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Zhang Z, Shi X, Liu W, Wang J, Shen Q, Xu G, Bao J, Dong Y. Effect of Prior Bariatric Surgery on the Outcomes of Joint Arthroplasty: A Systematic Review and Meta-Analysis. J INVEST SURG 2025; 38:2446579. [PMID: 39778885 DOI: 10.1080/08941939.2024.2446579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 12/14/2024] [Accepted: 12/18/2024] [Indexed: 01/11/2025]
Abstract
OBJECTIVE Obesity is a risk factor for joint arthroplasty complications. With this systematic review and meta-analysis, we assessed whether a positive history of bariatric surgery influences postoperative outcomes in patients undergoing various types of joint arthroplasty. METHODS We conducted a comprehensive search database such as Scopus, PubMed, Medline Ovid, CNKI, and CENTRAL for studies comparing outcomes between patients undergoing arthroplasty with and without a history of bariatric surgery. We extracted data on short-term medical complications, venous thromboembolism (VTE), periprosthetic infections, superficial wound infections, hospital stay length, and operative time. We used the data to conduct meta-analyses using random-effects models and subgroup analyses based on the type of arthroplasty. RESULTS Overall, 15 studies with nearly 150,000 participants were included. The analysis showed that prior bariatric surgery did not significantly affect overall medical complications post-arthroplasty, with OR of 0.968 (95%CI, 0.706-1.327). For VTE, the results similarly indicated no substantial difference, with an OR of 0.912 (95%CI, 0.644-1.291). In assessing periprosthetic infections, the OR was 0.754 (95%CI, 0.535-1.064), showing comparable rates between patients with and without a history of bariatric surgery.Regarding superficial wound infections, the analysis produced an OR of 2.390 (95%CI, 0.723-7.897), indicating variability but not statistical significance. Hospital stay length was reduced in patients with a history of bariatric surgery, reflected by SMD of -0.113 (95%CI, -0.221 to -0.005). Lastly, operative time also showed a significant reduction, with an SMD of -0.462 (95%CI, -0.865 to -0.059). CONCLUSIONS Prior bariatric surgery does not reduce the risk of short-term complications post-arthroplasty, but it seems to reduce the hospital stay length and operative time. The effects vary significantly across different types of joint arthroplasty, suggesting a need for tailored preoperative assessments and care protocols. PROTOCOL REGISTRATION This systematic review and meta-analysis was registered at PROSPERO, with the number: CRD42024539052.
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Affiliation(s)
- Zhou Zhang
- Department of Orthopaedics, Changxing County Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
| | - Xiang Shi
- Department of Orthopaedics, Changxing County Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
| | - Wei Liu
- Department of Orthopaedics, Deqing County Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
| | - Jianwei Wang
- Department of Orthopaedics, Changxing County Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
| | - Qingfeng Shen
- Department of Orthopaedics, Changxing County Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
| | - Guozhu Xu
- Department of Orthopaedics, Changxing County Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
| | - Jiakuan Bao
- Department of Oncology, Changxing County Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
| | - Yupeng Dong
- Department of Orthopaedics, Changxing County Hospital of Traditional Chinese Medicine, Huzhou, Zhejiang, China
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Vidman S, Ma YHE, Fullenkamp N, Plant GW. Human induced pluripotent stem cell-derived therapies for regeneration after central nervous system injury. Neural Regen Res 2025; 20:3063-3075. [PMID: 39715081 DOI: 10.4103/nrr.nrr-d-24-00901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 10/29/2024] [Indexed: 12/25/2024] Open
Abstract
In recent years, the progression of stem cell therapies has shown great promise in advancing the nascent field of regenerative medicine. Considering the non-regenerative nature of the mature central nervous system, the concept that "blank" cells could be reprogrammed and functionally integrated into host neural networks remained intriguing. Previous work has also demonstrated the ability of such cells to stimulate intrinsic growth programs in post-mitotic cells, such as neurons. While embryonic stem cells demonstrated great potential in treating central nervous system pathologies, ethical and technical concerns remained. These barriers, along with the clear necessity for this type of treatment, ultimately prompted the advent of induced pluripotent stem cells. The advantage of pluripotent cells in central nervous system regeneration is multifaceted, permitting differentiation into neural stem cells, neural progenitor cells, glia, and various neuronal subpopulations. The precise spatiotemporal application of extrinsic growth factors in vitro, in addition to microenvironmental signaling in vivo, influences the efficiency of this directed differentiation. While the pluri- or multipotency of these cells is appealing, it also poses the risk of unregulated differentiation and teratoma formation. Cells of the neuroectodermal lineage, such as neuronal subpopulations and glia, have been explored with varying degrees of success. Although the risk of cancer or teratoma formation is greatly reduced, each subpopulation varies in effectiveness and is influenced by a myriad of factors, such as the timing of the transplant, pathology type, and the ratio of accompanying progenitor cells. Furthermore, successful transplantation requires innovative approaches to develop delivery vectors that can mitigate cell death and support integration. Lastly, host immune responses to allogeneic grafts must be thoroughly characterized and further developed to reduce the need for immunosuppression. Translation to a clinical setting will involve careful consideration when assessing both physiologic and functional outcomes. This review will highlight both successes and challenges faced when using human induced pluripotent stem cell-derived cell transplantation therapies to promote endogenous regeneration.
