Showing papers in "European Journal of Orthopaedic Surgery and Traumatology in 2015"
TL;DR: TKA had higher postoperative complications than UKA, but had lower revision rates, and further research that assesses long-term survivorship is necessary to better evaluate UKA and TKA in the treatment of unicompartmental knee osteoarthritis.
Abstract: To compare clinical outcomes of unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). A systematic review and meta-regression to compare postoperative outcomes of pain VAS, knee function score, range of motion, complications and revision surgery rates between UKA and TKA were conducted. Relevant randomized controlled trials were identified from MEDLINE and Scopus from inception to August 29, 2014. Three of 1056 studies were eligible; two, three, two, three and three studies were included in pooling of pain visual analog score (VAS), Knee Society Score (KSS) and Bristol Knee Score (BKS), maximum knee flexion, postoperative complications (aseptic loosening, progressive degenerative joint disease of lateral compartment, bearing dislocation, DVT, fractures and infection) and revision rates, respectively. The unstandardized mean difference (UMD) of the function scores (KSS, BS) for UKA was 1.62 (95 % CI −1.17, 4.42) better than TKA and for pain score was 0.1 (95 % CI −3.54, 3.73) higher than TKA, but both without statistical significance. UKA was more likely to show higher mean maximum knee flexion with a UMD of 1.88 (95 % CI −0.54, 4.30) when compared to TKA, but was also not statistically significant. UKA had a statistically significant lower chance of postoperative complications by 0.35 U (95 % CI 0.12, 0.98) when compared to TKA, but had higher revision rates than TKA with a value of 5.36 (95 % CI 1.06, 27.08). In short-term outcomes (5 years or less, with follow-up of 0–5 years), TKA had higher postoperative complications than UKA, but had lower revision rates. There was only one study that reported long-term survivorship (more than 5 years, with follow-up of 5–15 years). Further research that assesses long-term survivorship is necessary to better evaluate UKA and TKA in the treatment of unicompartmental knee osteoarthritis.
117 citations
TL;DR: It is indicated that the introduction of a smartphone app “WhatsApp” as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.
Abstract: Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app “WhatsApp” as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp’s group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app “WhatsApp” as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.
92 citations
TL;DR: It is suggested that bone healing in the context of smoking behavior follows a similar time sequence as observed in wound healing, including improved risk stratification and better identification of circumstances where adjunct therapy is appropriate.
Abstract: Smoking is a worldwide epidemic. Complications related to smoking behavior generate an economic loss around $193 billion annually. In addition to impacting chronic health conditions, smoking is linked to increased perioperative complications in those with current or previous smoking history. Numerous studies have demonstrated more frequent surgical complications including higher rates of infection, poor wound healing, heightened pain complaints, and increased pulmonary morbidities in patients with a smoking history. Longer preoperative cessation periods also seem to correlate with reduced rates. At roughly 4 weeks of cessation prior to surgery, complication rates more closely reflect individuals without a smoking history in comparison with those that smoke within 4 weeks of surgery. In the musculoskeletal system, a similar trend has been observed in smokers with higher rates of fractures, nonunions, malunions, infections, osteomyelitis, and lower functional scores compared to non-smoking patients. Unfortunately, the present literature lacks robust data suggesting a temporal relationship between smoking cessation and bone healing. In our review, we analyze pseudoarthrosis rates following spinal fusion to suggest that bone healing in the context of smoking behavior follows a similar time sequence as observed in wound healing. We also discuss the implications for further clarity on bone healing and smoking cessation within orthopedics including improved risk stratification and better identification of circumstances where adjunct therapy is appropriate.
78 citations
TL;DR: IV or intraarticular use of TXA for patients undergoing TKA is effective and safe for the reduction blood loss and blood transfusion requirements, yet does not increase the risk of postoperative DVT.
Abstract: Tranexamic acid (TXA) is well established as a versatile intraarticular and intravenous (IV) antifibrinolytic agent that has been successfully used to control bleeding after total knee arthroplasty (TKA). The present meta-analysis aimed at assessing the effectiveness and safety of TXA in reducing blood loss and transfusion in TKA. We searched the PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases from 1966 to December 2013. Only randomized controlled trials (RCTs) were included in the present study. Two independent reviewers identified the eligible studies, assessed their methodological quality, and extracted data. The data were using fixed-effects or random-effects models with standard mean differences and risk ratios for continuous and dichotomous variables, respectively. Subgroup analysis was performed according to the IV or intraarticular administration of TXA. Thirty-four RCTs encompassing 2,594 patients met the inclusion criteria for our meta-analysis. Our meta-analysis indicated that when compared with the control group, the IV or intraarticular use of TXA significantly reduced total blood loss, postoperative blood loss, Hb loss, and transfusion rate as well as blood units transfused per patient after primary TKA, but did not reduce intraoperative blood loss. No significant difference in deep vein thrombosis (DVT), pulmonary embolism, or other adverse events among the study groups. IV or intraarticular use of TXA for patients undergoing TKA is effective and safe for the reduction blood loss and blood transfusion requirements, yet does not increase the risk of postoperative DVT. Level II.
