Harshad Shah; Amit Grover; Daksh Gadi; Sudarshan K
Volume 2, Issue 4 , October 2014, , Pages 255-257
Abstract
Hip fractures are one of the most common injuries which present to an orthopaedic surgeon. Most of these cases are unilateral .Bilateral simultaneous femur neck fracture is a rare occurrence. We report a case of a bilateral neck femur fracture in a 30 year male following a generalized tonic clonic seizure ...
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Hip fractures are one of the most common injuries which present to an orthopaedic surgeon. Most of these cases are unilateral .Bilateral simultaneous femur neck fracture is a rare occurrence. We report a case of a bilateral neck femur fracture in a 30 year male following a generalized tonic clonic seizure in view of its rarity and also to increase the awareness of such rare injuries. The patient was operated within 3 hours. At 5 months, the patient had good radiological and functional outcome. During a convulsion, there is a powerful and forceful contraction of muscles which may lead to fracture or dislocation. The incidence of fractures following a convulsion is 1.1%. A delay in diagnosis can lead to complications like avascular necrosis, osteoarthritis, non union, functional disability and legal consequences. All orthopaedic surgeons and emergency physicians should be aware of such uncommon injuries to ensure early diagnosis and treatment.
E. Carlos RODRIGUEZ-MERCHAN
Volume 3, Issue 1 , January 2015, , Pages 9-12
Abstract
There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL)reconstruction. The purpose of this article is to answer the following questions: 1) Bone patellar tendon bone (BPTB) reconstruction or hamstring reconstruction (HR); 2) Double bundle or single ...
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There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL)reconstruction. The purpose of this article is to answer the following questions: 1) Bone patellar tendon bone (BPTB) reconstruction or hamstring reconstruction (HR); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analysesfocused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years.
Shayan Abdollah Zadegan; Masoumeh Firouzi; Mohammad Hossein Nabian; Leila Oriady Zanjani; Ahmad Mohebbi Ashtiani; Reza Shahryar Kamrani
Volume 3, Issue 2 , April 2015, , Pages 82-87
Abstract
excessive scarring; paralleling the process in tendon reconstruction of the hand. Inspired by the advantages of the two-stage technique in tendon grafting and with encouraging preliminary results, we aimed to investigate the two-stage nerve grafting technique as an alternative method of secondary nerve ...
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excessive scarring; paralleling the process in tendon reconstruction of the hand. Inspired by the advantages of the two-stage technique in tendon grafting and with encouraging preliminary results, we aimed to investigate the two-stage nerve grafting technique as an alternative method of secondary nerve repair. Methods: Thirty female rats (~200 g) were randomly distributed into two groups (n=15). A 15 mm gap was created in the sciatic nerve of all the animals and an excessive extraneural scar was induced using the “mincing” method. In this method, a thin strip of muscle was removed, minced in a petri dish and returned to the peripheral nerve. In the two stage nerve graft group, a silicone tube was interposed in the first stage. After 4 weeks, in the second stage, the silicone tube was removed and a median nerve autograft was interposed through the newly formed vascularized sheath. In the conventional graft group, two nerve ends were protected with silicone caps in the first stage. After 4 weeks the caps were removed and the median graft was interposed. Behavioral assessments were performed at week 15 after surgery with the withdrawal reflex latency (WRL) and extensor postural thrust (EPT) and at the 3, 6 and 15-week time points with the TOA (toe out angle). Masson Trichrome staining method was used for histological assessments at week 15. Results: According to the EPT and WRL, the two-stage nerve graft showed significant improvement (P=0.020 and P =0.017 respectively). The TOA showed no significant difference between the two groups. The total vascular index was significantly higher in the two-stage nerve graft group (P<0.001). Conclusions: Two-stage nerve graft using a silicone tube enhances vascularity of the graft and improves functional recovery.
E. Carlos Rodriguez-Merchan
Volume 3, Issue 4 , October 2015, , Pages 241-243
Abstract
Prosthetic joint infection (PJI) is a serious complication of total knee arthroplasty (TKA). Control of infection after a failed two-stage TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA) or a the-knee (KF). The purpose of this review is to determine ...
