Patellar resurfacing in contemporary total knee arthroplasty: Frequency of complications in a matched cohort

Introduction

Optimum patient selection and outcomes following patellar resurfacing are ongoing debates amongst the arthroplasty community. This study compared the outcomes of patients who had a total knee arthroplasty (TKA) with patellar resurfacing to those left with their native patella.

Methods

A retrospective review of 1941 TKAs performed between 2016 and 2020 was conducted. 41 TKAs without patellar resurfacing and with 2-years of minimum follow-up were identified. Of these, 38 TKAs were matched on age (exact), sex (exact), and body mass index (±10) to 38 TKAs that had patellar resurfacing. The indications for patella resurfacing were subjective based upon the surgeon preference and assessment of cartilage quality. Paired t-tests and chi-square tests were used for analysis.

Results

There was 1 major patellofemoral complication in both the resurfaced group (patellar fracture) and the non-resurfaced group (patellar tendon tear), requiring nonoperative management and revision surgery, respectively. However, in the non-resurfaced group there were 4 cases of subjective patellofemoral pain compared to none in the resurfaced group (p = 0.37). Additionally, 3 non-resurfaced patients required manipulation under anesthesia (MUA) compared to none in the resurfaced group (p = 0.44).

Discussion

There was no difference in the frequency of major patella-specific complications between the groups. However, there was a non-statistically significant trend towards increased patellofemoral pain and MUA in the non-resurfaced group. Based on this study both methods of treatment remain viable options, but the trend towards increased pain and stiffness should continue to be closely evaluated.

Mitigating calcar fracture risk with automated impaction during total hip arthroplasty

Background

Automated broaching has recently been introduced for total hip arthroplasty (THA), with the goal of improving surgical efficiency and reducing surgeon workload. While studies have suggested that this technique may improve femoral sizing and alignment, little has been published regarding its safety, particularly with regard to calcar fractures. The purpose of our study was to evaluate the risk of calcar fracture during automated broaching, and to determine if this risk can be mitigated.

Methods

We queried our prospective institutional database and identified 1596 unilateral THAs performed by the senior author using automated impaction between 2019 and 2023. We identified the incidence of calcar fracture with automated impaction, and whether the fracture occurred during broaching or stem insertion. We additionally determined calcar fracture incidence within two consecutive subgroups of patients using different stem insertion techniques; subgroup (1): automated broaching with automated stem insertion for all patients; versus subgroup (2): automated broaching with automated stem insertion ONLY if a cushion of cancellous bone separated the broach from the calcar, otherwise the stem was placed manually. Continuous and categorical variables were analyzed with Student's t-test and Fisher's exact test, respectively.

Results

Seventeen calcar fractures occurred intraoperatively (1.1 %). Only two fractures occurred during automated broaching (0.1 %), while fifteen occurred during final stem impaction (0.9 %) (p = 0.007). Four calcar fractures (1.4 %) occurred in subgroup 1, compared to two in subgroup 2 (0.6 %) (p = 0.28).

Conclusions

Our study found a calcar fracture incidence of 1.1 % using automated impaction, consistent with historically reported rates of 0.4-3.7 %. We found that calcar fractures are more likely to occur during stem insertion than during femoral broaching. We recommend that if any part of the final broach is in direct contact with the calcar, the final stem should be impacted manually to minimize fracture risk.

A comparative meta-analysis of the efficacy and safety of arthroscopic versus open surgery in patients with lateral epicondylitis

Background

Lateral epicondylitis frequently necessitates surgical management when non-surgical treatments are ineffective. Anecdotal evidence suggests comparable efficacy between arthroscopic and open surgical repair; however, it is limited by the scarcity of data. This meta-analysis compares between both procedures regarding functional recovery, pain intensity, complications, and return-to-work time.

Methods

A detailed systematic review and meta-analysis of research published until February 2024 were performed, comparing arthroscopic and open surgery methods for lateral epicondylitis. The studies were sourced from PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. The included studies examined outcomes such as functional recovery, pain intensity, complication rates, and time to return to work. The risk of bias was evaluated using the Cochrane tool for randomized studies and the ROBINS-I tool for non-randomized studies.

