Arthroscopy & Arthroplasty.
David Ross; Omer Erkocak; Mohammad R. Rasouli; Javad Parvizi
Volume 7, Issue 3 , May 2019, , Pages 229-234
Abstract
Background: Allogeneic blood transfusion in patients undergoing total joint arthroplasty (TJA) has been shown tonegatively affect patient outcomes. This study aimed to examine if there is a correlation between operative time and theneed for allogeneic blood transfusions during TJA.Methods: We performed ...
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Background: Allogeneic blood transfusion in patients undergoing total joint arthroplasty (TJA) has been shown tonegatively affect patient outcomes. This study aimed to examine if there is a correlation between operative time and theneed for allogeneic blood transfusions during TJA.Methods: We performed a retrospective review of 866 patients who underwent primary TJA during a one-year periodat our institution. Logistic regression was performed to identify the association between operative time and need forallogeneic blood transfusion, controlling for other patient and surgical factors. Multiple linear regression analysis wasalso performed to see how the same factors affected CBL.Results: Of the 866 cases, 13%(115) were simultaneous bilateral. 52%(449) of patients received preoperativeautologous blood donation. The average operative time for unilateral and bilateral patients was 74.1±(33.9) and132.6±(36.0) minutes, respectively. Average CBL for unilateral patients was 2120mL±(1208) and 4051mL±(1311) forbilateral cases. The average number of allogeneic transfusions was also higher within the bilateral group (0.49 vs 1.15units). Multivariate analysis indicated that duration of surgery (odds ratio [OR]:1.35 per 15 minutes) and bilateral TJA(OR: 2.97) increase the risk of allogeneic blood transfusion, while patients having total knee arthroplasty are less likelyto receive allogeneic blood transfusion (OR: 0.50). CBL also increased significantly with surgical duration (211.5 mLper 15 minutes).Conclusion: A subgroup analysis confirmed that there was a correlation between operative time and need forallogeneic transfusion following unilateral TJA. Expeditious surgery can minimize blood loss and subsequent need forblood transfusion and its associated adverse consequences.
Shoulder
Jeffrey D. Tompson; Usman A. Syed; Eric M. Padegimas; Joseph A. Abboud
Volume 7, Issue 6 , November 2019, , Pages 484-492
Abstract
Background: This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization basedon patient race.Methods: The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplastyutilization at a national level. An institutional database ...
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Background: This study aimed to analyze national and institutional trends in shoulder arthroplasty utilization basedon patient race.Methods: The Nationwide Inpatient Sample (NIS) was employed to determine racial trends in shoulder arthroplastyutilization at a national level. An institutional database was then utilized to retrospectively identify all patients, undergoingshoulder arthroplasty within 2011-2013. Descriptive statistics were used to compare self-identified black and non-blacksubpopulations.Results: The NIS identified 256,832 primary shoulder arthroplasties within 2005-2011. Black patients constituted3.92% (n=10,074) of cases. Utilization increased from 3.36% in 2005 to 4.49% in 2011. Locally, a total number of1,174 primary shoulder arthroplasties were performed, the recipients of 5.96% (n=70) of which were black. Femalesaccounted for 48/70 (68.6%) of black patients. Black patients had a higher body mass index (33.6 vs. 30.1, P<0.0001)and were younger (62.6 vs. 67.2 years, P<0.0001), compared to the non-black patients. Regarding insurance type,1,074 patients (i.e., 65 black and 1,009 non-black) had comprehensive insurance data. Chi-square analysis of fivemajor insurance categories, including private, Medicare, Medicaid, workers’ compensation, and personal injury,indicated no difference in insurance patterns (χ2=3.658, P=0.454).Conclusion: The findings revealed significant racial disparity in shoulder arthroplasty utilization both at national andinstitutional levels. This disparity exists despite the similar rates of osteoarthritis in both white and black patients. Blackpatients in our institution had similar clinical, demographic, and socioeconomic characteristics as in our non-blackpatients. The obtained results highlighted the need for the expansion of black patients’ access to care services relatedto major joint reconstruction.Level of evidence: III
Elbow
Ante Prkić; Femke Claessen; Matthijs P. Somford; Bertram The; Michel P.J. van den Bekerom; Denise Eygendaal
Volume 7, Issue 5 , September 2019, , Pages 407-415
Abstract
Background: Recognition of total elbow arthroplasties (TEAs) on plain radiographs is difficult due to a multitude ofdifferent types and models. Especially if surgery reports and documentation are not available, lost or when the primarysurgery was performed in another hospital the prosthesis type may ...
