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Jeyaraman M, Jeyaraman N, Iyengar KP, Yadav S. Surgical Preparedness Index in Orthopaedics During the Coronavirus Disease 2019 (COVID-19) Pandemic. Cureus 2024; 16:e56066. [PMID: 38618428 PMCID: PMC11009917 DOI: 10.7759/cureus.56066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has increased the vulnerability of routine surgical procedures and elective surgery preparedness all over the world, with the suspension of most elective surgeries during the pandemic and the backlog of patients currently on waiting lists, especially in publicly funded healthcare systems. On average, at the beginning of the year 2022, about 200 million patients awaited surgery all over the world. By enhancing the strength of surgical preparedness, there is a better chance of strengthening elective surgical systems against shocks such as future pandemics or climate emergencies. We explore the implications, challenges, and strategies of the concept of surgical preparedness to maintain sustainability in the global healthcare system, especially in low- and middle-income countries (LMICs), with the experiences gained during the COVID-19 pandemic.
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Affiliation(s)
- Madhan Jeyaraman
- Clinical Research, Virginia Tech India, Dr MGR Educational and Research Institute, Chennai, IND
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | | | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Weinerman J, Vazquez A, Schurhoff N, Shatz C, Goldenberg B, Constantinescu D, Hernandez GM. The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review. Ann Med Surg (Lond) 2023; 85:5523-5527. [PMID: 37920654 PMCID: PMC10619579 DOI: 10.1097/ms9.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction The impact of anxiety and depression on outcomes in orthopaedic trauma surgery is a topic of growing research interest. Patients and methods Orthopaedic trauma patients often experience high rates of psychiatric disorders, with anxiety and depression being the most prevalent. Mental health disorders have been shown to increase the risk of negative surgical outcomes and morbidity. This narrative review seeks to summarize the current literature surrounding the impacts of anxiety and depression on orthopaedic trauma surgery outcomes. Discussion There is a bidirectional relationship between chronic pain and mental health disorders, involving overlapping brain regions and neurotransmitter pathways. Anxiety and depression have been identified as predictors of negative surgical outcomes in orthopaedic trauma patients. Screening tools like the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-7 (GAD-7), and Medical Outcomes Study 36-item Short Form (SF-36) can assess mental health status and help tailor interventions. Psychological distress, chronic pain, and traumatic limb amputation are factors that contribute to adverse mental health outcomes in orthopaedic trauma patients. Opioid use for pain management is common in orthopaedic surgery, but it can worsen symptoms of depression and lead to dependency. Non-opioid pain management strategies may improve postoperative outcomes by reducing the impact of opioid-exacerbated depression. Conclusion Mental health interventions, both preoperative and postoperative, are crucial in optimizing surgical outcomes and improving patient quality of life. Multidisciplinary approaches that address both physical and mental health are recommended for orthopaedic trauma patients. Further research is needed to develop effective interventions for improving mental health outcomes in this patient population.
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Affiliation(s)
- Jonathan Weinerman
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Arianna Vazquez
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Nicolette Schurhoff
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Connor Shatz
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Brandon Goldenberg
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | - David Constantinescu
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | - Giselle M. Hernandez
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
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Hamilton V, Sheikh S, Szczepanska A, Maskell N, Hamilton F, Reid JP, Bzdek BR, Murray JRD. Diathermy and bone sawing are high aerosol yield procedures. Bone Joint Res 2023; 12:636-643. [PMID: 37813391 PMCID: PMC10562079 DOI: 10.1302/2046-3758.1210.bjr-2023-0028.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Aims Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians' health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations. Methods The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures. Results Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields. Conclusion This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure.
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Affiliation(s)
| | | | | | - Nick Maskell
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | - James R. D. Murray
- Bristol Medical School, University of Bristol, Bristol, UK
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Mabrouk A, Abouharb A, Stewart G, Palan J, Pandit H. National variation in prophylactic antibiotic use for elective primary total joint replacement. Bone Jt Open 2023; 4:742-749. [PMID: 37797952 PMCID: PMC10555491 DOI: 10.1302/2633-1462.410.bjo-2023-0055.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Aims Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibiotic prophylaxis regimens and their impact on the risk of periprosthetic joint infection (PJI) in the first-year post-index procedure, and evaluate adherence to current international consensus guidance. Methods The guidelines for the primary and alternative recommended prophylactic antibiotic regimens in clean orthopaedic surgery (primary arthroplasty) for 109 hospitals and trusts across the UK were sought by searching each trust and hospital's website (intranet webpages), and by using the MicroGuide app. The mean cost of each antibiotic regimen was calculated using price data from the British National Formulary (BNF). Regimens were then compared to the 2018 Philadelphia Consensus Guidance, to evaluate adherence to international guidance. Results The primary choice and dosing of the prophylactic antimicrobial regimens varied widely. The two most used regimens were combined teicoplanin and gentamicin, and cefuroxime followed by two or three doses of cefuroxime eight-hourly, recommended by 24 centres (22.02%) each. The alternative choice and dosing of the prophylactic antimicrobial regimen also varied widely across the 83 centres with data available. Prophylaxis regimens across some centres fail to cover the likeliest causes of surgical site infection (SSI). Five centres (4.59%) recommend co-amoxiclav, which confers no Staphylococcus coverage, while 33 centres (30.28%) recommend cefuroxime, which confers no Enterococcus coverage. Limited adherence to 2018 Philadelphia Consensus Guidance was observed, with 67 centres (61.50%) not including a cephalosporin in their guidance. Conclusion This analysis of guidance on antimicrobial prophylaxis in primary arthroplasty across 109 hospitals and trusts in the UK has identified widespread variation in primary and alternative antimicrobial regimens currently recommended.
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Affiliation(s)
- Ahmed Mabrouk
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
| | - Alexander Abouharb
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
| | - Gabriel Stewart
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
| | - Jeya Palan
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
| | - Hemant Pandit
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
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Oumer KE, Aychew H, Daniel T, Mekete G, Belete KG, Negash TT. Incidence and associated factors of post-dural puncture headache among orthopaedic patients after spinal anesthesia: a prospective cohort study. Ann Med Surg (Lond) 2023; 85:4703-4708. [PMID: 37811087 PMCID: PMC10552984 DOI: 10.1097/ms9.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Background Post-dural puncture headache (PDPH) is one of a complication of spinal anaesthesia, influenced mostly by various factors including the patient's age, spinal needle size and design and sex. This headache can be severe and debilitating, preventing ambulation and limiting daily living activities. Objective This study assessed the incidence and associated factors of PDPH among patients who received spinal anaesthesia for orthopaedic procedures at the Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Methods Prospective cohort study design was employed using Consecutive sampling method among patients who received spinal anaesthesia for orthopaedics procedure at Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Data were collected by face to face interview and direct observation based on questionnaire. The data were entered to epidata 4.6 and analyzed by SPSS version 20 software. A total 95 patients aged 16-75 was participated in study. Those independent variable that were significant on binary logistic regression at P less than 0.2, were analyzed on multivariate regression, and considered significant association with PDPH at P value less than 0.05. Result Ninety-five study participants were included in our study of which 19 (20%) had developed PDPH. Among patients who develop PDPH; 9.5% of the patients reported moderate pain while 10.5% experience mild PDPH and 80% of patient has no pain. The BMI and age were found to have significant association with PDPH [(P value 0.018, adjusted odds ratio 8.738, 95% CI, 1.461-52.269) and (P value 0.011, adjusted odds ratio 12.146, 95% CI, 1.753-84.170)], respectively) to PDPH. Conclusion and recommendation The incidence of PDPH was found to be higher in Debre Tabor Comprehensive Specialized Hospital. The hospital management and the anaesthetists should minimize the magnitude of by strictly following different preventive strategies.