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Affiliation(s)
- Stephen Vidman
- Department of Neuroscience, Ohio State University, Columbus, OH, USA
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Medlar C, Kilkenny CJ, Davey MS, Farooq F, O'Daly BJ. The top 50 cited publications relating to femoral shaft fractures - A bibliometric analysis of the literature. J Orthop 2025; 67:88-93. [PMID: 39902144 PMCID: PMC11787685 DOI: 10.1016/j.jor.2025.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Accepted: 01/14/2025] [Indexed: 02/05/2025] Open
Abstract
Background Femoral shaft fractures (FSF's) represent common orthopaedic injuries, traditionally resulting from high-energy trauma in younger patients. Effective treatment is crucial for functional recovery, with significant social and economic implications. Despite extensive literature relating to FSF's, the quality of evidence and research trends remain unclear. Methods A bibliometric analysis was conducted using Web of Science (August 2024) to identify the top 50 most-cited publications related to FSF's. Publications were screened using specific inclusion and exclusion criteria, focusing on primary FSF-related research. Data including authorship, publishing institution, level of evidence (LOE), and study focus were analysed using VOSviewer software to explore bibliometric coupling, co-citation relationships and keyword co-occurrences. Results The 50 most-cited publications collectively received 9796 citations, with the highest cited paper accumulating 508 citations. Treatment outcomes (50 %) and epidemiology (32 %) were the predominant study focuses, while only 4 % addressed surgical techniques. Retrospective cohort and case-control studies constituted 84 % of the included papers, predominantly of level III evidence. The mean patient age was 37.96 years, with a majority being female (65.2 %). Hannover Medical School emerged as the most prolific institution, and the Journal of Bone and Joint Surgery published the highest number of articles. Co-occurrence analyses highlighted trends in osteoporosis and bisphosphonate-related FSFs. Conclusions FSF literature has expanded, focusing primarily on treatment outcomes and epidemiological risk factors. However, a significant proportion of studies are of low evidence, with limited prospective research and an underrepresentation of topics such as FSF complications and paediatric fractures. Future studies should aim to maximise research quality and address emerging themes, including gender-specific analyses and the management of atypical fractures in elderly male populations.
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Affiliation(s)
- Conor Medlar
- Department of Orthopaedic Surgery, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Conor J. Kilkenny
- Department of Orthopaedic Surgery, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Martin S. Davey
- Department of Orthopaedic Surgery, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Fahad Farooq
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Brendan J. O'Daly
- Department of Orthopaedic Surgery, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
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Viswanathan VK, Vaishya R, Iyengar KP, Jain VK, Vaish A. Strategies for preventing anterior cruciate ligament injuries in athletes: Insights from a scoping review. J Orthop 2025; 67:101-110. [PMID: 39911228 PMCID: PMC11791312 DOI: 10.1016/j.jor.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 12/29/2024] [Accepted: 01/01/2025] [Indexed: 02/07/2025] Open
Abstract
Background and aims Anterior cruciate ligament (ACL) injuries significantly impact young athletes, leading to long-term physical, psychological, and socioeconomic consequences. There is an urgent need to develop effective preventive strategies. This scoping review aims to evaluate modifiable and non-modifiable risk factors for ACL injuries and assess existing preventive strategies. Methods A comprehensive literature search was performed on November 20, 2024, across databases including Embase, PubMed, Web of Science, Google Scholar, and Cochrane Library. Articles published between 2000 and 2024 focusing on ACL injury prevention were included, while editorial content, non-clinical studies, and non-English publications were excluded. Results The search yielded 322 articles, narrowing down to 94 after deduplication. After title screening, 46 studies progressed to full review, ultimately leading to the inclusion of 14 relevant manuscripts. Key findings indicate that ACL injuries result from various factors, with female athletes being 2.2 times more susceptible. Genetic predispositions linked to collagen-related SNPs and biomechanical patterns, such as landing techniques and knee positioning, were identified as significant contributors. Effective preventive programs integrated strength training, neuromuscular training, and advanced technology, including wearable devices and video analysis. Conclusion The study reinforces the importance of a personalized, multifaceted approach to ACL injury prevention, focusing on risk stratification and optimizing training strategies alongside technological advancements. Implementing these strategies can significantly mitigate the risk of ACL injuries in high-risk populations.