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Background: Recognition of total elbow arthroplasties (TEAs) on plain radiographs is difficult due to a multitude ofdifferent types and models. Especially if surgery reports and documentation are not available, lost or when the primarysurgery was performed in another hospital the prosthesis type may be undeterminable. Therefore we investigatedin this platform study if a flowchart aids in recognition of thirteen different total elbow arthroplasty models on plainradiographs.Methods: An online questionnaire on the Shoulder and Elbow Platform was developed. Plain radiographs of thirteenTEA models were shown with and without the help of an especially developed flowchart describing distinguishingfeatures.Results: Ten orthopedic surgeons specialized in upper extremity surgery completed the study. Recognition rates of thethirteen total elbow arthroplasty models ranged between 20 and 100 percent without the flowchart. Using the flowchartrecognition varied between 40 and 90 percent. The recognition rates with the flowchart were not significantly higher.Inter-observer reliability did not increase on a significant level.Conclusion: Correct recognition of total elbow arthroplasty models with plain radiographs remains imperfect with ourdeveloped flowchart. The flowchart increased correct recognition rates and inter-observer reliability.Level of evidence: II
Pediatric
Francisco Soldado F.; Pedro Domenech-Fernandez; Sergi Barrera-Ochoa; Josep M. Bergua-Domingo; Paula Diaz-gallardo; Felipe Hodgson; Jorge Knorr
Volume 8, Issue 2 , March 2020, , Pages 142-146
Abstract
Background: The anterior approach to the elbow for pediatric lateral condyle fractures (LCF) would provide a bettervisualization of the articular fracture resulting in better functional results, less complications and a more cosmeticallyappealingscar than usually seen with the lateral approach.Methods: ...
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Background: The anterior approach to the elbow for pediatric lateral condyle fractures (LCF) would provide a bettervisualization of the articular fracture resulting in better functional results, less complications and a more cosmeticallyappealingscar than usually seen with the lateral approach.Methods: Retrospective study of children undergoing an open reduction and internal fixation of a displaced LCFvia an anterior approach with a transverse incision. Bilateral elbow range of motion (ROM), upper limb alignmentand complications were registered. A 4-point ordinal Likert-type scale was employed for parents to rate their level ofsatisfaction with the cosmetic appearance of the scar.Results: Eighteen children of mean age 76 months (range 27 to 101 months) were included. Fractures were classifiedas Jackob’s Type II in 14 cases and Milch’s type II in all cases. Mean follow-up was 12 (range 4 to19) months.Successful condral fracture visualization and reduction was achieved in every case. No intra-operative or post-operativecomplications occurred. In all cases bone union was obtained 4 to 5 weeks after surgery and at final follow-up, activeelbow ROM of at least 90%, was obtained. All parents claimed to be “very satisfied” with their child’s scar. A lateral spurwas identified in 66.7% o patients.Conclusion: The anterior approach to the elbow was both a feasible and safe allowing full anatomical cartilagereduction. Complications after this technique might decrease compared to the lateral approach but need futurecomparative studies. The rate of lateral spur did not decreased. Cosmetic scar results seem to be a clear advantage ofthis approach compared to the classical lateral approach.Level of evidence: IV
Hip
Omid Shahpari; Alireza Mousavian; Nafiseh Elahpour; Michael-Alexander Malahias; Mohammad H. Ebrahimzadeh; Ali Moradi PhD
Volume 8, Issue 1 , January 2020, , Pages 11-20
Abstract
Two stage total hip arthroplasty revision surgery includes foreign material debridment, insertion of antibiotic impregnatedcement spacer, and finally, reimplantation of the prosthesis. This review has aimed to evaluate the efficacy of antibioticimpregnated cement spacers in infection control and eradication ...
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Two stage total hip arthroplasty revision surgery includes foreign material debridment, insertion of antibiotic impregnatedcement spacer, and finally, reimplantation of the prosthesis. This review has aimed to evaluate the efficacy of antibioticimpregnated cement spacers in infection control and eradication in arthroplasties.A total of 85 articles on total hip arthroplasty were used in this narrative literature review.High concentrations of the antibiotic in targeted drug delivery by means of using antibiotic impregnated cementspacers is effective against infections while reduces the side effects of systemic antibiotic therapy. This results inprevention of bone and muscle atrophy as well as size discrepancy. Also, antibiotic impregnated cement spacersreduce dead space and help stabilize the limb in total hip arthroplasty. Despite all reported drawbacks, antibioticimpregnated cement spacers seem effective in eradicationg infections, although a consensus has not been yetachieved.Level of evidence: I
Farzad Omidi Kashani; Ebrahim Ghayem Hasankhani; Mohammad H Ebrahimzadeh; Amir Reza Kachooei; Mohammad Hasani; Ali Moradi
Volume 1, Issue 1 , September 2013, , Pages 9-13
Abstract
Background: Osteoporotic compression vertebral fractures are common clinical problems. In those with refractory fractures, percutaneous cement augmentation has been suggested. The aim of this study was to evaluate the functional outcome of percutaneous vertebroplasty in Iranian patients with refractory ...