76 citations
TL;DR: Activating mutations of the fibroblast growth factor 23 (FGF-23) gene and inactivating mutations in the phosphate regulating gene (PHEX gene with homologies to endopeptidases on the X chromosome) have been identified and have been implicated in the pathogenesis of these disturbances.
Abstract: Hypophosphatemic rickets (HR) is a genetic disorder, which prevents sufficient reabsorption of phosphate in the proximal renal tubule, with increased phosphate excretion, resulting in rickets. The more common form of HR is an X-linked inherited trait, with a prevalence of 1/20,000. The defective gene is located on the X chromosome, but females may present with a wide variety of clinical manifestations. The less common form of HR is caused by autosomal-dominant transmission. Activating mutations of the fibroblast growth factor 23 (FGF-23) gene and inactivating mutations in the phosphate regulating gene (PHEX gene with homologies to endopeptidases on the X chromosome), involved in the regulation of FGF-23, have been identified and have been implicated in the pathogenesis of these disturbances. A review of etiopathogenesis and clinical, differential diagnostic and therapeutic aspects of HR, with a particular emphasis on bone impairment, is reported.
74 citations
TL;DR: The meta-analysis revealed that ACL reconstruction with BPTB autografts resulted in increased anterior knee pain and kneeling pain compared with hamstring autografteds, andRadiographic evidence of osteoarthritis showed that incidence of OA was significantly higher in B PTB groups compared with HT groups based on IKDC system.
Abstract: The objective of this study was to evaluate the effectiveness of BPTB autografts versus HT autografts at a minimum of 5 years after anterior cruciate ligament (ACL) reconstruction. A systematical search of literature was performed in PubMed, Embase and the Cochrane library to identify published randomized controlled trials (RCT) or prospective cohort studies (PCS) relevant to ACL reconstruction comparing BPTB and HT autografts. The results of the eligible studies were analysed in terms of objective International Knee Documentation Committee (IKDC) scores, return to preinjury activity level, KT-1000, Lachman test, pivot shift test, anterior knee pain, kneeling pain, extension loss, and flexion loss, graft failure and radiographic outcomes. Study quality was assessed by using the Coleman methodology score for included studies. Two reviewers independently assessed each study for quality and extracted data. Subgroup analysis of the primary outcomes was conducted according to the type of study design (RCT or PCS). Twelve RCTs, two PCS including 1,443 patients comparing hamstring and patellar tendon autografts were identified. The results of the meta-analysis showed that there were no significant differences between BPTB and HT in terms of objective IKDC score (P = 0.83), return to preinjury activity (P = 0.69), KT-1000 (P = 0.12), Lachman test (P = 0.76), pivot shift test (P = 0.11), extension deficit (P = 0.09), flexion deficit (P = 0.71) and graft failure (P = 0.22). However, outcomes in favour of HT autografts were found in terms of anterior knee pain (P = 0.0001) and kneeling pain (P = 0.001). Radiographic evidence of osteoarthritis (OA) showed that incidence of OA was significantly higher in BPTB groups compared with HT groups based on IKDC system. These findings were still robust during the sensitivity analysis. Results from subgroup analysis of the primary outcomes were consistent with the overall analysis. Meta-analysis of prospective trials did not detect any significant differences in clinical results, as evidenced by the objective IKDC score, return to preinjury activity level, KT-1000, Lachman test, pivot shift test, extension loss, flexion loss and graft failure. However, the meta-analysis revealed that ACL reconstruction with BPTB autografts resulted in increased anterior knee pain and kneeling pain compared with hamstring autografts. Increased incidence of OA was found after ACL reconstruction at a minimum of 5 years in BPTB group compared with HT autografts. This result should be cautiously interpreted. More high-quality RCT with strictly specified inclusion criteria are highly required before drawing a reliable conclusion.
70 citations
TL;DR: Conservative treatment including physiotherapy and bracing is the mainstay in the treatment of symptomatic spondylolysis and low-grade isthmic sponylolisthesis in fine athletes.