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Affiliation(s)
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Abhishek Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India
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Moriarty B, Jacob T, Sadlowski M, Fowler M, Rowan C, Chavarria J, Avramis I, Rizkalla J. The use of exoskeleton robotic training on lower extremity function in spinal cord injuries: A systematic review. J Orthop 2025; 65:1-7. [PMID: 39713557 PMCID: PMC11656084 DOI: 10.1016/j.jor.2024.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 10/22/2024] [Accepted: 10/25/2024] [Indexed: 12/24/2024] Open
Abstract
Objective To perform a systematic review of the utility of exoskeleton robotic therapy on lower extremity recovery in Spinal Cord Injury (SCI) patients. Methods We used the Embase, Cochrane, and PubMed databases and searched from January 2012 to December 2023 for studies on exoskeleton robotic assist devices used in working with SCI patients. Only articles published in English were evaluated, and the retrieved articles were screened via our inclusion/exclusion criteria. We conducted our meta-analysis with the Cochrane Review Manager 5.4 (RevMan) software. Robotic assisted gait training and conventional gait training methodology were compared using Walking Index for Spinal Cord Injury II (WISCII), Spinal Cord Independence Measure III (SCIM III), and 6 Minute Walk Test (6MWT) as reported outcome measures. Results Eleven randomized clinical trials (RCTs) involving 552 total participants were included in the meta-analysis. The results of the meta-analysis indicated statistically significant improvement in SCIM III [MD 5.14, 95 % CI = (4.47, 5.810), P < 0.00001], WISCII [MD 2.31, 95 % CI = (2.13, 2.49), P < 0.00001] and 6MWT [MD 37.04, 95 % CI = (32.35, 41.74), P < 0.00001] in patients with SCI as compared to conventional gait training (CGT) therapy. Conclusion: Robotic Therapy could improve ambulation/quality of life in patients with spinal cord injuries compared to the standard treatment only, but future studies should include additional measures addressing quality of life and patient satisfaction.
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Affiliation(s)
- Brian Moriarty
- Baylor University Medical Center, Department of Orthopaedics, Dallas, TX, USA
| | - Thomas Jacob
- Baylor University Medical Center, Department of Orthopaedics, Dallas, TX, USA
| | - Max Sadlowski
- Baylor University Medical Center, Department of Orthopaedics, Dallas, TX, USA
| | - Michael Fowler
- Texas A&M School of Medicine, Texas A&M University Health Science Center, Bryan, TX, USA
| | - Colten Rowan
- Texas A&M School of Medicine, Texas A&M University Health Science Center, Bryan, TX, USA
| | - Joseph Chavarria
- Baylor University Medical Center, Department of Orthopaedics, Dallas, TX, USA
| | - Ioannis Avramis
- Baylor University Medical Center, Department of Orthopaedics, Dallas, TX, USA
| | - James Rizkalla
- Baylor University Medical Center, Department of Orthopaedics, Dallas, TX, USA
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Wu KA, Pottayil F, Jing C, Choudhury A, Anastasio AT. Surgical site soft tissue thickness as a predictor of complications following arthroplasty. World J Methodol 2025; 15:99959. [DOI: 10.5662/wjm.v15.i2.99959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 09/30/2024] [Accepted: 10/22/2024] [Indexed: 11/27/2024] Open
Abstract
Appreciation of soft-tissue thickness (STT) at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes. Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty, particularly infections, across procedures such as total knee, hip, shoulder, and ankle replacements. Several studies have indicated that increased STT is associated with a higher risk of complications, including infection and wound healing issues. The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instrumental in guiding preoperative planning to optimize outcomes in arthroplasty procedures. Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthroplasty surgery.
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Affiliation(s)
- Kevin A Wu
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Faheem Pottayil
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States
| | - Crystal Jing
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
| | - Ankit Choudhury
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Albert T Anastasio
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States
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White CA, Brewster RM, Yu J, O'Connor SJ, Fox ES, Kantrowitz D, Cagle PJ. Demographic and training descriptive analysis of National and American Hockey League team physicians. J Orthop 2025; 64:73-80. [PMID: 39691648 PMCID: PMC11648616 DOI: 10.1016/j.jor.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 11/17/2024] [Indexed: 12/19/2024] Open
Abstract
Aims/objective Assess the demographic/education backgrounds of team physicians (TPs) in the National Hockey League (NHL) and American Hockey League (AHL). Materials/methods Orthopedic Surgeon (O) and Primary Care (PC) TPs for each NHL and AHL team were recorded based on an internet search. Age, sex, and race were collected. Education and practice information were collected and included programs attended, program region, degree, fellowship completion, fellowship subspeciality, practice setting, and H-indices. Results Thirty-nine NHL O, 38 NHL PC, 39 AHL O, and 33 AHL PC TPs were identified. 100 % of O-NHL and -AHL TPs were male while 94.7 % and 87.9 % of NHL and AHL PC TPs were male, respectively. NHL TPs were 53.2 years old on average while AHL TPs were 50.8 years old (p = 0.11). Most TPs were Caucasian. More NHL O TPs were MDs (100 %) compared to NHL PC TPs (84.2 %; p = 0.011); similar trends were seen in the AHL. 66.7 % of NHL O TPs practice in academic settings, compared to 33.3 % of AHL O TPs (p = 0.030). NHL O TPs had the highest H-indices. The most represented residency/fellowship programs were Hospital for Special Surgery and Kerlan-Jobe. Conclusion NHL O TPs were more likely to have an MD, be fellowship trained, practice in an academic setting, and had higher H-indices compared to their NHL PC counterparts; similar trends were observed in the AHL. There was an overall lack of diversity amongst TPs in both leagues.