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Background: Osteoporotic compression vertebral fractures are common clinical problems. In those with refractory fractures, percutaneous cement augmentation has been suggested. The aim of this study was to evaluate the functional outcome of percutaneous vertebroplasty in Iranian patients with refractory osteoporotic fractures. Methods: We retrospectively studied 37 osteoporotic fractures in 28 patients (6 men and 22 women), who had been treated with vertebroplasty from August 2009 to June 2012. The mean follow-up period was 12.1±3.6 (range: 6-42 months). The patients’ states were assessed by the visual analogue scale and short form-36 questionnaire. Student t test was used to analyze the pre- and postoperative data. Results: The mean age of the patients was 71.6±6.1 (range: 50 to 91 years) and the most common fractured vertebrae were L1 and T12. There were five patients with two levels of vertebral fractures and two with three levels. Vertebroplasty could improve the scores for pain and quality of life from preoperative 7.6 ± 1.4 and 44.8 ± 7.6 to 1.8 ± 0.4 and 74.1 ± 5.3 at four weeks after surgery. At the last follow-up visit, this improvement continued with no significant decline. The most common complication was cement leakage (32.4% per vertebra), wherein all of of the patients were clinically asymptomatic. Adjacent vertebral fracture occurred in six cases. Conclusion: By understanding the risks, we propose vertebroplasty in Iranian patients with refractory osteoporotic vertebral fracture. If correctly performed, this procedure can significantly improve the pain and quality of life in these elderly osteoporotic patients.
Ali Moradi; Mohammad H Ebrahimzadeh; David Ring
Volume 1, Issue 2 , December 2013, , Pages 53-58
Abstract
Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients ...
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Nonspecific activity-related arm pain is characterized by an absence of objective physical findings and symptoms that do not correspond with objective pathophysiology. Arm pain without strict diagnosis is often related to activity, work-related activity in particular, and is often seen in patients with physically demanding work. Psychological factors such as catastrophic thinking, symptoms of depression, and heightened illness concern determine a substantial percentage of the disability associated with puzzling hand and arm pains. Ergonomic modifications can help to control symptoms, but optimal health may require collaborative management incorporating psychosocial and psychological elements of illness.
Ali parsa; Mohammad Hallaj Moghadam; Mohammad H Taraz Jamshidi
Volume 2, Issue 1 , March 2014, , Pages 7-10
Abstract
The Ponseti method is a safe and effective treatment for congenital clubfoot, and radically decreases the need for extensive corrective surgery. But a group of patients will still present with under corrected residual equinovarus deformities despite the proper use of the Ponseti method. About ...
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The Ponseti method is a safe and effective treatment for congenital clubfoot, and radically decreases the need for extensive corrective surgery. But a group of patients will still present with under corrected residual equinovarus deformities despite the proper use of the Ponseti method. About 25% of operated clubfeet will develop recurrence or show a marked residual deformity (recurrent clubfoot); however, in the recent literature, the failure rate of the Ponseti method, defined by the need for corrective surgery, ranges from 3% to 5%. Deformities encountered in patients with residual clubfeet comprise of various degrees of equinus, varus, adduction, supination, cavus, and toe deformity. Joint flexibility or stiffness, tarsal dysmorphism, articular incongruence, and progressive degrees of degeneration may be also present. We try to emphasize the current solutions for these deformities.
Asgar Elmi; Ali Reza Rohani; Ali Tabrizi
Volume 2, Issue 2 , June 2014, , Pages 103-105
Abstract
Background: Although intramedullary nailing (IMN) is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60, there is a lack of data on the results of this treatment on those over 60. The purpose of this study was to determine if the outcome of IMN ...
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Background: Although intramedullary nailing (IMN) is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60, there is a lack of data on the results of this treatment on those over 60. The purpose of this study was to determine if the outcome of IMN for femoral shaft fracture in elderly patients is also acceptable. Particular challenges in this group of patients included osteopenia and other associated multiple medical problems frequently observed. Methods: The outcome of 84 patients who had IMN for femoral shaft fracture was reviewed and the results were compared between two groups of patients (younger than 60 and over 60 year old patients). Complications and mortality was analyzed for each group, and then compared between the two groups by testing the null hypothesis that the outcome of treatment in the two groups are similar (P>0.05). Results: The mean duration of follow up was 57.3 months (range: 10-94 months). Incidence of malunion, nonunion, infection, DVT, and dependence on walker/crutch in the groups were similar and differences were not significant (P>0.05). However, incidence of mortality (P<0.05), knee pain, loss of motion, and dependence on cane were significantly higher in elderly patients (P<0.05). Conclusions: There is no significant difference between the outcomes of femoral shaft fracture treatment with IMN fixation in younger patients when compared with elderly patients. However, elderly patients with IMN have more symptoms when compared with younger patients.