Abstract: To provide evidence-based data about the aetiology, incidence, diagnosis and treatment of isthmic lumbar spondylolysis and low-grade spondylolisthesis and return to athletic activities in fine athlete. This is a comprehensive literature review. A thorough MEDLINE search in the period from 1973 to 2014 with the keywords: athlete, spondylolysis, low-grade spondylolisthesis, treatment and return to athletic activities was conducted. A total of 228 articles were initially enrolled from the search, and 74 case series and reviews were finally included because they referred to incidence, diagnosis, treatment and return to play in fine athletes with symptomatic isthmic spondylolysis and low-grade (Meyerding I and II) spondylolisthesis. There were 13 studies reporting surgical treatment (194 patients of average age 19 years) and 14 studies with conservative treatment (589 patients of average age 15.7). The percentage of athletes who were successfully treated with conservative or operative treatment was 85 and 87.8 %, respectively. Conservative treatment including physiotherapy and bracing is the mainstay in the treatment of symptomatic spondylolysis and low-grade isthmic spondylolisthesis in fine athletes. If consequent treatment fails, the operative treatment (pars repair and short fusion) is decided. Return to play following surgery varies from 6 to 12 months with prohibition in collision sports. Return to play is mostly depended on specific sport activity.
63 citations
TL;DR: The FJS-12 was correlated with and showed reliability similar to that of the JHEQ and WOMAC, which is not affected by culture or lifestyle, may be useful in Japan.
Abstract: The Forgotten Joint Score-12 (FJS-12) is for patients to forget their artificial joint and is reportedly a useful patient-reported outcome tool for artificial joints. The purpose of this study was to determine whether the FJS-12 is as useful as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) in Japan. All patients who visited our hospital’s hip joint specialists following unilateral THA from August 2013 to July 2014 were evaluated. Medical staff members other than physicians administered three questionnaires. Items evaluated were (1) the reliability of the FJS-12 and (2) correlations between the FJS-12 and the total and subscale scores of the WOMAC or JHEQ. Of 130 patients, 22 were excluded. Cronbach’s α coefficient was 0.97 for the FJS-12. The FJS-12 showed a significantly lower score than the WOMAC or JHEQ (p < 0.01). The FJS-12 was moderately correlated with the total WOMAC score (r = 0.522) and its subscale scores for “stiffness” (r = 0.401) and “function” (r = 0.539) and was weakly correlated with the score for “pain” (r = 0.289). The FJS-12 was favorably correlated with the total JHEQ score (r = 0.686) and its subscale scores (r = 0.530–0.643). The FJS-12 was correlated with and showed reliability similar to that of the JHEQ and WOMAC. The FJS-12, which is not affected by culture or lifestyle, may be useful in Japan.
61 citations
TL;DR: It was confirmed that stand-alone anchored PEEK cage is a valid alternative to plating in ACDF with a low rate of adjacent-level ossification, however, the potential to reduce the incidence of dysphasia was not confirmed.
Abstract: To avoid complications associated with plating in anterior cervical discectomy and fusion (ACDF), stand-alone anchored PEEK cage was developed and favourable outcomes with a low rate of dysphasia have been described. The objective of this study was to compare the clinical and radiological outcomes of ACDF using a standalone anchored PEEK cage (PREVAIL; Medtronic Sofamor Danek, Memphis, TN) with those of a PEEK cage with plating in a prospective randomized manner. Fifty patients with single-level cervical radiculopathy were randomly assigned to a PREVAIL or a PEEK cage with plating. Following 3, 6, 12, and 24 months, clinical and radiological outcomes were assessed. The mean surgical time for the patients with a PREVAIL was significantly shorter than that for those with a PEEK cage with plating. The clinical outcomes evaluated by visual analogue scale for pain and the Odom’s criteria were comparable between both the groups. Both the groups demonstrated the high fusion rate (92 % in PREVAIL; 96 % in PEEK cage with plating). The subsidence rate and the improvement of cervical alignment were comparable between both the groups. The incidence of adjacent-level ossification was significantly lower for patients with a PREVAIL than that for those with a PEEK cage with plating. The rate of dysphasia graded by the method of Bazaz and measurement of prevertebral soft tissue swelling indicated no significant differences between both the groups. Our prospective randomized study confirmed that stand-alone anchored PEEK cage is a valid alternative to plating in ACDF with a low rate of adjacent-level ossification. However, the potential to reduce the incidence of dysphasia was not confirmed.
57 citations
TL;DR: Compared with one-dose intravenous administration, intra-articular administration of TXA seems to be more effective in terms of reducing drained blood loss and transfusion frequency and recommend administration of topical TXA in primary TKA in healthy patients to decrease perioperative blood loss.
Abstract: The purpose of this study was to compare the efficacy of intravenous and topical tranexamic acid (TXA) versus control group for reduction in blood loss following primary total knee arthroplasty (TKA). A total of 90 patients were prospectively allocated to each of three groups (control, intravenous IV and intra-articular) and underwent unilateral total knee arthroplasty. In the IV group, patients received one dose of TXA of 15 mg/kg before deflation of the tourniquet, while in the intra-articular group patients received 2 g TXA via the drain retrogradely after closure of the wound. The mean drained blood loss in control, IV and intra-articular groups was 415 ± 24, 192 ± 21 and 121 ± 17 ml, respectively. About 43 % (control), 23 % (IV) and 17 % (intra-articular) of each group required transfusion, and the mean transfusion was 338, 168 and 79 ml, respectively. Preoperative hemoglobin values decreased at 24 h by 2.80 ± 0.14, 2.24 ± 0.17 and 2.26 ± 0.18 mg/dl, respectively. TXA reduced blood loss and transfusion requirement. Compared with one-dose intravenous administration, intra-articular administration of TXA seems to be more effective in terms of reducing drained blood loss and transfusion frequency. We recommend administration of topical TXA in primary TKA in healthy patients to decrease perioperative blood loss.