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Affiliation(s)
- Keder Essa Oumer
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| | - Habtamu Aychew
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| | - Tenbite Daniel
- Department of Anesthesia, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Mekete
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| | - Kumlachew Geta Belete
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| | - Tadese Tamire Negash
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
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Mercier MR, Koucheki R, Lex JR, Khoshbin A, Park SS, Daniels TR, Halai MM. The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery. Bone Jt Open 2023; 4:704-712. [PMID: 37704204 PMCID: PMC10499528 DOI: 10.1302/2633-1462.49.bjo-2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Aims This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures. Methods Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positive and -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events. Results Of 194,121 included patients, 740 (0.38%) were identified to be COVID-19-positive. Comparison of comorbidities demonstrated that COVID-19-positive patients had higher rates of diabetes, heart failure, and pulmonary disease. After propensity matching and controlling for all preoperative variables, multivariable analysis found that COVID-19-positive patients were at increased risk of several postoperative complications, including: any adverse event, major adverse event, minor adverse event, death, venous thromboembolism, and pneumonia. COVID-19-positive patients undergoing hip/knee arthroplasty and trauma surgery were at increased risk of 30-day adverse events. Conclusion COVID-19-positive patients undergoing orthopaedic surgery had increased odds of many 30-day postoperative complications, with hip/knee arthroplasty and trauma surgery being the most high-risk procedures. These data reinforce prior literature demonstrating increased risk of venous thromboembolic events in the acute postoperative period. Clinicians caring for patients undergoing orthopaedic procedures should be mindful of these increased risks, and attempt to improve patient care during the ongoing global pandemic.
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Affiliation(s)
| | - Robert Koucheki
- University of Toronto Faculty of Medicine, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Johnathan R. Lex
- University of Toronto Division of Orthopaedic Surgery, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Amir Khoshbin
- University of Toronto Division of Orthopaedic Surgery, Toronto, Canada
- Department of Orthopaedic Surgery, St Michael's Hospital, Toronto, Canada
| | - Sam S. Park
- University of Toronto Division of Orthopaedic Surgery, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Timothy R. Daniels
- University of Toronto Division of Orthopaedic Surgery, Toronto, Canada
- Department of Orthopaedic Surgery, St Michael's Hospital, Toronto, Canada
| | - Mansur M. Halai
- University of Toronto Division of Orthopaedic Surgery, Toronto, Canada
- Department of Orthopaedic Surgery, St Michael's Hospital, Toronto, Canada
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Shan L, Sun P, Zhang W, Zheng X, Li H, Wang S. Prophylactic alpha blockers fail to prevent postoperative urinary retention following orthopaedic procedures: evidence from a meta-analysis and trial sequential analysis of comparative studies. Front Pharmacol 2023; 14:1214349. [PMID: 37693901 PMCID: PMC10485607 DOI: 10.3389/fphar.2023.1214349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Objective: The present systematic review and meta-analysis aimed to estimate the prophylactic effect of alpha blockers against postoperative urinary retention (POUR) in orthopaedic patients. Methods: PubMed, Embase, Web of Science and Cochrane Library databases were searched between 1 January 1990 and 1 March 2023. The studies reporting the preventive efficacy of alpha blockers on POUR after orthopaedic procedures were identified. The pooled rates of POUR in the Intervention group (patients receiving alpha blockers) and the Control group (patients not receiving alpha blockers) were estimated and compared. The risk ratios (RRs) were calculated using the random-effects model. Subgroup analysis was performed based on surgical type. Trial sequential analysis (TSA) was conducted to confirm the robustness of pooled results. Results: Seven studies containing 1,607 patients were identified. The rates of POUR were similar between the two groups (Intervention group: 126/748 [16.8%] VS. Control group: 168/859 [19.6%]; RR = 0.75; 95% confidence interval [CI] 0.51 to 1.09; p = 0.130; Heterogeneity: I2 = 67.1%; p = 0.006). No significant difference in the incidence of POUR was observed in either the Arthroplasty subgroup or Spine surgery subgroup. The result of TSA suggested that the total sample size of the existing evidence might be insufficient to draw conclusive results. Administrating alpha blockers was associated with a higher risk of complications (88/651 [13.5%] VS. 56/766 [7.3%]; RR = 1.73; 95% CI 1.27 to 2.37; p = 0.0005; Heterogeneity: I2 = 0%; p = 0.69). Conclusion: Prophylactic alpha blockers do not reduce the risk of POUR in orthopaedic procedures, and administrating these drugs was associated with a higher risk of complications. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=409388.
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Affiliation(s)
- Lianliang Shan
- Department of Hand Surgery/Foot and Ankle Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Ping Sun
- Department of Hand Surgery/Foot and Ankle Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Wenping Zhang
- Department of Hand Surgery/Foot and Ankle Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Xuelian Zheng
- Dongying Vocational Institute, Dongying, Shandong, China
| | - Hua Li
- Department of Bone/Joint Surgery and Sports Medicine Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Songling Wang
- Department of Hand Surgery/Foot and Ankle Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, China
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Galán-Olleros M, Lopiz Y, Ciller G, Alcobía-Díaz B, García-Fernández C, Marco F. Does fluoroscopy improve baseplate position compared to conventional technique in reverse shoulder arthroplasty? A preliminary study. Shoulder Elbow 2023; 15:15-26. [PMID: 36895612 PMCID: PMC9990097 DOI: 10.1177/17585732211020657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/15/2022]
Abstract
Background Accurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of fluoroscopy as a surgical assistance method. Methods Prospective comparative study of 33 patients undergoing primary reverse shoulder arthroplasty during a 12-month period. Fifteen patients had a baseplate placed using the conventional "free hand" technique (control group), and 18 patients using intraoperative fluoroscopy assistance group, in a case-control design. Postoperative glenoid position was evaluated on postoperative Computed Tomography (CT) scan. Results The mean deviation of version and inclination for fluoroscopy assistance vs. control group was 1.75° (0.675-3.125) vs. 4.2° (1.975-10.45) (p = .015), and 3.85° (0-7.225) vs. 10.35° (4.35-18.75) (p = .009). The distance from the central peg midpoint to the inferior glenoid rim (fluoroscopy assistance 14.61 mm/control 4.75 mm, p = .581) and the surgical time (fluoroscopy assistance 1.93 ± 0.57/control 2.18 ± 0.44 h, p = .400) showed no differences, with an average radiation dose of 0.45 mGy and fluoroscopy time of 14 s. Conclusions Accurate axial and coronal scapular plane positioning of glenoid component is improved with intraoperative fluoroscopy at the cost of a greater radiation dose and without differences in surgical time. Comparative studies are needed to determine whether their use in relation to more expensive surgical assistance systems result in similar effectiveness.L evel of evidence : Level III, therapeutic study.