E. Carlos RODRIGUEZ-MERCHAN
Volume 2, Issue 3 , September 2014, , Pages 137-140
Abstract
The aim of this review article is to analyze the clinical effectiveness of total knee replacement (TKR) compared to unicompartmental knee replacement (UKR) in patients with medial unicompartmental osteoarthritis (MUO) in terms of survival rates, revision rates and postoperative complications. The search ...
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The aim of this review article is to analyze the clinical effectiveness of total knee replacement (TKR) compared to unicompartmental knee replacement (UKR) in patients with medial unicompartmental osteoarthritis (MUO) in terms of survival rates, revision rates and postoperative complications. The search engine was MedLine. The keywords used were: medial knee osteoarthritis. Three thousand and ninety-six articles were found on 28 April 2014. Of those, only twenty-eight were selected and reviewed because they were strictly focused on the topic of this article. Compared with those who have TKR, patients who undergo UKR have higher revision rates and lower survival rates at 5, 10 and 15 years. The reported overall risk of postoperative complications for patients undergoing TKR is 11%, compared with 4.3% for patients undergoing UKR. In conclusion, UKR have higher revision rates and lower survival rates than TKR. There is, however, an increased risk of postoperative complications after TKR.
Frans J Mulder; Mariano E Menendez; David Ring
Volume 2, Issue 4 , October 2014, , Pages 258-259
Abstract
We present two patients with a displaced fracture of the small finger metacarpal base, where the shaft of the small finger metacarpal was wedged between the bases of the ring and small finger metacarpals. The striking appearance on radiographs led to initial recommendations for surgery, but both patients ...
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We present two patients with a displaced fracture of the small finger metacarpal base, where the shaft of the small finger metacarpal was wedged between the bases of the ring and small finger metacarpals. The striking appearance on radiographs led to initial recommendations for surgery, but both patients preferred non-operative treatment and did well in the short term without surgery
Ahmet Kinaci; Valentin Neuhaus; David Ring
Volume 3, Issue 1 , January 2015, , Pages 13-18
Abstract
Background: Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States. Methods: We used the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery ...
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Background: Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States. Methods: We used the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS) data gathered in 2006-databases that together provide an estimate of all inpatient and ambulatory surgical care in the US. Results: An estimated 150,000 elbow surgeries were performed in the US in 2006, 75% in an outpatient setting. The most frequent diagnosis treated operative was enthesopathy (e.g. lateral epicondylitis) and it was treated with several different procedures. More than three quarters of all elbow surgeries treated enthesopathy, cubital tunnel syndrome, or fracture (radial head in particular). Arthroscopy and arthroplasty accounted for less than 10% of all elbow surgeries. Conclusions: Elbow surgery in the United States primarily addresses enthesopathies such as tennis elbow, cubital tunnel syndrome, and trauma. It is notable that some of the most common elbow surgeries (those that address enthesopathy and radial head fracture) are some of the most variably utilized and debated.
Valentin Neuhaus; Dimitrios C. Christoforou; Amir Reza Kachooei; Jesse B. Jupiter; David C. Ring; Chaitanya S. Mudgal
Volume 3, Issue 2 , April 2015, , Pages 88-93
Abstract
Background: The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis. Methods: This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 ...
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Background: The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis. Methods: This is a retrospective review of 14 adult patients (6 females and 8 males) from 2007 to 2011, who underwent radial head prosthesis removal by three surgeons. The average time between implantation and removal was 23 months (range from 2 weeks to 12 years, median 12 months). Results: The leading reported complaints before removal were restricted mobility of the elbow (active range of motion of less than 100 degrees) in 6, pain in 3, and pain together with restricted mobility in 4 patients. The objective findings before removal were restricted mobility of the elbow in 10 (71%), capitellar cartilage wear, loose implants, and heterotopic ossification each in 8 (57%), subluxation of the radio-capitellar joint or malpositioning of the stem in 5 (36%), and chronic infection in 2 (14%) patients. All patients with pain had wear of the capitellar cartilage on radiographs. The ulnar nerve was decompressed in four patients at the time of removal. Four patients underwent a subsequent operation for postoperative ulnar nerve symptoms 5 to 21 months after removal. Four patients were still complaining about persistent pain at the last follow-up visit. Except two patients, the total range of motion improved with a mean of 34 degrees (range 5 to 70) after a mean follow-up of 11 months. Conclusions: Removal of radial head prosthesis improved function and lessened pain in our case series. The reoperation rate was yet nearly 30% due to ulnar neuritis. Selective ulnar nerve decompression at the time of removal must be evaluated, especially in patients with expected large gain in range of motion after removal.
Francisco Soldado; Jorge Knorr; Sleiman Haddad; Paula Diaz-Gallardo; Jordi Palau-Gonzalez; Vasco Mascarenhas; Samir Karmali; Jerome Sales De Gauzay
Volume 3, Issue 3 , July 2015, , Pages 169-172
Abstract
Background: Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF) owing to the risk of ulnar nerve injury. Aim: To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization. ...