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Affiliation(s)
- Christopher A. White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Reginald M. Brewster
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Jennifer Yu
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Stephen J. O'Connor
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - E. Spencer Fox
- University College Dublin School of Medicine, Dublin, Ireland
| | - David Kantrowitz
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Paul J. Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Miskiewicz M, Madera R, Pesselev I, Gallagher J, Komatsu D, Nicholson J. Postoperative complications and cost implications in sickle cell disease patients undergoing total hip arthroplasty: A national inpatient sample study. J Orthop 2025; 64:68-72. [PMID: 39691649 PMCID: PMC11648639 DOI: 10.1016/j.jor.2024.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/20/2024] [Accepted: 11/21/2024] [Indexed: 12/19/2024] Open
Abstract
Background Sickle cell disease (SCD) is a genetic condition affecting approximately 5 % of the global population, with significant prevalence in sub-Saharan Africa and an estimated 89,079 cases in the United States. Osteonecrosis, particularly of the femoral head (ONFH), is a common orthopaedic complication in SCD, often requiring total hip arthroplasty (THA) when conservative treatments fail. While THA can improve pain and function, it carries significant perioperative risks, with complication rates in patients with SCD as high as 67 %. This study aims to compare postoperative outcomes, medical costs, and the impact of different THA implant designs in patients with SCD versus a matched non-SCD cohort. Methods The study utilized the National Inpatient Sample (NIS) database. Postoperative outcomes in patients with and without SCD undergoing total hip arthroplasty between the fourth quarter of 2015 and 2020 were analyzed using propensity score matching and multivariable logistic regression modeling. Additionally, a subgroup analysis examined outcomes based on the use of cemented versus non-cemented implants. Results The study analyzed 2,830,040 hip arthroplasty patients, including 2535 with sickle cell disease (SCD), and after propensity score matching, found that patients with SCD had significantly higher rates of postoperative complications such as periprosthetic fractures, dislocations, infections, and acute kidney injury. Multivariate analysis confirmed SCD as an independent risk factor for these complications, along with increased hospital stays and higher charges. Additionally, patients with SCD receiving cemented implants experienced worse outcomes, including higher risks of periprosthetic fractures and infections, compared to those with non-cemented implants. Conclusion This study found that patients with sickle cell disease (SCD) undergoing total hip arthroplasty had significantly higher complication rates, increased healthcare costs, and longer hospital stays, with cemented implants posing greater risks compared to press-fit implants.
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Affiliation(s)
- Michael Miskiewicz
- Renaissance School of Medicine at Stony Brook University Medical Center, 100 Nicolls Rd, Stony Brook, NY, 11794, United States
| | - Rafael Madera
- Renaissance School of Medicine at Stony Brook University Medical Center, 100 Nicolls Rd, Stony Brook, NY, 11794, United States
| | - Ilan Pesselev
- Renaissance School of Medicine at Stony Brook University Medical Center, 100 Nicolls Rd, Stony Brook, NY, 11794, United States
| | - James Gallagher
- Stony Brook University Hospital, Department of Orthopaedic Surgery, 100 Nicolls Rd, Stony Brook, NY, 11794, United States
| | - David Komatsu
- Stony Brook University Hospital, Department of Orthopaedic Surgery, 100 Nicolls Rd, Stony Brook, NY, 11794, United States
| | - James Nicholson
- Stony Brook University Hospital, Department of Orthopaedic Surgery, 100 Nicolls Rd, Stony Brook, NY, 11794, United States
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Sullivan G, Gill V, Lin EA, Cancio-Bello A, Haglin J, Bingham JS. Total knee arthroplasty reimbursement is declining overall and at a marginally faster rate amongst female orthopaedic surgeons: A Medicare analysis. J Orthop 2025; 63:8-15. [PMID: 39524106 PMCID: PMC11543502 DOI: 10.1016/j.jor.2024.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 10/18/2024] [Indexed: 11/16/2024] Open
Abstract
Background While the prevalence of total knee arthroplasty (TKA) is increasing, reimbursement is declining. The purpose of this study was to determine how surgeon gender influences procedure volume, reimbursement, practice style, and patient demographics for TKAs nationally and regionally between 2013 and 2021. Methods The Medicare Physician and Other Practitioners database was queried from 2013 to 2021 for procedure volume, TKA reimbursement, surgeon characteristics, and patient demographics for any surgeon who performed at least ten primary TKAs per year. Statistical tests were conducted to analyze differences based on surgeon gender, geography, and year. Results Of the 2,415,802 TKAs performed between 2013 and 2021, 1.5 % were billed by female surgeons. The number of TKAs performed annually increased by 29.1 % for female surgeons and decreased by 2.6 % for male surgeons. Between 2013 and 2021, reimbursement for TKAs decreased by 23.9 % for male surgeons and 26.2 % for female surgeons. In 2021, male surgeons were reimbursed $1017 per TKA while female surgeons were reimbursed $964 (p = 0.049). Male surgeons performed more TKAs annually in 2021 (Male: 39.3, Female: 30.9, p < 0.001), more total billable services (Male: 4148.0, Female: 2719.3, p < 0.001), and more unique billable services (Male: 70.7, Female: 55.3, p < 0.001) than female surgeons. Conclusions Female representation among surgeons who perform TKAs is increasing nationally. However, male surgeons treat more patients, perform more total billable services, and perform more unique billable services than female surgeons. TKA reimbursement is decreasing at a faster rate for female surgeons than male surgeons, although this is likely due to geographical differences.