Results

The meta-analysis included 19 studies with a total of 20,409 participants. The analysis found no significant differences in postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores (Mean Difference [MD] = 0.06; 95 % Confidence Interval [CI]: 0.81 to 0.94; P = 0.89) or Mayo Elbow Performance Scores (MD = 0.31; 95 % CI: 2.33 to 2.95; P = 0.80) between the arthroscopic and open surgical methods. The rates of good-to-excellent recovery, surgical failures, and complications were similar across both techniques. Nevertheless, arthroscopic surgery was associated with a significantly shorter return-to-work period (MD = -1.64 months; 95 % CI: 2.60 to -0.68; P = 0.001) and a temporary increase in grip strength six months after surgery (MD = -1.50 kg; 95 % CI: 2.67 to -0.33; P = 0.012).

Conclusions

Arthroscopic and open release techniques for lateral epicondylitis provide similar functional outcomes and complication rates. However, arthroscopic surgery may allow for a quicker return to work, suggesting a potential advantage in the early postoperative period. These findings highlight the need for individualized surgical decision-making based on patient-specific factors and surgeon expertise.

The current epidemiology of vascular injuries associated with knee dislocation in the United States from 2010 to 2022

Introduction

Despite the recognized importance of managing vascular injury associated with knee dislocation, studies have been limited by small patient sizes, data older than five years, and lack of inclusion of newer procedural and diagnoses codes. This has been reflected in the reported frequency of knee dislocation associated with vascular injury ranging from 1.6 % to 64 %. As such, we sought to determine: (1) the frequency of knee dislocations associated with vascular injuries; (2) the frequency of knee dislocations associated with vascular injuries that required repair; as well as (3) independent risk factors for knee dislocation with vascular injury that require repair, across different age groups, sexes, and United States geographic regions.

Methods

A national, all-payer database was queried from January 1, 2010 to June 31, 2022. The frequency of a vascular injury was calculated by dividing the number of vascular injuries within 30 days of all knee dislocations by the total number of knee dislocations in each category. The frequency of a vascular injury that required repair was calculated by dividing the number of vascular injuries that required repair associated with knee dislocation by the total number of vascular injuries associated with knee dislocations. Patients were categorized by year of diagnosis, age, sex, and US geographic region. Multivariable logistic regressions were calculated to determine independent risk factors for knee dislocation with vascular injury.

Results

From 2010 to 2022, there were 99,688 knee dislocations. Of the total knee dislocations, there were 1066 (1.1 %) vascular injuries associated with knee dislocations, 96,530 (96.8 %) were closed dislocations, and 3158 (2.2 %) were open dislocations. Of the 1066 vascular injuries associated with knee dislocations, 262 (24.6 %) vascular injuries required repair. Male sex (P < 0.001), Elixhauser Comorbidity Index (ECI) > 3 (P < 0.001), alcohol abuse (P = 0.006), congestive heart failure (P = 0.01), hypothyroidism (P = 0.003), and obesity (P < 0.001), were independent risk factors for knee dislocation with vascular injuries.

Conclusion

Our study provides a refined understanding of the historically low incidence of knee dislocation with vascular injury as well as an increase in vascular injuries requiring repair from 2010 to 2022. Given the large expense of irreversible injury in these patients, vulnerable patient populations identified in our study, such as obese patients with additional comorbidities, should be a focus of future intervention. These findings can guide physicians in a clinical setting to appropriately manage the expectations of patients as well as minimize the morbidity and mortality associated with this presentation.