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Affiliation(s)
- María Galán-Olleros
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Yaiza Lopiz
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
- Department of Surgery, Complutense
University, Madrid, Spain
| | - Gabriel Ciller
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Borja Alcobía-Díaz
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Orthopaedic
Surgery and Traumatology Department, Clínico San Carlos Hospital, Madrid,
Spain
- Department of Surgery, Complutense
University, Madrid, Spain
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Farrow L, Jenkins PJ, Dunstan E, Murray A, Blyth MJG, Simpson AHRW, Clement ND. Predicted waiting times for orthopaedic surgery : an urgent need to address the deficit in capacity. Bone Joint Res 2022; 11:890-892. [PMID: 36513099 PMCID: PMC9792871 DOI: 10.1302/2046-3758.1112.bjr-2022-0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cite this article: Bone Joint Res 2022;11(12):890-892.
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Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK,Grampian Orthopaedics, Woodend Hospital, Aberdeen, UK, Luke Farrow. E-mail:
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10
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Gurung B, Liu P, Harris PDR, Sagi A, Field RE, Sochart DH, Tucker K, Asopa V. Artificial intelligence for image analysis in total hip and total knee arthroplasty : a scoping review. Bone Joint J 2022; 104-B:929-937. [PMID: 35909383 DOI: 10.1302/0301-620x.104b8.bjj-2022-0120.r2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common orthopaedic procedures requiring postoperative radiographs to confirm implant positioning and identify complications. Artificial intelligence (AI)-based image analysis has the potential to automate this postoperative surveillance. The aim of this study was to prepare a scoping review to investigate how AI is being used in the analysis of radiographs following THA and TKA, and how accurate these tools are. METHODS The Embase, MEDLINE, and PubMed libraries were systematically searched to identify relevant articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O'Malley framework were followed. Study quality was assessed using a modified Methodological Index for Non-Randomized Studies tool. AI performance was reported using either the area under the curve (AUC) or accuracy. RESULTS Of the 455 studies identified, only 12 were suitable for inclusion. Nine reported implant identification and three described predicting risk of implant failure. Of the 12, three studies compared AI performance with orthopaedic surgeons. AI-based implant identification achieved AUC 0.992 to 1, and most algorithms reported an accuracy > 90%, using 550 to 320,000 training radiographs. AI prediction of dislocation risk post-THA, determined after five-year follow-up, was satisfactory (AUC 76.67; 8,500 training radiographs). Diagnosis of hip implant loosening was good (accuracy 88.3%; 420 training radiographs) and measurement of postoperative acetabular angles was comparable to humans (mean absolute difference 1.35° to 1.39°). However, 11 of the 12 studies had several methodological limitations introducing a high risk of bias. None of the studies were externally validated. CONCLUSION These studies show that AI is promising. While it already has the ability to analyze images with significant precision, there is currently insufficient high-level evidence to support its widespread clinical use. Further research to design robust studies that follow standard reporting guidelines should be encouraged to develop AI models that could be easily translated into real-world conditions. Cite this article: Bone Joint J 2022;104-B(8):929-937.
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Affiliation(s)
- Binay Gurung
- South West London Elective Orthopaedic Centre, Epsom, UK
| | - Perry Liu
- South West London Elective Orthopaedic Centre, Epsom, UK
| | | | - Amit Sagi
- South West London Elective Orthopaedic Centre, Epsom, UK.,Barzilai Medical Centre, Ashkelon, Israel
| | - Richard E Field
- South West London Elective Orthopaedic Centre, Epsom, UK.,St George's, University of London, London, UK
| | | | - Keith Tucker
- South West London Elective Orthopaedic Centre, Epsom, UK.,Orthopaedics Data Evaluation Panel, London, UK
| | - Vipin Asopa
- South West London Elective Orthopaedic Centre, Epsom, UK
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11
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Strayer AL, Kuo WC, King BJ. In-hospital medical complication in older people after spine surgery: a scoping review. Int J Older People Nurs 2022; 17:e12456. [PMID: 35262279 DOI: 10.1111/opn.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/10/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Worldwide, older people are suffering from lumbar degenerative disease at an annual rate of 266 million. Although spine surgeries restore mobility, reduce pain and resolve neurological damage, these procedures can place older persons at high-risk for medical complications due to multiple comorbid conditions that are often present in this population. However, the prevalence of complications occurring in older people prior to discharge is unknown. Postoperative medical complications lead to increased healthcare costs as well as pain and potential harm for the patient. Hence, this scoping review aimed to provide an overview of the current knowledge state regarding in-hospital medical postoperative complications in older people (≥65 years) after elective spine surgery. METHOD A scoping review was conducted following Arksey and O'Malley's framework. Four databases (PubMed, Cochrane, Scopus and CINAHL) were systematically searched. Inclusion criteria were medical complication(s) after elective spine surgery prior to discharge, age ≥65 years and English language. Co-occurrence analysis was used to examine how often each complication was examined in the literature and how often the complications co-occur. RESULTS Twenty-six studies met inclusion criteria. The most frequently examined postoperative medical complications after spine surgery are delirium and urinary tract infection, followed by gastrointestinal and pulmonary embolus. Despite the list of in-hospital medical complications, definitions or criteria for measurement of any identified complication were sparse and inconsistent. There is a lack of definition or instruments to comprehensively assess medical complications incurred by older people following spine surgery, including characteristics, classification methodology and temporality. To date, no research has been conducted on how older people experience or perceive a medical complication after elective spine surgery. CONCLUSION The findings highlight the importance to develop comprehensive instruments to assess co-occurrence of postoperative medical complications and design interventions to mitigate the negative impacts of medical complications incurred by older people after spine surgery.