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Background: Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF) owing to the risk of ulnar nerve injury. Aim: To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization. Methods: Fifteen children, with a mean age of 60 months, with displaced SHF were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury. Results: Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve that required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique. Conclusions: Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric SHF.
Ahmadreza Afshar; Afshin Mohammadi; Kian Zohrabi; Nasrin Navaeifar; Sam Sami; Hassan Taleb
Volume 3, Issue 4 , October 2015, , Pages 244-249
Abstract
Background: Scaphoid malunion alters the carpal kinematics and impairs clinical outcome because of pain, weakness, restricted range of motion and predisposing the wrist joint to early osteoarthritis. The aim of this study was to evaluate the influence of the scaphoid morphological angles on clinical ...
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Background: Scaphoid malunion alters the carpal kinematics and impairs clinical outcome because of pain, weakness, restricted range of motion and predisposing the wrist joint to early osteoarthritis. The aim of this study was to evaluate the influence of the scaphoid morphological angles on clinical outcomes in patients with reconstructed scaphoid by non-vascularized bone graft. Methods: Seventeen male patients with the mean age of 31.7±3.7 years and mean non-union time of 31.5±14.7 months were enrolled in this retrospective study. Average follow up was 48.8±9.4 months. At the last follow-up, the patients were evaluated clinically for pain, wrist range of motion, grip strength, and wrist functional status. They were also evaluated radiologically by wrist radiographs and computerized tomography (CT). The overall clinical outcomes were evaluated by the Cooney wrist function score. The morphology of the reconstructed scaphoids was evaluated by the lateral intrascaphoid angle, antroposterior intrascaphoid angle, dorsal cortical angle, measuring the length (mm), and height-to-length ratio on CT scan. The radiological measurements were compared against the overall clinical outcomes. Results: There were 7 excellent, 7 good, 3 fair clinical results. The mean Cooney wrist function score was 83±4. The mean lateral intrascaphoid angle was 34.8±1.4 degrees, mean antroposterior intrascaphoid angle was 33.4±2.2 degrees, mean dorsal cortical angle was 158.3±4.8 degrees, mean scaphoid length was 22.1± 0.7 mm, and mean scaphoid height-to-length ratio was 0.74±0.04. There were no significant statistical correlations between the lateral intrascaphoid angles, antroposterior intrascaphoid angles, dorsal cortical angles, scaphoid lengths and scaphoid height-to-length ratios and Cooney wrist scores in the patients. Conclusion: In the current study, all the patients had some degree of scaphoid malunion; however, the radiological measurements of the reconstructed scaphoids did not correlate with the clinical outcomes.
Edward K. Rodriguez; Jeeva Munasinghe
Volume 4, Issue 2 , April 2016, , Pages 109-115
Abstract
Background: In this feasibility study, a mechanically loaded in-vitro tissue culture model of joint morphogenesis using the isolated lower extremity of the 8 day old chick embryo was developed to assess the effects of mechanical loading on joint morphogenesis. Methods: The developed in-vitro ...
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Background: In this feasibility study, a mechanically loaded in-vitro tissue culture model of joint morphogenesis using the isolated lower extremity of the 8 day old chick embryo was developed to assess the effects of mechanical loading on joint morphogenesis. Methods: The developed in-vitro system allows controlled flexion and extension of the chick embryonic knee with a range of motion of 20 degrees from a resting position of 90-100 degrees of flexion. Joint morphogenesis at 2, 3, 4 and 7 days of culture was assessed by histology and micro MRI in 4 specimen types: undisturbed in-ovo control embryos, in-ovo paralyzed embryos, in-vitro unloaded limb cultures, and in-vitro loaded limb cultures. Relative glycosaminoglycan (GAG) concentration across the joint was assessed with an MRI technique referred to as dGEMRIC (delayed gadolinium enhanced MRI of cartilage) where T1 is proportional to glycosaminoglycan concentration. Results: Average T1 over the entire tissue image for the normal control (IC) knee was 480 msec; for the 4 day loaded specimen average T1 was 354 msec; and for the 7 day loaded specimens T1 was 393 msec. The 4 day unloaded specimen had an average T1 of 279 msec while the 7 day unloaded specimen had an average T1 of 224 msec. The higher T1 values in loaded than unloaded specimens suggest that more glycosaminoglycan is produced in the loaded culture than in the unloaded preparation. Conclusion: Isolated limb tissue cultures under flexion-extension load can be viable and exhibit more progression of joint differentiation and glycosaminoglycan production than similarly cultured but unloaded specimens. However, when compared with controls consisting of intact undisturbed embryos in-ovo , the isolated loaded limbs in culture do not demonstrate equivalent amounts of absolute growth or joint differentiation.
