https://www.oarsijournal.com/article/S1063-4584(13)00940-0/pdf

Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study

Heterotopic ossification (HO) is a diverse pathologic process, defined as the formation of extraskeletal bone in muscle and soft tissues. HO can be conceptualized as a tissue repair process gone awry and is a common complication of trauma and surgery. This comprehensive review seeks to synthesize the clinical, pathoetiologic, and basic biologic features of HO, including nongenetic and genetic forms. First, the clinical features, radiographic appearance, histopathologic diagnosis, and current methods of treatment are discussed. Next, current concepts regarding the mechanistic bases for HO are discussed, including the putative cell types responsible for HO formation, the inflammatory milieu and other prerequisite "niche" factors for HO initiation and propagation, and currently available animal models for the study of HO of this common and potentially devastating condition. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Heterotopic Ossification: A Comprehensive Review.

Background After more than 4 decades experience of total knee arthroplasty (TKA), there is still a group of patients who are not satisfied with the outcome. In spite of the improvement of many aspects around the procedure, for unexplainable reasons, patient dissatisfaction is still approximately the same. We conducted this study to analyze correlations between preoperative psychological aspects and dissatisfaction after TKA. Methods A total of 186 patients were operated with a primary TKA. Patients filled out the Hospital Anxiety and Depression Scale, Visual Analog Pain Scale (0-100), and Knee injury and Osteoarthritis Outcome Score preoperatively and 4 years postoperatively. Four years postoperatively, the patients also scored their satisfaction degree with the outcome of the surgery. Results Of 186 patients, 27 (15%) reported that they were dissatisfied or uncertain with the result of their TKA 4 years postoperatively. Sixteen of those 27 patients had reported anxiety/depression preoperatively compared with 11 of 159 (7%) in the satisfied or very satisfied groups. Patients with preoperative anxiety or depression had more than 6 times higher risk to be dissatisfied compared with patients with no anxiety or depression ( P P  = .03). Dissatisfied patients had 1-day longer hospital stay compared with the satisfied group ( P Conclusion Preoperative anxiety and/or depression is an import predictor for dissatisfaction after TKA. Psychological assessment and treatment preoperatively might improve degree of satisfaction.

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Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty : A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up

Preoperative anxiety can influence the intensity of postoperative pain and anesthesia and analgesia requirement. In certain types of surgery, anxiety may even increase postoperative morbidity and mortality. The goal of this narrative review is to remind anesthesiologists that anxiety measurement using specific tools can be done in clinical practice, to present the implications of preoperative anxiety on postoperative patient recovery, and to acknowledge the importance of a dedicated anesthesia plan in the management of anxious adult patients. Preoperative assessment performed several weeks before surgery in an outpatient clinic is a reasonable option to give information about surgery, anesthesia and postoperative pain. This is the time to assess patient preoperative anxiety by using VAS-A. If high anxiety level is detected early, the patient can be referred to a psychologist for preoperative preparation. This is consistent with the guidelines for enhanced recovery after surgeries, which underline the importance of patient-doctor discussion about hospitalization and perioperative care. Patients with preoperative anxiety could benefit from multimodal analgesia, including non-pharmacological methods, such as cognitive therapy and music therapy and relaxation. The authors' opinion is that greater education about preoperative anxiety consequences in the surgical community is needed. A systemized approach and guidelines about the management of preoperative anxiety should be followed.

Preoperative anxiety and implications on postoperative recovery: what can we do to change our history.

Background:Although patellofemoral instability is among the most prevalent knee disorders, the management of patients with this condition is complex and remains variable, given the lack of long-ter...

Patellar Instability Management: A Survey of the International Patellofemoral Study Group.

Patient-based and psychological factors do influence outcome in patients undergoing total knee arthroplasty (TKA). The purpose was to investigate if preoperative psychological factors influence the subjective and objective outcomes 6 weeks, 4 months and 1 year after TKA. Our hypothesis was that there is a significant influence of psychological factors on clinical outcome scores before and after TKA. A prospective, longitudinal, single-cohort study investigating the correlation of depression, control beliefs, anxiety and a variety of other psychological factors with outcomes of patients undergoing TKA was performed. A total of 104 consecutive patients were investigated preoperatively using the Beck`s depression inventory, the State-Trait Anxiety Index, the questionnaire for assessment of control beliefs and the SCL-90R inventory. The Knee Society Clinical Rating System (KSS) and the WOMAC were used. Analysis of TKA position was performed on radiographs according to Ewald et al. Correlation of psychological variables with outcomes was performed (p < .05). Self-efficacy did not influence clinical scores. More depressed patients showed higher pre- and postoperative WOMAC scores, but no difference in amelioration. KSS scores were not influenced. Patients with higher State and Trait Anxiety Indexes had higher WOMAC and lower KSS scores before and after the operation, but most significant correlations were <0.3. Several SCL-90 dimensions had significant correlations with pre- and postoperative clinical scores, but not with their amelioration. The SCL-90 subscore for somatization and the overall SCL-90 significantly correlated with the WOMAC, KSS before and after TKA. Depression, anxiety, a tendency to somatize and psychological distress were identified as significant predictors for poorer clinical outcomes before and/or after TKA. Standardized preoperative screening and subsequent treatment should become part of the preoperative work-up in orthopaedic practice. Prognostic prospective, Level I.

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The unhappy total knee arthroplasty (TKA) patient: higher WOMAC and lower KSS in depressed patients prior and after TKA.