57 citations
TL;DR: The authors' data suggests equivocal outcomes as measured by similar catastrophic failure rate between both short and long cephalomedullary nails for intertrochanteric femur fractures, however, there was an increased risk of secondary femur fracture with short cEPhalomed Mullary nails when compared to long nails that approached statistical significance.
Abstract: Hip fractures are becoming increasingly common resulting in significant morbidity, mortality and raising healthcare costs. Both short and long cephalomedullary devices are currently employed to treat intertrochanteric hip fractures. However, which device is optimal continues to be debated as each implant has unique characteristics and theoretical advantages. This study looked to identify rates of complications associated with both long and short cephalomedullary nails for the treatment of intertrochanteric hip fractures. We retrospectively reviewed charts from 2006 to 2011, and we identified 256 patients were identified with AO class 31.1–32.3 fractures. Sixty were treated with short nails and 196 with long nails. Radiographs and charts were then analysed for failures and hardware complications. Catastrophic failure and hardware complication rates were not statistically different between short or long cephalomedullary nails. The overall catastrophic failure rate was 3.1 %; there was a 5 % failure rate in the short-nail group compared with a 2.6 % failure rate in the long-nail group (p = 0.191). There was a 3.33 % secondary femur fracture rate in the short-nail group, compared with none in the long-nail cohort (p = 0.054). The rate of proximal fixation failure was 1.67 % for the short-nail group and 2.0 % in the long-nail group (p = 0.406). Our data suggests equivocal outcomes as measured by similar catastrophic failure rate between both short and long cephalomedullary nails for intertrochanteric femur fractures. However, there was an increased risk of secondary femur fracture with short cephalomedullary nails when compared to long nails that approached statistical significance.
TL;DR: Diabetes and smoking were independent risk factors for SSIs and it is recommended to tightly regulate blood glucose levels and stop smoking to reduce the SSIs.
Abstract: Surgical site infection (SSI) is the most common complication following surgical procedures. The aim of this study was to determine the incidence and associated risk factors of SSI in orthopedic patients admitted in a tertiary care center. Data were collected which focused on demographic details, lifestyle factors, diagnosis, surgical procedure, duration of surgery, prophylactic antibiotics, postoperative antibiotics and comorbidity obtained from the patients hospital records. Univariate analysis and multinomial logistic regression tests were performed to identify independent risk factors for orthopedic incisional SSIs. The overall rate of SSI was 2.1 %. Univariate analysis showed diabetes, smoking and duration of hospital stay to be significantly associated with patients in whom SSI developed than in uninfected control patients. Independent risk factors for SSI that were identified by multinomial logistic regression were diabetes (OR 3.953) and smoking (OR 38.319). Diabetes and smoking were independent risk factors for SSIs. Therefore, it is recommended to tightly regulate blood glucose levels and stop smoking to reduce the SSIs.
TL;DR: The LIA technique cannot be recommended for shoulder replacement unless substantially modified, and occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.
Abstract: Shoulder replacement involves significant post-operative pain, which is often managed by continuous interscalene brachial plexus block. Catheter displacement and complications limit the beneficial effect of the block. Local infiltration analgesia (LIA) has provided good results in knee replacement. We aimed to assess the effectiveness of LIA for pain after shoulder replacement. Patients scheduled for primary shoulder replacement under general anaesthesia were randomized to receive either local infiltration analgesia (LIA) (150 ml ropivacaine 0.2 % with epinephrine intra-operatively) or interscalene brachial plexus catheter (ISC) (ropivacaine 0.75 %, 7 ml bolus followed by 48-h 5 ml/h infusion). The primary outcome was opioid consumption during the first 24 post-operative hours. Secondary outcomes were pain ratings, supplementary analgesics, and side effects for 3 days, and complications until 3 months after surgery. Data were analysed for 61 patients (LIA 30, ISC 31). Twenty-four-hour opioid consumption was higher in the LIA group compared with the ISC group: median (IQR) 95 mg (70–150 mg) versus 40 mg (8–76 mg) (P = 0.0001). No significant difference in opioid consumption was found between groups during the following 3 days. The LIA group had higher pain scores at 0, 2, 4, and 8 h. Two patients in the ISC group had long-lasting complications. The LIA technique cannot be recommended for shoulder replacement unless substantially modified. Occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.