Satisfaction with telemedicine use during COVID-19 pandemic in the UK: a systematic review

Background: Telemedicine became a fundamental part of healthcare provision during COVID-19 pandemic. An evaluation of telemedicine-associated satisfaction helps the service develop more viable applications. This review evaluated the satisfaction of healthcare users and providers and their willingness to use this modality in future.Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search on empirical articles published between March 2020 and December 2022 was performed on 'PubMed' and 'Scopus' databases. Findings that reported on satisfaction of patients, families and caregivers as well as clinicians were extracted and analysed. Quality of included studies was assessed. After applying inclusion and exclusion criteria, the review included 27 eligible studies.Results: Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare. Almost all studies were undertaken within the NHS. There were many tools that measured satisfaction. Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%. Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information. Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people. In general, willingness to use telemedicine in future was high in the recipients as well as the providers of healthcare.Conclusion: COVID-19 pandemic has transformed healthcare in the UK and promoted a revolution in telemedicine applications. Satisfaction was high among both recipient and provider of healthcare. Telemedicine managed to provide a continued care throughout the pandemic while maintaining social distance. The current review presented commendable evidence to encourage different specialities to engage in telemedicine application.

Applying 3D surface scanning technology to create photorealistic three-dimensional printed replicas of human anatomy

Aim: To describe advances in 3D data capture and printing that allow photorealistic replicas of human anatomical specimens for education and research, and discuss advantages of current generation printing for replica design and manufacture. Materials & methods: We combine surface scanning and computerized tomography datasets that maximize precise color and geometric capture with ultra violet (UV) curable resin printing to replicate human anatomical specimens. Results: We describe the process for color control, print design and translation of photorealistic 3D meshes into 3D prints in durable resins. Conclusion: Current technologies allow previously unachievable ability to capture and reproduce anatomical specimens, and provide a platform for a new generation of 3D printed teaching materials to be designed and used in anatomy education environments.

The combination of HSI and NMR techniques with deep learning for identification of geographical origin and GI markers of Lycium barbarum L

Lycium barbarum L. (L. barbarum) is renowned worldwide for its nutritional and medicinal benefits. Rapid and accurate identification of L.barbarum's geographic origin is essential because its nutritional content, medicinal efficacy, and market price significantly vary by region. This study proposes an innovative method combining hyperspectral imaging (HSI), nuclear magnetic resonance (NMR), and an improved ResNet-34 deep learning model to accurately identify the geographical origin and geographical indication (GI) markers of L.barbarum. The deep learning model achieved a 95.63% accuracy, surpassed traditional methods by 6.26% and reduced runtime by 29.9% through SHapley Additive exPlanations (SHAP)-based feature selection. Pearson correlation analysis between GI markers and HSI characteristic wavelengths enhanced the interpretability of HSI data and further reduced runtime by 33.99%. This work lays the foundation for portable multispectral devices, offering a rapid, accurate, and cost-effective solution for quality assurance and market regulation of L.barbarum products.

Evaluation of the protective effects of chondroitin sulfate oligosaccharide against osteoarthritis via inactivation of NLRP3 inflammasome by in vivo and in vitro studies

Osteoarthritis (OA) is the most prevalent degenerative arthritis disease linked to aging, obesity, diet, and accumulation of octacalcium phosphate (OCP) crystals in joints. Current research has focused on inflammation and chondrocytes apoptosis as underlying OA mechanisms. Inflammatory cytokines like IL-1β activate matrix metalloproteinase-13 (MMP-13) and aggrecanase (the member of A Disintegrin and Metalloproteinase with Thrombospondin motifs family, ADAMTS), leading to cartilage matrix degradation. The NLRP3 inflammasome also contributes to OA pathogenesis by maturing IL-1β. Natural products like chondroitin sulfate oligosaccharides (oligo-CS) show promise in OA treatment by inhibiting inflammation. Our study evaluates the protective effects of oligo-CS against OA by targeting NLRP3 inflammation. Stimulating human SW1353 chondrocytes and human mononuclear macrophage THP-1 cells with OCP showed increased NLRP3 inflammation initiation, NF-κB pathway activation, and the production of inflammatory cytokines (IL-1β, IL-6) and the metabolic index (MMP-13, ADAMTS-5), leading to cartilage matrix degradation. However, oligo-CS treatment significantly reduced inflammation. In a 28-day in vivo study with C57BL/6 female mice, OCP was injected into their right knee and oligo-CS was orally administered. The OCP group exhibited significant joint space narrowing and chondrocyte loss, while the oligo-CS group maintained cartilage integrity. Oligo-CS groups also regulated gut microbiota composition to a healthier state. Taken together, our findings suggest that oligo-CS can be considered as a protective compound against OA.

