101
|
Langner JL, Pham NS, Richey A, Oquendo Y, Mehta S, Vorhies JS. Spinal fusion is an aerosol generating procedure. World J Orthop 2023; 14:340-347. [PMID: 37304197 PMCID: PMC10251270 DOI: 10.5312/wjo.v14.i5.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/14/2023] [Accepted: 03/27/2023] [Indexed: 05/18/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures. Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons. Aerosolized particles containing infectious coronavirus are typically 0.5-8.0 μm.
AIM To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer (OPS).
METHODS We quantified airborne particle counts during five posterior spinal instrumentation and fusions (9/22/2020-10/15/2020) using an OPS near the surgical field. Data were analyzed by 3 particle size groups: 0.3-0.5 μm/m3, 1.0-5.0 μm/m3, and 10.0 μm/m3. We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress. A spike was defined as a > 3 standard deviation increase from average baseline levels.
RESULTS Upon univariate analysis, bovie (P < 0.0001), high speed pneumatic burring (P = 0.009), and ultrasonic bone scalpel (P = 0.002) were associated with increased 0.3-0.5 μm/m3 particle counts relative to baseline. Bovie (P < 0.0001) and burring (P < 0.0001) were also associated with increased 1-5 μm/m3 and 10 μm/m3 particle counts. Pedicle drilling was not associated with increased particle counts in any of the size ranges measured. Our logistic regression model demonstrated that bovie (OR = 10.2, P < 0.001), burring (OR = 10.9, P < 0.001), and bone scalpel (OR = 5.9, P < 0.001) had higher odds of a spike in 0.3-0.5 μm/m3 particle counts. Bovie (OR = 2.6, P < 0.001), burring (OR = 5.8, P < 0.001), and bone scalpel (OR = 4.3, P = 0.005) had higher odds of a spike in 1-5 μm/m3 particle counts. Bovie (OR = 0.3, P < 0.001) and drilling (OR = 0.2, P = 0.011) had significantly lower odds of a spike in 10 μm/m3 particle counts relative to baseline.
CONCLUSION Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range. Further research is warranted to determine if such particles have the potential to contain infectious viruses. Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.
Collapse
Affiliation(s)
- Joanna Lind Langner
- Pediatric Orthopaedic Surgery, Stanford University, Palo Alto, CA 94304, United States
| | - Nicole Segovia Pham
- Pediatric Orthopaedic Surgery, Stanford University, Palo Alto, CA 94304, United States
| | - Ann Richey
- Pediatric Orthopaedic Surgery, Stanford University, Palo Alto, CA 94304, United States
| | - Yousi Oquendo
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Shayna Mehta
- Pediatric Orthopaedic Surgery, Stanford University, Palo Alto, CA 94304, United States
| | | |
Collapse
|
102
|
Abstract
Pott's spine, commonly known as spinal tuberculosis (TB), is an extrapulmonary form of TB caused by Mycobacterium TB. Pott's paraplegia occurs when the spine is involved. Spinal TB is usually caused by the hematogenous spread of infection from a central focus, which can be in the lungs or another location. Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply, which can result in severe morbidity even after years of approved therapy. Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body. The clinical, radiographic, microbiological, and histological data are used to make the diagnosis of spinal TB. In Pott's spine, combination multidrug antitubercular therapy is the basis of treatment. The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection. Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care. Debridement, fusion stabilization, and correction of spinal deformity are the cornerstones of surgical treatment. Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.
Collapse
Affiliation(s)
- Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
| | - Pathomthep Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
| | - Tawithep Leowattana
- Department of Medicine, Faculty of Medicine, Srinakarinwirot University, Wattana 10110, Bangkok, Thailand
| |
Collapse
|
103
|
Ubillus HA, Samsonov AP, Azam MT, Forney MP, Jimenez Mosquea TR, Walls RJ. Implications of obesity in patients with foot and ankle pathology. World J Orthop 2023; 14:294-301. [PMID: 37304200 PMCID: PMC10251267 DOI: 10.5312/wjo.v14.i5.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 05/18/2023] [Imported: 07/06/2023] Open
Abstract
Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2. It is predicted that by 2030, 48.9% of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups. This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields. The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies, with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates. In line with increasing interest on the impact of obesity in orthopedics, there has been a similar output of publications in the foot and ankle literature. This review article evaluates several foot and ankle pathologies, their risk factors associated with obesity and subsequent management. It provides an updated, comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes, with the ultimate aim of educating both surgeons and allied health professionals about the risks, benefits, and modifiable factors of operating on obese patients.
Collapse
Affiliation(s)
- Hugo A Ubillus
- Department of Orthopedic Surgery, NYU Langone Health, New York City, NY 10002, United States
| | - Alan P Samsonov
- Department of Orthopedic Surgery, NYU Langone Health, New York City, NY 10002, United States
| | - Mohammad T Azam
- Department of Orthopedic Surgery, NYU Langone Health, New York City, NY 10002, United States
| | - Megan P Forney
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, United States
| | | | - Raymond J Walls
- Department of Orthopedic Surgery, NYU Langone Health, New York City, NY 10002, United States
| |
Collapse
|
104
|
Primadhi RA, Septrina R, Hapsari P, Kusumawati M. Amputation in diabetic foot ulcer: A treatment dilemma. World J Orthop 2023; 14:312-318. [PMID: 37304194 PMCID: PMC10251268 DOI: 10.5312/wjo.v14.i5.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/27/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023] [Imported: 07/06/2023] Open
Abstract
Diabetic foot is a clinical manifestation of diabetes with a wide range of symptoms, including ulceration, osteomyelitis, osteoarticular destruction, and gangrene, as a consequence of advanced disease. Some diabetic foot cases present general indications for amputation, including dead limb, threat to the patient’s life, pain, loss of function, or nuisance. Various tools have been introduced to help decision-making in amputation for diabetic foot. However, it remains a conundrum because diabetic foot involves multiple pathomechanisms and factors that hinder its outcomes. Sociocultural issues often impede treatment from the patient’s side. We reviewed different perspectives in diabetic foot management, particularly related to amputation. In addition to deciding whether to amputate, physicians should address amputation level, timing, and ways to avoid patient deconditioning. Surgeons should not be autocratic in these circumstances and should be aware of beneficence and maleficence when considering whether to amputate. The main goal should be improving the patients’ quality of life rather than preserving the limb as much as possible.
Collapse
Affiliation(s)
- Raden Andri Primadhi
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
| | - Rani Septrina
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
| | - Putie Hapsari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
| | - Maya Kusumawati
- Internal Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
| |
Collapse
|
105
|
Shim BJ, Won H, Kim SY, Baek SH. Surgical strategy of the treatment of atypical femoral fractures. World J Orthop 2023; 14:302-311. [PMID: 37304202 PMCID: PMC10251271 DOI: 10.5312/wjo.v14.i5.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 05/18/2023] [Imported: 07/06/2023] Open
Abstract
The atypical femoral fracture (AFF) has been attracting significant attention because of its increasing incidence; additionally, its treatment is challenging from biological and mechanical aspects. Although surgery is often required to manage complete AFFs, clear guidelines for the surgical treatment of AFFs are currently sparse. We reviewed and described the surgical treatment of AFFs and the surveillance of the contralateral femur. For complete AFFs, cephalomedullary intramedullary nailing spanning the entire length of the femur can be used. Various surgical techniques to overcome the femoral bowing common in AFFs include a lateral entry point, external rotation of the nail, and the use of a nail with a small radius of curvature, or a contralateral nail. In the case of a narrow medullary canal, severe femoral bowing, or pre-existing implants, plate fixation may be considered as an alternative. For incomplete AFFs, prophylactic fixation depends on several risk factors, such as a subtrochanteric location, presence of a radiolucent line, functional pain, and condition of the contralateral femur; the same surgical principles as those in complete AFFs can be applied. Finally, once AFF is diagnosed, clinicians should recognize the increased risk of contralateral AFFs, and close surveillance of the contralateral femur is recommended.
Collapse
Affiliation(s)
- Bum-Jin Shim
- Department of Orthopedic Surgery, Kyungpook National University Chilgok Hospital, Daegu 41404, South Korea
- Department of Orthopedic Surgery, Kyungpook National University, College of Medincine, Daegu 41944, South Korea
| | - Heejae Won
- Department of Orthopedic Surgery, Kyungpook National University Chilgok Hospital, Daegu 41404, South Korea
| | - Shin-Yoon Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University, College of Medincine, Daegu 41944, South Korea
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University, College of Medincine, Daegu 41944, South Korea
| |
Collapse
|
106
|
Emara KM, Diab RA, Emara AK, Eissa M, Gemeah M, Mahmoud SA. Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease. World J Orthop 2023; 14:328-339. [PMID: 37304198 PMCID: PMC10251266 DOI: 10.5312/wjo.v14.i5.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease (LCPD) is controversial. Although the concept of femoral head containment is a well-established technique of treatment, its use remains debatable in the late stages of the disease, as it does not improve symptoms in terms of limb length discrepancy and gait.
AIM To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease.
METHODS From 2000 to 2007, 36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion (ROM) variables. The Mose classification was also assessed at the last follow-up to reflect possible remodeling. The patients were 8 years old or older at the time of surgery, in the post-fragmentation stage, and complaining of pain, limited ROM, Trendelenburg gait, and/or abductor weakness.
RESULTS The preoperative IOWA score (average: 53.3) markedly improved at the 1-year post follow-up period (average: 85.41) and then slightly improved at the last follow-up (average: 89.4) (P value < 0.05). ROM improved, with internal rotation increased on average by 22° (from 10° preoperatively to 32° postoperatively) and abduction increased on average by 15.9° (from 25° preoperatively to 41° postoperatively). The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period. The tests used were the paired t-test and Pearson correlation test, where the level of significance was a P value less than 0.05.
CONCLUSION Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.
Collapse
Affiliation(s)
- Khaled M Emara
- Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt
| | - Ramy Ahmed Diab
- Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 9500, United States
| | - Mohamed Eissa
- Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt
| | - Mostafa Gemeah
- Health Care Innovation Program, Arizona State University, Tempe, AZ 85287, United States
| | | |
Collapse
|
107
|
Tabeayo E, Saucedo JM, Srinivasan RC, Shah AR, Karamanos E, Rockwood J, Rodriguez-Merchan EC. Bridge plating in the setting of radiocarpal instability: Does distal fixation to the second or third metacarpal matter? A cadaveric study. World J Orthop 2023; 14:207-217. [PMID: 37155513 PMCID: PMC10122777 DOI: 10.5312/wjo.v14.i4.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Radiocarpal dislocations are rare but potentially devastating injuries. Poorer outcomes are associated with inadequate or lost reduction, such as ulnar translocation, but no consensus exists on the ideal fixation technique. Dorsal bridge plate fixation has been described for various settings in the treatment of complex distal radius fractures and can be fixed distally to the second or third metacarpal, but its application for radiocarpal dislocations has not been established.
AIM To determine whether distal fixation to the second or third metacarpal matters.
METHODS Using a cadaveric radiocarpal dislocation model, the effect of distal fixation was studied in two stages: (1) A pilot study that investigated the effect of distal fixation alone; and (2) a more refined study that investigated the effect of described techniques for distal and proximal fixation. Radiographs were measured in various parameters to determine the quality of the reduction achieved.
RESULTS The pilot study found that focusing on distal fixation alone without changing proximal fixation results in ulnar translocation and volar subluxation when fixing distally to the second metacarpal compared with the third. The second iteration demonstrated that anatomic alignment in coronal and sagittal planes could be achieved with each technique.
CONCLUSION In a cadaveric radiocarpal dislocation model, anatomic alignment can be maintained with bridge plate fixation to the second metacarpal or the third metacarpal if the described technique is followed. When considering dorsal bridge plate fixation for radiocarpal dislocations, the surgeon is encouraged to understand the nuances of different fixation techniques and how implant design features may influence proximal placement.