TL;DR: Compared with SF/CS, SF/C scaffold showed better porosity, water absorption expansion rate, elasticity modulus and pore size, cells grow well inside the scaffolds, and was more suitable for tissue engineering.
Abstract: In this study, the silk fibroin blended constructs were produced, scaffold performances of different kinds of scaffold were analyzed, and the better type for tissue engineering was optimized.
The silk fibroin/collagen (SF/C) and silk fibroin/chitosan (SF/CS) were made using a freeze-drying technique, porosity, water absorption expansion rate, mechanical properties and pore size of different scaffold was detected. Bone marrow mesenchymal stem cells (BMSCs) of 4-week-old male Wistar rats were separated by density gradient centrifugation, third generation BMSCs were seeded onto scaffolds, cultured 14 days, proliferation and metabolize of cells were detected in different time using the thiazolyl blue tetrazolium bromide (MTT) assay method, and cell morphology and distribution were observed by histological analysis and scanning electron microscopy (SEM). Porosity, water absorption expansion rate and Young’s modulus of SF/C were significantly higher than SF/CS (p 0.05); MTT results showed that the metabolism of cells in the SF/C was better than SF/CS; after cultivation for 14 days, in the inner zone of scaffolds, cells staining were little or absent from SF/CS, lots of cells staining were existing in SF/C; pore size was consistent, holes communicated with each other better, stem cells grew well inside the scaffolds, extended fully and secreted much extracellular matrix under SEM in SF/C scaffold; internal structure of SF/CS was disorder, holes size were not consistent, and did not communicated with each other and cells were partly dead. Compared with SF/CS, SF/C scaffold showed better porosity, water absorption expansion rate, elasticity modulus and pore size, cells grow well inside the scaffolds, and was more suitable for tissue engineering.
TL;DR: It is concluded that intra-articular TXA in patients undergoing unilateral TKA could significantly reduce postoperative blood loss and blood transfusion and avoid perioperative anemia-related complications without increased risk of venous thrombosis.
Abstract: The objective of this randomized controlled trial was to evaluate the efficacy and safety of intra-articular injections of tranexamic acid (TXA) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty (TKA) without drainage. Primary TKA was performed on a total of 80 patients (80 knees) affected to various degrees by knee osteoarthritis. The patients were randomized to receive 500 mg of TXA in 20 mL of normal saline solution (n = 40) or an equivalent volume of normal saline solution (n = 40), applied into the joint for 5 min at the end of surgery. Data on routine blood examination, blood loss and blood transfusion after TKA were compared between the two groups. The results showed no significant difference between the two groups in intra-operative blood loss (P = 0.136). The mean postoperative visible blood loss, hidden blood loss and transfusion requests were significantly different between the two groups (P < 0.05). The values of postoperative hemoglobin and hematocrit were lower in the control group compared with those in the treatment group (P < 0.05). No deep vein thrombosis was detected through Doppler ultrasound examination. Three hour postoperative D-dimer in the control group was higher than the treatment group (P = 0.02). There was no statistically significant difference between the coagulation indicators and range of motion in the two groups. We conclude that intra-articular TXA in patients undergoing unilateral TKA could significantly reduce postoperative blood loss and blood transfusion and avoid perioperative anemia-related complications without increased risk of venous thrombosis. Level I. Therapeutic study.
TL;DR: Some of the limitations that remain regarding the prevention, diagnosis and treatment of post-traumatic long bone osteomyelitis are highlighted.
Abstract: The management of post-traumatic long bone osteomyelitis remains challenging [1]. While significant progress has been made over the past 10–20 years, many simple questions such as optimal duration or route of antibiotics administration remain unanswered [2]. General principles of early aggressive management, optimization of host factors and wide debridement of affected tissues with later reconstruction are commonly accepted. These principles share similarities with those applied in tumor surgery [3]. Unfortunately, specific diagnostic and treatment strategies are ill-defined and lack prospective evidence. In this paper, we highlight some of the limitations that remain regarding the prevention, diagnosis and treatment of post-traumatic long bone osteomyelitis. Numerous variables in the disease and host type
TL;DR: The two procedures suffer from equal risk of subsequent spinal fractures; PVP has a significant higher cement leakage rate compared to BKP, mainly caused by a higher paravertebral leakage, patients with extremely poor pulmonary function or unstable haemodynamic are better candidates for BKp.
Abstract: Purpose
To compare complications of percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs).
TL;DR: The authors' analysis showed a significant reduction in prevalence of CRPS with the use of vitamin C, and high-quality RCTs with standard dosages and common diagnostic criteria are needed to be able to deliver solid conclusions.