Enhancing recovery and reducing readmissions: The impact of remote monitoring on acute postoperative care in outpatient total joint arthroplasty

Introduction

Outpatient total joint arthroplasty (TJA) is gaining popularity in the United States. With a shift towards value-based healthcare and bundled payment models, the importance of safe discharge after TJA is pertinent in reducing readmissions and subsequent cost of care. However, many acute issues or complications may not occur until after discharge which can result in emergency department visits and readmission. Our study aims to characterize the effect of remote monitoring devices on acute postoperative recovery in TJA discharged within 24 h. We hypothesized there would be a decreased readmission rate in the remote home monitoring cohort.

Methods

This prospective cohort compared 50 outpatient TJAs (primary total hip and total knee replacements) defined as discharged within 24 h with a remote home monitoring device to 50 outpatient TJAs who did not receive remote monitoring. Demographics, hospital length of stay, American Society of Anesthesiology scores, and Charlson Comorbidity Index were compared with no significant difference observed between cohorts (p > 0.05). Patients' vital signs were transmitted to a virtual response center for up to 48 h after discharge. An on-call medical team reviewed the transmissions and if prompted, would contact the patient to troubleshoot and triage. Primary outcome was 30-day hospital readmissions rates, while 30-day ED visits and patient satisfaction scores for the remote home monitoring were measured as secondary outcomes.

Results

Within the remote monitoring cohort there was a 20 % incidence (10 patients) of abnormal vitals captured and 2 patients visited the ED, however there were no readmissions attributed to this group. Readmission rates and ED visits in the control non-monitored group were significantly higher at 12 % (p = 0.03), secondary to syncope, uncontrolled postoperative pain, cellulitis, hip dislocations, and postoperative fever. Of the patients who received remote monitoring, 14 % had trouble connecting the device to their smartphone, 44 % felt home monitoring helped in their care while recovering at home, 52 % made them feel safer, and 70 % would recommend this program.

Conclusions

Remote home monitoring with a virtual response team after outpatient TJA is a feasible way to mitigate readmissions in the acute postoperative period and increase patient satisfaction. Efforts to minimize costs should not be implemented at the expense of patients' health outcomes with a goal to find an appropriate balance between both agendas.

Level of evidence

Therapeutic Level III.

Human umbilical cord mesenchymal stem cells protect MC3T3-E1 osteoblasts from dexamethasone-induced apoptosis via induction of the Nrf2-ARE signaling pathway

Objective

To investigate the protective effect human umbilical cord mesenchymal stem cells (hUC-MSCs) have on Dexamethasone (Dex)-induced apoptosis in osteogenesis via the Nrf2-ARE signaling pathway.

Methods

Glucocorticoid-induced osteonecrosis of the femoral head (GC-ONFH) was developed in rats through the administration of lipopolysaccharide and methylprednisolone. The incidence of femoral head necrosis, cavity notch, apoptosis of osteoblasts, and bone density were observed by HE staining, TUNEL staining, and Micro-CT. HUC-MSCs were co-cultured with mouse pre-osteoblast MC3T3-E1. The survival rate of osteoblasts was determined by CCK8, and apoptosis and ROS levels of osteoblasts were determined by flow cytometer. The viability of antioxidant enzymes SOD, GSH-Px, and CAT was analyzed by biochemistry. Nrf2 expression levels and those of its downstream proteins and apoptosis-related proteins were analyzed by Western blotting.