Collapse
Affiliation(s)
- Eloy Tabeayo
- Department of Orthopedic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY 10461, United States
| | - James M Saucedo
- Houston Methodist Institute for Academic Medicine, Houston Methodist Orthopedics and Sports Medicine, Houston, TX 77479, United States
| | - Ramesh C Srinivasan
- Hand Center of San Antonio and the Department of Orthopedic Surgery, University of Texas Health Science Center, The Hand Center of San Antonio, San Antonio, TX 78240, United States
| | - Amita R Shah
- University of Texas Health Science Center at San Antonio, University of North Carolina at Chapel Hill, San Antonio, TX 78229, United States
| | - Efstathios Karamanos
- Surgeon in the Division of Acute Care Surgery in the Department of Surgery at Henry Ford Hospital in Detroit, UT Health San Antonio, San Antonio, TX 78229, United States
| | | | | |
Collapse
|
108
|
Wen Z, Wu YY, Kuang GY, Wen J, Lu M. Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children. World J Orthop 2023; 14:186-196. [PMID: 37155509 PMCID: PMC10122774 DOI: 10.5312/wjo.v14.i4.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/19/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
Developmental dysplasia of hip seriously affects the health of children, and pelvic osteotomy is an important part of surgical treatment. Improving the shape of the acetabulum, preventing or delaying the progression of osteoarthritis is the ultimate goal of pelvic osteotomies. Re-directional osteotomies, reshaping osteotomies and salvage osteotomies are the three most common types of pelvic osteotomy. The influence of different pelvic osteotomy on acetabular morphology is different, and the acetabular morphology after osteotomy is closely related to the prognosis of the patients. But there lacks comparison of acetabular morphology between different pelvic osteotomies, on the basis of retrospective analysis and measurable imaging indicators, this study predicted the acetabular shape after developmental dysplasia of the hip pelvic osteotomy in order to help clinicians make reasonable and correct decisions and improve the planning and performance of pelvic osteotomy.
Collapse
Affiliation(s)
- Zhi Wen
- Graduate School, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Yu-Yuan Wu
- Department of Pediatric Orthopedics, Traditional Chinese Medicine Hospital in Huaihua, Huaihua 418000, Hunan Province, China
| | - Gao-Yan Kuang
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Min Lu
- Department of Joint Orthopedics, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| |
Collapse
|
109
|
Tang K, Goldman S, Avrumova F, Lebl DR. Background, techniques, applications, current trends, and future directions of minimally invasive endoscopic spine surgery: A review of literature. World J Orthop 2023; 14:197-206. [PMID: 37155511 PMCID: PMC10122780 DOI: 10.5312/wjo.v14.i4.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/02/2023] [Accepted: 04/12/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
Across many of the surgical specialties, the use of minimally invasive techniques that utilize indirect visualization has been increasingly replacing traditional techniques which utilize direct visualization. Arthroscopic surgery of the appendicular skeleton has evolved dramatically and become an integral part of musculoskeletal surgery over the last several decades, allowing surgeons to achieve similar or better outcomes, while reducing cost and recovery time. However, to date, the axial skeleton, with its close proximity to critical neural and vascular structures, has not adopted endoscopic techniques at as rapid of a rate. Over the past decade, increased patient demand for less invasive spine surgery combined with surgeon desire to meet these demands has driven significant evolution and innovation in endoscopic spine surgery. In addition, there has been an enormous advancement in technologies that assist in navigation and automation that help surgeons circumvent limitations of direct visualization inherent to less invasive techniques. There are currently a multitude of endoscopic techniques and approaches that can be utilized in the treatment of spine disorders, many of which are evolving rapidly. Here we present a review of the field of endoscopic spine surgery, including the background, techniques, applications, current trends, and future directions, to help providers gain a better understanding of this growing modality in spine surgery.
Collapse
Affiliation(s)
- Kevin Tang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Samuel Goldman
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Fedan Avrumova
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| |
Collapse
|
110
|
Simonetta R, Russo A, Palco M, Costa GG, Mariani PP. Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide. World J Orthop 2023; 14:171-185. [PMID: 37155506 PMCID: PMC10122773 DOI: 10.5312/wjo.v14.i4.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/22/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
Over the years, several studies demonstrated the crucial role of knee menisci in joint biomechanics. As a result, save the meniscus has become the new imperative nowadays, and more and more studies addressed this topic. The huge amount of data on this topic may create confusion in those who want to approach this surgery. The aim of this review is to provide a practical guide for treatment of meniscus tears, including an overview of technical aspects, outcomes in the literature and personal tips. Taking inspiration from a famous movie directed by Sergio Leone in 1966, the authors classified meniscus tears in three categories: The good, the bad and the ugly lesions. The inclusion in each group was determined by the lesion pattern, its biomechanical effects on knee joint, the technical challenge, and prognosis. This classification is not intended to substitute the currently proposed classifications on meniscus tears but aims at offering a reader-friendly narrative review of an otherwise difficult topic. Furthermore, the authors provide a concise premise to deal with some aspects of menisci phylogeny, anatomy and biomechanics.
Collapse
Affiliation(s)
- Roberto Simonetta
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro 88100, Italy
| | - Arcangelo Russo
- Orthopaedic and Traumatology Unit, Umberto I Hospital, Enna 94100, Italy
| | - Michelangelo Palco
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro 88100, Italy
| | | | - Pier Paolo Mariani
- Department of Orthopaedic and Traumatology, Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Roma 00135, Italy
| |
Collapse
|
111
|
Primadhi RA, Kartamihardja AHS. Subclinical ankle joint tuberculous arthritis - The role of scintigraphy: A case series. World J Orthop 2023; 14:260-267. [PMID: 37155508 PMCID: PMC10122779 DOI: 10.5312/wjo.v14.i4.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/06/2023] [Accepted: 03/23/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Tuberculosis remains a complicated problem. A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis. Delayed management, particularly in osteoarticular regions, results in unnecessary procedures, including joint-sacrificing surgery.
CASE SUMMARY Three cases of subclinical ankle joint tuberculosis without clear signs of tuberculosis were presented. The efficacy of technetium-99m-ethambutol scintigraphy in diagnosing early-stage tuberculous arthritis is reported.
CONCLUSION The reports suggested that scintigraphy is recommended to diagnose subclinical tuberculous arthritis, especially in tuberculosis endemic regions.
Collapse
Affiliation(s)
- Raden Andri Primadhi
- Department Orthopaedics and Traumatology, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung 40161, Indonesia
| | | |
Collapse
|
112
|
Tan IEH, Chok AY, Zhao Y, Chen Y, Koo CH, Aw J, Soh MHT, Foo CH, Ang KA, Tan EJKW, Tan AHC, Au MKH. Acute hospital-community hospital care bundle for elderly orthopedic surgery patients: A propensity score-matched economic analysis. World J Orthop 2023; 14:231-239. [PMID: 37155510 PMCID: PMC10122775 DOI: 10.5312/wjo.v14.i4.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/18/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND While Singapore attains good health outcomes, Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals. An Acute Hospital-Community Hospital (AH-CH) care bundle has been developed to assist patients in postoperative rehabilitation. The core concept is to transfer patients out of AHs when clinically recommended and into CHs, where they can receive more beneficial dedicated care to aid in their recovery, while freeing up bed capacities in AHs.
AIM To analyze the AH length of stay (LOS), costs, and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic surgery.
METHODS A total of 862 1:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital (SGH) before (2017-2018) and after (2019-2021) the care bundle intervention period was analyzed. Outcome measures were AH LOS, CH LOS, hospitalization metrics, postoperative 30-d mortality, and modified Barthel Index (MBI) scores. The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.
RESULTS Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention, the age distribution, sex, American Society of Anesthesiologists classification, Charlson Comorbidity Index, and surgical approach were comparable between both groups. Patients transferred to CHs after the surgery had a shorter median AH LOS (7 d vs 9 d, P < 0.001). The mean total AH inpatient cost per patient was 14.9% less for the elderly group transferred to CHs (S$24497.3 vs S$28772.8, P < 0.001). The overall AH U-turn rates for elderly patients within the care bundle were low, with a 0% mortality rate following orthopedic surgery. When elderly patients were discharged from CHs, their MBI scores increased significantly (50.9 vs 71.9, P < 0.001).
CONCLUSION The AH-CH care bundle initiated and implemented in the Department of Orthopedic Surgery appears to be effective and cost-saving for SGH. Our results indicate that transitioning care between acute and community hospitals using this care bundle effectively reduces AH LOS in elderly patients receiving orthopedic surgery. Collaboration between acute and community care providers can assist in closing the care delivery gap and enhancing service quality.
Collapse
Affiliation(s)
- Ivan En-Howe Tan
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yun Zhao
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yonghui Chen
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
| | - Chee Hoe Koo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Junjie Aw
- Post-Acute and Continuing Care, Family Medicine, Outram Community Hospital, Singapore 168582, Singapore
| | | | - Chek Hun Foo
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
| | - Kwok Ann Ang
- Finance, Singapore General Hospital, Singapore 169608, Singapore
| | | | - Andrew Hwee Chye Tan
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Marianne Kit Har Au
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
- Singhealth Community Hospital, Singapore 168582, Singapore
| |
Collapse
|
113
|
Christ AB, Chung BC, Urness M, Mayer LW, Gettleman BS, Heckmann ND, Menendez LR. Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications. World J Orthop 2023; 14:218-230. [PMID: 37155507 PMCID: PMC10122776 DOI: 10.5312/wjo.v14.i4.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/10/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Endoprosthetic distal femoral replacement (DFR) is a well-established salvage procedure following resection of malignant tumors within the distal femur. Use of an all-polyethylene tibial (APT) component is cost-effective and avoids failure due to locking-mechanism issues and backside wear, but limits modularity and the option for late liner exchange. Due to a paucity of literature we sought to answer three questions: (1) What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications? (2) What is the survivorship, rate of all-cause reoperation, and rate of revision for aseptic loosening of these implants? And (3) Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?
AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.
METHODS After Institutional Review Board approval, a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database. Inclusion criteria consisted of all patients who underwent DFR with a GMRS® (Global Modular Replacement System, Stryker, Kalamazoo, MI, United States) cemented distal femoral endoprosthesis and APT component for an oncologic indication. Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded. Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.
RESULTS 55 DFRs (55 patients) with an average age of 50.9 ± 20.7 years and average body mass index of 29.7 ± 8.3 kg/m2 were followed for 38.8 ± 54.9 mo (range 0.2-208.4). Of these, 60.0% were female and 52.7% were white. The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma (n = 22, 40.0%), giant cell tumor (n = 9, 16.4%), and metastatic carcinoma (n = 8, 14.6%). DFR with APT implantation was performed as a primary procedure in 29 patients (52.7%) and a revision procedure in 26 patients (47.3%). Overall, twenty patients (36.4%) experienced a postoperative complication requiring reoperation. The primary modes of implant failure included Henderson Type 1 (soft tissue failure, n = 6, 10.9%), Type 2 (aseptic loosening, n = 5, 9.1%), and Type 4 (infection, n = 6, 10.9%). There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups. In total, 12 patients (21.8%) required a revision while 20 patients (36.4%) required a reoperation, resulting in three-year cumulative incidences of 24.0% (95%CI 9.9%-41.4%) and 47.2% (95%CI 27.5%-64.5%), respectively.
CONCLUSION This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications. Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.
Collapse
Affiliation(s)
- Alexander B Christ
- Department of Orthopedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Brian C Chung
- Department of Orthopedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Matthew Urness
- Department of Orthopedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Lucas W Mayer
- Department of Orthopedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Brandon S Gettleman
- University of South Carolina School of Medicine, Columbia, SC 29209, United States
| | - Nathanael D Heckmann
- Department of Orthopedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Lawrence R Menendez
- Department of Orthopedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| |
Collapse
|
114
|
Aytekin MN, Hasanoglu I, Öztürk R, Tosun N. Knowledge and attitudes of orthopedic surgeons regarding prosthesis joint infection. World J Orthop 2023; 14:240-247. [PMID: 37155512 PMCID: PMC10122778 DOI: 10.5312/wjo.v14.i4.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/25/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a critical complication after joint arthroplasty and is accompanied by increasing rates of morbidity and mortality. Several studies have aimed at preventing PJI.
AIM To research the knowledge level and attitudes of orthopedic surgeons, who play a key role in both preventing and managing PJI.
METHODS We conducted a web-based survey to evaluate orthopedic surgeons' knowledge level and attitudes regarding PJI. The Likert scale survey utilized consisted of 30 questions which were prepared based on the "Proceedings of the International Consensus on Periprosthetic Joint Infection".
RESULTS A total of 264 surgeons participated in the survey. Their average age was 44.8, and 173 participants (65.5%) had more than 10 years of experience. No statistically significant relationship was found between the PJI knowledge of the surgeons and their years of experience. However, participants who worked in training and research hospitals demonstrated higher levels of knowledge than the ones in the state hospitals. It was also noticed that surgeons' knowledge concerning the duration of antibiotic therapy and urinary infections was not consistent with their attitudes.