Trochleoplasty and reconstruction of the medial patellofemoral ligament (MPFL) are among the most commonly performed surgical treatments in patients with patellofemoral instability. The primary purpose of the study was to perform a systematic literature review on trochleoplasty in the treatment of patients with patellofemoral instability. The secondary purpose was to compare the outcomes with those seen in patients treated after reconstruction of the MPFL. A standardised search on search engines was performed. All observational and experimental studies dealing with trochleoplasty were then obtained and reviewed in a consensus meeting. Fifteen articles out of 1543 were included and analysed using the CASP appraisal scoring system. Twenty-five studies on MPFL reconstruction were obtained for comparison. The clinical and radiological outcomes were statistically analysed. Both treatment groups showed significant improvement in outcomes from pre- to post-operatively. The mean post-operative Kujala and the Lysholm scores significantly increased in both groups when compared to preoperatively (trochleoplasty group: Kujala 61.4–80.8 and Lysholm 55.5–78.5; MPFL group: Kujala 46.9–88.8 and Lysholm 59.9–91.1). Post-operatively a positive apprehension test was found in 20 and 8 % of the trochleoplasty and MPFL groups, respectively. No significant differences in redislocation (2 %) and subluxation (5–6 %) rates were found. This systematic review showed that both trochleoplasty and MPFL reconstruction are able to deliver good clinical outcomes with stable patellofemoral joints. III.

Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review

Heterotopic ossification (HO) is a well-known complication after total hip arthroplasty (THA). Recently, the trend is to operate THA minimally invasive being less traumatic than standard approaches and promising a faster return to activity. The purpose of the study was to investigate if minimal invasive surgery (MIS), leads also to less HO after THA. This retrospective study included 134 consecutive patients undergoing THA. In 42 (31.3%) patients a standard modified anterolateral (STD-Watson-Jones), in 28 (20.9%) patients a standard transgluteal Bauer approach (STD-Bauer), in 39 (29.1%) a MIS direct anterior approach (AMIS) and in 25 (18.7%) patients a MIS anterolateral (MIS-AL) approach was used. Standard preoperative anterior-posterior and lateral radiographs were assessed for occurrence of HO. HO was classified according to Brooker. In addition, short- and long-term adverse events were noted. Data was statistically analyzed using Chi-square tests, analysis of variance, multivariate data analysis and Pearson’s correlation (p < 0.05). Overall, HO was found in 38 caucasian patients (28.4%) after THA. The STD-Watson-Jones group showed the highest HO rate (45.2% n = 19) with a significant difference to the AMIS (23.1% n = 9) and STD-Bauer approach (14.3% n = 4). No statistical difference was found to the MIS-AL approach (24.0% n = 6). Postoperative complications did not differ significantly except for a higher incidence of Trendelenburg`s sign in STD-Bauer. The rate and degree of HO after THA were significantly different with regards to the surgical approach. The standard modified anterolateral approach resulted in the highest HO rate, however, MIS approaches showed higher HO rates than the STD-Bauer.

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Influence of surgical approach on heterotopic ossification after total hip arthroplasty – is minimal invasive better? A case control study

Chondral lesions with osseous involvement represented by grades 3 and 4 showed higher SPECT/CT bone tracer uptake than those without osseous involvement (grades 1 and 2).

Do Chondral Lesions of the Knee Correlate with Bone Tracer Uptake by Using SPECT/CT?

Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) tracer uptake has been shown to reflect the loading history of the tibiofemoral knee joint and correlate with the mechanical and anatomical alignment. It was our primary purpose to develop a novel standardized SPECT/CT algorithm for patients undergoing high tibial osteotomy, evaluate the inter- and intra-observer reliability (OR), and assess the clinical applicability for follow-up of patients before and after high tibial osteotomy. The localization scheme defines 9 femoral, 8 patellar, and 13 tibial zones to accurately map the examined tracer uptake volume in each anatomical area of interest. Maximum values for each area (mean ± standard deviation, median, and range) of the localization scheme were recorded as well as normalized values for the intensity of SPECT/CT tracer uptake calculated. The inter- and intra-OR was assessed for SPECT/CT localization and tracer activity. Pre- and postoperative mechanical alignment was assessed in SPECT/CT using a custom-made specialized software. The median inter- and intra-observer differences of the measured mechanical alignment were calculated along with the inter- and intra-OR. The localization scheme showed near-perfect inter- and intra-OR (intra-class correlation coefficient (ICC) > 0.9) for the measurement of tracer activity and localization in all anatomical regions. For measurements of mechanical alignment, there was a strong agreement between the two observers (an inter-OR of ICC = 0.99 and an intra-OR of ICC = 0.98). The presented SPECT/CT algorithm is highly reliable and clinically feasible. Combined with mechanical alignment analysis, it provides the surgeon with helpful information about realignment effects of high tibial osteotomies (HTOs) and might help identify the optimal personalized degree of correction in HTO surgery.

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Enrique Adrian Testa

Papers

The unhappy total knee arthroplasty (TKA) patient: higher WOMAC and lower KSS in depressed patients prior and after TKA.

Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review

Influence of surgical approach on heterotopic ossification after total hip arthroplasty – is minimal invasive better? A case control study

Do Chondral Lesions of the Knee Correlate with Bone Tracer Uptake by Using SPECT/CT?

Assessment of the loading history of patients after high tibial osteotomy using SPECT/CT - a new diagnostic tool and algorithm