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Affiliation(s)
- Andrea L Strayer
- University of Wisconsin - Madison School of Nursing, Madison, Wisconsin, USA.,Department of Neurological Surgery, University of Wisconsin - Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Wan-Chin Kuo
- University of Wisconsin - Madison School of Nursing, Madison, Wisconsin, USA
| | - Barbara J King
- University of Wisconsin - Madison School of Nursing, Madison, Wisconsin, USA
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Brzeszczynski F, Brzeszczynska J, Duckworth AD, Murray IR, Simpson AHRW, Hamilton DF. The effect of sarcopenia on outcomes following orthopaedic surgery : a systematic review. Bone Joint J 2022; 104-B:321-330. [PMID: 35227092 DOI: 10.1302/0301-620x.104b3.bjj-2021-1052.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Sarcopenia is characterized by a generalized progressive loss of skeletal muscle mass, strength, and physical performance. This systematic review primarily evaluated the effects of sarcopenia on postoperative functional recovery and mortality in patients undergoing orthopaedic surgery, and secondarily assessed the methods used to diagnose and define sarcopenia in the orthopaedic literature. METHODS A systematic search was conducted in MEDLINE, EMBASE, and Google Scholar databases according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies involving sarcopenic patients who underwent defined orthopaedic surgery and recorded postoperative outcomes were included. The quality of the criteria by which a diagnosis of sarcopenia was made was evaluated. The quality of the publication was assessed using Newcastle-Ottawa Scale. RESULTS A total of 365 studies were identified and screened, 26 full-texts were reviewed, and 19 studies were included in the review. A total of 3,009 patients were included, of whom 2,146 (71%) were female and 863 (29%) were male. The mean age of the patients was 75.1 years (SD 7.1). Five studies included patients who underwent spinal surgery, 13 included hip or knee surgery, and one involved patients who underwent fixation of a distal radial fixation. The mean follow-up was 1.9 years (SD 1.9; 5 days to 5.6 years). There was wide heterogeneity in the measurement tools which were used and the parameters for the diagnosis of sarcopenia in the studies. Sarcopenia was associated with at least one deleterious effect on surgical outcomes in all 19 studies. The postoperative rate of mortality was reported in 11 studies (57.9%) and sarcopenia was associated with poorer survival in 73% (8/11) of these. The outcome was most commonly assessed using the Barthel Index (4/19), and sarcopenic patients recorded lower scores in 75% (3/4) of these. Sarcopenia was defined using the gold-standard three parameters (muscle strength, muscle quantity or quality, and muscle function) in four studies (21%), using two parameters in another four (21%) and one in the remaining 11 (58%). The methodological quality of the studies was moderate to high. CONCLUSION There is much heterogeneity in the reporting of the parameters which are used for the diagnosis of sarcopenia, and evaluating the outcome of orthopaedic surgery in sarcopenic patients. However, what data exist suggest that sarcopenia impairs recovery and increases postoperative mortality, especially in patients undergoing emergency surgery. Further research is required to develop processes that allow the accurate diagnosis of sarcopenia in orthopaedics, which may facilitate targeted pre- and postoperative interventions that would improve outcomes. Cite this article: Bone Joint J 2022;104-B(3):321-330.
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Affiliation(s)
- Filip Brzeszczynski
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Joanna Brzeszczynska
- Institute of Biomedical and Environmental Health Research, University of the West of Scotland, Paisley, UK.,Department of Molecular Biophysics, University of Lodz, Lodz, Poland
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - A Hamish R W Simpson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.,Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - David F Hamilton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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13
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Wang X, Penm J, Patanwala AE. Cost-effectiveness of tapentadol immediate release versus oxycodone immediate release for acute post-operative pain after major hip surgeries. Curr Med Res Opin 2022; 38:115-121. [PMID: 34641744 DOI: 10.1080/03007995.2021.1993161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of tapentadol immediate-release (IR) versus oxycodone IR for post-operative pain after a major hip surgery. METHODS This study has been conducted using an Australian societal perspective, focusing on adult patients after a major hip surgery. A cost-effectiveness analysis was conducted using a decision-analytic model. The model incorporated drug and other resource costs, the probability of opioid-related adverse events, and quality-adjusted life months (QALM) in each treatment arm. A willingness to pay (WTP) threshold of AU$2500 was used per QALM gained. A probabilistic sensitivity analysis was conducted to examine the uncertainty of the assumptions. The primary outcome was the incremental cost-effectiveness ratio (ICER) of tapentadol IR versus oxycodone IR, expressed as Australian dollars (AU$) per QALM gained. RESULTS Tapentadol IR dominated oxycodone IR, with a cost savings of AU$201 and an increase in QALM by 0.014. The ICER was -13,946 AU$/QALM (negative value attributed to numerator). In the probabilistic sensitivity analysis, 84.2% of the simulations were in favour of tapentadol IR at the WTP threshold. CONCLUSIONS Tapentadol IR may be more cost-effective than oxycodone IR for the treatment of acute postoperative pain after major hip surgeries.
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Affiliation(s)
- Xinyi Wang
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, Australia
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14
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Asopa V, Sagi A, Bishi H, Getachew F, Afzal I, Vyrides Y, Sochart D, Patel V, Kader D. The safe resumption of elective orthopaedic services following the first wave of the COVID-19 pandemic : a review of 2,316 consecutive cases and implications for recovery following further waves. Bone Jt Open 2022; 3:42-53. [PMID: 35037765 PMCID: PMC9047075 DOI: 10.1302/2633-1462.31.bjo-2021-0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aims There is little published on the outcomes after restarting elective orthopaedic procedures following cessation of surgery due to the COVID-19 pandemic. During the pandemic, the reported perioperative mortality in patients who acquired SARS-CoV-2 infection while undergoing elective orthopaedic surgery was 18% to 20%. The aim of this study is to report the surgical outcomes, complications, and risk of developing COVID-19 in 2,316 consecutive patients who underwent elective orthopaedic surgery in the latter part of 2020 and comparing it to the same, pre-pandemic, period in 2019. Methods A retrospective service evaluation of patients who underwent elective surgical procedures between 16 June 2020 and 12 December 2020 was undertaken. The number and type of cases, demographic details, American society of Anesthesiologists (ASA) grade, BMI, 30-day readmission rates, mortality, and complications at one- and six-week intervals were obtained and compared with patients who underwent surgery during the same six-month period in 2019. Results A total of 2,316 patients underwent surgery in 2020 compared to 2,552 in the same period in 2019. There were no statistical differences in sex distribution, BMI, or ASA grade. The 30-day readmission rate and six-week validated complication rates were significantly lower for the 2020 patients compared to those in 2019 (p < 0.05). No deaths were reported at 30 days in the 2020 group as opposed to three in the 2019 group (p < 0.05). In 2020 one patient developed COVID-19 symptoms five days following foot and ankle surgery. This was possibly due to a family contact immediately following discharge from hospital, and the patient subsequently made a full recovery. Conclusion Elective surgery was safely resumed following the cessation of operating during the COVID-19 pandemic in 2020. Strict adherence to protocols resulted in 2,316 elective surgical procedures being performed with lower complications, readmissions, and mortality compared to 2019. Furthermore, only one patient developed COVID-19 with no evidence that this was a direct result of undergoing surgery. Level of evidence: III Cite this article: Bone Jt Open 2022;3(1):42–53.
