, anesthesia and physiological considerations, and documentation and credentialing requirements to optimize SEP monitoring to aid in protecting the nervous system during surgery.
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Affiliation(s)
| | | | - Faisal R Jahangiri
- Global Innervation LLC, Dallas, TX, USA
- Department of Neuroscience, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Laura B Hemmer
- Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Shen S, You X, Ren Y, Ye S. Adjacent Vertebral Refracture Prediction Model Based on Imaging Data After Vertebroplasty for Osteoporotic Vertebral Compression Fracture. World Neurosurg 2024:S1878-8750(24)01303-2. [PMID: 39074585 DOI: 10.1016/j.wneu.2024.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVES To establish a predictive model to evaluate the risk of adjacent vertebral refracture (VRF) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) based on perioperative imaging data. METHODS This study was a retrospective cohort study which established a predictive model of VRF after PKP for OVCF. Patients who underwent PKP for OVCF in our hospital between January 2018 and December 2020 were enrolled and divided into a refracture group and normal group. Perioperative imaging data including preoperative bone mineral density (BMD), fatty infiltration (FI%) of paravertebral muscle, sagittal parameters of the spine and pelvis, and recovery rate of vertebral height were collected. The prediction model is obtained by multifactor logistic regression analysis. RESULTS A total of 242 patients were included, including 23 cases in the VRF group and 219 cases in the normal group. There were statistical differences in BMD, FI%, recovery rate of vertebral height, and sagittal imbalance between the 2 groups. Receiver operating characteristic curve analysis of continuous variables showed that BMD ≤-2.80, FI% ≥40%, and recovery rate of vertebral height ≥ 10% were the cutoff values. Logistic regression analysis showed that BMD ≤-2.80, FI% ≥40%, and sagittal imbalance were independent risk factors for VRF. The area under the curve according to the predicted probability was 0.85 (P < 0.05). After simplifying the model, the total point of the model was 7 points, with a cutoff value of 5 points. CONCLUSIONS The prediction model obtained in this study can predict refracture after PKP for OVCF early and effectively. It has an excellent predictive effect which is suitable for clinicians.
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Affiliation(s)
- Shufeng Shen
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang, China.
| | - Xinmao You
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang, China
| | - Yingqing Ren
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang, China
| | - Senqi Ye
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang, China
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Pham C, Ebner PJ, Yoshida R, McCullough MC, Brown T, Tanabe K, Kulber DA. Outcomes of Patients Receiving Proximal Row Carpectomy and Meniscus Interposition Allografts for the Treatment of End-Stage Wrist Arthritis: A Comparative Study. Hand (N Y) 2024:15589447241262052. [PMID: 39066490 DOI: 10.1177/15589447241262052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Proximal row carpectomy (PRC) is a mainstay of wrist arthritis treatment; however, it is traditionally contraindicated in patients with an affected capitate. The use of soft tissue interposition grafts to resurface the radiocapitate articulation has been previously described to allow for PRC in these patients. In the current study, we reviewed our outcomes using knee meniscus allograft interposition to resurface the radiocapitate articulation in patients who would have otherwise been contraindicated for PRC. METHODS A retrospective study of patients who underwent PRC with or without meniscus interposition arthroplasty was performed from 2011 to 2022. Patient demographics (age, sex, occupation, hand dominance, etc) were collected. Improvement in pain was the primary outcome. Wrist range of motion and reconstructive failure requiring fusion were the secondary outcomes. RESULTS We identified a total of 83 patients and 43 met the inclusion criteria. Fifteen patients (35%) underwent PRC with meniscus interposition arthroplasty, and 28 patients (65%) underwent PRC alone. Patients with and without meniscus interposition arthroplasty had documented improvement in pain postoperatively (93% vs 95%, P > .05) at a median follow-up time of 11 (range, 3-38 months) and 9 months (range, 3-64 months), respectively. Postoperative wrist range of motion (flexion: +9 vs -4, P > .05, extension: +12 vs -4, P = .10) trended toward increase in patients undergoing meniscus interposition arthroplasty compared with PRC alone. CONCLUSIONS Our short- to mid-term outcomes in patients with end-stage wrist arthritis affecting the capitate who undergo PRC and meniscus interposition arthroplasty are comparable with those receiving PRC alone.
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Affiliation(s)
| | | | - Ryu Yoshida
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Kylie Tanabe
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Daniel E, Smith IC, Ly V, Bourque PR, Breiner A, Lochmuller H, Maltez N, Thavorn K, Warman-Chardon J. Direct and indirect costs of idiopathic inflammatory myopathies in adults: A systematic review. PLoS One 2024; 19:e0307144. [PMID: 39058702 PMCID: PMC11280229 DOI: 10.1371/journal.pone.0307144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are rare disorders characterized by inflammation of skeletal muscle, which can result in fatty replacement of muscle, muscle atrophy, and subsequent weakness. Therapeutic advancements have improved clinical outcomes but impose an economic impact on healthcare systems. We aimed to summarize the direct and indirect costs associated with IIMs in a systematic review (PROSPERO Registration #CRD42023443143). Electronic databases (MEDLINE, Embase, CINAHL, and Scopus) were systematically searched for full-length articles (excluding case reports) reporting costs specific to patients diagnosed with an IIM, published between database inception and April 19, 2023. Direct cost categories included inpatient, outpatient, medication, home/long-term care, and durable medical equipment such as mobility and respiratory aids. Indirect costs included lost productivity. Eligibility criteria were met by 21 of the 3,193 unique titles identified. Costs are expressed in 2023 United States of America dollars, with adjustments for differences in purchasing power applied to currency conversions. As no study reported on all cost categories, annualized cost of IIM per patient was estimated by calculating the mean cost per category, and then adding the means of the different cost categories. By this method, IIM was estimated to cost $52,210 per patient per year. Proportional contributions by category were lost productivity (0.278), outpatient care (0.214), medications (0.171), inpatient care (0.161), home/long-term care (0.122), and durable medical equipment (0.053). Newer findings with intravenous immunoglobulin considered first line therapy for IIM demonstrated markedly higher annual medication costs per patient, upwards of $33,900 compared to an average of $3,908 ± $1,042 in older studies. Future cost-effectiveness studies require updated cost-of-illness studies reflecting the evolving sub-classification and treatment options for IIM, and should consider the impact of IIM on patients and their families.
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Affiliation(s)
- Eden Daniel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian C. Smith
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Valentina Ly
- Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre R. Bourque
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ari Breiner
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hanns Lochmuller
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario and Research Institute, Ottawa, Ontario, Canada
| | - Nancy Maltez
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Rheumatology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario and Research Institute, Ottawa, Ontario, Canada
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