Results

In rats, hUC-MSCs can reduce the rates of empty bone lacuna and osteoblast apoptosis that are induced by glucocorticoids (GCs), while reducing the incidence of GC-ONFH. hUC-MSCs can significantly improve the survival rate and antioxidant SOD, GSH-Px, and CAT activity of MC3T3-E1 cells caused by Dex, and inhibit apoptosis and oxidative stress levels. In addition, hUC-MSCs can up-regulate the expression of osteoblast antioxidant protein Nrf2 and its downstream protein HO-1, NQO-1, GCLC, GCLM, and apoptosis-related protein bcl-2, while also down-regulating the expression of apoptosis-related protein bax, cleaved caspase-3, cleaved caspase-9, and cytochrome C in MC3T3-E1 cells. hUC-MSCs improve the ability of MC3T3-E1 cells to mineralize to osteogenesis. However, the promoting effects of hUC-MSCs were abolished following the blocking of the Nrf2-ARE signaling pathway for osteoblasts.

Conclusion

The results reveal that hUC-MSCs can reduce Dex-induced apoptosis in osteoblasts via the Nrf2-ARE signaling pathway.

Generalized inhomogeneity-resilient relaxation along a fictitious field (girRAFF) for improved robustness in rotating frame relaxometry at 3T

PURPOSE

To optimize Relaxation along a Fictitious Field (RAFF) pulses for rotating frame relaxometry with improved robustness in the presence ofB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ field inhomogeneities.

METHODS

The resilience of RAFF pulses againstB 0 $$ {\mathrm{B}}_0 $$ andB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities was studied using Bloch simulations. A parameterized extension of the RAFF formulation was introduced and used to derive a generalized inhomogeneity-resilient RAFF (girRAFF) pulse. RAFF and girRAFF preparation efficiency, defined as the ratio of the longitudinal magnetization before and after the preparation (M z ( T p ) / M 0 $$ {M}_z\left({T}_p\right)/{M}_0 $$ ), were simulated and validated in phantom experiments.T RAFF $$ {T}_{\mathrm{RAFF}} $$ andT girRAFF $$ {T}_{\mathrm{girRAFF}} $$ parametric maps were acquired at 3T in phantom, the calf muscle, and the knee cartilage of healthy subjects. The relaxation time maps were analyzed for resilience against artificially induced field inhomogeneities and assessed in terms of in vivo reproducibility.

RESULTS

Optimized girRAFF preparations yielded improved preparation efficiency (0.95/0.91 simulations/phantom) with respect to RAFF (0.36/0.67 simulations/phantom).T girRAFF $$ {T}_{\mathrm{girRAFF}} $$ preparations showed in phantom/calf 6.0/4.8 times higher resilience toB 0 $$ {\mathrm{B}}_0 $$ inhomogeneities than RAFF, and a 4.7/5.3 improved resilience toB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities. In the knee cartilage,T girRAFF $$ {T}_{\mathrm{girRAFF}} $$ (53± $$ \pm $$ 14 ms) was higher thanT RAFF $$ {T}_{\mathrm{RAFF}} $$ (42± $$ \pm $$ 11 ms). Moreover, girRAFF preparations yielded 7.6/4.9 times improved reproducibility acrossB 0 $$ {\mathrm{B}}_0 $$ /B 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneity conditions, 1.9 times better reproducibility across subjects and 1.2 times across slices compared with RAFF. Dixon-based fat suppression led to a further 15-fold improvement in the robustness of girRAFF to inhomogeneities.

CONCLUSIONS

RAFF pulses display residual sensitivity to off-resonance and pronounced sensitivity toB 1 + $$ {\mathrm{B}}_1^{+} $$ inhomogeneities. Optimized girRAFF pulses provide increased robustness and may be an appealing alternative for applications where resilience against field inhomogeneities is required.

Efficacy of superficial femoral artery as a recipient in free flap reconstruction around the knee: Four case reports and a literature review

Purpose

Reconstructing soft tissue defects around the knee with free flaps presents challenges in recipient vessel selection. Although the superficial femoral artery (SFA) offers exposure ease and anatomical stability, concerns arise regarding its distance from the defect site, difficulty in performing anastomosis and potential peripheral ischaemia. This study aimed to reassess the suitability of SFA as a recipient vessel for knee reconstructions by examining our cases and those from previous reports.