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Prosthetic joint infection (PJI) is a serious complication of total knee arthroplasty (TKA). Control of infection after a failed two-stage TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA) or a the-knee (KF). The purpose of this review is to determine which treatment method (AKA or KF) yields better function and ambulatory status for patients after a failed two-stage reimplantation. A PubMed search related to the resolution of infection by means of an above-the-knee amputation (AKA) or a knee fusion was performed until 10 January 2015. The key words were: infected TKA and above-the-knee amputation. Five hundred and sixty-six papers were found, of which ten were reviewed because they were focused on the topic of the article. KF should be strongly considered as the treatment of choice for patients who have persistent infected TKA after a failed two-stage revision arthroplasty. Patients can walk at least inside the house, and activity of daily living independence is achieved by the patients with successful KF, although walking aids, including a shoe lift, are required. An intramedullary nail leads to better functional results than an external fixator. The functional outcome after AKA performed after TKA is poor. A substantial percentage of the patients never fit with a prosthesis, and those who are seldom obtain functional independence. Only 50% of patients are able to walk after AKA. Patients receiving KF for treating recurrent PJI after TKA have better function and ambulatory status compared to patients receiving AKA. KF must be recommended as the treatment of choice for patients who have persistent infected TKA after a failed two-stage reimplantation procedure.
Fatih Küçükdurmaz; Miguel Gomez; Eric Secrist; Javad Parvizi
Volume 3, Issue 3 , July 2015, , Pages 163-168
Abstract
Background: The Internet has become the most widely-used source for patients seeking information more about their health and many sites geared towards this audience have gained widespread use in recent years. Additionally, many healthcare institutions publish their own patient-education web sites with ...
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Background: The Internet has become the most widely-used source for patients seeking information more about their health and many sites geared towards this audience have gained widespread use in recent years. Additionally, many healthcare institutions publish their own patient-education web sites with information regarding common conditions. Little is known about how these resources impact patient health, though, as they have the potential both to inform and to misinform patients regarding their prognosis and possible treatments. In this study we investigated the reliability, readability and quality of information about femoracetabular impingement, a condition which commonly affects young patients.
Methods: The terms “hip impingement” and “femoracetabular impingement” were searched in Google® in November 2013 and the first 30 results were analyzed. The LIDA scale was used to assess website accessibility, usability and reliability. The DISCERN scale was used to assess reliability and quality of information. The FRE score was used to assess readability.
Results: The patient-oriented sites performed significantly worse in LIDA reliability, and DISCERN reliability. However, the FRE score was significantly higher in patient-oriented sites.
Conclusion: According to our results, the websites intended to attract patients searching for information regarding femoroacetabular impingement are providing a highly accessible, readable information source, but do not appear to apply a comparable amount of rigor to scientific literature or healthcare practitioner websites in regard to matters such as citing sources for information, supplying methodology and including a publication date. This indicates that while these resources are easily accessed by patients, there is potential for them to be a source of misinformation.
Tyler Gonzalez; Eric Bluman; David Palms; Jeremy Smith; Christopher Chiodo
Volume 4, Issue 1 , January 2016, , Pages 10-15
Abstract
Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. ...
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Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application. Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed. Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group. Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety.
Ioannis Polyzois; Rupen Dattani; Rohit Gupta; Ofer Levy; A Ali Narvani
Volume 4, Issue 2 , April 2016, , Pages 104-108
Abstract
Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these ...
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Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA), the effects of delaying surgery and the optimal method of immobilisation. Extensive literature review was performed looking for previous publication addressing 4 points. i) Natural history of primary shoulder dislocation ii) Effect of surgical intervention on natural history iii) Risk of long term osteoarthritis with and without surgical intervention iv) Immobilisation techniques post reduction. Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.
Joost Kortlever; Stein Janssen; Jeroen Molleman; Michiel Hageman; David Ring
Volume 4, Issue 3 , July 2016, , Pages 213-219
Abstract
Background: Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: 1) Which demographic factors ...
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Background: Nonspecific symptoms are common in all areas of medicine. Patients and caregivers can be frustrated when an illness cannot be reduced to a discrete pathophysiological process that corresponds with the symptoms. We therefore asked the following questions: 1) Which demographic factors and psychological comorbidities are associated with change from an initial diagnosis of nonspecific arm pain to eventual identification of discrete pathophysiology that corresponds with symptoms? 2) What is the percentage of patients eventually diagnosed with discrete pathophysiology, what are those pathologies, and do they account for the symptoms? Methods: We evaluated 634 patients with an isolated diagnosis of nonspecific upper extremity pain to see if discrete pathophysiology was diagnosed on subsequent visits to the same hand surgeon, a different hand surgeon, or any physician within our health system for the same pain. Results: There were too few patients with discrete pathophysiology at follow-up to address the primary study question. Definite discrete pathophysiology that corresponded with the symptoms was identified in subsequent evaluations by the index surgeon in one patient (0.16% of all patients) and cured with surgery (nodular fasciitis). Subsequent doctors identified possible discrete pathophysiology in one patient and speculative pathophysiology in four patients and the index surgeon identified possible discrete pathophysiology in four patients, but the five discrete diagnoses accounted for only a fraction of the symptoms. Conclusion: Nonspecific diagnoses are not harmful. Prospective randomized research is merited to determine if nonspecific, descriptive diagnoses are better for patients than specific diagnoses that imply pathophysiology in the absence of discrete verifiable pathophysiology.