CONCLUSION Even though orthopedic surgeons have adequate knowledge about preventing and managing PJI, their attitudes might contradict their knowledge. Future studies are required to examine the causes and solutions of the contradictions between orthopedic surgeons' knowledge and attitudes.
Collapse
Affiliation(s)
- Mahmut Nedim Aytekin
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara 06500, Turkey
| | - Imran Hasanoglu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara City Hospital, Ankara 06500, Turkey
| | - Recep Öztürk
- Department of Orthopedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara 06200, Turkey
| | - Nihat Tosun
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara 06500, Turkey
| |
Collapse
|
115
|
Berry A, Houchen-Wolloff L, Crane N, Townshend D, Clayton R, Mangwani J. Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons. World J Orthop 2023; 14:248-259. [PMID: 37155505 PMCID: PMC10122781 DOI: 10.5312/wjo.v14.i4.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case. This could have significant benefits for patients and the health service. However there are theoretical concerns about post-operative complications and patient satisfaction due to pain.
AIM To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom (UK).
METHODS An online survey (19 questions) was sent to UK foot and ankle surgeons via the British Orthopaedic Foot & Ankle Society membership list in August 2021. Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended treatment pathway.
RESULTS 132 people responded to the survey invitation with 80% working in Acute NHS Trusts. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. 78% felt that there was scope to perform more procedures as day-case at their centre. Post-operative pain (34%) and patient satisfaction (10%) was not highly measured within their centres. Lack of adequate physiotherapy input pre/post-operatively (23%) and lack of out of hours support (21%) were the top perceived barriers to performing more major foot and ankle procedures as day-case.
CONCLUSION There is consensus among UK surgeons to do more major foot/ankle procedures as day-case. Out of hours support and physiotherapy input pre/ post-op were perceived as the main barriers. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery. At a local level, the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.
Collapse
Affiliation(s)
- Amber Berry
- Department of Physiotherapy, Spire Hospital, Leicester LE2 2FF, United Kingdom
| | - Linzy Houchen-Wolloff
- Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
| | - Natalie Crane
- Department of Physiotherapy, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, United Kingdom
| | - David Townshend
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, North Sheilds NE29 8NH, United Kingdom
| | - Robert Clayton
- Department of Orthopaedics, Victoria Hospital, Kirkcaldy KY2 5AH, United Kingdom
| | - Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
| |
Collapse
|
116
|
Ahmed AH, Ahmed S, Barakat A, Mangwani J, White H. Inflammatory response in confirmed non-diabetic foot and ankle infections: A case series with normal inflammatory markers. World J Orthop 2023; 14:136-145. [PMID: 36998381 PMCID: PMC10044321 DOI: 10.5312/wjo.v14.i3.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/23/2022] [Accepted: 02/01/2023] [Indexed: 03/17/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND The distinction between foot and ankle wound healing complications as opposed to infection is crucial for the appropriate and efficacious allocation of antibiotic therapy. Multiple reports have focused on the diagnostic accuracy of different inflammatory markers, however, mainly in the diabetic population.
AIM To evaluate the diagnostic accuracy of white cell count (WCC) and C-reactive protein (CRP) as diagnostic tools for this distinction in the non-diabetic cohort.
METHODS Data was reviewed from a prospectively maintained Infectious Diseases Unit database of 216 patients admitted at Leicester University Hospitals–United Kingdom with musculoskeletal infections over the period between July 2014 and February 2020 (68 mo). All patients with confirmed diagnosis of diabetes were excluded while only those with confirmed microbiological or clinical diagnosis of foot or ankle infection were included in our study. For the included patients, we retrospectively retrieved the inflammatory markers (WCCs and CRP) at the time of presentation. Values of CRP 0-10 mg/L and WCC 4.0-11.0 × 109/L were considered normal.
RESULTS After exclusion of patients with confirmed diabetes, 25 patients with confirmed foot or ankle infections were included. All infections were confirmed microbiologically with positive intra-operative culture results. 7 (28%) patients with osteomyelitis (OM) of the foot, 11 (44%) with OM of the ankle, 5 (20%) with ankle septic arthritis and 2 (8%) patients with post-surgical wound infection were identified. Previous bony surgery was identified in 13 (52%) patients, either a corrective osteotomy or an open reduction and internal fixation for a foot or ankle fracture with the infection developing on top of the existing metalwork. 21 (84%) patients did have raised inflammatory markers while 4 (16%) patients failed to mount an inflammatory response even with subsequent debridement and removal of metal work. CRP sensitivity was 84%, while WCC sensitivity was only 28%.
CONCLUSION CRP has a relatively good sensitivity in the diagnosis of foot and ankle infections in non-diabetic patients, whereas WCC is a poor inflammatory marker in the detection of such cases. In presence of clinically high level of suspicion of foot or ankle infection, a normal CRP should not rule out the diagnosis of OM.
Collapse
Affiliation(s)
- Amr Hassan Ahmed
- Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, Leicester LE1 5WW, Leicestershire, United Kingdom
| | - Shah Ahmed
- Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, Leicester LE1 5WW, Leicestershire, United Kingdom
| | - Ahmed Barakat
- Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, Leicester LE1 5WW, Leicestershire, United Kingdom
| | - Jitendra Mangwani
- Department of Trauma and Orthopedics, Leicester University Hospitals-NHS Trust, Leicester LE1 5WW, Leicestershire, United Kingdom
| | - Helena White
- Department of Infectious Diseases and Tropical Medicine, Leicester Royal Infirm, Leicester LE1 5WW, Leicestershire, United Kingdom
| |
Collapse
|
117
|
Satria O, Hadinoto SA, Fathurrahman I. Advances in wrist arthroscopic surgery in Indonesia. World J Orthop 2023; 14:103-112. [PMID: 36998384 PMCID: PMC10044324 DOI: 10.5312/wjo.v14.i3.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 02/21/2023] [Indexed: 03/17/2023] [Imported: 07/06/2023] Open
Abstract
Since the 1990s, new insights in wrist arthroscopy have led to the introduction of numerous treatment methods. Consequently, therapeutic procedures are no longer limited to resection as more specialized repair and functional reconstruction methods, involving tissue replacement and essential structural augmentation, have been shown to be beneficial. This article discusses the most prevalent reasons and uses for wrist arthroscopy, with an emphasis on Indonesia’s most recent and major advances in reconstructive arthroscopic surgery. Joint debridement, synovectomy, ganglionectomy, capsular release, and osteotomies are frequent resection operations. Ligament repair and arthroscopy-aided reduction and fixation for fractures and nonunion are all examples of reconstructive surgery.
Collapse
Affiliation(s)
- Oryza Satria
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Jakarta Selatan 12430, Daerah Khusus Ibukota Jakarta, Indonesia
| | - Seti Aji Hadinoto
- Department of Orthopaedic and Traumatology, Prof. Dr. Soeharso Orthopaedic Hospital, Faculty of Medicine, Sebelas Maret University, Solo 57162, Central Java, Indonesia
| | - Irfan Fathurrahman
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Jakarta Selatan 12430, Daerah Khusus Ibukota Jakarta, Indonesia
| |
Collapse
|
118
|
Sridhar S, Mouat-Hunter A, McCrory B. Rural implementation of the perioperative surgical home: A case-control study. World J Orthop 2023; 14:123-135. [PMID: 36998383 PMCID: PMC10044325 DOI: 10.5312/wjo.v14.i3.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/01/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Perioperative surgical home (PSH) is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas.
AIM To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study.
METHODS The research study was conducted at an 83-bed, licensed level-III trauma rural community hospital. A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts (n = 2305). To evaluate the importance of PSH in the rural surgical system, a case-control study was performed to compare TJR surgical outcomes (LOS, discharge disposition, and 90-d readmission) of the PSH cohort against two control cohorts [Control-1 PSH (C1-PSH) (n = 1413) and Control-2 PSH (C2-PSH) (n = 892)]. Statistical tests including Chi-square test or Fischer’s exact test were performed for categorical variables and Mann-Whitney test or Student’s t-test were performed for continuous variables. The general linear models (Poisson regression and binomial logistic regression) were performed to fit adjusted models.
RESULTS The LOS was significantly shorter in PSH cohort compared to two control cohorts (median PSH = 34 h, C1-PSH = 53 h, C2-PSH = 35 h) (P value < 0.05). Similarly, the PSH cohort had lower percentages of discharges to other facilities (PSH = 3.5%, C1-PSH = 15.5%, C2-PSH = 6.7%) (P value < 0.05). There was no statistical difference observed in 90-d readmission between control and PSH cohorts. However, the PSH implementation reduced the 90-d readmission percentage (PSH = 4.7%, C1-PSH = 6.1%, C2-PSH = 3.6%) lower than the national average 30-d readmission percentage which is 5.5%. The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician co-management. The elements of PSH including preoperative assessment, patient education and optimization, and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital.
CONCLUSION Implementation of the PSH system in a rural community hospital reduced LOS, increased direct-to-home discharge, and reduced 90-d readmission percentages.
Collapse
Affiliation(s)
- Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation, College of Public Health, The Ohio State University, Columbus, OH 43210, United States
| | - Amy Mouat-Hunter
- Preanesthesia Clinic, Bozeman Health, Bozeman, MT 59715, United States
| | - Bernadette McCrory
- Mechanical and Industrial Engineering, Montana State University, Bozeman, MT 59715, United States
| |
Collapse
|
119
|
Cutter B, Lum ZC, Giordani M, Meehan JP. Utility of D-dimer in total joint arthroplasty. World J Orthop 2023; 14:90-102. [PMID: 36998388 PMCID: PMC10044320 DOI: 10.5312/wjo.v14.i3.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/22/2022] [Accepted: 02/13/2023] [Indexed: 03/17/2023] [Imported: 07/06/2023] Open
Abstract
As the number of patients receiving total joint replacements continues to rise, considerable attention has been directed towards the early detection and prevention of postoperative complications. While D-dimer has long been studied as a diagnostic tool in venous thromboembolism (VTE), this assay has recently received considerable attention in the diagnosis of periprosthetic joint infection (PJI). D-dimer values are substantially elevated in the acute postoperative period after total joint arthroplasty, with levels often exceeding the standard institutional cutoff for VTE (500 µg/L). The utility of D-dimer in detecting VTE after total joint replacement is currently limited, and more research to assess its value in the setting of contemporary prophylaxis protocols is warranted. Recent literature supports D-dimer as a good to excellent biomarker for the diagnosis of chronic PJI, especially when using serum sample technique. Providers should exercise caution when interpreting D-dimer levels in patients with inflammatory and hypercoagulability disorders, as the diagnostic value is decreased. The updated 2018 Musculoskeletal Infection Society criteria, which includes D-dimer levels > 860 µg/L as a minor criterion, may be the most accurate for diagnosing chronic PJI to date. Larger prospective trials with transparent lab testing protocols are needed to establish best assay practices and optimal cutoff values for D-dimer in the diagnosis of PJI. This review summarizes the most current literature on the value of D-dimer in total joint arthroplasty and elucidates areas for future progress.
Collapse
Affiliation(s)
- Brenden Cutter
- Department of Orthopedic Surgery, Valley Orthopedic Surgery Residency/Valley Consortium for Medical Education, Modesto, CA 95351, United States
| | - Zachary C Lum
- Department of Orthopaedics, Adult Reconstruction Division, University of California, Davis Medical Center, Sacramento, CA 95817, United States
| | - Mauro Giordani
- Department of Orthopaedics, Adult Reconstruction Division, University of California, Davis Medical Center, Sacramento, CA 95817, United States
| | - John P Meehan
- Department of Orthopaedics, Adult Reconstruction Division, University of California, Davis Medical Center, Sacramento, CA 95817, United States
| |
Collapse
|
120
|
Vij N, Goncalves LF, Llanes A, Youn S, Belthur MV. Prenatal radiographic evaluation of congenital transverse limb deficiencies: A scoping review. World J Orthop 2023; 14:155-165. [PMID: 36998387 PMCID: PMC10044319 DOI: 10.5312/wjo.v14.i3.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/18/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Congenital transverse deficiencies are horizontal deficiencies of the long bones that occur with a reported incidence as high 0.38%. They can occur alone or represent a manifestation of a various clinical syndromes. Diagnosis has traditionally comprised of conventional radiography and prenatal imaging studies. There has been much advancement regarding prenatal imaging modalities to allow for early diagnosis and appropriate treatment.