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Affiliation(s)
- Vipin Asopa
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | - Amit Sagi
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | - Habeeb Bishi
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | - Fanuelle Getachew
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | - Irrum Afzal
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | - Yiannis Vyrides
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | - David Sochart
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | - Vipul Patel
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | - Deiary Kader
- South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK.,University of Kurdistan Hewler, Erbil, Iraq
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15
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Hampton K, Tiede A, Shivamurthy S, Chowdary P. Clinical outcomes after joint surgery in patients on turoctocog alfa pegol (N8-GP) prophylaxis: A post hoc analysis. Haemophilia 2021; 28:158-165. [PMID: 34811856 DOI: 10.1111/hae.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Joint damage in haemophilia often requires surgical correction. However, the surgery effect on bleeding rates and other clinical joint outcomes can be unclear. AIM To investigate the effects of joint surgery on joint annualized bleeding rates (JABRs) and physical health outcomes in patients with haemophilia A undergoing N8-GP prophylaxis. METHODS Patients in the pathfinder 2 trial received N8-GP prophylaxis, enrolling in the pathfinder 3 trial for indicated surgery. Patients returned to pathfinder 2 post-surgery, continuing N8-GP prophylaxis until end-of-trial. JABRs were calculated from bleeding across all joints for pre-surgery (immediately before surgery) and post-surgery (to pathfinder 2 study end) periods. Joint-health-related outcomes were derived from patient records. RESULTS Data (41 joint surgeries; n = 30) were analysed statistically using datamining and descriptively. Pre-surgery mean JABR was higher in patients who later were operated than in 146 non-operated patients (p = .004). In operated patients, mean JABR decreased from 1.33 pre-surgery to .37 post-surgery (p = .011). In all but three patients, JABR improved or remained the same post-surgery. In the three patients whose JABR remained at one (all with multiple joint arthropathy), post-surgery bleeds were mostly at non-operated sites. Two of the three patients whose JABR increased post-surgery had undergone surgery for reasons unlikely to improve JABR. Mobility parameters often improved in patients whose JABR remained at zero. CONCLUSION Patients with haemophilia treated with N8-GP prophylaxis benefit from surgeries. However, this analysis could not differentiate the relative contributions of surgical interventions and prophylactic treatment to the improvement of JABR.
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Affiliation(s)
- Kingsley Hampton
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Andreas Tiede
- Department of Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hanover, Germany
| | | | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
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16
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Franceschetti E, Giovannetti de Sanctis E, Gregori P, Palumbo A, Paciotti M, Di Giacomo G, Franceschi F. Return to sport after reverse total shoulder arthroplasty is highly frequent: a systematic review. J ISAKOS 2021; 6:363-366. [PMID: 34794965 DOI: 10.1136/jisakos-2020-000581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
IMPORTANCE One of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery. OBJECTIVE The aim of this systematic review was to determine the rate of return to sport after reverse total shoulder arthroplasty (RSA) and the subjective level of performance. EVIDENCE REVIEW The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review. A systematic electronic search was performed using the PubMed (MEDLINE), Embase and Cochrane Library databases. All the studies analysing the rates were pooled; data were extracted and statistically analysed. The eligibility criteria were studies with at least 20 adult patients recruited. All studies had to relate return to sports after RSA. FINDINGS A total of six studies were included for a total of 457 patients. Mean age and average follow-up were, respectively, 74.7 years (range 33-88 years) and 3.6 years (range 1-9.4 years). The mean rate of return to sport ranged from 60% to 93%. The mean time for resuming sports was 5.3 months. The overall rate of return to sport after reverse shoulder arthroplasty was 79%. The mean level of sports at the time of the survey was worsened in 7.9%, improved in 39.6% and had no change in 55.2% of the cases. CONCLUSIONS AND RELEVANCE Based on the current available data, return to sports after reverse shoulder arthroplasty is possible and highly frequent. The subjective level of practice undergoes no change or improves in most of the cases. More studies and better-designed trials are needed in order to enrich the evidence on specific sports recovery after the procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Edoardo Giovannetti de Sanctis
- Department of Orthopaedic and Traumatology, Policlinico Agostino Gemelli - Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Gregori
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessio Palumbo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Michele Paciotti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Giovanni Di Giacomo
- Department of Orthopaedic and Trauma Surgery, Concordia Hospital for Special Surgery, Rome, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
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17
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Chuntamongkol R, Meen R, Nash S, Ohly NE, Clarke J, Holloway N. Resuming elective orthopaedic services during the COVID-19 pandemic : our experience. Bone Jt Open 2021; 2:951-957. [PMID: 34783253 PMCID: PMC8636296 DOI: 10.1302/2633-1462.211.bjo-2021-0080.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aims The aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery. Methods This was a prospective study of all elective orthopaedic patients within an elective unit running a green pathway at a COVID-19 light site. Rates of preoperative and 30-day postoperative COVID-19 symptoms or infection were examined for a period of 40 weeks. The unit resumed elective orthopaedic services on 29 June 2020 at a reduced capacity for a limited number of day-case procedures with strict patient selection criteria, increasing to full service on 29 August 2020 with no patient selection criteria. Results A total of 2,373 cases were planned in the 40-week study period. Surgery was cancelled in 59 cases, six (10.2%) of which were due to having a positive preoperative COVID-19 screening test result. Of the remaining 2,314, 996 (43%) were male and 1,318 (57%) were female. The median age was 67 years (interquartile range 59.2 to 74.6). The median American Society of Anesthesiologists grade was 2. Hip and knee arthroplasties accounted for the majority of the operations (76%). Six patients tested positive for COVID-19 preoperatively (0.25%) and 39 patients were tested for COVID-19 within 30 days after discharge, with only five patients testing positive (0.22%). Conclusion Through strict application of a COVID-19 green pathway, elective orthopaedic surgery could be safely delivered to a large number of patients with no selection criteria. Cite this article: Bone Jt Open 2021;2(11):951–957.
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Affiliation(s)
| | | | - Sophie Nash
- Orthopaedics, NHS Golden Jubilee, Glasgow, UK
| | | | - Jon Clarke
- Orthopaedics, NHS Golden Jubilee, Glasgow, UK
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18
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O'Donovan M, Singleton E, Roche S, McGowan M, Benson J, Bergin C, Bird R, Byrne M, Duggan C, Gilmore R, Ryan K, Dougall A, O'Donnell JS, O'Connell NM. Single centre, real-world experience of perioperative rFIXFc use in adult patients with haemophilia B undergoing major and minor surgery. Haemophilia 2021; 27:e690-e697. [PMID: 34614282 DOI: 10.1111/hae.14426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/27/2021] [Accepted: 09/20/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Recombinant factor IX fusion protein concentrate (rFIXFc) is increasingly used for prophylaxis in people with haemophilia B (PWHB), but experience in the perioperative setting is limited. AIMS To evaluate real-world perioperative factor usage, bleeding and complications in PWHB (≥18 years) who received rFIXFc for surgical haemostasis and to describe the treatment regimens used. METHODS Single centre, retrospective review of all PWHB who underwent a major or minor surgical procedure between June 2017 and July 2020 and received rFIXFc perioperatively for maintenance of surgical haemostasis. RESULTS A total of 56 PWHB (45 male and 11 female), including people with mild (n = 32), moderate (n = 4) and severe (n = 20) haemophilia B, underwent 11 major and 131 minor procedures with rFIXFc for surgical haemostasis. Haemostasis was rated as excellent (9/11) or good (2/11) in all major procedures. Median total rFIXFc consumption for orthopaedic surgeries was 972 IU/kg (range 812-1031 IU/kg) and for other major (non-orthopaedic) surgeries was 323 IU/kg (range 167-760 IU/kg). The median number of perioperative rFIXFc infusions was 19 (range 17-26) for orthopaedic surgery and 7 (range 5-17) for other major surgeries. The number of infusions in the postoperative period was determined by procedure and patient factors. Complications included bowel ileus and wound infection. Most minor procedures were managed with single infusion of rFIXFc, with no bleeding complications in 95% of minor procedures. There were no thromboembolic events or inhibitor formation. CONCLUSION This unique data provides real-world evidence that rFIXFc is safe and effective in achieving haemostasis in PWHB undergoing surgery.