Georgios Drosos; Georgios Kiziridis; Cristina Aggelopoulou; Dimitrios Galiatsatos; George Anastassopoulos; Athanasios Ververidis; Konstantinos Kazakos
Volume 4, Issue 1 , January 2016, , Pages 16-22
Abstract
Background: The pneumatic tourniquet (PT) is routinely used in upper and lower limb operations by most orthopaedic surgeons. The silicone ring tourniquet (SRT) was introduced in clinical practice the last decade. Clinical as well comparative studies in volunteers concerning its safety and efficacy ...
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Background: The pneumatic tourniquet (PT) is routinely used in upper and lower limb operations by most orthopaedic surgeons. The silicone ring tourniquet (SRT) was introduced in clinical practice the last decade. Clinical as well comparative studies in volunteers concerning its safety and efficacy have been published. The aim of this study was to investigate the postoperative effect of the silicone ring tourniquet (SRT), primarily on the motor nerve conduction, and secondarily on the pain and grip strength, in comparison to the effect of the pneumatic tourniquet (PT) in healthy volunteers. Methods: Both tourniquets were applied in the forearm of the dominant arm in 20 healthy volunteers and were kept on for 10 minutes. Pain was measured using the visual analogue scale and grip strength was measured with a hand dynamometer. We evaluated the following parameters of median nerve conduction: motor conduction velocity (MCV), latency (LAT) and amplitude (AMP). Results: Pain score at the time of tourniquet application was higher in SRT group but the alteration in pain scores in PT group was higher, with statistical significance (P<0.05). The grip strength was reduced by the application of both tourniquets; however there was a significantly higher reduction in the SRT group (P<0.05). The conduction impairment of the median nerve was worse in the PT group than in the SRT one, according to the changes in MCV (P<0.05). Conclusion: Median nerve conduction was affected more after PT application as compared to the SRT. Nevertheless, the reduction of grip strength was higher after the SRT application.
E. Carlos RODRIGUEZ-MERCHAN
Volume 4, Issue 4 , October 2016, , Pages 307-313
Abstract
Background: The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis. Methods: The search engine used was PubMed. The keywords were: "high tibial osteotomy versus ...
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Background: The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis. Methods: The search engine used was PubMed. The keywords were: "high tibial osteotomy versus unicompartmental knee arthroplasty". Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they strictly focused on the topic. Results: In a meta-analysis the ratio for an excellent outcome was higher in unicompartmental knee arthroplasty than high tibial osteotomy and the risks of revision and complications were lower in the former. A prospective comparative study showed that unicompartmental knee arthroplasty offers better long-term success (77% for unicompartmental knee arthroplasty and 60% for high tibial osteotomy at 7-10 years). However, a review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that unicompartmental knee osteoarthritis without constitutional deformity should be treated with unicompartmental knee arthroplasty while in cases with constitutional deformity high tibial osteotomy should be indicated. A case control study stated that unicompartmental knee arthroplasty offers a viable alternative to high tibial osteotomy if proper patient selection is done. Conclusion: The literature is still controversial regarding the best surgical treatment for unicompartmental knee osteoarthritis (high tibial osteotomy or unicompartmental knee arthroplasty). However, unicompartmental knee arthroplasty utilization is increasing, while high tibial osteotomy utilization is decreasing, and a meta-analysis has shown better outcomes and less risk of revision and complications in the former. A systematic review has found that with correct patient selection, both procedures show effective and reliable results. However, prospective randomized studies are needed in order to answer the question of this article.
Saroj K. Golay; Philippa Rust; David Ring
Volume 4, Issue 3 , July 2016, , Pages 220-223
Abstract
Background:To determine the prevalence of incidental Kienböck disease. Methods: A retrospective analysis of 150,912 radiological reports or images obtained over a five year period was performed of 76,174 patients who underwent a radiograph or computed tomography scan which included ...
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Background:To determine the prevalence of incidental Kienböck disease. Methods: A retrospective analysis of 150,912 radiological reports or images obtained over a five year period was performed of 76,174 patients who underwent a radiograph or computed tomography scan which included the wrist, in Edinburgh and Lothian, UK. Results: There were 5 cases of incidental Kienböck disease and 13 cases of symptomatic Kienböck disease. There were no significant differences in age, sex, ethnicity, comorbidities, smoking status, excess alcohol use or Lichtman stage between the incidental and symptomatic Kienböck groups. Conclusion: The radiological prevalence of incidental Kienböck disease was 0.0066% or 7 in 100,000 patients.
Shoulder
Paolo Consigliere; Ioannis Polyzois; Tanaya Sarkhel; Rohit Gupta; Ofer Levy; A Ali Narvani
Volume 5, Issue 1 , January 2017, , Pages 14-21
Abstract
Background: Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially ...