Methods

We reviewed four cases of knee soft tissue defects reconstructed with free flaps using the SFA, detailing surgical techniques and outcomes. Additionally, a comprehensive literature search was conducted for articles on using SFA as a recipient vessel for knee free flaps, using PubMed, Web of Science and EBSCOhost databases.

Results

In all four cases, latissimus dorsi (LD) flaps were used, with end-to-side anastomosis performed using a large slit-shaped arteriotomy. All flaps demonstrated successful survival without complications. Our analysis included 85 cases, comprising four of our cases and 81 cases from 16 articles. Sarcoma resection was the most common aetiology, followed by total knee prosthesis-related defects, trauma and osteomyelitis. Complete flap necrosis occurred in 5% of cases. The LD flap was the predominant choice, alongside other long-pedicle flaps. The SFA provided coverage for all knee areas except the distal lateral patellar region.

Conclusion

Despite the limited evidence, the SFA appears to be a reliable recipient vessel for knee soft tissue reconstruction. Comprehensive understanding of the characteristics of the SFA and flaps used enhances the safety and efficacy of soft tissue defect reconstruction around the knee.

Spinal schwannoma: Limitations of CT imaging

Spinal schwannomas are benign lesions that most commonly appear in the lumbar and thoracic regions of the spine. Although computed tomography (CT) scans are often used to assess spinal conditions, they are ineffective at detecting soft tissue abnormalities. This case is for a 49-year-old female who experienced a gradual loss of sensation and strength in her lower extremities, along with increased urinary urgency, over six weeks. In addition, mid-back pain has been present for one year. Initially, a CT scan was done and did not show any significant findings, which suggested the absence of a spinal abnormality. However, magnetic resonance imaging (MRI) revealed an intradural extramedullary lesion causing spinal cord compression. The patient successfully underwent surgery to remove the tumor, and histological analysis confirmed it as spinal schwannoma. This case underlines the diagnostic limitations of CT imaging for spinal lesions and illustrates the superior accuracy of MRI. Thus, a negative CT should not halt further diagnostic evaluation when symptoms persist.

Hearing impairment increases the risk of hip fracture-related mortality and recurrent hip fractures: A propensity score matching analysis

PURPOSE

Despite the ongoing rise in hip fractures and the adverse effects of hearing impairment (HI) on increased mortality and morbidity, research addressing the influence of HI on mortality risk or complications in patients with hip fractures remains absent. This study aimed to analyze the effects of HI on mortality and treatment outcomes among patients with hip fracture.

METHODS

We retrospectively collected data from consecutive patients diagnosed with hip fractures between January 2007 and March 2022 who had auditory examination records. From the initially enrolled 265 patients, data for 58 with HI and 58 without HI (control group) were extracted using a 1:1 propensity score matching. The primary outcome included comparison of mortality rates, and the secondary outcome encompassed the comparison of postoperative medical and surgical complications.

RESULTS

The 1-year cumulative mortality rate was not significantly different between the HI and control groups, but the overall cumulative mortality rate was significantly higher in the HI than in the control group (63.0 % and 48.6, respectively; P = 0.046) in a follow-up period of up to 16 years. The HI group had a significantly higher incidence of "second hip fractures due to falls" than the control group (P = 0.016), although no differences in other medical and surgical complications were revealed.

CONCLUSIONS

Awareness of the long-term risk of higher mortality when managing patients with hip fracture and HI is important. To reduce the risk of second hip fractures, paying more attention to fall prevention education and taking a more proactive approach, especially for those with HI.