AIM To summarize the current state of knowledge on congenital transverse limb deficiencies and to provide an update regarding the radiographic evaluation of congenital transverse limb deficiencies.
METHODS This IRB-exempt scoping review followed the PRISMA-ScR checklist for scoping reviews strictly. Five search engines were searched for a total of 265 publications. Four authors reviewed these during the screening process. Of these, 51 studies were included in our article. Prenatal magnetic resonance imaging (MRI), 3D Ultrasound, and multidetector Computed tomography (CT) exist are emerging modalities that have the potential to improve diagnosis.
RESULTS Use of the appropriate classification system, three-dimensional ultrasonography with a maximum intensity projection, and appropriate use of prenatal MRI and prenatal CT can improve diagnosis and inter-provider communication.
CONCLUSION Further scholarly efforts are required to develop improve standardized guidelines regarding the pre-natal radiographic evaluation of congenital limb deficiencies.
Collapse
Affiliation(s)
- Neeraj Vij
- Department of Orthopedic Surgery, Phoenix Children’s Hospital, Phoenix, AZ 85016, United States
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ 85016, United States
| | - Aaron Llanes
- Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, United States
| | - Sean Youn
- Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, United States
| | - Mohan V Belthur
- Department of Orthopedic Surgery, Phoenix Children’s Hospital, Phoenix, AZ 85016, United States
| |
Collapse
|
121
|
Sadat-Ali M, Al-Mousa SA, Al-Tabash KW, Abotaleb MM, Al-Anii FM. Can we suppress excessive post-surgical scar formation: A case report. World J Orthop 2023; 14:166-170. [PMID: 36998386 PMCID: PMC10044323 DOI: 10.5312/wjo.v14.i3.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/14/2022] [Accepted: 02/09/2023] [Indexed: 03/17/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Hypertrophic scars (HSs) formation is a complication that occurs after wounds heal with secondary intention and sometimes after clean surgical incisions. Many treatments are in vogue now with varying successes. Although the mechanism or mechanisms that cause a HS to form are not clearly understood, one thing that is clear is that once scar tissue matures, any intervention will not be successful. In this paper, we report on a case where a patient who was known to develop HS was treated with a new combination of ingredients (Phyto-chemicals + Silicone JUMI) to suppress HS formation.
CASE SUMMARY A 68-year-old female of African descent presented a severe HS post total knee replacement (TKR), which the patient describes as itchy and painful. Due to complications caused by the scar, she was apprehensive about undergoing TKR on her other knee. However, after the TKR of the contralateral side post-removal of skin clips, JUMI anti-scar cream (JASC) was used to suppress excessive scar formation.
CONCLUSION JASC appears potent and efficacious at suppressing excessive scar formation. We believe that this warrants further studies on larger patient groups and on different surgical sites.
Collapse
Affiliation(s)
- Mir Sadat-Ali
- Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31142, Saudi Arabia
| | - Sulaiman A Al-Mousa
- Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31142, Saudi Arabia
| | - Khalid Waleed Al-Tabash
- Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31142, Saudi Arabia
| | - Mohamed M Abotaleb
- Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31142, Saudi Arabia
| | - Fawaz M Al-Anii
- Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31142, Saudi Arabia
| |
Collapse
|
122
|
Alrayes MM, Sukeik M. Two-stage revision in periprosthetic knee joint infections. World J Orthop 2023; 14:113-122. [PMID: 36998382 PMCID: PMC10044322 DOI: 10.5312/wjo.v14.i3.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 03/17/2023] [Imported: 07/06/2023] Open
Abstract
Periprosthetic joint infection (PJI) following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens. The road to efficiently diagnosing and treating PJI is challenging, as there is still no gold standard method to reach the diagnosis as early as desired. There are also international controversies with respect to the best approach to manage PJI cases. In this review, we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.
Collapse
Affiliation(s)
- Majd M Alrayes
- Department of Orthopedics, Imam Abdulrahman bin Faisal University, Khobar 34423, Saudi Arabia
| | - Mohamed Sukeik
- Department of Trauma & Orthopaedics, Dr. Sulaiman Al-Habib Hospital – Al Khobar, Al Khobar 34423, Al Khobar, Saudi Arabia
| |
Collapse
|
123
|
Sankova MV, Nikolenko VN, Oganesyan MV, Vovkogon AD, Gadzhiakhmedova AN, Zharikova TS, Zharikov YO. Identifying sex-specific injury predictors as a key factor in maintaining optimal physical activity levels. World J Orthop 2023; 14:146-154. [PMID: 36998385 PMCID: PMC10044326 DOI: 10.5312/wjo.v14.i3.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/11/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Optimal physical activity is known to reduce cardiovascular, respiratory and endocrine system diseases and, as a consequence, improve quality of life. An important risk factor for reinjuries during normal exercise is the initial connective tissue pathology. The variety of clinical dysplastic manifestations significantly complicate the timely diagnosis of this comorbidity.
AIM To establish pathognomonic sex-specific dysplasia phenotypes that indicate a particular sensitivity to physical exertion.
METHODS The study involved 117 participants with recurrent musculoskeletal injuries that occurred during normal exercise. There were 67 women (57.26%) and 50 men (42.74%), which made it possible to compare the presence of the identified signs between sexes. A validated questionnaire was used to screen their connective tissue status.
RESULTS Ranking the most commonly revealed dysplasia signs depending on their clinical significance made it possible to establish pathognomonic sex-specific phenotypes that indicated a particular susceptibility to injuries. Individualized programs of optimal physical activity are necessary for men with chest deformities, flat-valgus feet, dolichostenomelia, arachnodactylia, hemorrhoids, abdominal muscle diastasis and recurrent hernias. In women, special sensitivity to physical exertion was associated with a combination of signs such as asthenic body, joint hypermobility, overly soft auricles, thin hyperelastic skin, atrophic striae, telangiectasias and varicose veins. Of particular importance were universal signs such as gothic palate, scoliosis, kyphosis, leg deformities, temporomandibular joint crunching, and moderate to high myopia.
CONCLUSION Participants’ connective tissue condition should be considered when designing optimal physical activity programs. Identifying the established sex-specific dysplasia phenotypes will allow timely optimization of training loads, thus reducing the risk of injury.
Collapse
Affiliation(s)
- Maria V Sankova
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Vladimir N Nikolenko
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
- Department of Normal and Topographic Anatomy, Lomonosov Moscow State University, Moscow 119991, Russia
| | - Marine V Oganesyan
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
- Department of Normal and Topographic Anatomy, Lomonosov Moscow State University, Moscow 119991, Russia
| | - Andjela D Vovkogon
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
- European Osteopathic Clinical Center of the Moscow Branch of the “Medical Academy of Osteopathic Education”, Saint Petersburg 199106, Russia
| | - Aida N Gadzhiakhmedova
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
| | - Tatyana S Zharikova
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
- Department of Normal and Topographic Anatomy, Lomonosov Moscow State University, Moscow 119991, Russia
| | - Yury O Zharikov
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| |
Collapse
|
124
|
Lipatov KV, Asatryan A, Melkonyan G, Kazantcev AD, Solov’eva EI, Gorbacheva IV, Vorotyntsev AS, Emelyanov AY. New classification for septic arthritis of the hand. World J Orthop 2023; 14:85-89. [PMID: 36844377 PMCID: PMC9945245 DOI: 10.5312/wjo.v14.i2.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/29/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023] [Imported: 07/06/2023] Open
Abstract
The severity of septic arthritis of the hand and the prospects for restoration of joint function are determined by a complex of factors. Among them, the leading role belongs to local changes in tissue structures. This includes the destruction of articular cartilage and bone tissue with the development of osteomyelitis, the involvement of paraarticular soft tissues in the purulent process, and the destruction of the flexor/extensor tendons of the fingers. The currently missing specialized classification of septic arthritis could help in systematizing the diseases, determining treatment tactics, and predicting the results of treatment. The classification of septic arthritis of the hand proposed for discussion is based on the following principle: Joint−Wound−Tendon (JxWxTx); Jx characterizes damage to the osteochondral structures of the joint, Wx is the presence of paraarticular purulent wounds or fistulas, and Tx is destruction of the flexor/extensor tendons of the finger. The classification of the diagnosis makes it possible to assess the nature and severity of damage to the structures of the joint and may also be useful when comparing the results of treatment of septic arthritis of the hand.
Collapse
Affiliation(s)
- Konstantin V Lipatov
- Department of General Surgery, Institute of Clinical Medicine Named After N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
| | - Arthur Asatryan
- Department of Wound and Wound Infection Surgery, State Budgetary Institution “City Clinical Hospital named after S.S. Yudin of Moscow Healthcare Department”, Moscow 115446, Russia
| | - George Melkonyan
- Department of General Surgery, Hospital for War Veterans №3, Moscow 129336, Russia
| | - Aleksandr D Kazantcev
- Department of General Surgery, Institute of Clinical Medicine Named After N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
| | - Ekaterina I Solov’eva
- Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | - Irina V Gorbacheva
- Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | - Alexander S Vorotyntsev
- Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | - Andrey Y Emelyanov
- Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
| |
Collapse
|
125
|
Joob B, Wiwanitkit V. Effect of SARS-CoV-2 infection on trauma throughput to alternative elective care approaches. World J Orthop 2023; 14:83-84. [PMID: 36844380 PMCID: PMC9945244 DOI: 10.5312/wjo.v14.i2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] [Imported: 07/06/2023] Open
Abstract
In response to the paper on coronavirus disease 2019's effects on trauma throughput, elective care models should be modified. Concerns about the relevant factors and their potential therapeutic applications are brought up and looked into.
Collapse
Affiliation(s)
- Beuy Joob
- Academic Center, Sanitation 1 Medical Academic Center, Bangkok 1033000, Thailand
| | - Viroj Wiwanitkit
- Community Medicine, Dy Patil Vidhayapeeth, Pune 2303002323, India
| |
Collapse
|
126
|
Zeng M, Xu Z, Song ZQ, Li JX, Tang ZW, Xiao S, Wen J. Diagnosis and treatment of chronic osteomyelitis based on nanomaterials. World J Orthop 2023; 14:42-54. [PMID: 36844379 PMCID: PMC9945247 DOI: 10.5312/wjo.v14.i2.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] [Imported: 07/06/2023] Open
Abstract
Chronic osteomyelitis is a painful and serious disease caused by infected surgical prostheses or infected fractures. Traditional treatment includes surgical debridement followed by prolonged systemic antibiotics. However, excessive antibiotic use has been inducing rapid emergence of antibiotic-resistant bacteria worldwide. Additionally, it is difficult for antibiotics to penetrate internal sites of infection such as bone, thus limiting their efficacy. New approaches to treat chronic osteomyelitis remain a major challenge for orthopedic surgeons. Luckily, the development of nanotechnology has brought new antimicrobial options with high specificity to infection sites, offering a possible way to address these challenges. Substantial progress has been made in constructing antibacterial nanomaterials for treatment of chronic osteomyelitis. Here, we review some current strategies for treatment of chronic osteomyelitis and their underlying mechanisms.
Collapse
Affiliation(s)
- Ming Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie-Xiao Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| |
Collapse
|
127
|
Semita IN, Utomo DN, Suroto H. Mechanism of spinal cord injury regeneration and the effect of human neural stem cells-secretome treatment in rat model. World J Orthop 2023; 14:64-82. [PMID: 36844381 PMCID: PMC9945248 DOI: 10.5312/wjo.v14.i2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Globally, complete neurological recovery of spinal cord injury (SCI) is still less than 1%, and 90% experience permanent disability. The key issue is that a pharmacological neuroprotective-neuroregenerative agent and SCI regeneration mechanism have not been found. The secretomes of stem cell are an emerging neurotrophic agent, but the effect of human neural stem cells (HNSCs) secretome on SCI is still unclear.
AIM To investigate the regeneration mechanism of SCI and neuroprotective-neuroregenerative effects of HNSCs-secretome on subacute SCI post-laminectomy in rats.
METHODS An experimental study was conducted with 45 Rattus norvegicus, divided into 15 normal, 15 control (10 mL physiologic saline), and 15 treatment (30 μL HNSCs-secretome, intrathecal T10, three days post-traumatic). Locomotor function was evaluated weekly by blinded evaluators. Fifty-six days post-injury, specimens were collected, and spinal cord lesion, free radical oxidative stress (F2-Isoprostanes), nuclear factor-kappa B (NF-κB), matrix metallopeptidase 9 (MMP9), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), B cell lymphoma-2 (Bcl-2), nestin, brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF) were analyzed. The SCI regeneration mechanism was analyzed using partial least squares structural equation modeling (PLS SEM).