Abstract: Complex regional pain syndrome is a well-known complication after distal radius fracture with incidence ranging from 10.5 to 37 %. Some studies recommend the use of vitamin C to prevent complex regional pain syndrome. The objective of this meta-analysis was to evaluate the efficacy of vitamin C in prevention of CRPS. We searched the PubMed, EMBASE and Cochrane library databases for randomized controlled trial (RCT) and comparative studies reporting use of vitamin C to prevent distal radius fracture. Dichotomous variable was presented as risk ratio with 95 % confidence intervals. We obtained 220 articles from the database search. After the exclusion of duplicates, unrelated articles, letter to editor and editorials, we found four articles relevant to our topic. Meta-analysis of the CRPS incidence revealed that the incidence of CRPS was significantly lower in the vitamin C group [RD 0.41 (0.19–0.92), P = 0.03]. There was moderate to high heterogeneity in the studies included I
2 = 63 %). Our analysis showed a significant reduction in prevalence of CRPS with the use of vitamin C. Further high-quality RCTs with standard dosages and common diagnostic criteria are needed to be able to deliver solid conclusions.
TL;DR: According to this experiment, press-fit fixation of a cementless acetabular cup achieved rigid stability, and although the supplemental screws increased stability of the implant under good press- fit conditions, they showed little impact on whole-cup stability.
Abstract: Background
Press-fit and screw fixation are important technical factors to achieve initial stability of a cementless acetabular cup for good clinical results of total hip arthroplasty. However, how these factors affect one another in initial cup fixation remains unclear. Therefore, this study aimed to evaluate the mutual influence between press-fit and screw fixation on initial cup stability.
TL;DR: A significant degree of postoperative improvement in terms of SF-36 scores for common orthopedic interventions in particular to primary TKA, THA and TLIF at 6 months and 2 years of follow-up is shown.
Abstract: Patient quality of life scores are commonly used to assess patient-reported satisfaction following orthopedic interventions. Our main aim was to review the satisfaction scores of four common orthopedic interventions in our tertiary institution, primary hallux valgus (HV) corrective surgery, primary single-level transforaminal lumbar interbody fusion (TLIF), primary unilateral total knee arthroplasty (TKA) and primary total hip arthroplasty (THA). We retrospectively reviewed prospectively collected data on patients who underwent four different types of orthopedic surgeries using the SF-36 score and two questions adopted from North American Spine Society Questionnaire. The database of a tertiary hospital between January 2007 and December 2009 was reviewed. There were 3488, 374, 184 and 73 patients who underwent TKA, THA, TLIF and HV surgery, respectively. Patients who underwent primary TLIF, TKA and THA had significant degree of improvement in all aspects of SF-36 scores at 6 months and 2 years of follow-up (p < 0.001). Postoperatively at 2 years, the most satisfied postoperative patients were those who underwent THA (91.9 %), followed by TKA (90.5 %), TLIF (86.1 %) and HV (77.4 %). This study shows a significant degree of postoperative improvement in terms of SF-36 scores for common orthopedic interventions in particular to primary TKA, THA and TLIF at 6 months and 2 years of follow-up. With a significant degree of improvement in SF-36 scores postoperatively, this also translated into patient satisfaction and meeting their expectations of surgery.
TL;DR: It is inferred that hyaluronic acid works synergically and improves the activity of several molecules contained in platelet-rich plasma in order to improve clinical and functional outcomes in knee osteoarthritis.
Abstract: The combined use of hyaluronic acid and platelet-rich plasma has never been reported in the treatment for osteoarthritis. Aim of this paper was to evaluate the efficacy of this association and to compare retrospectively these results with those of a cohort of patients treated with platelet-rich plasma only. Subjects with mild-to-moderate knee osteoarthritis were enrolled. After clinical and ultrasound evaluation, patients received a weekly intra-articular injection of 2 ml of hyaluronic acid added with 2 ml of platelet-rich plasma for 3 weeks. Follow-up was performed at 1, 3, and 6 months. The same clinical parameters were retrospectively collected from a cohort of patients treated with 4–5 ml of platelet-rich plasma only. Forty knees were treated in both groups. The intra-group comparison showed a significant improvement in clinical and functional outcomes at 1, 3, and 6 months, while the infra-group comparison did not show any significant difference. The association of platelet-rich plasma + hyaluronic acid has the same efficacy of platelet-rich plasma only, administered in higher volume. We may infer that hyaluronic acid works synergically and improves the activity of several molecules contained in platelet-rich plasma.
TL;DR: A review of the available literature relating cerclage-wiring techniques and updates the recommendations for clinical use is presented.
Abstract: Cerclage wiring is a simple technique that has been practiced widely since the advent of surgical treatment of fractures. Many studies have reported the use of various cerclage technologies with a wide range of results and clinical applications. The increasing numbers of periprosthetic fractures have led to a revival of interest for this simple technique. When cerclages function as implants, they may be used alone or together with a protecting device such as external or internal splints (such as plates, nails, stems of prosthesis or a combination of thereof). This article presents a review of the available literature relating cerclage-wiring techniques and updates the recommendations for clinical use.