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Background: Recurrence rate of rotator cuff tears is still high despite the improvements of surgical techniques, materials used and a better knowledge of the healing process of the rotator cuff tendons. Large to massive rotator cuff tears are particularly associated with a high failure rate, especially in elderly. Augmentation of rotator cuff repairs with extracellular matrix or synthetic patches has gained popularity in recent years with the aim of reducing failure.The aim of this study was to investigate the outcome of rotator cuff repairs augmented with denatured extracellular matrix in a series of patients who underwent arthroscopic rotator cuff repair for large to massive tears.Methods: Ten consecutive patients, undergoing arthroscopic rotator cuff repair with extracellular matrix augment for large and massive tears, were prospectively enrolled into this single surgeon study. All repairs were performed arthroscopically with a double row technique augmented with extracellular matrix. Oxford Shoulder Score, Constant Score and pain visual analogue scale (VAS) were used to monitor the shoulder function and outcome pre-operatively and at three, six and 12-month follow-up. Minimum follow up was tree months. Mean follow up was 7 months.Results: Mean Constant score improved from 53 (SD=4) pre-operatively to 75 (SD=11) at final follow up. Mean Oxford score also increased from 30 (SD=8) pre-operatively to 47 (SD=10) at the final follow up. The visual analogue scale (VAS) improved from seven out of 10 (SD=2) preoperatively to 0.6 (SD=0.8) at final follow up. Additionally, there was significant improvement at three months mark in Constant score. Conclusion: Arthroscopic repair and augmentation of large and massive rotator cuff tears with extracellular matrix patch has good early outcome.
Ankle
Lauren k Ehrlichman; Tyler A Gonzalez; Alec A. Macaulay; Mohammad Ghorbanhoseini; John Y Kwon
Volume 5, Issue 2 , March 2017, , Pages 89-95
Abstract
Background: While various radiographic parameters and application of manual/gravity stress have been proposed to elucidate instability for Weber B fibula fractures, the prognostic capability of these modalities remains unclear. Determination of anatomic positioning of the mortise is paramount. We propose ...
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Background: While various radiographic parameters and application of manual/gravity stress have been proposed to elucidate instability for Weber B fibula fractures, the prognostic capability of these modalities remains unclear. Determination of anatomic positioning of the mortise is paramount. We propose a novel view, the Gravity Reduction View (GRV), which helps elucidate non-anatomic positioning and reducibility of the mortise.Methods: The patient is positioned lateral decubitus with the injured leg elevated on a holder with the fibula directed superiorly. The x-ray cassette is placed posterior to the heel, with the beam angled at 15˚ of internal rotation to obtain a mortise view. Our proposed treatment algorithm is based upon the measurement of the medial clear space (MCS) on the GRV versus the static mortise view (and in comparison to the superior clear space (SCS)) and is based on reducibility of the MCS. A retrospective review of patients evaluated utilizing the GRV was performed.Results: 26 patients with Weber B fibula fractures were managed according to this treatment algorithm. Mean age was 50.57 years old (range: range:18-81, SD=19). 17 patients underwent operative treatment and 9 patients were initially treated nonoperatively. 2 patients demonstrated late displacement and were treated surgically. Using this algorithm, at a mean follow-up of 26 weeks, all patients had a final MCS that was less than the SCS (final mean MCS 2.86 mm vs. mean SCS of 3.32) indicating effectiveness of the treatment algorithm.Conclusion: The GRV is a novel radiographic view in which deltoid competency, reducibility and initial positioning of the mortise are assessed by comparing a static mortise view with the appearance of the mortise on the GRV. We have developed a treatment algorithm based on the GRV and have found it to be useful in guiding treatment and successful at achieving anatomic mortise alignment.
Trauma
Ali Andalib; Erfan Sheikhbahaei; Zeynab Andalib; Mohammad A. Tahririan
Volume 5, Issue 5 , September 2017, , Pages 290-295
Abstract
Background: Comminuted fractures happen frequently due to traumas. Fixation without opening the fracture site,known as minimally invasive plate osteosynthesis (MIPO), has recently become prevalent. This study has beendesigned to assess the outcomes of this treatment for tibial and femoral comminuted ...
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Background: Comminuted fractures happen frequently due to traumas. Fixation without opening the fracture site,known as minimally invasive plate osteosynthesis (MIPO), has recently become prevalent. This study has beendesigned to assess the outcomes of this treatment for tibial and femoral comminuted fractures.Methods: A total of 60 patients with comminuted femoral or tibial fractures were operated with MIPO method in thiscross-sectional study at Alzahra university hospital in 2015. Eleven patients were excluded due to lack of adequatefollow-ups. Patients’data including union time; infection in the fractured site; hip and knee range of motion; and anymalunion or deformities like limb length discrepancy were collected after the surgery in every session.Results: Among 32 femoral and 17 tibial fractures, union was completed in48 patients, while only one patient withfemoral fracture had nonunion. The mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia(17.76±2.36 compared to 19±2.37 weeks, respectively, P=0.09). None of the patients suffered from infections or fistula.The range of motion in hip and knee remained intact in approximately all patients. Malunion happened in 3 patients; 100internal rotation in 1 patient; and 1cm limb shortening in 2 patients.Conclusion: According to the result of this study, MIPO is a simple and effective method of fixation with a high rateof union as well as minimal complications for comminuted fractures of long bones. Infection is rare, and malunion orany deformity is infrequent. MIPO appears to be a promising and safe treatment alternative for comminuted fractures.