Knee
Mokhtar Arazpour; Fateme Bahramian; Atefe Aboutorabi; Seyed Taghi Nourbakhsh; Ardeshir Alidousti; Hamidreza Aslani
Volume 4, Issue 4 , October 2016, , Pages 298-306
Abstract
Background: Patellofemoral pain syndrome (PFPS) is one of the most frequent causes of anterior knee pain in adolescents and adults. This disorder can have a big effect on patients’ ability and quality of life and gait. Methods: This review included all articles published during 1990 ...
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Background: Patellofemoral pain syndrome (PFPS) is one of the most frequent causes of anterior knee pain in adolescents and adults. This disorder can have a big effect on patients’ ability and quality of life and gait. Methods: This review included all articles published during 1990 to 2016. An extensive literature search was performed in databases of Science Direct, Google Scholar, PubMed and ISI Web of Knowledge using OR, AND, NOT between the selected keywords. Finally, 16 articles were selected from final evaluation. Results: In PFPS subjects, there was lower gait velocity, decreased cadence, and reduced knee extensor moment in the loading response and terminal stance, delayed peak rear foot eversion during gait and greater hip adduction compared to healthy subjects, while for hip rotation, there was controversy in studies. Conclusion: Changes in the walking patterns of PFPS subjects may be associated with the strategy used for the reduction of patellofemoral joint reaction force and pain.
Hand
AndrewJ. Miller; Christopher Jones; Frederick Liss; Jack Abboudi; William Kirkpatrick; Pedro Beredjiklian
Volume 5, Issue 1 , January 2017, , Pages 10-13
Abstract
Object: The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital ...
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Object: The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital hand X-rays in osteoporosis screening. We hypothesized that similar to analog counterparts, digital hand X-rays have poor correlation and reliability in determining bone mineral density (BMD) relative to DEXA.Methods: We prospectively evaluated female patients older than 65 years who presented to our hand clinic with digital hand and wrist X-rays as part of their evaluation over six months. Patients who had a fracture and were without DEXA scans within the past two years were excluded. Five fellowship-trained hand surgeons, blinded to DEXA T-scores, evaluated the x-rays over two assessments separated by four weeks and classified them as osteoporotic, osteopenic, or normal BMD. Accuracy relative to DEXA T-score, interobserver and intraobserver rates were calculated.Results: Thirty four patients met the inclusion criteria and a total of 340 x-rays reviews were performed. The assessments were correct in 169 cases (49%) as compared to the DEXA T-scores. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) reflecting a fair agreement. The first and second assessment for all five physicians was 0.46 (range 0.19-0.78) reflecting a moderate agreement. Grouping osteoporosis and osteopenia together compared to normal, the accuracy, interobserver and intraobserver rates increased to 63%, 0.42 and 0.54 respectively.Conclusion: Abnormally low BMD is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy relative to DEXA scan and only fair agreement in diagnosing osteoporosis using visual assessments of digital x-rays.
Arthroscopy & Arthroplasty.
Abhiram R. Bhashyam; Catherine Logan; Heather J. Roberts; Rameez A. Qudsi; Jacky Fils; George S.M. Dyer
Volume 5, Issue 2 , March 2017, , Pages 82-88
Abstract
Background: Little is known about how to introduce complex technologies like arthroscopy into low-income countries. Thus, we compared low- versus high-resource intensive methods of teaching basic arthroscopic skills in a randomized controlled trial in Haiti. Methods: Forty-eight Haitian orthopaedic surgeons ...