Cortical intermittent theta burst stimulation on gait pathomechanics and urinary tract dysfunction in incomplete spinal cord injury patients: Protocol for a randomized controlled trial

Gait impairment and neurogenic bladder are co-existing common findings in incomplete spinal cord injury (iSCI). Repetitive transcranial magnetic stimulation (rTMS), evident to be a promising strategy adjunct to physical rehabilitation to regain normal ambulation in SCI. However, there is a need to evaluate the role of Intermittent theta burst stimulation (iTBS), a type of patterned rTMS in restoring gait and neurogenic bladder in SCI patients. The aim of the present study is to quantify the effect of iTBS on spatiotemporal, kinetic, and kinematic parameters of gait and neurogenic bladder dyssynergia in iSCI. After maturing all exclusion and inclusion criteria, thirty iSCI patients will be randomly divided into three groups: Group-A (sham), Group-B (active rTMS) and Group-C (active iTBS). Each group will receive stimulation adjunct to physical rehabilitation for 2 weeks. All patients will undergo gait analysis, as well assessment of bladder, electrophysiological, neurological, functional, and psychosocial parameters. All parameters will be assessed at baseline and 6th week (1st follow-up). Parameters except urodynamics and gait analysis will also be assessed after the end of the 2 weeks of the intervention (post-intervention) and at 12th week (2nd follow-up). Appropriate statistical analysis will be done using various parametric and non-parametric tests based on results.

Publications and ranking in orthopaedics and sports medicine of European countries during the last three decades: A bibliometric analysis

Introduction

The present investigation examined the trend of publications and ranking in Orthopaedics and Sports Medicine of European countries during the years 1996 to 2022 and compared these with all the regions globally.

Methods

In September 2023, the SCOPUS data of publications in Orthopaedics and Sports Medicine from the SCImago Journal & Country Rank website were retrieved. All the data from Western and Eastern Europe were extracted from the overall data of the global countries and merged into Excel files, for each of the years 1996-2022 and 2022.

Results

Western European countries contributed significantly to the global share of publications in Orthopaedics and Sports Medicine with nearly 1/3rd of the total publications. Eastern European countries' contribution was minimal to the global publications and was almost 10 times less than the Western European countries. The total number of publications in the area of Orthopaedics and Sports Medicine from 1996 to 2022 at the European scale was led by the United Kingdom (N = 51510) and has maintained its supremacy until recently, in 2022. Amongst Western European countries, during the cumulative period of 1996-2022, the maximum contributions were made by the United Kingdom (N = 51510), and also in 2022, the United Kingdom contributed maximally (N = 3339). In the cumulative period of 1996-2022, Poland contributed maximally (N = 4049) among the Eastern European countries. In 2022, the maximum contribution from the Eastern European countries came from the Russian Federation (N = 462).

Conclusion

The European continent is the major contributor to Orthopaedics and Sports Medicine research and publications, with almost 1/3rd of the global share of publications. Western European countries are far ahead in their contributions than Eastern European countries.

Multifunctional piezoelectric surfaces enhanced with layer-by-layer coating for improved osseointegration and antibacterial performance

Implant failure is primarily caused by poor osseointegration and bacterial colonization, which demands readmissions and revision surgeries to correct it. A novel approach involves engineering multifunctional interfaces using piezoelectric polyvinylidene fluoride (PVDF) materials, which mimic bone tissue's electroactive properties to promote bone integration and provide antibacterial functionality when mechanically stimulated. In this study, PVDF films were coated with antibacterial essential oil nanoparticles and antibiofilm enzymes using a layer-by-layer (LBL) approach to ensure antibacterial properties even without mechanical stimulation. The experimental results confirmed the LBL build-up and demonstrated notable antibiofilm properties against Pseudomonas aeruginosa and Staphylococcus aureus while enhancing pre-osteoblast cell proliferation under mechanical dynamic conditions in a bioreactor that replicated the real-life environment of implants within the body. The findings highlight the potential of PVDF-coated surfaces to prevent biofilm formation and boost cell proliferation through the piezoelectric effect, paving the way for advanced implantable devices with improved osseointegration and antibacterial performance.

Global Health Inequities in Orthopaedic Care: Perspectives Beyond the US

PURPOSE OF REVIEW

The burden of musculoskeletal disease is increasing globally and disproportionately affecting people in low and middle income countries (LMIC). We sought to review global access to orthopaedic care, burden of trauma, research infrastructure, impact of surgical mission trips, implant availability, and the effect of COVID-19 upon the delivery of orthopaedic care worldwide.