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Affiliation(s)
- Mairead O'Donovan
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Evelyn Singleton
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Sheila Roche
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Mark McGowan
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Julie Benson
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Catherine Bergin
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Rachel Bird
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Mary Byrne
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | | | | | - Kevin Ryan
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Alison Dougall
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | | | - Niamh M O'Connell
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Zargaran A, Zargaran D, Trompeter AJ. The role of Vitamin D in orthopaedic infection: a systematic literature review. Bone Jt Open 2021; 2:721-727. [PMID: 34488428 PMCID: PMC8479837 DOI: 10.1302/2633-1462.29.bjo-2020-0192.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims Orthopaedic infection is a potentially serious complication of elective and emergency trauma and orthopaedic procedures, with a high associated burden of morbidity and cost. Optimization of vitamin D levels has been postulated to be beneficial in the prevention of orthopaedic infection. This study explores the role of vitamin D in orthopaedic infection through a systematic review of available evidence. Methods A comprehensive search was conducted on databases including Medline and Embase, as well as grey literature such as Google Scholar and The World Health Organization Database. Pooled analysis with weighted means was undertaken. Results Pooled analysis of four studies including 651 patients found the mean 25(OH)D level to be 50.7 nmol/l with a mean incidence of infection of 70%. There was a paucity of literature exploring prophylactic 25(OH)D supplementation on reducing orthopaedic infection, however, there was evidence of association between low 25(OH)D levels and increased incidence of orthopaedic infection. Conclusion The results indicate a significant proportion of orthopaedic patients have low 25(OH]D levels, as well as an association between low 25(OH)D levels and orthopaedic infection, but more randomized controlled trials need to be conducted to establish the benefit of prophylactic supplementation and the optimum regimen by dose and time. Cite this article: Bone Jt Open 2021;2(9):721–727.
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Affiliation(s)
- Alexander Zargaran
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London
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20
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Lasswell TL, Medley JB, Callaghan JP, Cronin DS, McKinnon CD, Singh S, Rasoulinejad P. Biomechanical comparison of a C1 posterior arch clamp with C1 lateral mass screws in constructs for C1-C2 fusion. Proc Inst Mech Eng H 2021; 235:1463-1470. [PMID: 34278841 PMCID: PMC8573685 DOI: 10.1177/09544119211032479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this experimental study was to assess the biomechanical performance of a novel C1 posterior arch (C1PA) clamp compared with C1 lateral mass (C1LM) screws in constructs used to treat atlantoaxial instability. These constructs had either C2 pedicle (C2P) screws or C2 translaminar (C2TL) screws. Eight fresh-frozen human cadaveric ligamentous spine specimens (C0-C3) were tested under six conditions: the intact state, the destabilized state after a simulated odontoid fracture, and when instrumented with four constructs (C1LM-C2P, C1LM-C2TL, C1PA-C2P, C1PA-C2TL). Each specimen was tested in a spinal loading simulator that separately applied axial rotation, flexion-extension and lateral bending. In each test condition, displacement controlled angular motion was applied in both directions at a speed of 2 deg/s until a resulting moment of 1.5 Nm was achieved. The measured ranges of motion (ROM) of the C1-C2 segments were compared for each test condition using nonparametric Friedman tests. The destabilized state had significantly more C1-C2 motion (p < 0.05) than the intact state in all cases, and all constructs greatly reduced this motion. C2 pedicle screw constructs that used the C1PA clamp had significantly less C1-C2 motion (p < 0.05) than those with C1LM screws in flexion-extension as well as axial rotation and no statistically significant difference was detected in lateral bending. C2 translaminar screw constructs that used the C1PA clamp had significantly less C1-C2 motion (p < 0.05) than those with C1LM screws in flexion-extension and no statistically significant difference was detected in axial rotation or in lateral bending. Data from the current study suggested that constructs using the novel C1PA clamp would provide as good, or improved, biomechanical stability to the C1-C2 segment compared with constructs using C1LM screws.
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Affiliation(s)
- Timothy L Lasswell
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - John B Medley
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Jack P Callaghan
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Duane S Cronin
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Colin D McKinnon
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Supriya Singh
- Division of Orthpaedic Surgery, Department of Surgery, Western University and Victoria Hospital, London Health Sciences Centre, London, ON, Canada
| | - Parham Rasoulinejad
- Division of Orthpaedic Surgery, Department of Surgery, Western University and Victoria Hospital, London Health Sciences Centre, London, ON, Canada
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21
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Ballal P, Peloquin C, Boer CG, Neogi T. Response to: 'Correspondence on: 'Warfarin use and risk of knee and hip replacements'' by He et al. Ann Rheum Dis 2021:annrheumdis-2021-220855. [PMID: 34099485 DOI: 10.1136/annrheumdis-2021-220855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Priyanka Ballal
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christine Peloquin
- Clinical Epidemiology Unit, Boston University, Boston, Massachusetts, USA
| | | | - Tuhina Neogi
- Section of Rheumatology, Boston University, Boston, Massachusetts, USA
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22
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Belk JW, Thon SG, Hart J, McCarty EC, McCarty EC. Subpectoral versus suprapectoral biceps tenodesis yields similar clinical outcomes: a systematic review. J ISAKOS 2021; 6:356-362. [PMID: 34016736 DOI: 10.1136/jisakos-2020-000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/04/2022]
Abstract
IMPORTANCE Arthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are two surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior to posterior (SLAP) tears. There is insufficient knowledge regarding the clinical superiority of one technique over the other. OBJECTIVE To systematically review the literature in order to compare the clinical outcomes and safety of ABT and OBT for treatment of LHBT or SLAP pathology. EVIDENCE REVIEW A systematic review was performed by searching PubMed, the Cochrane Library and Embase to identify studies that compared the clinical efficacy of ABT versus OBT. The search phrase used was: (bicep OR biceps OR biceps brachii OR long head of biceps brachii OR biceps tendinopathy) AND (tenodesis). Patients were assessed based on the American Shoulder and Elbow Surgeons Score, the visual analogue scale, the Single Assessment Numeric Evaluation, Constant-Murley Score, clinical failure, range of motion, bicipital groove pain and strength. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and both the Cochrane Collaboration's and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) risk of bias tools were used to evaluate risk of bias. FINDINGS Eight studies (one level I, seven level III) met inclusion criteria, including 326 patients undergoing ABT and 381 patients undergoing OBT. No differences were found in treatment failure rates or patient-reported outcome scores between groups in any study. One study found OBT patients to experience significantly increased range of shoulder forward flexion when compared with ABT patients (p=0.049). Two studies found ABT patients to experience significantly more postoperative stiffness when compared with OBT patients (p<0.05). CONCLUSIONS Patients undergoing ABT and OBT can be expected to experience similar improvements in clinical outcomes at latest follow-up without differences treatment failure or functional performance. ABT patients may experience an increased incidence of stiffness in the early postoperative period. LEVEL OF EVIDENCE III.