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Background: Little is known about how to introduce complex technologies like arthroscopy into low-income countries. Thus, we compared low- versus high-resource intensive methods of teaching basic arthroscopic skills in a randomized controlled trial in Haiti. Methods: Forty-eight Haitian orthopaedic surgeons and residents attending an orthopaedic conference in Haiti were block randomized to receive instruction through a composite video (Control) or a composite video plus hands-on teaching with an expert visiting surgeon (Intervention). A low-fidelity surgical simulator tested visualization and triangulation skills. Participants completed a pre- and post-test where the goal was to sequentially tap the most numbers in 2.5 minutes. Outcome metrics included highest tapped number, number of errors, visualization loss, and number of lookdowns.Multivariate linear regression was used to confirm randomization and compare outcomes between groups. Results: Seventy-five percent of initially randomized attendees participated with similar attrition rates between both groups. All participants who performed a pre-test completed a post-test. In terms of highest tapped number, treatment and control groups significantly improved compared to pre-test scores, with mean improvement of 3.2% (P=0.007) and 2.2% (P=0.03), respectively. Improvement between treatment and control groups was not statistically different (P=0.4). No statistically significant change was seen with regard to other metrics. Conclusion: We describe a protocol to introduce basic arthroscopic skills in a low-income country using a low-resource intensive teaching method. However, this method of learning may not be optimal given the failure to improve in all outcome measures.
Joint Replacement
Dimitrios N. Lyras; Robert Greenhow; Craig Loucks
Volume 5, Issue 5 , September 2017, , Pages 283-289
Abstract
Background: The aim of this study is to evaluate the accuracy of bone cuts and the resultant alignment, using theMyKnee patient specific cutting blocks.Methods: We retrospectively reviewed 132 patients undergoing primary TKR for osteoarthritis by one single surgeon.The operative time, the preoperative ...
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Background: The aim of this study is to evaluate the accuracy of bone cuts and the resultant alignment, using theMyKnee patient specific cutting blocks.Methods: We retrospectively reviewed 132 patients undergoing primary TKR for osteoarthritis by one single surgeon.The operative time, the preoperative Hip-Knee-Ankle (HKA) axis based on the CT-scan, the postoperative HKA axisbased on long axis standing x-rays, the planned and the actual size of the femoral and the tibial components, and thenumber of the recuts which has been made intraoperative were measured.Results: The average preoperative HKA axis was 177.50 (range 163.50 to 1940), whereas the average postoperativeHKA axis was 179.40 (range 177.10 to 182.70). No outliers were reported in the study (0%). Intraoperatively, 4 femoralcomponents (3.03%), and 7 tibial components (5.30%) applied to the patients were different than the planned size.There was no need of recuts in any of our cases intraoperatively.Conclusion: The MyKnee system evaluated in this study was shown to be remarkable reliable in the coronal planealignment, and the prediction of the component size. However, further studies are needed to determine whether thereare any clinically important improvements in outcomes or patient satisfaction when using patient-specific cutting blocksfor TKA.
Hand
William Kirpatrick; Jack Abboudi; Nayoung Kim; Juana Medina; Mitchell Maltenfort; Daniel Seigerman; Kevin Lutksy; Pedro K. Beredjiklian
Volume 5, Issue 3 , May 2017, , Pages 139-144
Abstract
Background: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com). Methods: A total of 433 ASSH active members were searched in two ...
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Background: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com). Methods: A total of 433 ASSH active members were searched in two popular rating websites for a total of 866 web searches. Demographic data, overall and subcategory scores, number of reviews, and wait times were scored from each member’s webpage. Results: The average number of reviews per surgeon on Healthgrades.com and Vitals.com were 13.8 (range 1-108) and 9.4 (range 0-148), respectively. The average overall score for physicians was 8.1 out of 10 points. For both websites, the vast majority (80-90%) of active members of the ASSH had 20 or less reviews. Multivariate data analysis revealed no statistical differences in overall score by region (P=0.24) or gender (P=0.38). Increasing physician age negatively correlated with overall score (P=0.01). Wait time was not associated with a negative score (P=0.38). Conclusion: Active members of the ASSH received generally positive reviews. The average number of reviews for active members of the ASSH was exceedingly small, bringing into question the legitimacy and validity of these scores. This is especially important when taking into consideration the increasing popularity of these websites, and the reliance of patients on them to obtain physician information. The clinical implication of this study is that physicians have a vested interest in the legitimacy of the data provided by these websites and other physician rating outlets.
Shoulder
Adam Seidl; Daniel Sholder; William Warrender; Michael Livesey; Gerald Williams Jr.; Joseph Abboud; Surena Namdari
Volume 5, Issue 4 , July 2017, , Pages 213-220
Abstract
Background: This study compared the outcomes between patients with proximal humerus fractures (PHF) whounderwent acute reverse total shoulder arthroplasty (RSA) to those who underwent an alternative initial treatmentbefore requiring (secondary) RSA.Methods: Patients who underwent RSA after suffering ...