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Affiliation(s)
| | - Vikram Gill
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Eugenia A. Lin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Jack Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
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Khorram R, Borazjani R, Khavandegar A, Behjat M, Rahmanipour E, Vafadar R, Vali M, Parsa A, Ghorbani M. The efficacy of tranexamic acid in perioperative bleeding following total hip arthroplasty through different surgical approaches: Systematic review and meta-analysis. J Orthop 2025; 62:112-121. [PMID: 39524687 PMCID: PMC11541936 DOI: 10.1016/j.jor.2024.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 10/18/2024] [Accepted: 10/19/2024] [Indexed: 11/04/2024] Open
Abstract
Introduction Tranexamic acid (TXA) has been documented to reduce perioperative blood loss following orthopedic surgeries, such as total hip arthroplasty (THA). Previous studies focused on the best applicable dose and administration method to minimize blood loss. Although the surgical approach is another factor that may influence perioperative bleeding, no previous research has examined its concurrent impact alongside TXA. This meta-analysis investigated the effect of intravenous TXA on perioperative bleeding in primary THA, focusing on the surgical approach used. Method The authors searched PubMed, Web of Science, Scopus, Embase, and the Cochrane Library through November 2022. Fourteen studies, comprising 1358 patients, were identified as suitable for inclusion in this meta-analysis. To assess perioperative bleeding, hemoglobin (Hb) decline, transfused blood products, total blood loss (TBL), and intraoperative blood loss (IOBL) were recorded. Results The study showed that the lateral approach (LA) maintains the postoperative Hb level more effectively (WMD = 1.081, 95 % CI: 0.620-1.541). Significantly less IOBL was observed with the posterolateral approach (PLA; WMD = -70.578, 95 % CI: [-130.389] - [-10.766]). The posterior approach (PA) was associated with a reduction in TBL (WMD = -392, 95 % CI: [-474.439] - [-310.231], P-value <0.0001). Conclusion The surgical approach plays a significant role in blood management during surgery. Overall, the PLA resulted in the least IOBL, while the LA was associated with the least blood transfusion and a decline in Hb level. Additionally, the PA was linked to the lowest TBL.
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Affiliation(s)
- Roya Khorram
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Armin Khavandegar
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Behjat
- Department of Orthopedic Surgery, School of Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Rahmanipour
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Vafadar
- Department of Orthopedic Surgery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohebat Vali
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Parsa
- Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Ghorbani
- Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
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Ward TR, Boksh K, Airey G, Myatt D, Aamir J, Chapman J, Kyaw H, Jeyaseelan L, Greasley L, Drummond I, Elbannan M, Tanaka H, Mangwani J, Mason L. Lateral column midfoot injury: Do they all need fixation? J Orthop 2025; 62:22-26. [PMID: 39502676 PMCID: PMC11532135 DOI: 10.1016/j.jor.2024.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 10/06/2024] [Indexed: 11/08/2024] Open
Abstract
Introduction/purpose Research on midfoot injuries have primarily concentrated on the central column and the Lisfranc ligament without amassing evidence on lateral column injuries. Classically lateral column injuries were treated with Kirschner wire fixation. Our aim was to analyse midfoot lateral column injuries and their methods of treatment. Methods Multicentre observational study. Data was retrospectively collected from three centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26. Results A total of 409 surgically treated midfoot injuries were identified for further investigation. Following analysis, a total of 235 cases were diagnosed as having a lateral column injury, and 222 had data available for further analysis. All but 1 case (234, 99.6 %) of lateral column injury was associated with central column injury and 166 cases (70.6 %) were associated with medial column injuries.There were 44 cases where the lateral column underwent Kirschner wire fixation, 23 lateral column plate fixations and 3 lateral column screw fixations. Most patients (147, 63 %) had no fixation for their lateral column injury with only 2.84 % losing alignment at subsequent follow up. The patients undergoing K wire fixation had a greater loss of alignment rate (5.88 %). The use of a bridge plate to fix the central column appears protective and purely ligamentous injury was a higher risk than an injury that included the bone. Conclusion Lateral column injury occur in over half of midfoot fractures in this study. It rarely occurs alone and is most commonly related to three column injuries. Nevertheless, following stabilisation of the central column, additional fixation of injuries to the lateral unlikely to be required in the majority of cases. In cases where lateral column stabilisation is required, plates and screws may be preferable to K wires.