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Affiliation(s)
- John W Belk
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Stephen G Thon
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA.,Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - John Hart
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA.,Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA
| | - Eric C McCarty
- Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA .,Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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Jain VK, Upadhyaya GK, Iyengar KP, Patralekh MK, Lal H, Vaishya R. Impact of COVID-19 on Clinical Practices during Lockdown: A pan India Survey of Orthopaedic Surgeons. Malays Orthop J 2021; 15:55-62. [PMID: 33880149 PMCID: PMC8043638 DOI: 10.5704/moj.2103.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted. Materials and Methods: An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness. Results: A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and non-trauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%). Conclusion: This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.
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Affiliation(s)
- V K Jain
- Department of Orthopaedics, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - G K Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Raibarelly, India
| | - K P Iyengar
- Department of Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom
| | - M K Patralekh
- Department of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - H Lal
- Department of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - R Vaishya
- Department of Orthopaedics, Dr Ram Manohar Lohia Hospital, New Delhi, India
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24
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Austin DC, Torchia MT, Lurie JD, Jevsevar DS, Bell JE. Identifying regional characteristics influencing variation in the utilization of rotator cuff repair in the United States. J Shoulder Elbow Surg 2019; 28:1568-1577. [PMID: 30956144 PMCID: PMC6646059 DOI: 10.1016/j.jse.2018.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is a lack of consensus regarding indications for surgical management of rotator cuff disease, which can lead to increased regional variation. The objectives of this study were to describe the geographic variation in rates of rotator cuff repair (RCR) in the United States over time and to identify regional characteristics associated with utilization. METHODS The United States was divided into 306 hospital referral regions. The adjusted per capita RCR rate was calculated using procedural counts derived from the Medicare Part B Carrier File from 2004-2014. Population-weighted multivariable regression was used to identify regional characteristics independently associated with utilization in 2014. RESULTS In 2014, an 8-fold difference in rates of RCR was found between regions. Between 2010 and 2014, the overall rate of RCR grew only 3.6% and regional variation decreased. Higher regional utilization of several other orthopedic procedures (P < .02), as well as the regional supply of orthopedic surgeons (P = .002), was independently associated with significantly increased utilization. The South, Southeast, and Southwest were independently associated with significantly higher utilization (P < .001) compared with the Northeast. A higher prevalence of resident physicians, a marker of the academic presence within a region, was independently associated with decreased utilization (P < .001). CONCLUSION Utilization of RCR has increased substantially over the past decade, but the rate of growth appears to be slowing. RCR remains a procedure with significant regional variation, and increased utilization across regions is associated with higher orthopedic surgeon supply and increased rates of other orthopedic procedures.
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Affiliation(s)
- Daniel C Austin
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - Michael T Torchia
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jonathan D Lurie
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - John-Erik Bell
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Wertheimer A, Kirzner N, Olaussen A, Abetz J, Martin C, Jones C. Keeping your cool - a simple reusable neck cooler in orthopaedic surgery: a pilot randomized controlled trial. ANZ J Surg 2018; 88:1294-1297. [PMID: 30362226 DOI: 10.1111/ans.14902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infection in orthopaedic surgery can be catastrophic. Increased perspiration from theatre staff has been associated with higher rates of wound contamination. Wearing lead safety gowns, which is often done during surgery to allow the use of image intensifier, may result in heavy perspiration. This study aimed to determine the feasibility of wearing a neck cooling device during surgery and whether it reduced surgeons' subjective discomfort and perspiration levels during orthopaedic procedures requiring the use of lead gowns. METHODS A pilot randomized controlled trial was conducted. Surgeons were randomized to either wearing the neck cooling device (intervention) or not wearing the device (control). Procedure duration, theatre temperature, humidity and perceived technical difficulty of operation were recorded. After the procedure, surgeons completed a questionnaire documenting how the temperature and humidity had a negative effect on their comfort and perceived level of perspiration. Multilevel mixed effects linear regression with random effects, adjusting for potential confounders was performed. Alfred Ethics Committee approved the study and the trial was registered (ACTRN12618000976280). RESULTS A total of 29 cases (44.6%) were randomized to the intervention group and 36 to the control group. Adjusting for operating room temperature and perceived difficulty of surgery, the neck cooler reduced surgeons' level of discomfort by 1.9 points (95% CI 1.1-2.8, P < 0.001), as well improved on their self-reported perspiration by approximately 1.9 points (95% CI 1.0-2.8, P = 0.04). CONCLUSIONS Wearing a neck cooling device during surgery is feasible, reduces perceived levels of perspiration and decreases the negative impact of temperature and humidity on surgeons' comfort levels.
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Affiliation(s)
- Adam Wertheimer
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Sandringham Hospital, Melbourne, Victoria, Australia
| | - Nathan Kirzner
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Alexander Olaussen
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Abetz
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris Jones
- Department of Orthopaedic Surgery, Sandringham Hospital, Melbourne, Victoria, Australia
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26
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Ballesteros DR, Forero PL, Ballesteros LE. Accessory head of the flexor pollicis longus muscle: anatomical study and clinical significance. Folia Morphol (Warsz) 2018; 78:394-400. [PMID: 30299534 DOI: 10.5603/fm.a2018.0091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/19/2018] [Accepted: 06/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The accessory head of the flexor pollicis longus (AHFPL) has an oblique trajectory from medial to lateral aspect of the forearm below the flexor digitorum superficialis muscle and then joins the flexor pollicis longus muscle. When the anterior interosseous nerve (AIN) courses underneath the muscle belly of the AHFPL an entrapment neuropathy may occur, known as anterior interosseous nerve syndrome (AINS). MATERIALS AND METHODS This descriptive cross-sectional study evaluated 106 fresh upper extremities. When the AHFPL was present, its fascicle was traced up to evaluate the origin site. The morphometric variables were measured using a digital micrometre (Mitutoyo, Japan). The relationship between the AHFLP and the AIN was evaluated. RESULTS The AHFPL was found in 34 (32.1%) of the 106 forearms. The AHFPL arose from the flexor digitorum superficialis muscle in 16 (47.1%) forearms, the medial epicondyle of the humerus in 10 (29.4%) forearms and the coronoid process of ulna in 8 (23.5%) forearms. The average total length of the AHFPL was 94.11 ± ± 10.33 mm. The AIN was located lateral to the AHFPL in 3 (8.8%) forearms, posterolateral in 7 (20.6%) forearms and posterior in 24 (70.6%) forearms. CONCLUSIONS This study performed in a South American population sample revealed a prevalence of the AHFPL in a lower range compared to previous studies in North Americans and Asians. The AIN coursed more frequently underneath the muscle belly of AHFPL. This finding has clinical significance in the onset of the AINS and the subsequent surgical procedure for the AIN decompression.