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Background: This study compared the outcomes between patients with proximal humerus fractures (PHF) whounderwent acute reverse total shoulder arthroplasty (RSA) to those who underwent an alternative initial treatmentbefore requiring (secondary) RSA.Methods: Patients who underwent RSA after suffering a PHF were identified. Two year clinical follow-up was requiredfor inclusion. Patients were divided into an acute group (RSA secondary RSA group was subdivided by initial treatment (non-operative, hemiarthroplasty, open reduction internalfixation (ORIF)). Clinical and radiographic outcomes were compared.Results: Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group.The acute RSA group demonstrated better external rotation (28˚) than the secondary RSA group (18˚, P=0.0495). Theacute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosityhealing rate was higher in the acute RSA group.Conclusion: While acute and secondary RSA can yield successful outcomes, acute RSA results in a higher tuberosityhealing rate and improved external rotation.
Spine
Felix Tome-Bermejo; Angel R. Piñera; Luis Alvarez
Volume 5, Issue 6 , November 2017, , Pages 363-374
Abstract
Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. ...
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Osteoporosis has become a major medical problem as the aged population of the world rapidly grows. Osteoporosis predisposes patients to fracture, progressive spinal deformities, and stenosis, and is subject to be a major concern before performing spine surgery, especially with bone fusions and instrumentation. Osteoporosis has often been considered a contraindication for spinal surgery, while in some instances patients have undergone limited and inadequate procedures in order to avoid concomitant instrumentation. As the population ages and the expectations of older patients increase, the demand for surgical treatment in older patients with osteoporosis and spinal degenerative diseases becomes progressively more important. Nowadays, advances in surgical and anesthetic technology make it possible to operate successfully on elderly patients who no longer accept disabling physical conditions. This article discusses the biomechanics of the osteoporotic spine, the diagnosis and management of osteoporotic patients with spinal conditions, as well as the novel treatments, recommendations, surgical indications, strategies and instrumentation in patients with osteoporosis who need spine operations.
Joint Replacement
Sarah Trainor; Jamie Collins; Hannah Mulvey; Wolfgang Fitz
Volume 6, Issue 2 , March 2018, , Pages 100-104
Abstract
Background: Various sizes of implants need to be available during surgery. The purpose of this paper is to comparebody height and shoe size with implant sizes in patients who underwent total knee replacement surgery to see whichbiomarker is a better predictor for preoperative planning to determine implant ...
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Background: Various sizes of implants need to be available during surgery. The purpose of this paper is to comparebody height and shoe size with implant sizes in patients who underwent total knee replacement surgery to see whichbiomarker is a better predictor for preoperative planning to determine implant size.Methods: A total of 100 knees, belonging to 50 females and 50 males, were observed. Participants’ body height andshoe size were collected and correlated to implant sizes of a current, frequently used, standard total knee replacement(TKR) implant. The femoral anteroposterior and mediolateral width and the tibial anteroposterior and mediolateral widthwere correlated with height and shoe size.Results: The correlation between shoe size and the four knee implant dimensions, femoral AP, ML, and tibial AP andML were higher than the correlations between height and the same four dimensions.Conclusion: The results indicated that shoe size is a better predictor of component dimensions than is body height.
Knee
Santiago Pache; Zachary S. Aman; Mitchel Kennedy; Gilberto Nakama; Gilbert Moatshe; Connor Ziegler; Robert F. LaPrade
Volume 6, Issue 1 , January 2018, , Pages 8-18
Abstract
The posterior cruciate ligament (PCL) is the largest and strongest ligament in the human knee, and the primary posteriorstabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCLinjuries are typically combined with other ligamentous, meniscal and ...
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The posterior cruciate ligament (PCL) is the largest and strongest ligament in the human knee, and the primary posteriorstabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCLinjuries are typically combined with other ligamentous, meniscal and chondral injuries. Stress radiography has becomean important and validated objective measure in surgical decision making and post-operative assessment. Isolatedgrade I or II PCL injuries can usually be treated non-operatively. However, when acute grade III PCL ruptures occurtogether with other ligamentous injury and/or repairable meniscal body/root tears, surgery is indicated. Anatomic singlebundlePCL reconstruction (SB-PCLR) typically restores the larger anterolateral bundle (ALB) and represents the mostcommonly performed procedure. Unfortunately, residual posterior and rotational tibial instability after SB-PCLR hasled to the development of an anatomic double-bundle (DB) PCLR to restore the native PCL footprint and co-dominantbehavior of the anterolateral and posteromedial bundles and re-establish normal knee kinematics. The purpose of thisarticle is to review the pertinent details regarding PCL anatomy, biomechanics, injury diagnosis and treatment options,with a focus on arthroscopically assisted DB-PCLR.