TL;DR: The current approach for staging, principles of biopsy, tumor classification, treatment, and follow-up of patients with bone sarcomas are presented.
Abstract: Bone sarcomas are a variety of non-epithelial, malignant neoplasms of bone. The most common bone sarcomas are osteosarcoma, Ewing's sarcoma, and chondrosarcoma. The approach to a patient with a suspected bone sarcoma from initial examination to the histological diagnosis and classification is staging. Staging is of critical importance, in order to classify different treatment options and point out which combination of them is more suitable depending on the severity of the tumor in every individual patient. Staging should include medical history, physical and imaging examination, and biopsy. This article presents the current approach for staging, principles of biopsy, tumor classification, treatment, and follow-up of patients with bone sarcomas.
TL;DR: The meta-analysis showed that the use of barbed sutures was associated with increased superficial infection rate and shorter estimated closure time, and more RCTs are needed to examine the efficacy and safety of the barbedSutures.
Abstract: The use of barbed sutures in various surgical specialities has shown lower operative time and equivalent wound complications. Use of barbed suture in total knee arthroplasty is still at nascent stage with only few studies comparing it with the standard closure techniques. The purpose of this review was to appraise the clinical outcomes of barbed suture use in closure of total knee arthroplasty. We searched the Cochrane library, PubMed and EMBASE up to December 2014 for clinical trials comparing the outcomes of closure of total knee arthroplasty with barbed sutures versus standard sutures. When there was no high heterogeneity, we used a fixed effects model. Dichotomous variables were presented as risk ratios (RRs) with 95 % confidence intervals (CIs), and continuous data were measured as measured differences with 95 % CIs. Five studies were included, with sample size ranging from 178 to 416. Fixed effect analysis showed that superficial infection was higher with barbed suture (RR 1.54, 95 % CI 0.36–2.59, P = 0.94). The barbed sutures have significantly lower closure time (MI −2.74, CI −3.06, −2.42, P < 0.00001). There was no difference in terms of deep infection, wound dehiscence, arthrofibrosis and total operative time. Our meta-analysis showed that the use of barbed sutures was associated with increased superficial infection rate and shorter estimated closure time. More RCTs are needed to examine the efficacy and safety of the barbed sutures.
TL;DR: BPTB autograft shows potential as an optimal choice for ACL reconstruction on the basis of earlier functional recovery and fewer graft failure as well as a significant difference in clinical failure.
Abstract: This review aims to compare the clinical results of bone–patellar tendon–bone (BPTB) autograft and BPTB allograft in primary anterior cruciate ligament (ACL) reconstruction
PubMed Medline, EMBASE, and the Cochrane Library were systematically searched for prospective or retrospective cohort studies that compared BPTB autograft with BPTB allograft in ACL reconstruction The results of the eligible studies were independently extracted and analyzed according to the following: one-leg test, range of motion (ROM), overall International Knee Documentation Committee (IKDC), Lachman test, pivot shift test, Lysholm scores, Tegner scores, KT-1000 test, anterior knee pain, crepitus, and clinical failure Random-effect and fixed-effect models were adopted to calculate the weight mean difference and the odds ratio for continuous and dichotomous variables with 95 % confidence interval
Thirteen studies met the inclusion criteria, resulting in 1,046 (484 autografts and 562 allografts) patients available for the present study A meta-analysis showed no significant differences between the two treatment groups in terms of the following: one-leg test (p = 021), ROM (p = 041), overall IKDC (p = 025), Lysholm scores (p = 025), Tegner scores (p = 009), KT-1000 (p = 069), Lachman test (p = 089), positive pivot shift test (p = 018), anterior knee pain (p = 093), and crepitus (p = 096) However, a significant difference in clinical failure (p = 001) in favor of autograft was observed In the fresh-frozen subgroup, no difference in the evaluations, except for Tegner scores, were found between autograft and allograft Therefore, BPTB autograft shows potential as an optimal choice for ACL reconstruction on the basis of earlier functional recovery and fewer graft failure
TL;DR: A more liberal RBC transfusion strategy was not associated with higher risk of infection among residents from nursing homes or sheltered housing undergoing hip fracture surgery.
Abstract: Objectives
It is still under debate that red blood cell (RBC) transfusions might increase the risk of healthcare-associated infections after hip fracture surgery. Previously, we found that a liberal RBC transfusion strategy improved survival in nursing home residents. Our aim, therefore, was to investigate whether a more liberal RBC transfusion strategy was associated with a higher infection risk in frail elderly hip fracture patients.
TL;DR: TightRope and clavicular hook plate repairs of unstable distal clavicle fractures result in similar fracture union and good clinical outcomes, according to data from the RAND 36-item questionnaire.