RESULTS HNSCs-secretome significantly improved locomotor recovery according to Basso, Beattie, Bresnahan (BBB) scores and increased neurogenesis (nestin, BDNF, and GDNF), neuroangiogenesis (VEGF), anti-apoptotic (Bcl-2), anti-inflammatory (IL-10 and TGF-β), but decreased pro-inflammatory (NF-κB, MMP9, TNF-α), F2-Isoprostanes, and spinal cord lesion size. The SCI regeneration mechanism is valid by analyzed outer model, inner model, and hypothesis testing in PLS SEM, started with pro-inflammation followed by anti-inflammation, anti-apoptotic, neuroangiogenesis, neurogenesis, and locomotor function.
CONCLUSION HNSCs-secretome as a potential neuroprotective-neuroregenerative agent for the treatment of SCI and uncover the SCI regeneration mechanism.
Collapse
Affiliation(s)
- I Nyoman Semita
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
- Department of Orthopedic and Traumatology, Faculty of Medicine, University of Jember, Jember 68121, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Surabaya 60118, East Java, Indonesia
| | - Heri Suroto
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Surabaya 60118, East Java, Indonesia
| |
Collapse
|
128
|
Mishra A, Juneja D. Fungal arthritis: A challenging clinical entity. World J Orthop 2023; 14:55-63. [PMID: 36844378 PMCID: PMC9945246 DOI: 10.5312/wjo.v14.i2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/22/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] [Imported: 07/06/2023] Open
Abstract
There has been an increasing incidence of fungal infections in recent years. Rarely joints are also affected by fungal infections. Mainly, these infections develop in prosthetic joints, but sometimes native joints are also involved. Candida infections are mostly reported, but patients may also develop infections secondary to non-Candida fungi, especially Aspergillus. Diagnosis and management of these infections is challenging and may involve multiple surgical interventions and prolonged antifungal therapy. Despite this, these infections are associated with high morbidity and mortality. This review described the clinical features, risk factors, and therapeutic interventions required to manage fungal arthritis.
Collapse
Affiliation(s)
- Anjali Mishra
- Department of Critical Care Medicine, Holy Family Hospital, New Delhi 110025, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Specialty Hospital, Saket, New Delhi 110017, India
| |
Collapse
|
129
|
Pace V, Marzano F, Placella G. Update on surgical procedures for carpal tunnel syndrome: What is the current evidence and practice? What are the future research directions? World J Orthop 2023; 14:6-12. [PMID: 36686281 PMCID: PMC9850791 DOI: 10.5312/wjo.v14.i1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a multifactorial compression neuropathy. It is reported to be very common and rising globally. CTS’s treatment varies from conservative measures to surgical treatments. Surgery has shown to be an effective method for more severe cases. However few unclear aspects and room for further research and improvements still remains. We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS. The simple algorithm of leaving the choice of the surgical method to surgeons’ preference and experience (together with consideration of patients’ related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews. We suggest that surgeons (unless in presence of precise indications towards endoscopic release) should tend to perform a minimally invasive open approach release, favoring the advantage of a better neurovascular structures visualization (and a consequent higher chance to perform a complete release with long term relief of symptoms) instead of favoring an early reduction (in the first postoperative days) of immobilization and pain. Research towards a universally accepted standardization should be aimed for by the researchers, who have failed to date to sufficiently limit bias and limitations.
Collapse
Affiliation(s)
- Valerio Pace
- Department of Trauma & Orthopaedics, AOSP Terni - University of Perugia, Terni 05100, Italy
| | - Fabrizio Marzano
- Department of Trauma & Orthopaedics, University of Perugia, Perugia 06100, Italy
| | - Giacomo Placella
- Department of Trauma and Orthopaedics, IRCSS San Raffaele Hospital, Milan 20132, Italy
| |
Collapse
|
130
|
Abstract
Osteoarthritis (OA) is the most common form of arthritis that has a major impact on patient morbidity and health care services. Despite its prevalence and impact, we do not have any effective management strategy to prevent or control their manifestations. Several decades of pharmacological development have failed to deliver a disease-modifying solution to OA. This editorial article outlines the lacunae in the research efforts of the past, the challenges that we are facing at present, and the exciting opportunities we have in the future for the management of OA. OA research has to be made more personalized concerning the phenotypic and endotypic disease variants. To begin with, robust disease classification criteria need to be defined for early OA, and biomarkers to detect such early diseases to aid in patient stratification. We also need to refine our clinical research design to make them more objective to meet the demands of the patient and the regulatory agencies. Embracing the current technologies such as artificial intelligence along with the use of genomic profiling from the omics platforms, the future of OA is more promising in developing appropriate management of OA.
Collapse
Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul 624001, India
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
- School of Engineering and Technology, Sharda University, Greater Noida 201310, Uttar Pradesh, India
| |
Collapse
|
131
|
Muthu S, Patil SC, Jeyaraman N, Jeyaraman M, Gangadaran P, Rajendran RL, Oh EJ, Khanna M, Chung HY, Ahn BC. Comparative effectiveness of adipose-derived mesenchymal stromal cells in the management of knee osteoarthritis: A meta-analysis. World J Orthop 2023; 14:23-41. [PMID: 36686284 PMCID: PMC9850793 DOI: 10.5312/wjo.v14.i1.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/20/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is the most common joint disorder, is associated with an increasing socioeconomic impact owing to the ageing population.
AIM To analyze and compare the efficacy and safety of bone-marrow-derived mesenchymal stromal cells (BM-MSCs) and adipose tissue-derived MSCs (AD-MSCs) in knee OA management from published randomized controlled trials (RCTs).
METHODS Independent and duplicate electronic database searches were performed, including PubMed, EMBASE, Web of Science, and Cochrane Library, until August 2021 for RCTs that analyzed the efficacy and safety of AD-MSCs and BM-MSCs in the management of knee OA. The visual analog scale (VAS) score for pain, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, Tegner score, magnetic resonance observation of cartilage repair tissue score, knee osteoarthritis outcome score (KOOS), and adverse events were analyzed. Analysis was performed on the R-platform using OpenMeta (Analyst) software. Twenty-one studies, involving 936 patients, were included. Only one study compared the two MSC sources without patient randomization; hence, the results of all included studies from both sources were pooled, and a comparative critical analysis was performed.
RESULTS At six months, both AD-MSCs and BM-MSCs showed significant VAS improvement (P = 0.015, P = 0.012); this was inconsistent at 1 year for BM-MSCs (P < 0.001, P = 0.539), and AD-MSCs outperformed BM-MSCs compared to controls in measures such as WOMAC (P < 0.001, P = 0.541), Lysholm scores (P = 0.006; P = 0.933), and KOOS (P = 0.002; P = 0.012). BM-MSC-related procedures caused significant adverse events (P = 0.003) compared to AD-MSCs (P = 0.673).
CONCLUSION Adipose tissue is superior to bone marrow because of its safety and consistent efficacy in improving pain and functional outcomes. Future trials are urgently warranted to validate our findings and reach a consensus on the ideal source of MSCs for managing knee OA.
Collapse
Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, Tamil Nadu, India
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, Uttar Pradesh, India
- Research Associate, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
- Indian Stem Cell Study Group Association, Lucknow 226001, Uttar Pradesh, India
| | - Sandesh C Patil
- Department of Orthopaedic Rheumatology, Dr. RML National Law University, Lucknow 226012, Uttar Pradesh, India
| | - Naveen Jeyaraman
- Indian Stem Cell Study Group Association, Lucknow 226001, Uttar Pradesh, India
- Department of Orthopaedic Rheumatology, Dr. RML National Law University, Lucknow 226012, Uttar Pradesh, India
| | - Madhan Jeyaraman
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, Uttar Pradesh, India
- Research Associate, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
- Indian Stem Cell Study Group Association, Lucknow 226001, Uttar Pradesh, India
- Department of Orthopaedics, ACS Medical College & Hospital, Dr MGR Educational and Research Institute, Chennai 600056, Tamil Nadu, India
| | - Prakash Gangadaran
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Ramya Lakshmi Rajendran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Eun Jung Oh
- Department of Plastic and Reconstructive Surgery, CMRI, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Manish Khanna
- Indian Stem Cell Study Group Association, Lucknow 226001, Uttar Pradesh, India
| | - Ho Yun Chung
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Plastic and Reconstructive Surgery, CMRI, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, South Korea
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Byeong-Cheol Ahn
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu 41944, South Korea
| |
Collapse
|
132
|
Kyriazis Z, Kollia P, Grivea I, Stefanou N, Sotiriou S, Dailiana ZH. Polydactyly: Clinical and molecular manifestations. World J Orthop 2023; 14:13-22. [PMID: 36686282 PMCID: PMC9850794 DOI: 10.5312/wjo.v14.i1.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/04/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
Polydactyly is a malformation during the development of the human limb, which is characterized by the presence of more than the normal number of fingers or toes. It is considered to be one of the most common inherited hand disorders. It can be divided into two major groups: Non-syndromic polydactyly or syndromic polydactyly. According to the anatomical location of the duplicated digits, polydactyly can be generally subdivided into pre-, post-axial, and mesoaxial forms. Non-syndromic polydactyly is often inherited with an autosomal dominant trait and defects during the procedure of anterior-posterior patterning of limb development are incriminated for the final phenotype of the malformation. There are several forms of polydactyly, including hand and foot extra digit manifestations. The deformity affects upper limbs with a higher frequency than the lower, and the left foot is more often involved than the right. The treatment is always surgical. Since the clinical presentation is highly diverse, the treatment combines single or multiple surgical operations, depending on the type of polydactyly. The research attention that congenital limb deformities have recently attracted has resulted in broadening the list of isolated gene mutations associated with the disorders. Next generation sequencing technologies have contributed to the correlation of phenotype and genetic profile of the multiple polydactyly manifestations and have helped in early diagnosis and screening of most non-syndromic and syndromic disorders.
Collapse
Affiliation(s)
- Zisis Kyriazis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Panagoula Kollia
- Department of Genetics and Biotechnology, Faculty of Biology, University of Athens, Athens 15701, Greece
| | - Ioanna Grivea
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Sotirios Sotiriou
- Laboratory of Histology and Embryology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| |
Collapse
|
133
|
Prasathaporn N, Kuptniratsaikul V, Thamrongskulsiri N, Itthipanichpong T. Accuracy of the rotator cuff reparability score. World J Orthop 2022; 13:1038-1046. [PMID: 36567865 PMCID: PMC9782545 DOI: 10.5312/wjo.v13.i12.1038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/22/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The reparability of large or massive rotator cuff tears is difficult to determine pre-operatively. We previously identified age ≥ 65 years, acromiohumeral interval ≤ 6 mm, and anteroposterior tear size ≥ 22 mm as risk factors for rotator cuff repair failure. We therefore developed a rotator cuff reparability score where each of the above risk factors is assigned a score of one point.
AIM To determine the accuracy of a rotator cuff reparability score.
METHODS This was a retrospective cohort study of recruited patients with large or massive rotator cuff tears treated at our institution between January 2013 and December 2019. Exclusion criteria were revision surgery and patients with contraindications for surgery. All patients underwent arthroscopic rotator cuff repair and were categorized into either complete or partial rotator cuff repair. Rotator cuff reparability scores were calculated for each patient. The sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio were assessed. A receiver operating characteristic curve was plotted to determine the optimal cut-off rotator cuff reparability score.
RESULTS Eighty patients (mean age, 61 years; range, 25–84 years; 41 females and 39 males) were recruited. Intra- and inter-observer reliabilities were good to excellent. The number of patients with 0, 1, 2, and 3 risk factors for rotator cuff repair failure were 24, 33, 17, and 6, respectively. Complete repair was performed in all patients without risk factors. Two of the 33 patients with one risk factor and seven of the 17 patients with two risk factors underwent partial repair. One of the six patients with three risk factors underwent complete repair. The area under the curve was 0.894. The optimal cut-off score was two points with a sensitivity of 85.71% and a specificity of 83.33%.
CONCLUSION A rotator cuff reparability score of two was determined to be the optimal cut-off score for predicting the reparability of large or massive rotator cuff tears.