Shoulder
Gary F. Updegrove; Thema A. Nicholson; Surena Namdari; Gerald R. Williams; Joseph A. Abboud
Volume 6, Issue 5 , September 2018, , Pages 353-358
Abstract
Background: The Global Unite Shoulder System is the next generation of implant from the Depuy Global Shoulderline. The primary feature of the Global Unite is adaptability through the interchangeable modular bodies, modular suturecollars, and stems. Short-term functional and radiographic outcomes of the ...
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Background: The Global Unite Shoulder System is the next generation of implant from the Depuy Global Shoulderline. The primary feature of the Global Unite is adaptability through the interchangeable modular bodies, modular suturecollars, and stems. Short-term functional and radiographic outcomes of the Global Unite Platform Shoulder Systemwere assessed as well as complication and revision rates.Methods: 95 subjects were enrolled prospectively between 2013 and 2015 that underwent anatomic or reverseshoulder arthroplasty utilizing the DePuy Global Unite Anatomic Platform Shoulder System. Functional outcome data(ASES and SANE) as well as radiographic data was collected on these patients pre-operatively, and at 6 months, 1year and 2 years post-operatively.Results: The cohort consisted of 97 shoulders in 95 patients of which 54 (56.8%) are males and 41 (43.2%) are female.There were 55/97 (56.7%) were primary anatomic total shoulder arthroplasties, 37/97 (38.1%) primary reverse shoulderarthroplasties, and 3/97 (3.1%) revision procedures to a reverse shoulder arthroplasty. Outcome scores demonstratedan increase in ASES score from a mean of 33.00 to 79.56 and SANE score of 21.30 to 84.08.Conclusion: The Depuy Global Unite shoulder system demonstrated very good short-term results in this two-year outcomestudy. Functional outcome scores are similar to current literature for anatomic and reverse primary cases. Radiographicmeasures at two years are promising with only 2 cases of grade 1 scapular notching and one case of grade 2 scapularnotching. Overall the Depuy Global Unite is a versatile shoulder system with very good early outcomes.Level of evidence: IV
Tumor
Khodamorad Jamshidi; Mohamad Gharehdaghi; Sami Sam Hajialiloo; Masoud Mirkazemi; Kamran Ghaffarzadehgan; Azra Izanloo
Volume 6, Issue 4 , July 2018, , Pages 260-268
Abstract
Recent studies suggest that Denosumab reduces tumor size, therefore, makes the surgery easier with lowermorbidity. However, some studies have reported several complications for this drug. So, this systematic reviewwas performed to determine the effectiveness and safety of Denosumab in reducing bone destructions ...
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Recent studies suggest that Denosumab reduces tumor size, therefore, makes the surgery easier with lowermorbidity. However, some studies have reported several complications for this drug. So, this systematic reviewwas performed to determine the effectiveness and safety of Denosumab in reducing bone destructions activity ofgiant cell tumor and skeletal-related events (SRE) in affected patients with giant cell tumor of bone (GCTB) and itsrecurrence.We explored studies in PubMed, and Cochrane Library. For this purpose, articles of various levels were retrieveduntil October 22, 2016. Two reviewers assessed the articles independently based on predefined criteria to extract therelevant data. Primary outcomes associated with skeletal-related event, overall survival, and secondary outcomessuch as pain, quality of life and adverse events were evaluated and analyzed.The total population of this meta-analysis consisted of 686 patients. Of this population, 55% had primary GCTB and45% had giant cell tumor recurrence, with 2% experiencing secondary recurrence.The results showed the effectiveness of Denosumab in reducing the tumor size due to inhibiting the Osteoclastogenesis.Denosumab didnot show any effect on reducing tumor recurrence, but, in cases where complete tumor surgery isnot possible and tumor residuals may remain, Denosumab can be helpful. Also, the clinicians should consider therisk benefit of Denosumab.
Knee
Michael Alexander Malahias; Omid Shahpari; Maria Kyriaki Kaseta
Volume 6, Issue 3 , May 2018, , Pages 161-168
Abstract
Background: Patients with an anterior cruciate ligament-deficient varus-angulated knee may need not only an isolated high tibial osteotomy (HTO), but also an additional anterior cruciate ligament reconstruction (ACLR). A number of prospective clinical trials have been published considering the ...