Abstract: This retrospective study aimed to compare the fracture union and functional results of clavicular hook plate fixation versus arthroscopy-assisted TightRope fixation of unstable fractures of the distal clavicle. Forty patients with unstable (Neer II) distal clavicular fracture were treated surgically using either a clavicular hook plate (n = 19) or arthroscopy-assisted TightRope fixation (n = 21) between 2007 and 2012 in our hospital. Medical records were retrospectively reviewed. Clinical and radiological results after an average period of 62 months for the clavicular hook plate and 32 months for TightRope were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, the Constant score, and the RAND 36-item health questionnaire. One fracture in each group was failed to unite. The mean Constant score was 93 in the TightRope group and 89 in the clavicular hook plate group, with mean DASH scores of 6 and 11, respectively. According to data from the RAND 36-item questionnaire, health-related quality of life returned to normal in both groups. Removal of the plate was the main reason for reoperation. TightRope and clavicular hook plate repairs of unstable distal clavicular fractures result in similar fracture union and good clinical outcomes.
TL;DR: The assessment of the lumbar–pelvic–femoral complex by EOS imaging makes it possible to define the intrinsic and extrinsec extension reserves to describe the reciprocal adaptive capacities of the hips and spine.
Abstract: Introduction
Sagittal balance of the coxofemoral joint in standing position and its extension capacity determine hip/spine adaptation, especially in relation to pelvic retroversion, which may be age-associated or follow either spinal arthrodesis or vertebral osteotomies. The concept of extension reserve is essential for assessing posterior hip impingement. The global visualization of the lumbar–pelvic–femoral complex obtained by EOS® imaging enables this sagittal analysis of both the subpelvic region and lumbar spine by combining the reference standing position and the possibility of dynamic tests.
TL;DR: ISB is superior to GA and GA + ISB in patients undergoing shoulder arthroscopy in terms of faster recovery and analgesics consumption.
Abstract: This randomized clinical trial evaluates interscalene brachial plexus block (ISB), general anaesthesia (GA) and the combination of both anaesthetic methods (GA + ISB) in patients undergoing shoulder arthroscopy. From July 2011 until May 2012, 120 patients (male/female), aged 20–80 years, were allocated randomly to receive ISB (10 ml mepivacaine 1 % and 20 ml ropivacaine 0.375 %), GA (propofol, sunfentanil, desflurane) or ISB + GA. The primary outcome variable was opioid consumption at the day of surgery. Anaesthesia times were analysed as secondary endpoints. After surgery, 27 of 40 patients with a single ISB bypassed the recovery room (p < 0.0001). Postoperative monitoring time was significantly shorter with single ISB compared with both other groups [GA: 93 (5–182) min vs. GA + ISB: 57.5 (11–220) min vs. ISB: 35 (5–106) min, p < 0.0001]. Opioid consumption was reduced using a single ISB at the day of surgery [GA: n = 25 vs. GA + ISB: n = 10 vs. ISB: n = 10, p = 0.0037]. ISB is superior to GA and GA + ISB in patients undergoing shoulder arthroscopy in terms of faster recovery and analgesics consumption.
TL;DR: Transosseous suture technique is a safe and effective treatment method for acute TTR with a low rate of complications and excellent functional outcomes.
Abstract: The purpose of this study was to present the functional outcomes and complications after primary repair of triceps tendon ruptures (TTR). A retrospective review was performed on eight patients (six males, two females) who underwent transosseous suture repair for TTR. Mayo elbow score, range of motion, muscle strength and patient satisfaction were evaluated after at least 1-year follow-up. The mean age of the patients was 25.1 years (range 16–42). The mechanism of injury was a sports injury in three patients, simple fall (fall on outstretched hand) in four and motorcycle accident in one patient. Two patients had associated radial head fracture, and one had a radial head fracture and trochlear fracture, and one patient had a medial epicondyle fracture. In two patients the diagnosis was missed at the initial admission to ED (delay, 20 and 75 days). Only one patient, who was a bodybuilder, had a history of anabolic steroid use, and the rest had no underlying disease or a predisposing factor for TTR. One of the patients with radial head fracture (displaced three parts) underwent simultaneous fixation using two headless screws. Patients were followed up for a mean of 18.8 months (range 12–26). At the final follow-up, all patients were satisfied with the treatment and the Mayo elbow score was excellent in six patients and good in two patients. There was 5° extension loss in two patients. Triceps muscle strength was 5/5 in all patients. Ulnar nerve entrapment occurred in one patient, so ulnar nerve release and anterior transposition were performed 3 months after surgery. Posterior interosseous nerve palsy occurred in one patient who underwent simultaneous radial head fracture fixation, but eventually returned back to normal 3 months postoperatively. All patients returned to their previous level of activity and occupation. Transosseous suture technique is a safe and effective treatment method for acute TTR with a low rate of complications and excellent functional outcomes. Retrospective case series, Level IV.