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Affiliation(s)
- D R Ballesteros
- Department of Basic Sciences, Industrial University of Santander. Bucaramanga, Colombia.
| | - P L Forero
- Department of Pathology, Industrial University of Santander. Bucaramanga, Colombia
| | - L E Ballesteros
- Department of Basic Sciences, Industrial University of Santander. Bucaramanga, Colombia
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27
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Gaulton TG, Fleisher LA, Neuman MD. The association between obesity and disability in survivors of joint surgery: analysis of the health and retirement study. Br J Anaesth 2017; 120:109-116. [PMID: 29397117 DOI: 10.1016/j.bja.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Obesity is associated with osteoarthritis and the need for joint surgery. Obese patients who undergo joint surgery may have a higher risk of morbidity compared with normal or overweight patients but less is known about their risk of postoperative disability. The primary objective of our study was to determine the association between obesity and the development of new dependence in activities of daily living within 2 years after joint surgery. METHODS We obtained data from the Health and Retirement Study, a longitudinal survey of older Americans. We included participants who indicated having joint surgery for arthritis. We defined obesity as a BMI ≥30 kg m-2. Our outcome was a new or increased dependence in one or more activities of daily living after surgery. RESULTS We analysed data on 2519 respondents who underwent joint surgery for arthritis. Respondents had a median age of 69yr, 65.5% were female, 66.6% had joint replacement surgery and 45.3% were obese. The overall incidence of a new dependence within 2years was 22.1%. Obese respondents had a higher incidence of new dependence compared with non-obese respondents (25.4% vs 19.4%, P<0.001). In adjusted analysis, obese respondents had increased odds of developing dependence [odds ratio 1.35 (95% CI 1.09-1.68), P=0.007]. CONCLUSIONS Obesity is associated with an increased risk of developing dependence in the 2 years after joint surgery. Our study findings identify a high-risk group that may benefit from targeted interventions and allocation of perioperative resources to optimize recovery and minimize longer-term disability.
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Affiliation(s)
- T G Gaulton
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, PA, USA.
| | - L A Fleisher
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, PA, USA
| | - M D Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, PA, USA
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28
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Pullin R, Wright BJ, Kapur R, McCrory JP, Pearson M, Evans SL, Crivelli D. Feasibility of detecting orthopaedic screw overtightening using acoustic emission. Proc Inst Mech Eng H 2017; 231:213-221. [PMID: 28116977 DOI: 10.1177/0954411916689112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A preliminary study of acoustic emission during orthopaedic screw fixation was performed using polyurethane foam as the bone-simulating material. Three sets of screws, a dynamic hip screw, a small fragment screw and a large fragment screw, were investigated, monitoring acoustic-emission activity during the screw tightening. In some specimens, screws were deliberately overtightened in order to investigate the feasibility of detecting the stripping torque in advance. One set of data was supported by load cell measurements to directly measure the axial load through the screw. Data showed that acoustic emission can give good indications of impending screw stripping; such indications are not available to the surgeon at the current state of the art using traditional torque measuring devices, and current practice relies on the surgeon's experience alone. The results suggest that acoustic emission may have the potential to prevent screw overtightening and bone tissue damage, eliminating one of the commonest sources of human error in such scenarios.
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Affiliation(s)
- Rhys Pullin
- 1 Cardiff School of Engineering, Cardiff University, Cardiff, UK
| | - Bryan J Wright
- 2 Orthopedic Department, Ringerike Sykehus, Hønefoss, Norway
| | - Richard Kapur
- 1 Cardiff School of Engineering, Cardiff University, Cardiff, UK
| | - John P McCrory
- 1 Cardiff School of Engineering, Cardiff University, Cardiff, UK
| | - Matthew Pearson
- 1 Cardiff School of Engineering, Cardiff University, Cardiff, UK
| | - Sam L Evans
- 1 Cardiff School of Engineering, Cardiff University, Cardiff, UK
| | - Davide Crivelli
- 1 Cardiff School of Engineering, Cardiff University, Cardiff, UK
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Osooli M, Lövdahl S, Steen Carlsson K, Knobe K, Baghaei F, Holmström M, Astermark J, Berntorp E. Comparative burden of arthropathy in mild haemophilia: a register-based study in Sweden. Haemophilia 2017; 23:e79-e86. [PMID: 28155262 DOI: 10.1111/hae.13166] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Mild haemophilia is a congenital bleeding disorder affecting males. The burden of arthropathy in mild haemophilia has not been comprehensively described. AIM The aim of this study was to compare the incidence, age at diagnosis and surgery for arthropathy and related hospitalizations between people with mild haemophilia and the general population in Sweden. METHODS This was a register-based cohort study. Eligible participants were those with mild haemophilia born between 1941 and 2008 and a randomly selected, birthdate and sex-matched comparison group from the general population. Follow-up was from birth (or earliest 1984) until death, emigration or end of the study in 2008. Data on arthropathy were obtained from a national patient register. Negative binomial and competing risk regression and Kaplan-Meier estimate curves were used in the analysis. RESULTS Overall, 315 people with haemophilia and 1529 people in the comparison group were included. Participants with haemophilia born between 1984 and 2008 had a ninefold (95% CI: 3.3-27.2) and 16-fold (95% CI: 6.7-36.5) increased incidence of arthropathy-related hospital admission and arthropathy diagnosis respectively. None in this cohort underwent surgery. Among participants with haemophilia born prior to 1984, the rates of arthropathy diagnosis and surgery of the index joints (knee, elbow, ankle) were increased twofold (95% CI: 1.0-3.2) and fivefold (95% CI: 1.7-17.8) respectively. CONCLUSION Our data suggested a higher burden of arthropathy among individuals with mild haemophilia compared to the general population. Further research should investigate the need for targeted joint screening programmes among individuals with mild haemophilia.
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Affiliation(s)
- M Osooli
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - S Lövdahl
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Novo Nordisk A/S, Søborg, Denmark
| | - K Steen Carlsson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Swedish Institute for Health Economics, Lund, Sweden
| | - K Knobe
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Novo Nordisk A/S, Søborg, Denmark
| | - F Baghaei
- Coagulation Centre, Department of Medicine/Haematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Holmström
- Coagulation Unit, Haematology Centre, Karolinska University Hospital, Stockholm, Sweden
| | - J Astermark
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - E Berntorp
- Centre for Thrombosis and Haemostasis, Skane University Hospital, Malmo, Sweden.,Department of Translational Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Abstract
Laser cutting of bones has been proposed as a technology in orthopaedic surgery. In this short study, the laser-bone interaction was examined using a pulsed erbium-doped yttrium aluminium garnet laser and compared to a conventional cutting technique. Microscopic analysis revealed the nature of waste debris and showed higher proportions of finer particles for conventional sagittal sawing compared to laser cutting.
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Affiliation(s)
| | - Garrett B McGuinness
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin, Ireland
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