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Background: Patients with an anterior cruciate ligament-deficient varus-angulated knee may need not only an isolated high tibial osteotomy (HTO), but also an additional anterior cruciate ligament reconstruction (ACLR). A number of prospective clinical trials have been published considering the combination of HTO and ACL reconstruction. Our aim was to investigate whether one-stage combined HTO and ACL reconstruction is an effective, well-established technique with long-term results in the treatment of varus-angu lated knees with ACL deficiency. Methods: A systematic review was conducted by two independent reviewers by searching the MEDLINE/PubMed and the Cochrane Database of Systematic Reviews. These databases were queried with the term ‘combined high tibial osteotomy anterior cruciate ligament reconstruction’ and ‘simultaneous high tibial osteotomy anterior cruciate ligament reconstruction’. Results: From the initial 41 studies we finally chose and assessed 6 studies were eligible according to our inclusion-exclusion criteria. The vast majority of the patients were treated with hamstrings autograft (85.6% of the patients), whereas a small minority had a patellar Bone-to-Bone autograft (12.8% of the patients) and 3 patients received a patellar allograft. High tibial open wedge osteotomy was performed in 116 patients (57.4%) and closed wedge in 86 patients (42.6%). The mean pre-operative angle of the patients included in our review was 6.6º varus, while the mean final post-operative angle was found to be 1.3º valgus. All 6 studies illustrated improved post-operative IKDC with the use of one-stage HTO and ACLR, whereas the reoperation rate was very low. Conclusion: Despite the lack of high quality studies, it seems that one-stage HTO and ACLR is a safe and effective procedure for treatment of patients suffering from symptomatic varus osteoarthritis in combination with anterior knee instability. Level of evidence: II
Shoulder
Juan Martìn Patiño; Alejandro Felix Rullan Corna; Alejandro Emilio Michelini; Ignacio Abdon; Sandra Denise Hochbaum; Fernando Zicovich Wilson
Volume 7, Issue 2 , March and April 2019, , Pages 105-111
Abstract
Background: The aim of this study was to evaluate functional outcome and complications with a long term followup (minimum of 2 years post-operative) in patients with mid-shaft clavicle fractures treated with precontoured lockingplates.Methods: We included 41 patients. Goniometric measurement of shoulder ...
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Background: The aim of this study was to evaluate functional outcome and complications with a long term followup (minimum of 2 years post-operative) in patients with mid-shaft clavicle fractures treated with precontoured lockingplates.Methods: We included 41 patients. Goniometric measurement of shoulder range of motion (ROM) was performed,as well as functional evaluation using the rating scale shoulder of the University of California (UCLA), the Constantscale, score of disability of the arm, shoulder and hand (DASH) and visual analog scale (VAS). Postoperativecomplications, implants removal rates and new x-rays were analized.Results: The mean postoperative follow-up was 41.5 (24; 69. SD 13.4) months. Mean shoulder anterior elevationwas 168.5º (120; 180. SD 22.9). The average value obtained for abduction was 175.2° (150; 180. SD 27.8), as tointernal and external rotations, these were not affected. DASH 1.27% (0%; 25%. SD 4.3), UCLA 33.6 points (20;35. SD 3.5), Constant 90.5 points (50; 100. SD 11.2) and VAS was 0 in 34 patients (83%). Complications: mildresidual pain (3), hypoesthesia of the infraclavicular area (2), and rupture (1) and loosening (1) of the implant.hardware removal due to intolerance (2 cases) and new osteosynthesis due to acute implant rupture (1 case).Conclusion: Our experience after a mean follow-up of 41.5 months with precontoured locking plates for the treatmentof displaced mid-shaft clavicle fractures has shown good functional results, with low complication and reoperationrate.Level of evidence: IV
Hosseinali Hadi; Mahmood Jabalameli; Abolfazl Bagherifard; Amir Shahryar Ariamanesh; Fatemeh Khosravi Pour; Hojat Hejazi
Volume 6, supplement 1 , June 2018, , Pages 4-4
Abstract
This was Presented in 5th International Congress of Iranian Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology (ISKAST), 14-17 Feb 2018- Kish, Iran
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This was Presented in 5th International Congress of Iranian Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology (ISKAST), 14-17 Feb 2018- Kish, Iran
Arthroscopy & Arthroplasty.
Jorge Manrique; Pouya Alijanipour; Snir Heller; Michael Dove; Javad Parvizi
Volume 6, Issue 6 , November 2018, , Pages 486-491
Abstract
Purpose: To investigate whether surgery for PJI of the hip, the number of procedures and their duration contribute to risk of HO formation. Methods: 56 patients with hip PJI undergoing one-stage (10) or two-stage (46) exchange arthroplasty were matched to 112 patients undergoing revision arthroplasty ...