Collapse
Affiliation(s)
- Niti Prasathaporn
- Department of Orthopaedics, Ramkhamhaeng Hospital, Bangkok 10240, Thailand
| | - Vanasiri Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Napatpong Thamrongskulsiri
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Thun Itthipanichpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| |
Collapse
|
134
|
Alaseem AM, Turcotte RE, Ste-Marie N, Alzahrani MM, Alqahtani SM, Goulding KA. Occupational injuries and burn out among orthopedic oncology surgeons. World J Orthop 2022; 13:1056-1063. [PMID: 36567863 PMCID: PMC9782546 DOI: 10.5312/wjo.v13.i12.1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/12/2022] [Accepted: 11/29/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Orthopedic oncology surgeons commonly engage in prolonged and complex surgical procedures. These types of surgeries increase the risk of physical and psychological stressors, which may in turn make these physicians prone to work-related occupational injuries.
AIM The aim of this study was to explore in orthopedic oncologists, the prevalence of work-related physical injuries and psychological disturbances.
METHODS A modified version of the physical discomfort survey was developed to assess occupational injuries among orthopedic oncology surgeon members of the Musculoskeletal Tumor Society, the Canadian Orthopedic Oncology Society and European Musculoskeletal Oncology Societies. The survey was sent by email, and it explored musculoskeletal complaints, psychological disturbances, treatment required for these complaints and the requirement of time off work.
RESULTS A total of 67 surgeon responses were collected. A high number of orthopedic oncologists (84%) reported an occupational injury. Low back pain (39%) was the most prevalent musculoskeletal condition, followed by lumbar disk herniation (16%), shoulder tendinitis (15%) and lateral epicondylitis (13%). Of the cohort, 46% required surgery and 31% required time off work due to their injury. Thirty-three respondents reported a psychological disorder. Burnout (27%), anxiety (20%) and insomnia (20%) were the most commonly reported. Time required off work due to injury was associated with old age and years in practice.
CONCLUSION Orthopedic oncology surgeons report a high prevalence of work-related disorders. Lower back related injury and burnout were the most reported disorders. Improving operative room ergonomics and prevention of stress related to the work environment should be areas to explore in upcoming research.
Collapse
Affiliation(s)
- Abdulrahman M Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Robert E Turcotte
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal H4A3J1, Canada
| | - Nathalie Ste-Marie
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal H4A3J1, Canada
| | - Mohammad M Alzahrani
- Department of Orthopedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam 34212, Saudi Arabia
| | - Saad M Alqahtani
- Department of Orthopedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam 34212, Saudi Arabia
| | - Krista A Goulding
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona 85054, USA
| |
Collapse
|
135
|
Trevisan C, Lombardo AS, Gallinari G, Zeppieri M, Klumpp R. Taper-wedge stem suitable for anterior approach total hip arthroplasty: Adequate biomechanical reconstruction parameters and excellent clinical outcome at mid-term follow-up. World J Orthop 2022; 13:1047-1055. [PMID: 36567862 PMCID: PMC9782544 DOI: 10.5312/wjo.v13.i12.1047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/09/2022] [Accepted: 12/06/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty (THA) is a less invasive and muscle-sparing approach that seems to improve early function and patient satisfaction. Several studies, however, have reported high complication and revision rates due to the technical difficulties related to the femoral preparation.
AIM To evaluate the usefulness and safety of a new stem equipped with a morphometric design and a size-specific medial curvature in DAA for THA.
METHODS This retrospective study was based on 130 patients that underwent mini-invasive DAA procedures for THA using the Accolade II stem. A total of 144 procedures were included in the assessment, which was based on postoperative complications, survival rates, functional parameters, and patient related outcomes.
RESULTS Overall complications were recorded in 6 procedures (4.2%). There were no complications related to the stem implantation and no intraoperative fractures. Only one patient was revised for deep infection. On radiographs, biomechanical hip reconstruction was satisfactory and no stem showed any subsidence greater than 2 mm. Full osseointegration based on Engh scores was seen in all of the implanted stems. Median Harris hip score at final follow-up was 99 points (range 44-100 points), which resulted excellent in 91.3% of patients. The median values of the osteaorthritis outcome score ranged from 87.5 to 95.
CONCLUSION The mid-term positive outcomes and low complication rate in our consecutive series of patients support the safety and suitability of this new stem design in DAA for THA.
Collapse
Affiliation(s)
- Carlo Trevisan
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST, Bergamo Est 24068, Italy
| | | | - Gianluca Gallinari
- UOC Ortopedia e Traumatologia, Ospedale Bolognini Seriate ASST, Bergamo Est 24068, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Raymond Klumpp
- UOC Ortopedia e Traumatologia, Ospedale Treviglio-Caravaggio ASST, Bergamo Ovest 24047, Italy
| |
Collapse
|
136
|
Kerketta AH, Kumar R, Sahu S, Laik JK, Rajak MK. Wooden foreign body impalement through the right shoulder region – an unusual penetrating injury: A case report. World J Orthop 2022; 13:1064-1068. [PMID: 36567864 PMCID: PMC9782543 DOI: 10.5312/wjo.v13.i12.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/17/2022] [Accepted: 11/04/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Impalement of the body is a rare injury and comes with varied presentation. There is no set classification or defined protocols for managing this injury. This case report aims to create awareness among trauma surgeons about unusual presentation and management of such case.
CASE SUMMARY A 45-year-old man presented to the emergency department with a sharp penetrating wooden plank at right clavicular region between the neck and shoulder following a road traffic accident. The vehicle had crashed into a roadside wooden hut, thus causing an impalement injury. He was meticulously worked up and taken to emergency theatre. The wooden plank was removed and the wound healed uneventfully. Postoperatively, he had fairly good shoulder function and was able to return back to work successfully.
CONCLUSION Each impalement injury brings in challenges in management as no two cases are the same. The varied presentation and risks involved should be known to medical professionals handling the emergency. Coordinated multidisciplinary team approach is needed for successful outcome.
Collapse
Affiliation(s)
- Abhay Harsh Kerketta
- Department of Joint Replacement and Orthopaedics, Tata Main Hospital, Singhbhum 831001, Jharkhand, India
| | - Ritesh Kumar
- Department of Joint Replacement and Orthopaedics, Tata Main Hospital, Singhbhum 831001, Jharkhand, India
| | - Seelora Sahu
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India
| | - Jayanta Kumar Laik
- Department of Joint Replacement and Orthopaedics, Tata Main Hospital, Singhbhum 831001, Jharkhand, India
| | - Manoj Kumar Rajak
- Department of Joint Replacement and Orthopaedics, Tata Main Hospital, Singhbhum 831001, Jharkhand, India
| |
Collapse
|
137
|
McCormack DJ, Solan M, Aziz S, Faroug R, Kirmani S, Wright G, Mangwani J. Role of the posterior deep deltoid ligament in ankle fracture stability: A biomechanical cadaver study. World J Orthop 2022; 13:969-977. [PMID: 36439368 PMCID: PMC9685633 DOI: 10.5312/wjo.v13.i11.969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/01/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The deltoid ligament is a key component of ankle fracture stability. Clinical tests to assess deltoid ligament injury have low specificity. In supination external-rotation (SER) type-IV ankle fractures, there is either a medial malleolus fracture or deltoid ligament injury. These injuries are often considered unstable, requiring surgical stabilisation. We look to identify the anatomical basis for this instability. This study investigates the anatomical basis for such instability by re-creating SER type ankle fractures in a standardised cadaveric study model, investigating the anatomical basis for such instability.
AIM To investigate the anatomical basis for fracture instability in SER type ankle fractures.
METHODS Four matched pairs of cadaveric limbs were tested for stability both when axially loaded and under external rotation stress. Four matched pairs of cadaveric limbs (8 specimens) were tested for stability when axially loaded to 750 N with a custom rig. Specimens were tested through increasing stages of SER injury in a stepwise fashion before restoring the lateral side with open reduction and internal fixation (ORIF). Clinical photographs and radiographs were recorded at each step. We defined instability in accordance with well accepted radiological parameters: > 4 mm medial clear space opening on a mortise-view radiograph or > 7 degrees of talar tilt.
RESULTS All specimens with an intact posterior deep deltoid ligament were stable. Once the posterior deep deltoid ligament was sectioned there was instability in all specimens. Stabilisation of the lateral side prevented talar shift, but not talar tilt.
CONCLUSION If the posterior deep deltoid ligament is intact then SER fractures can be managed without surgery. If the posterior deep deltoid is incompetent, ORIF and cautious rehabilitation is recommended because the talus can still tilt in the mortise.
Collapse
Affiliation(s)
- Daniel James McCormack
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester LE1 5WW, United Kingdom
| | - Matthew Solan
- Department of Trauma and Orthopaedic Surgery, Royal Surrey City Hospital NHS Trust, University of Surrey, Guilford GU2 7XX, United Kingdom
| | - Sheweidin Aziz
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester LE1 5WW, United Kingdom
| | - Radwane Faroug
- Department of Trauma and Orthopaedics, Stoke Mandeville Hospital, Aylesbury HP21 8AL, Buckinghampshire, United Kingdom
| | - Sayyied Kirmani
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester LE1 5WW, United Kingdom
| | - Georgina Wright
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester LE1 5WW, United Kingdom
| | - Jitendra Mangwani
- Department of Trauma and Orthopaedics, University Hospitals of Leicester, Leicester LE1 5WW, United Kingdom
| |
Collapse
|
138
|
Obamiro E, Trivedi R, Ahmed N. Changes in trends of orthopedic services due to the COVID-19 pandemic: A review. World J Orthop 2022; 13:955-968. [PMID: 36439371 PMCID: PMC9685630 DOI: 10.5312/wjo.v13.i11.955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/13/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
As of June 10, 2022, the World Health Organization has recorded over 532 million documented coronavirus disease 2019 (COVID-19) [(Coronavirus) SARS-CoV-2] cases and almost 6.3 million deaths worldwide, which has caused strain on medical specialties globally. The aim of this review is to explore the impact that COVID-19 has had on orthopedic practices. Providers observed a rapid decline in the number of orthopedic patients’ admissions due to cancellation of elective procedures; however, emergent cases still required treatment. Various observational studies, case reports, and clinical trials were collected through a PubMed database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2019 and 2021. The keywords used were “COVID-19” and/or “Orthopedic Injuries”. Thirty-seven studies were retained. The pandemic brought on significant changes to the mechanism of injury, number of admissions, type of injuries, and patient outcomes. Mortality rates significantly increased particularly amongst patients with hip fractures and COVID-19. Road traffic injuries remained a common cause of injury and domestic injuries became more prevalent with lockdown. Social isolation negatively affected mental health resulting in several orthopedic injuries. Telehealth services and separation for COVID-positive and COVID-negative patients benefited both patients and providers. While hospitals and medical facilities are still facing COVID-19 case surges, it is important to understand how this pandemic has impacted preparation, care, and opportunities for prevention education and ongoing care.
Collapse
Affiliation(s)
- Eunice Obamiro
- Department of Surgery,Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
| | - Radhika Trivedi
- Department of Surgery,Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
| | - Nasim Ahmed
- Department of Surgery,Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
- Department of Surgery, Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
| |
Collapse
|
139
|
Leeprakobboon D. Can immediate postoperative radiographs predict outcomes in pediatric clubfoot? World J Orthop 2022; 13:986-992. [PMID: 36439369 PMCID: PMC9685637 DOI: 10.5312/wjo.v13.i11.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain. However, currently accepted treatment protocols are not always successful. Based on the abnormal bone alignment reported in this disease, some studies have noted a correlation between radiographic characteristics and outcome, but this correlation remains debated.
AIM To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts functional outcome.
METHODS To predict the outcome and prevent early failure of the Ponseti’s method, we used a simple radiographic method to predict outcome. Our study included newborns with idiopathic clubfoot treated with Ponseti’s protocol from November 2018 to August 2022. After Achilles tenotomy and a long leg cast were applied, the surgeon obtained a single lateral radiograph. Radiographic parameters included the tibiocalcaneal angle (TiCal), talocalcaneal angle (TaCal), talofirst metatarsal angle (Ta1st) and tibiotalar angle (TiTa). During the follow-up period, the Dimeglio score and functional score were examined 1 year after surgery. Additionally, recurring events were reported. The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression, and the optimal predictor was also identified.