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Affiliation(s)
- Thomas R.W. Ward
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, UK
| | - Khalis Boksh
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, UK
| | - Grace Airey
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Institute of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Darren Myatt
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Junaid Aamir
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - James Chapman
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Htin Kyaw
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, UK
| | - Lucky Jeyaseelan
- Institute of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lauren Greasley
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Institute of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Isabella Drummond
- Barts Bone & Joint Health, They Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, UK
| | - Lyndon Mason
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Institute of Health and Life Sciences, University of Liverpool, Liverpool, UK
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12
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K S A, Singh V, Regmi A, Kumar N, Sharma C, Maheshwari V. Elastic stable intramedullary nailing versus submuscular plating in length unstable pediatric diaphyseal femur fractures: A prospective comparative study. J Clin Orthop Trauma 2025; 63:102920. [PMID: 39902338 PMCID: PMC11787538 DOI: 10.1016/j.jcot.2025.102920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/02/2025] [Accepted: 01/12/2025] [Indexed: 02/05/2025] Open
Abstract
Objective This study aims to compare the effectiveness of ESIN versus SMPs in both length-stable and unstable fractures of the femoral diaphysis in children above five years of age. Methods A Prospective Comparative Study was done including 40 children aged 5-13 years with a displaced shaft of femur fracture. Patients were randomized with either elastic nailing or submuscular plating as one of the operating options and were operated on according to their unique hospital identification number. The mean blood loss, operative time, fluoroscopy time, duration of analgesic use, and complications in both groups were noted. At end of 12 months, the primary outcome as per Flynn's criteria, was evaluated. Minimum 2 year follow up was done to evaluate for any complications. Results 40 patients were available for the study, 22 in ESIN (group1) and 18 in SMP (group2). In the ESIN (group1), 16 patients (72.72 %) had excellent grade, 4 patients (18.18 %) had satisfactory grade, and 2 patients (9.09 %) had a poor grade. In the SMP group, 17patients (94.44 %) had excellent grade, and 1 patient (5.55 %) had a poor outcome. Surgical parameters such as the mean operative time, incision length, blood loss, mean fluoroscopy time was significantly shorter in ESIN group compared to the SMP group (<0.001). Conclusions The outcome of fractures, irrespective of length stability managed by ESIN are comparable to SMP. Based on our findings, ESIN can safely be employed for management of length unstable fractures. The choice of implant should be based on surgeon's discretion, comfort level, patient decision and overall cost of the procedure, rather than on length stability of fracture.
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Affiliation(s)
- Aditya K S
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vivek Singh
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Anil Regmi
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Naveen Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Cury Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vikas Maheshwari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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13
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Sun X, Zhang N, Chen L, Lai Y, Yang S, Li Q, Zheng Y, Chen L, Shi X, Yang J. Collagen/polyvinyl alcohol scaffolds combined with platelet-rich plasma to enhance anterior cruciate ligament repair. BIOMATERIALS ADVANCES 2025; 169:214164. [PMID: 39756091 DOI: 10.1016/j.bioadv.2024.214164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 12/16/2024] [Accepted: 12/27/2024] [Indexed: 01/07/2025]
Abstract
In anterior cruciate ligament (ACL) repair methods, the continuous enzymatic erosion of synovial fluid can impede healing and potentially lead to repair failure, as well as exacerbate articular cartilage wear, resulting in joint degeneration. Inspired by the blood clot during medial collateral ligament healing, we developed a composite scaffold comprising collagen (1 %, w/v) and polyvinyl alcohol (5 %, w/v) combined with platelet-rich plasma (PRP). The composite scaffold provides a protective barrier against synovial erosion for the ruptured ACL, while simultaneously facilitating tissue repair, thereby enhancing the efficacy of ACL repair techniques. The composite scaffold is primarily formed through hydrogen bonding between molecular chains and physical cross-linking of microcrystalline regions using a simple cyclic freeze-thaw method, resulting in improved mechanical properties and an extended degradation period. The maximum tensile fracture load of the composite scaffold reached 5.99 ± 0.30 N. The incorporation of PRP facilitates cell migration, proliferation, and blood vessel growth by enabling slow release of various growth factors. In vivo results demonstrate that this composite scaffold promotes rabbit hindlimb rupture ACL healing by stimulating fibroblast proliferation, collagen deposition, microvascular formation, and proprioceptor generation. Furthermore, it effectively reduces meniscus and cartilage wear while mitigating bone arthritis and joint degenerative diseases. Overall, our proposed composite scaffold holds great promise as a candidate for ACL healing.
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Affiliation(s)
- Xiaohan Sun
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China
| | - Nanxin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou 350004, China
| | - Longhui Chen
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China
| | - Yuchao Lai
- Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou 350004, China
| | - Shasha Yang
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China
| | - Qiang Li
- Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou 350004, China.
| | - Yunquan Zheng
- Fujian Key Laboratory of Medical Instrument and Pharmaceutical Technology, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China
| | - Li Chen
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China; Fujian Key Laboratory of Medical Instrument and Pharmaceutical Technology, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China
| | - Xianai Shi
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China; Fujian Key Laboratory of Medical Instrument and Pharmaceutical Technology, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China
| | - Jianmin Yang
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China; Fujian Key Laboratory of Medical Instrument and Pharmaceutical Technology, Fuzhou University, No. 2 Xueyuan Road, Fuzhou 350108, China.
