Is macitentan not a treatment option for digital ulcers in systemic sclerosis?

Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

PURPOSE

The aim of this meta-analysis was a comparison between medial pivot (MP) and posterior-stabilised (PS) knee designs regarding functional and radiological outcomes as well as gait parameters.

METHODS

A systematic literature search was conducted in PubMed, Cochrane Library, Science Direct and Clinical Trials.gov from conception up to April 2022, to identify eligible randomised control trials (RCTs). The extracted data were analysed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement.

RESULTS

Fifteen studies met inclusion criteria, enrolling 1101 patients who underwent 1242 total knee arthroplasties (TKAs). A total of 1158 TKAs (581 MP/577 PS) were included in the quantitative analysis. Mean follow-up ranged from 6 months up to 6.6 years. MP knees showed comparable range of motion (ROM) with PS design 1, 2 and 4 years postoperatively (p = 0.2, p = 0.25, p = 0.34, respectively). No statistical difference was found in patient-related outcome measures (PROMs) (p > 0.05). Mean walking speed (MWS), length of stay (LOS), radiographic alignment and complications rates were also similar between the two groups (p > 0.05).

DISCUSSION

The present meta-analysis demonstrated that the theoretical biomechanical advantage of MP implants does not have a better impact on patient satisfaction compared to the traditional PS knees.

LEVEL OF EVIDENCE

I.

The threat, hype, and promise of artificial intelligence in education

The idea of building intelligent machines has been around for centuries, with a new wave of promising artificial intelligence (AI) in the twenty-first century. Artificial Intelligence in Education (AIED) is a younger phenomenon that has created hype and promises, but also been seen as a threat by critical voices. There have been rich discussions on over-optimism and hype in contemporary AI research. Less has been written about the hyped expectations on AIED and its potential to transform current education. There is huge potential for efficiency and cost reduction, but there is also aspects of quality education and the teacher role. The aim of the study is to identify potential aspects of threat, hype and promise in artificial intelligence for education. A scoping literature review was conducted to gather relevant state-of-the art research in the field of AIED. Main keywords used in the literature search were: artificial intelligence, artificial intelligence in education, AI, AIED, teacher perspective, education, and teacher. Data were analysed with the SWOT-framework as theoretical lens for a thematic analysis. The study identifies a wide variety of strengths, weaknesses, opportunities, and threats for artificial intelligence in education. Findings suggest that there are several important questions to discuss and address in future research, such as: What should the role of the teacher be in education with AI? How does AI align with pedagogical goals and beliefs? And how to handle the potential leak and misuse of user data when AIED systems are developed by for-profit organisations?

Macitentan in the treatment of severe digital ulcers

Digital ulcers are one of the earliest and most disabling manifestations of systemic sclerosis (SSc). We report the clinical case of a female patient with SSc and severe digital ulcers, recurrent and refractory to the classic treatments to whom it was prescribed off-label macitentan with complete resolution of the condition.

Medial ball and socket total knee arthroplasty: five-year clinical results

AIMS

Between 15% and 20% of patients remain dissatisfied following total knee arthroplasty (TKA). The SAIPH knee system (MatOrtho, Surrey, United Kingdom) is a medial ball and socket TKA that has been designed to replicate native knee kinematics in order to maximize the range of movement, stability, and function. This system is being progressively introduced in a stepwise fashion, with this study reporting the mid-term clinical and radiological outcomes.

PATIENTS AND METHODS

A retrospective review was undertaken of the first 100 consecutive patients with five-year follow-up following SAIPH TKA performed by the senior authors. The data that were collected included the demographics of the patients, clinical findings, the rate of intraoperative ligamentous release, patient-reported outcome measures (PROMS), radiological assessment, complications, and all-cause revision. Revision data were cross-checked with a national registry.

RESULTS

A total of 100 TKAs in 92 patients were included. Three patients died (three TKAs) and a further two TKAs were revised. Of the remaining 95 TKAs, five-year follow-up data were available for 81 TKAs (85%) in 87 patients. There were significant improvements in all PROMs and high satisfaction. The mean ROM at final follow-up was from 0° (full extension) to 124° flexion. There were seven major complications (7%): one infection, two deep vein thromboses, one cerebrovascular event, and two patients with stiffness requiring a manipulation under anaesthesia. Two patients required a lateral retinacular release to optimize patellar tracking in valgus knees; no additional ligament releases were performed in any patient. Radiological analysis demonstrated no evidence of implant-related complications.

CONCLUSION

These results demonstrate satisfactory clinical and radiological outcomes at five years following a medial ball and socket TKA. The complication and revision rates are consistent with those previously reported for patients undergoing TKA. These results demonstrate the safety and efficacy of the SAIPH Knee TKA system and support its wider use.

Morphological classification of the femoral trochlear groove based on a quantitative measurement of computed tomographic models

PURPOSE

This study aimed to investigate the natural morphology of the femoral trochlear groove based on quantitative measurement.

METHODS

Computed tomographic femur models of 50 male and 50 female healthy Chinese adults (30-60 years) were analysed using three-dimensional software. Coaxial cutting planes (15° increments) rotating about the trochlear groove axis from the proximal to distal point were created, followed by the deepest point of the trochlear groove marked at each cross section. The shape, position, and orientation of the trochlear groove were analysed.

RESULTS

The trochlear groove was located laterally relative to the mechanical axis and consisted of the laterally oriented proximal part and medially oriented distal part. Based on the turning points located on different cross sections, the trochlear groove was classified into four types: types 45°, 60°, 75°, and 90°. The mediolateral position relative to the mechanical axis was types 45°, 60°, 75°, and 90°, from the lateral to medial side, while the distal parts of them extended along the same path. The orientation of the trochlear groove was relatively consistent and smooth, which oriented at approximately 1° medially between two adjacent segments, except at approximately 10° medially at the turning point.

CONCLUSION

The trochlear groove tracking varies greatly amongst a population that is mainly categorized into four types. This study may be helpful for better understanding of the natural trochlear groove anatomy, prosthetic design modification, and provide the reference value for studying patellofemoral diseases such as patellar maltracking and trochlear dysplasia.

LEVEL OF EVIDENCE

Prospective study, Level II.