RESULTS In total, 54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days. The average TiCal, TaCal, Ta1st, and TiTa angles were 75.24, 28.96, 7.61, and 107.31 degrees, respectively. After 12 mo of follow up, we found 66% excellent-to-good and 33.3% fair-to-poor functional outcomes. The Dimeglio score significantly worsened in the poor outcome group (P value < 0.001). Tical and TaCal showed significant differences between each functional outcome (P value < 0.05), and the TiCal strongly correlated with outcome, with a smaller angle indicating a better outcome, each 1 degree decrease improved the functional outcome by 10 percent. The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome.
CONCLUSION The TiCal, derived from lateral radiographs immediately after Achilles tenotomy, can predict functional outcome at 1 year postoperatively, justifying its use for screening patients who need very close follow-up.
Collapse
|
140
|
Kyriazis Z, Kollia P, Grivea I, Sotiriou S, Dailiana ZH. Genetics of congenital anomalies of the hand. World J Orthop 2022; 13:949-954. [PMID: 36439370 PMCID: PMC9685634 DOI: 10.5312/wjo.v13.i11.949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Congenital anomalies of the hand are malformations occurring during the development of the human limb, and present as isolated disorders or as a part of a syndrome. During the last years, molecular analysis techniques have offered increasing knowledge about the molecular basis of hand malformations. Disturbances in the signaling pathways during the development of the upper limb result in malformations of the upper extremity. At present, several genes have been identified as responsible for hand anomalies and other have been recognized as suspect genes related to them. Different and new high throughput methods have been introduced for the identification of the gene mutations. In the current editorial, we summarize concisely the current molecular status of isolated hand genetic disorders and the recent progress in molecular genetics, including the genes related to the disorder. This progress improves the knowledge of these disorders and has implications on genetic counselling and prenatal diagnosis.
Collapse
Affiliation(s)
- Zisis Kyriazis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Panagoula Kollia
- Department of Genetics and Biotechnology, Faculty of Biology, National and Kapodistrian University of Athens, Athens 10679, Greece
| | - Ioanna Grivea
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Sotirios Sotiriou
- Laboratory of Histology and Embryology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| |
Collapse
|
141
|
Blough C, Najdawi J, Kuschner S. Patient preference for trigger finger treatment. World J Orthop 2022; 13:1006-1014. [PMID: 36439373 PMCID: PMC9685636 DOI: 10.5312/wjo.v13.i11.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/28/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Trigger finger is a common disorder of the hand that can cause disabling symptoms. Treatment options range from conservative management with observation and splinting, to surgical release, but there is currently not a consensus on a treatment algorithm.
AIM To determine patient preference for the treatment of trigger finger using an online survey.
METHODS An online crowdsourcing platform, Amazon Mechanical Turk, was used to recruit participants for this study. Participants were led through a scenario in which they were diagnosed with trigger finger. They were then asked to rank their preference of treatment options from the following: Observation, splinting, corticosteroid injection, surgery. The results of the surveys were then analyzed using R software.
RESULTS Of 323 participants completed the survey. 7 participants were excluded because they failed to correctly answer the attention question, leaving 316 participants whose results were included. As a first choice for treatment 117 (37%) of the included participants chose observation, 86 (27%) chose splinting, 61 (19%) chose corticosteroid injection, and 52 (16%) chose surgery. The mean rank for observation was 2.26, for splinting was 2.30, for corticosteroid injection was 2.53, and for surgery was 2.91. The ranking of each treatment option was statistically different (P value < 0.05) from the others except for observation and splinting.
CONCLUSION The practice of shared decision making with patients is imperative to providing the best care possible. The results from this study, especially the preference for less invasive treatment, may help providers better frame discussion around treatment options of trigger fingers. This in turn, may increase patient satisfaction in the treatment of trigger finger.
Collapse
Affiliation(s)
- Christian Blough
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Jawad Najdawi
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Stuart Kuschner
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| |
Collapse
|
142
|
Lipatov KV, Asatryan A, Melkonyan G, Kazantcev AD, Solov’eva EI, Gorbacheva IV, Vorotyntsev AS, Emelyanov AY. Septic arthritis of the hand: From etiopathogenesis to surgical treatment. World J Orthop 2022; 13:993-1005. [PMID: 36439365 PMCID: PMC9685638 DOI: 10.5312/wjo.v13.i11.993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Septic arthritis of the hand, which is the second most common after damage of the knee joint, remains one of the leading causes of temporary disability. An inflammation can cause dysfunction of the joint, and in the most severe cases, the need for amputation of the finger may arise. The results of their treatment today, especially from a functional point of view, cannot be considered satisfactory. Urgent surgical treatment is extremely important in septic arthritis of the hand, as it helps to prevent cartilage destruction and the development of osteomyelitis.
AIM To explore the features of the course of septic arthritis of the hand as well as approaches to surgical treatment and its results, depending on the nature of the damage to the articular structures.
METHODS The results of the treatment of 170 patients with septic arthritis of the hand, which were treated in the period of 2020-2021, were analyzed. Inflammation of the interphalangeal and metacarpophalangeal joints (MCP) of fingers 1, 2, and 3 was more often noted in 147 (81.6%) joints. The most common cause of arthritis was a penetrating injury as a result of household trauma (101, 59.4%), animal bite (30, 17.6%), and clenched fist injury (15, 8.8%). Septic arthritis with contiguous osteomyelitis was observed in 98 (54.4%) cases. Surgical treatment was completed with drainage and irrigation of the joint. Early mobilization was used to restore function. In patients with osteomyelitis, it was aimed at the formation of neoarthrosis. Arthrodesis was not applied. Long-term results of treatment were assessed in 142 (83.5%) patients within 1 mo to 12 mo after discharge from the hospital [the median was 7 mo (IQR: 4-9)].
RESULTS The most commonly isolated organism was Staphylococcus aureus (35.3%). The median treatment delay in patients without osteomyelitis was 5 d (IQR: 4-7); for septic arthritis with contiguous osteomyelitis, it was 14 d (IQR: 5-21). Radiography for osteomyelitis within 2 wk was uninformative: 41.2% of diagnoses. A single surgical treatment was required in 138 (81.2%) patients, two treatments in 22 (12.9%), and three or more in 10 (5.9%). Total elimination of the infection was achieved in 163 (95.9%) patients. The best functional results of treatment were noted in patients without osteomyelitis. After septic arthritis, Total Active Motion (TAM) for the MCP was 96.2% (IQR: 85.1-98.0), for the proximal interphalangeal joint (PIP) 82.4% (IQR: 54.5-98.5), and for the distal interphalangeal joint (DIP) 69.4% (IQR: 65.4-74.1). In cases with osteomyelitis, it was possible to achieve the formation of neoarthrosis with TAM for MCP-64.2% (IQR: 45.3-90.1), for PIP-62.5% (IQR: 41.8-68.9), and for DIP-59.4% (IQR: 50-62.1). Additionally, the severity of pain during movements did not exceed 1 point.
CONCLUSION The delay in treatment of patients with septic arthritis of the hand was accompanied by a high incidence of osteomyelitis, especially in the presence of diabetes mellitus. Urgent surgical treatment, along with continued irrigation of the joint and antibiotic therapy, made it possible to eliminate the infection, and early rehabilitation restored the range of motion. The best results were noted in patients without osteomyelitis. With the development of osteomyelitis, a complex of early rehabilitation measures also made it possible to partially restore the range of motion due to the formation of neoarthrosis, without resorting to arthrodesis.
Collapse
Affiliation(s)
- Konstantin V Lipatov
- General Surgery Department, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
| | - Arthur Asatryan
- General Surgery Department, State Budgetary Institution “City Clinical Hospital named after S.S. Yudin of Moscow Healthcare Department”, Moscow 115142, Russia
| | - George Melkonyan
- General Surgery Department, The Hospital for War Veterans N3, Moscow 129336, Russia
| | - Aleksandr D Kazantcev
- General Surgery Department, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
| | - Ekaterina I Solov’eva
- General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Irina V Gorbacheva
- General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Alexander S Vorotyntsev
- General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Andrey Y Emelyanov
- General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia
| |
Collapse
|
143
|
Sidiropoulos K, Christofilos SI, Tsikopoulos K, Kitridis D, Drago L, Meroni G, Romanò CL, Kavarthapu V. Viral infections in orthopedics: A systematic review and classification proposal. World J Orthop 2022; 13:1015-1028. [PMID: 36439372 PMCID: PMC9685635 DOI: 10.5312/wjo.v13.i11.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/01/2021] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized, the influence of viral infections on the musculoskeletal system might have been underestimated.
AIM To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.
METHODS We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), the Reference Citation Analysis (RCA), and Scopus for completed studies published before January 30, 2021, to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries. Quality assessment was performed using SYRCLE's risk of bias tool for animal studies, Moga score for case series, Wylde score for registry studies, and Newcastle-Ottawa Scale for case-control studies.
RESULTS Six human and four animal studies were eligible for inclusion in the qualitative synthesis. Hepatitis C virus was implicated in several peri- and post-operative complications in patients without cirrhosis after major orthopedic surgery. Herpes virus may affect the integrity of lumbar discs, whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.
CONCLUSION Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis. Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms. Therefore, based on our literature search, the proposed clinical and pathogenetic classification scheme is as follows: (1) Viral infections of bone or joint; (2) Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues; and (3) Viral infection as a risk factor for post-surgical bacterial infection.
Collapse
Affiliation(s)
| | - Savvas Ilias Christofilos
- Department of Genetics, Evolution and Environment, University College London, London WC1E 6BT, United Kingdom
| | | | - Dimitrios Kitridis
- the First Department of Orthopaedics, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Lorenzo Drago
- Department of Biomedical Sciences for Health and Microbiome, University of Milan, Milan 20133, Italy
| | - Gabriele Meroni
- Department of Biomedical, Surgical, and Dental Sciences, One Health Unit, University of Milan, Milan 20133, Italy
| | - Carlo Luca Romanò
- Gruppo di Studio SIOT Infezioni-Clinica San Gaudenzio-Novara-Gruppo Policlinico di Monza, University of Milan, Milan 20100, Italy
| | - Venu Kavarthapu
- Trauma, and Orthopaedics, Kings College Hospital London, Denmark Hill, London SE59RS, United Kingdom
| |
Collapse
|
144
|
Gruenberger E, Bae AS, Kelly T, Ponce BA, McGrory J. Patient-reported dissatisfaction following second side in staged bilateral total knee arthroplasty: A systematic review. World J Orthop 2022; 13:1029-1037. [PMID: 36439367 PMCID: PMC9685631 DOI: 10.5312/wjo.v13.i11.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/16/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Around one third of patients who undergo total knee arthroplasty (TKA) will eventually have the contralateral knee replaced. Overall patient satisfaction after staged bilateral total knee arthroplasty procedures performed on different days is reportedly similar to unilateral TKA. Nevertheless, in our anecdotal experience patients often report less satisfying outcomes following the second side. A cursory review of available literature tended to confirm that observation. We sought therefore to consolidate all of the available data on this issue to further investigate this phenomenon.
AIM To consolidate available published data revealing satisfaction scores among patients following staged bilateral TKA, and to evaluate the phenomenon of less satisfying results following TKA2.
METHODS A systematic review of available literature reporting on satisfaction with TKA1 and TKA2 after staged bilateral knee arthroplasty was undertaken using PubMed, Google Scholar, and Embase. From 427 records, five full-length articles met criteria for inclusion in the meta-analysis. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).
RESULTS A total of 1889 patients with an average age of 68 (range: 38–92) underwent staged bilateral TKA with outcomes reported at 1 year following each TKA with a mean 21.9 mo between surgeries (range: 2 d to 14.5 years). Overall satisfaction with both knees was 83.70% (1581) and dissatisfaction with both knees was 2.75% (52). In the remaining 13.56% (256) who were dissatisfied with one side, 61.0% were dissatisfied with TKA2, and 39.0% were dissatisfied with TKA1. Patient-reported outcome scores for TKA2 were frequently lower than TKA1 even in patients reporting overall satisfaction with both knees.
CONCLUSION At 1-year follow-up, there was a 50% greater risk of dissatisfaction with TKA2 among the 13.56% of patients reporting dissatisfaction in one knee after staged bilateral TKA. Whether the interval between procedures or long-term follow-up changes these results requires further investigation.