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14
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Balakrishnan KR, Selva Raj DR, Ghosh S, Robertson GAJ. Diabetic foot attack: Managing severe sepsis in the diabetic patient. World J Crit Care Med 2025; 14:98419. [DOI: 10.5492/wjccm.v14.i1.98419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 10/23/2024] [Accepted: 11/15/2024] [Indexed: 12/11/2024] Open
Abstract
Diabetic foot attack (DFA) is the most severe presentation of diabetic foot disease, with the patient commonly displaying severe sepsis, which can be limb or life threatening. DFA can be classified into two main categories: Typical and atypical. A typical DFA is secondary to a severe infection in the foot, often initiated by minor breaches in skin integrity that allow pathogens to enter and proliferate. This form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy, microvascular disease, and hyperglycemia, which facilitate infection spread and tissue necrosis. This form of DFA can present as one of a number of severe infective pathologies including pyomyositis, necrotizing fasciitis, and myonecrosis, all of which can lead to systemic sepsis and multi-organ failure. An atypical DFA, however, is not primarily infection-driven. It can occur secondary to either ischemia or Charcot arthropathy. Management of the typical DFA involves prompt diagnosis, aggressive infection control, and a multidisciplinary approach. Treatment can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections, and the combined British Orthopaedic Foot and Ankle Society-Vascular Society guidelines. This article highlights the importance of early recognition, comprehensive management strategies, and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.
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Affiliation(s)
- Kisshan Raj Balakrishnan
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Dharshanan Raj Selva Raj
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Sabyasachi Ghosh
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Gregory AJ Robertson
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
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15
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Javid K, Akins X, Lemaster NG, Ahmad A, Stone AV. Impact of time between meniscal injury and isolated meniscus repair on post-operative outcomes: A systematic review. World J Clin Cases 2025; 13:95004. [DOI: 10.12998/wjcc.v13.i7.95004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 10/13/2024] [Accepted: 11/14/2024] [Indexed: 11/25/2024] Open
Abstract
BACKGROUND Meniscal tears are one of the most common knee injuries. After the diagnosis of a meniscal tear has been made, there are several factors physicians use to guide clinical decision-making. The influence of time between injury and isolated meniscus repair on patient outcomes is not well described. Assessing this relationship is important as it may influence clinical decision-making and can add to the preoperative patient education process. We hypothesized that increasing the time from injury to meniscus surgery would worsen postoperative outcomes.
AIM To investigate the current literature for data on the relationship between time between meniscus injury and repair on patient outcomes.
METHODS
PubMed, Academic Search Complete, MEDLINE, CINAHL, and SPORTDiscus were searched for studies published between January 1, 1995 and July 13, 2023 on isolated meniscus repair. Exclusion criteria included concomitant ligament surgery, incomplete outcomes or time to surgery data, and meniscectomies. Patient demographics, time to injury, and postoperative outcomes from each study were abstracted and analyzed.
RESULTS Five studies met all inclusion and exclusion criteria. There were 204 (121 male, 83 female) patients included. Three of five (60%) studies determined that time between injury and surgery was not statistically significant for postoperative Lysholm scores (P = 0.62), Tegner scores (P = 0.46), failure rate (P = 0.45, P = 0.86), and International Knee Documentation Committee scores (P = 0.65). Two of five (40%) studies found a statistically significant increase in Lysholm scores with shorter time to surgery (P = 0.03) and a statistically significant association between progression of medial meniscus extrusion ratio (P = 0.01) and increasing time to surgery.
CONCLUSION Our results do not support the hypothesis that increased time from injury to isolated meniscus surgery worsens postoperative outcomes. Decision-making primarily based on injury interval is thus not recommended.
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Affiliation(s)
- Kashif Javid
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY 40504, United States
| | - Xavier Akins
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY 40504, United States
| | - Nicole G Lemaster
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY 40504, United States
| | - Amer Ahmad
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY 40504, United States
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY 40504, United States
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16
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Johar D, Bedair El-Assal AH, Abou-El-Makarem MM, Hammouda EFA, Hegazy MS, Zaky S. Do oxidized low-density lipoproteins link to extra hepatic manifestations in chronic, non-cirrhotic HCV patients? Metabol Open 2025; 25:100339. [PMID: 39790936 PMCID: PMC11714377 DOI: 10.1016/j.metop.2024.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 12/07/2024] [Accepted: 12/09/2024] [Indexed: 01/12/2025] Open
Abstract
Background Tissue damage by viral hepatitis is a major cause of morbidity and mortality worldwide. Oxidation reactions and reactive oxygen species (ROS) transform proteins and lipids in plasma low-density lipoproteins (LDL) into the abnormal oxidized LDL (ox-LDL). Hepatitis C virus (HCV) infection induces oxidative/nitrosative stress from multiple sources, including the inducible nitric oxide synthase (iNOS), the mitochondrial electron transport chain, hepatocyte NAD(P)H oxidases (NOX enzymes), and inflammation. Further, HCV decreases reduced glutathione (GSH) synthesis and regeneration. Design Cross-section. Objective to quantify ox-LDL in serum of chronic non-cirrhotic HCV patients, and to assess ox-LDL association with HCV-induced extra hepatic manifestations. Patients and methods Twenty chronic, non-cirrhotic HCV female patients with extra hepatic manifestations, twenty chronic, non-cirrhotic female HCV patients without extra hepatic manifestations and twenty healthy age, sex matched controls. Methods Serum was used for determination of liver function tests, ox-LDL and the extracellular antioxidant enzyme Superoxide Dismutase EC CuZn-SOD. Results Patients with extra hepatic manifestations had statistically higher ox-LDL (76.63 ± 6.86 μg/L) than patients without extra hepatic manifestations (63.05 ± 6.6 μg/L) p < 0.001, and both patient groups had higher ox-LDL levels than the control group (44.1 ± 4.1 μg/L) p < 0.001. EC CuZn-SOD correlated negatively with ox-LDL in HCV patients with extra hepatic manifestation only. Conclusion Extra hepatic manifestations were not risk for anthropometric changes seen with HCV infection. Extra hepatic manifestations were associated with high serum ox-LDL. High serum levels of ox-LDL associated with- or were due to deregulated expression of serum EC CuZn-SOD in chronic HCV patients.