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Purpose: To investigate whether surgery for PJI of the hip, the number of procedures and their duration contribute to risk of HO formation. Methods: 56 patients with hip PJI undergoing one-stage (10) or two-stage (46) exchange arthroplasty were matched to 112 patients undergoing revision arthroplasty for aseptic failure based on age, gender, body mass index (BMI), surgical approach (all direct lateral) and date of surgery (2006-2013). Patients with Paget’s disease and ankylosing spondylitis, or preoperative HO were excluded. Perioperative pain management included use of the anti-inflammatory medications in all patients without prophylactic radiotherapy. Six-month postoperative radiographs were reviewed based on Brooker classification. Results: The incidence of overall HO in PJI and aseptic groups was 84% (47/56) and 11% (12/112), respectively. High grade HO (grades 3 and 4) in PJI and aseptic groups were 25% (24/56) and 4% (4/112), respectively. PJI was an independent risk factor for HO in the multivariate analysis (odds ratio of 9.3, 95% CI: 2.9-29.9, p<0.001). Conclusions: Patients undergoing surgical treatment of hip PJI seem to be at increased risk of developing HO compared to aseptic failure. HO prophylaxis regimens may be recommendable in eligible patients undergoing surgical intervention for PJI of the hip.
Joint Replacement
Anuwat Pongkunakorn; Patanapong Palawong; Swist Chatmaitri; Nawakun Phetpangnga
Volume 7, Issue 4 , July 2019, , Pages 314-320
Abstract
Background: Femoral stem anteversion during hip arthroplasty is generally estimated by eye intraoperatively and hasproven to be different from targeted values. This study aims to determine the accuracy of a novel technique using adigital protractor and a spirit level to improve surgeons’ estimation ...
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Background: Femoral stem anteversion during hip arthroplasty is generally estimated by eye intraoperatively and hasproven to be different from targeted values. This study aims to determine the accuracy of a novel technique using adigital protractor and a spirit level to improve surgeons’ estimation of stem anteversion.Methods: A prospective non-randomized study was conducted among 93 patients with femoral neck fracture whounderwent cemented hemiarthroplasty via posterolateral approach. In the control group (N=62), five experiencedsurgeons assessed stem anteversion related to the posterior femoral condylar plane using visual estimation with atarget angle of 15°-25°. In the study group (N=31), another two surgeons assessed stem anteversion with the sametarget angle by placing a digital protractor on the femoral stem inserter handle while the assistant held the leg in the trulyvertical position, verified by a spirit level that was attached to the shin with cable ties. Stem anteversion was measuredblind, postoperatively, on 2D-CT and compared with the intraoperative results.Results: The mean postoperative anteversion was 22.4° (-4.2° to 51.3°, SD 11.1°) in the control group and 23.0° (16.0°to 29.9°, SD 3.6°) in the study group (P=0.810). The study group had more stems positioned in 15°-25° anteversion(71.0% vs 32.3%, P=0.001) and the mean absolute value of surgeon error was -0.2° (-5.4° to 7.0°, SD 3.0°). Twentyeightstems of the study group (90.3%) had an error within 5°. Surgeon overestimation >5° was found in 1 hip (3.2%)and underestimation >5° was found in 2 hips (6.4%).Conclusion: Using a digital protractor and a spirit level was reliable with high accuracy and precision to improve theintraoperative estimation of cemented stem anteversion.Level of evidence: II
Shoulder
Richard A. C. Dimock; Sheraz Malik; Paolo Consigliere; Mohamed A. Imam; A. Ali Narvani
Volume 7, Issue 1 , January and February 2019, , Pages 3-11
Abstract
The management of irreparable rotator cuff tears remains challenging. Since its introduction by Mihata in 2012, superiorcapsule reconstruction (SCR) has grown in popularity at an astonishingly rapid rate. The aim of this article is to providea comprehensive review of the available literature, in order ...
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The management of irreparable rotator cuff tears remains challenging. Since its introduction by Mihata in 2012, superiorcapsule reconstruction (SCR) has grown in popularity at an astonishingly rapid rate. The aim of this article is to providea comprehensive review of the available literature, in order to highlight what has so far been published on SCR,covering all aspects including biomechanical, clinical and radiological studies as well as descriptions of the varioustechniques for performing the procedure.The short-term clinical results of SCR are promising, but there is need for further long-term studies, as well as randomisedcontrolled trials comparing SCR to other treatment modalities for irreparable rotator cuff tears. Further imaging studieslooking at graft healing rates are also required as the healing rates published so far are variable. Additionally, themechanism of action by which SCR delivers good short-term functional outcomes needs further clarification, as doesthe importance of the choice of graft type and thickness.