General Orthopedics
Seyed Mohammad J. Abrisham; Fathollah Bouzarjomehri; Reza Nafisi-Moghadam; Mohammad R. Sobhan; Mahdie Gadimi; Fereshte Omidvar
Volume 5, Issue 3 , May 2017, , Pages 145-148
Abstract
Background: This study has aimed to measure the patient dose in entire spine radiography by EOS system in comparison with the digital radiography. Methods: EOS stereo-radiography was used for frontal and lateral view spine imaging in 41 patients in a prospective analytical study. A calibrated ...
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Background: This study has aimed to measure the patient dose in entire spine radiography by EOS system in comparison with the digital radiography. Methods: EOS stereo-radiography was used for frontal and lateral view spine imaging in 41 patients in a prospective analytical study. A calibrated dose area product (DAP) meter was used for calibration of the DAP in EOS system. The accuracy and precision of the system was confirmed according to the acceptance testing. The same procedure was used for 18 patients referred for lumbar spine digital radiology (overall 36 images). Results: Although radiation fields in the EOS were almost twice of that in digital radiology, and the average peak tube voltage (kVp), current supply to the tube (mA), and the average size and age of the patients referred for EOS imaging were greater than digital radiology, however, the average DAP in EOS was 1/5 of that in digital radiology system. Also, the average dose in the EOS was about 1/20 of that in digital radiology. Conclusion: The patient dose in EOS imaging system was lower in comparison with digital radiology (1/20).
Leif Claassen; Christian Plaass; Marc-Frederic Pastor; Sarah Ettinger; Mathias Wellmann; Christina Stukenborg-Colsman; Hazibullah Waizy; Sayyed-Hadi Sayyed-Hosseinian
Volume 5, Issue 4 , July 2017, , Pages 221-225
Abstract
Background:Locking plate fixation is increasingly used for first metatarsophalangeal joint (MTP-I) arthrodesis. Still there is few comparable clinical data regarding this procedure. Methods:We retrospectively evaluated 60 patients who received an arthrodesis of the MTP-I between January 2008 and June ...
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Background:Locking plate fixation is increasingly used for first metatarsophalangeal joint (MTP-I) arthrodesis. Still there is few comparable clinical data regarding this procedure. Methods:We retrospectively evaluated 60 patients who received an arthrodesis of the MTP-I between January 2008 and June 2010. With 20 patients each we performed a locking plate fixation with lag screw, arthrodesis with crossed-screwsor with a nonlocking plate with lag screw. Results: There were four non-unions in crossed-screws patients and one nonunion in non-locked plate group. All the patients in locking plate group achieved union. 90% of the patients were completely or mildly satisfied in locking plate group, whereas this rate was 80% for patients in both crossed screws and non-locking plate groups. Conclusions: Use of dorsal plating for arthrodesis of MTP1 joint either locking or non-locking were associated with high union rate and acceptable and comparable functional outcome. Although nonunion rate was high using two crossed screws but functional outcome was not significantly different compare to dorsal plating. Level of evidence:Ш, retrospective comparative study
E. Carlos RODRIGUEZ-MERCHAN
Volume 6, Issue 1 , January 2018, , Pages 19-22
Abstract
High tibial osteotomy (HTO) is a well established technique for the treatment of medial osteoarthritis ofthe knee with varus malalignment. The outcome of total knee arthroplasty (TKA) after HTO remains uncertain.The aim of this paper is to revise the literature with the aim of answering the following ...
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High tibial osteotomy (HTO) is a well established technique for the treatment of medial osteoarthritis ofthe knee with varus malalignment. The outcome of total knee arthroplasty (TKA) after HTO remains uncertain.The aim of this paper is to revise the literature with the aim of answering the following question: Does a previous (HTO)influence the long-term function or survival of a TKA?. The search engine was MedLine. The keywords used were: total knee arthroplasty after high tibial osteotomy. One hundred and ten articles were found. Of those, only 19 were selected and reviewed because they were strictly focused on the topic and the question of this article. The reports published so far have a low grade of evidence (levels III and IV). Most of them are prospective case series (level IV). One is a systematic review of level III studies reported in 2009. Two recent studies based in a great number of cases (registers) showed similar survival in the 2 groups: around 92% at 10 years, and 88% at 15 years. The review of the literature suggests that a previous HTO does not influence the function or survival of a TKA in the long-term.