Collapse
Affiliation(s)
| | - Andrew S Bae
- Department of Orthopedic Surgery, Jack Hughston Memorial Hospital, Phenix City, AL 36867, United States
| | - Tyler Kelly
- The Hughston Foundation, Columbus, GA 31909, United States
| | - Brent A Ponce
- The Hughston Foundation, Columbus, GA 31909, United States
| | - James McGrory
- Department ofOrthopedic Surgery, Hughston Foundation and Jack Hughston Memorial Hospital, Columbus, GA 31909, United States
| |
Collapse
|
145
|
Zhou J, Frey C, Segovia N, Yao J. Anatomic relationship of extensor indicis propius and extensor digitorum communis: Implications for tendon transfer. World J Orthop 2022; 13:978-985. [PMID: 36439366 PMCID: PMC9685632 DOI: 10.5312/wjo.v13.i11.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/06/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The extensor indicis proprius (EIP) tendon is a frequently used donor for a variety of tendon transfers, most commonly for reconstruction of the extensor pollicis longus (EPL). EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.
AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum, where tendon harvest is often performed, and share our preferred technique for EIP to EPL transfer.
METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected. Tendon circumference and relationship of the EIP and extensor digitorum communis to the index (EDCI) at the metacarpophalangeal (MCP) joint and the distal extensor retinaculum were recorded. Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.
RESULTS EIP was ulnar to the EDCI in 96.5% of specimens (28/29) at the distal edge of the extensor retinaculum. In the remaining specimen, EIP was volar to EDCI. Tendon circumference at the distal extensor retinaculum averaged (9.3 mm ± 1.7 mm) for EDCI and 11.1 mm (± 2.7 mm) for EIP (P = 0.0010). The tendon circumference at the index MCP joint averaged 11.0 mm (± 1.7 mm) for EDCI and 10.6 mm (± 2.1 mm) for EIP (P = 0.33). EIP had a greater circumference in 76% (22/29) of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31% (9/29) of specimens at the MCP joint.
CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum, which can be taken into consideration for tendon transfers involving EIP.
Collapse
Affiliation(s)
- Joanne Zhou
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford University, Redwood city, CA 94063, United States
| | - Christopher Frey
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford University, Redwood city, CA 94063, United States
| | - Nicole Segovia
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford University, Redwood city, CA 94063, United States
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford University, Redwood city, CA 94063, United States
| |
Collapse
|
146
|
Tella GF, Donadono C, Castagnini F, Bordini B, Cosentino M, Di Liddo M, Traina F. Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty: A 1-year experience. World J Orthop 2022; 13:903-910. [PMID: 36312522 PMCID: PMC9610863 DOI: 10.5312/wjo.v13.i10.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/27/2022] [Accepted: 09/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) in primary total hip replacement (THR) is one of the most important threats in orthopedic surgery, so one important surgeon’s target is to avoid or early diagnose a PJI. Although the incidence of PJI is very low (0.69%) in our department, with an average follow-up of 595 d, this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.
AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.
METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection (0.69%) with a mean follow-up of 596 d (min 30, max 1451). We reviewed all medical records to collect the data: duration and time of the surgery, presence, type and duration of the antibiotic therapy, preoperative diagnosis, blood values before and after surgery, transfusions, presence of preoperative drugs (in particularly anticoagulants and antiaggregant, corticosteroids and immunosuppressants), presence of some comorbidities (high body mass index, blood hypertension, chronic obstructive pulmonary disease, cardiac ischemia, diabetes, rheumatological conditions, previous local infections).
RESULTS No preoperative, intraoperative, or postoperative analysis showed a higher incidence of PJI. We did not find any class with evident major odds of PJI. In our study, we did not find any border value to predict PJI and all patients had similar values in both groups (non-PJI and PJI). Only some categories, such as female patients, showed more frequency of PJI, but this difference related to sex was not statistically significant.
CONCLUSION We did not find any category with a higher risk of PJI in THR, probably due to the lack of few cases of infection.
Collapse
Affiliation(s)
- Giuseppe Ferdinando Tella
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Cesare Donadono
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Michele Di Liddo
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna 40125, Italy
| |
Collapse
|
147
|
Xing L, Xu HR, Wang QL, Kong H, Zhang H, Tian J, Ding Y, Yang RX, Zhang L, Jiang B. Traditional Chinese medicine ointment combined with tuina therapy in treatment of pain and swelling after total knee arthroplasty. World J Orthop 2022; 13:932-939. [PMID: 36312520 PMCID: PMC9610864 DOI: 10.5312/wjo.v13.i10.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The most effective treatment for knee joint pain is total knee arthroplasty (TKA), but the risk of pain and swelling in patients after surgery is high. Ice application, ankle pump exercise and non-steroidal anti-inflammatory painkillers are the primary clinical treatments after surgery. However, long-term use of non-steroidal anti-inflammatory pain relievers can easily cause gastrointestinal damage. Traditional Chinese medicine (TCM) ointments and tuina therapy integrate TCM and manipulation, which effectively promotes the penetration of TCM into the skin lesions, improves local blood circulation and inflammatory reaction and has good long-term effects on patients.
AIM To evaluate the efficacy of TCM ointment combined with tuina therapy in the treatment of pain and swelling after TKA.
METHODS The randomized controlled clinical trial enrolled 80 patients who underwent TKA via the same procedure. The patients were randomly divided among the treatment group (n = 40) and the control group (n = 40). The control group was given an analgesia pump in addition to oral painkillers as the postoperative intervention. The treatment group received TCM ointment with tuina therapy in addition to the analgesia pump and oral painkillers in the postoperative period. The following variables were recorded 3 d before surgery and 3 d, 7 d and 14 d after surgery: Visual analogue scale (VAS) score; skin temperature; circumferences at 15 cm above and below the patella; maximum active knee flexion angle; and the knee injury and Osteoarthritis Outcome score (KOOS).
RESULTS After treatment, VAS was significantly lower in the treatment group than the control group at 7 d (t = 7.536, P < 0.001) and 14 d (t = 8.563, P < 0.001). The skin temperature of participants in the treatment group was significantly lower than that in the control group at 7 d (t = 2.968, P = 0.004) and 14 d (t = 4.423, P < 0.001). The circumference values of the two positions in the treatment group were lower than those in the control group at 7 d [t = 2.315, P = 0.023 (above); t = 2.121, P = 0.037 (below)] and 14 d [t = 2.374, P = 0.020 (above); t = 2.095, P = 0.039 (below)]. After 14 d of treatment, the maximum active knee flexion angle and KOOS of the two groups were significantly improved but were significantly higher in the treatment group (P < 0.05 for both).
CONCLUSION TCM ointment and tuina therapy have significant advantages over standard care in the treatment of pain and swelling after TKA. This additional treatment may improve knee function but additional studies are needed to confirm our observations.
Collapse
Affiliation(s)
- Liang Xing
- Department of Arthroscopy and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Hui-Rong Xu
- Department of Nursing, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Qing-Lin Wang
- Department of Vascular Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Hua Kong
- Department of Arthroscopy and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Hua Zhang
- Department of Arthroscopy and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Jing Tian
- Department of Orthopedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Ying Ding
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Ru-Xin Yang
- Department of Arthroscopy and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Lei Zhang
- Department of Arthroscopy and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Bo Jiang
- Department of Arthroscopy and Sports Medicine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| |
Collapse
|
148
|
Wenning KE, Schildhauer TA, Jones CB, Hoffmann MF. Derotational osteotomy and internal fixation of a 180° malrotated humerus: A case report. World J Orthop 2022; 13:940-948. [PMID: 36312524 PMCID: PMC9610866 DOI: 10.5312/wjo.v13.i10.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/28/2022] [Accepted: 10/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Humeral shaft fractures are relatively common in adults. Rotational malalignment is reported as one complication but severe rotational deformity of the humerus is extremely rare. To our knowledge, only three cases of symptomatic humeral malrotation have been reported. There are sparse literature reports of humeral reconstruction correction.
CASE SUMMARY We present a case of extreme rotational deformity of the humerus (180°) after humeral shaft fracture. The patient complained of pain and difficulties with activities of daily living. In addition, she found the deformity cosmetically unacceptable. Therefore, she was searching for surgical correction. Neurolysis of the radial nerve followed by derotational osteotomy of the humerus and internal fixation were performed. Postoperatively, the patient demonstrated transient iatrogenic radial nerve palsy which recovered completely during postoperative follow-up. The Disabilities of the Arm, Shoulder, and Hand score improved from 55 preoperatively to 16 at the final 2-year follow-up.
CONCLUSION Single-stage radial neurolysis, derotational osteotomy and stable fixation is a feasible option to improve anatomic and functional problems of severely malrotated humeral shaft fractures.
Collapse
Affiliation(s)
- Katharina Elisabeth Wenning
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Bochum 44789, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Bochum 44789, Germany
| | - Clifford Barry Jones
- Department of Orthopaedic Surgery, Creighton Medical School Phoenix, Phoenix, 85012, United States
| | - Martin Franz Hoffmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Bochum 44789, Germany
| |
Collapse
|
149
|
Wang JL, Ma YJ, Ma L, Ma N, Guo DM, Ma LS. Baishideng’s Reference Citation Analysis database announces the first Journal Article Influence Index of 104 core journals and a list of high-quality academic journals in orthopedics. World J Orthop 2022; 13:891-902. [PMID: 36312521 PMCID: PMC9610868 DOI: 10.5312/wjo.v13.i10.891] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
After three rounds of rigorous evaluation of core journals in orthopedics conducted by the Reference Citation Analysis (RCA) editorial team of Baishideng Publishing Group (Baishideng), the RCA database of Baishideng officially released the 2022 Journal Article Influence Index (2022 JAII) of 104 core journals and a list of high-quality academic journals in orthopedics, for the first time on August 9, 2022. The list of 104 core journals can be found at: https://www.referencecitationanalysis.com/SearchJournal. Among them, the highest 2022 JAII is 55.015 and the lowest is 3.076. This article introduces the 21 high-quality academic journals and describes the calculation method for the 2022 JAII, the evaluation process, and the inclusion principles for journals in the RCA. These steps are the underpinning of the RCA’s empirical journal academic evaluation service by which the digital platform addresses the needs of authors to select reliable journals for submission, readers to select high-quality literature for reading, and editors to track their own journal citation performance. As such, the RCA core journal list will serve as a useful Find-a-Journal tool. Any interested party is welcome to use this journal list and recommend it to their peers.
Collapse
Affiliation(s)
- Jin-Lei Wang
- Baishideng Publishing Group Inc, Pleasanton, CA 94566, United States
| | - Yu-Jie Ma
- Baishideng Publishing Group Inc, Pleasanton, CA 94566, United States
| | - Li Ma
- Baishideng Publishing Group Inc, Pleasanton, CA 94566, United States
| | - Na Ma
- Baishideng Publishing Group Inc, Pleasanton, CA 94566, United States
| | - Diao-Mei Guo
- Baishideng Publishing Group Inc, Pleasanton, CA 94566, United States
| | - Lian-Sheng Ma
- Baishideng Publishing Group Inc, Pleasanton, CA 94566, United States
| |
Collapse
|
150
|
Albishi W, Baltow B, Albusayes N, Sayed AA, Alrabai HM. Hamstring autograft utilization in reconstructing anterior cruciate ligament: Review of harvesting techniques, graft preparation, and different fixation methods. World J Orthop 2022; 13:876-890. [PMID: 36312526 PMCID: PMC9610869 DOI: 10.5312/wjo.v13.i10.876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/16/2022] [Accepted: 08/16/2022] [Indexed: 02/06/2023] Open
Abstract
Rupture of the anterior cruciate ligament (ACL) is a common orthopedic injury. Various graft options are available for the reconstruction of ruptured ACL. Using the hamstring muscle as an autograft was first described in 1934, and it remains a commonly harvested graft for ACL reconstruction. Hamstring autografts can be harvested using the traditional anteromedial approach or the newer posteromedial technique. An isolated semitendinosus tendon can be used or combined with the gracilis tendon. There are numerous methods for graft fixation, such as intra-tunnel or extra-tunnel fixation. This comprehensive review discusses the different hamstring muscle harvesting techniques and graft preparation options and fixation methods. It provides a comprehensive overview for choosing the optimal surgical technique when treating patients.
Collapse
Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Baraa Baltow
- Department of Orthopedic Surgery, AlHada Armed Forces Hospital, Ministry of Defense, AlHada 26792, Saudi Arabia
| | - Nora Albusayes
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Ameer A Sayed
- Department of Orthopedic Surgery, King Fahad Armed Forces Hospital, Ministry of Defense, Jeddah 23311, Saudi Arabia
| | - Hamza M Alrabai
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| |
Collapse
|