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Affiliation(s)
- Dina Johar
- Department of Biochemistry and Nutrition, Faculty of Women for Arts, Sciences and Education, Ain Shams University, Heliopolis, Cairo, Egypt
| | | | | | | | - Mohamed Soliman Hegazy
- Hepatogastroenterology and Infectious Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Samy Zaky
- Hepatogastroenterology and Infectious Diseases Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Ishii S, Baba T, Shirogane Y, Hayashi K, Homma Y, Muto O, Kaneko K, Ishijima M. Callus formation after total hip arthroplasty using a short tapered-wedge stem. Skeletal Radiol 2025; 54:447-455. [PMID: 39052073 DOI: 10.1007/s00256-024-04756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The incidence of periprosthetic fractures after total hip arthroplasty using a short tapered-wedge stem is high. Callus formation preceding this fracture, which indicates postoperative stress fracture around the stem, has been reported. However, previous studies on postoperative callus are limited. Hence, the current study aimed to evaluate the prevalence and risk factors of postoperative callus after total hip arthroplasty with a short tapered-wedge stem. MATERIALS AND METHODS This retrospective study included 127 patients who underwent total hip arthroplasty using a cementless short tapered-wedge stem. The depth of stem insertion was measured as the distance from the lateral corner of the stem to the most medial point of the lesser trochanter along the body axis. Postoperative callus was defined as a bridging callus on the lateral femoral cortex at the distal end of the porous coating of the stem. Plain radiography was performed before surgery and immediately and at 1, 3, and 6 months after surgery to assess postoperative callus. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PC. RESULTS In total, 60 (47.2%) of 127 patients presented with postoperative callus. Multivariate logistic regression analysis with postoperative callus as the dependent variable revealed that the stem depth at 1 month after total hip arthroplasty (odds ratio, 1.14; 95% confidence interval, 1.04-1.24, p = 0.002) was a significant and independent risk factor of postoperative callus. CONCLUSION Deep insertion of a short tapered-wedge stem is a risk factor for postoperative callus.
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Affiliation(s)
- Seiya Ishii
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan.
- Department of Orthopaedic Surgery, Yokohama Tsurugamine Hospital, Kanagawa, Japan.
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuichi Shirogane
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Osamu Muto
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Department of Orthopaedic Surgery, Yokohama Tsurugamine Hospital, Kanagawa, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
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18
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Giardulli B, Prior Y, Bumin G, Kinikli GI, Prior JA, Stones SR, Flurey C, Testa M, Lavender A, Battista S. Sexual Health, Pleasure, Justice, and Well-Being in People With Rheumatic and Musculoskeletal Diseases: A Scoping Review Protocol. Musculoskeletal Care 2025; 23:e70040. [PMID: 39763178 PMCID: PMC11704450 DOI: 10.1002/msc.70040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 12/13/2024] [Accepted: 12/16/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION Sexual health, pleasure, justice (equity in sexual rights and experiences), and well-being are crucial determinants of health and life quality, yet often overlooked in the rheumatic and musculoskeletal diseases (RMD) field. However, this topic has received more attention recently, and there is a need to map the current literature to inform the direction of future studies. Hence, this protocol outlines a scoping review to systematically map existing evidence on sexual health in people with RMD, exploring key themes and identifying evidence gaps across multiple dimensions, including sexual well-being, justice and pleasure. METHOD AND ANALYSIS This scoping review will follow the methodological guidance of the Joanna Briggs Institute and be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. The search strategy will involve PubMed, Embase, Cochrane Central, CINAHL, PsychInfo, LGBTQIA+ Source, Web of Science, and the grey literature. Identified articles will be reviewed based on the eligibility criteria. The results will be narratively synthesised and aligned with the framework proposed by Mitchel et al. (2021), identifying four pillars of comprehensive public health for sexuality: 'Sexual Health', 'Sexual Pleasure', 'Sexual Justice', and 'Sexual Well-Being'. DISSEMINATION The scoping review will synthesise the scientific literature published on sexual health, pleasure, justice and well-being in people with RMD. This review will provide an understanding of how sexual health is addressed in the literature to inform future research and clinical practices. The findings will be disseminated as research publications, including peer-reviewed article(s), conference abstract(s)/presentation(s), and plain language summaries.
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