RECENT FINDINGS

The majority of people in LMIC do not have access to safe, quality surgical care, and there are few fellowship-trained orthopaedic traumatologists. Road traffic accidents are the leading cause of long bone fractures in LMIC and result in significant morbidity and mortality. Of the orthopaedic literature published globally in the last 10 years, less than 15% had authors from LMIC. There has been growth in surgical mission trips to LMIC, but few organizations have established bidirectional partnerships. Among the challenges to delivering quality musculoskeletal care in LMIC is timely access to quality orthopaedic implants. Implant options in LMIC are more limited and subjected to less rigorous testing and regulation than high income countries (HIC). The COVID-19 pandemic dramatically reduced elective surgeries but saw the increase in telemedicine utilization which has prevailed in both HIC and LMIC. Awareness of global inequities in orthopaedic care is growing. Much can be learned through collaborations between orthopaedic surgeons from HIC and LMIC to advance patient care worldwide. There is a need for high quality, accurate data regarding incidence and prevalence of musculoskeletal disease, care utilization/availability, and postoperative outcomes so resources can be allotted to make orthopaedic care more equitable globally.

Predicting Functional Outcomes Following Dysvascular Lower Limb Amputation: An Evidence Review of Personalizing Patient Outcomes

Most research on people undergoing lower limb amputations for dysvascular disease summarizes average patient outcome risks and average associations between patient factors and these outcomes. More recently, the importance of predicting patient-specific outcomes based on individual factors (ie, personalized rehabilitation) has become evident. This article reviews the evidence and discusses the importance of the following: (1) predicting outcomes to facilitate amputation-level and prosthesis prescription decisions and (2) how prediction models can be leveraged to develop decision support tools to facilitate provider/patient shared decision-making to ensure decisions considering each individual patient's priorities and preferences. Examples of these tools are discussed and referenced.

The Use of General Anesthesia in Revision Joint Arthroplasty

BACKGROUND

Several studies have suggested that spinal anesthesia gives superior outcomes for primary total joint arthroplasty (TJA). However, there is a lack of available data regarding contemporary general anesthesia (GA) approaches for revision TJA utilized at high-volume joint arthroplasty centers.

METHODS

We retrospectively reviewed a series of 850 consecutive revision TJAs (405 revision total hip arthroplasties and 445 revision total knee arthroplasties) performed over 4 years at a single institution that uses a contemporary GA protocol and reported on the lengths of stay, early recovery rates, perioperative complications, and readmissions.

RESULTS

Of the revision arthroplasty patients, 74.4% (632 of 850) were discharged on postoperative day 1 and 68.5% (582 of 850) of subjects were able to participate in physical therapy on the day of surgery. Only 6 patients (0.7%) required an intensive care unit stay postoperatively. The 90-day readmission rate over this time was 11.3% (n = 96), while the reoperation rate was 9.4% (n = 80).

CONCLUSIONS

While neuraxial anesthesia is commonly preferred when performing revision TJA, we have demonstrated favorable safety and efficiency metrics utilizing GA in conjunction with contemporary enhanced recovery pathways. Our data support the notion that modern GA techniques can be successfully used in revision TJA.

Regional Anesthesia is Associated with Improved Mortality and Morbidity in Patients with Congestive Heart Failure Undergoing Lower Extremity Amputation

BACKGROUND

While existing literature reports variable results of general anesthesia (GA) and regional anesthesia (RA) in patients undergoing lower extremity amputation (LEA), the effect of RA on patients with congestive heart failure (CHF) has not been explored. This study aims to assess whether the choice of anesthesia plays a role in influencing outcomes within this vulnerable population.

METHODS

Using the American College of Surgeons National Surgical Quality Improvement Program files between 2005 and 2022, all patients receiving LEA were identified, and the subset of patients with CHF was included. Patient characteristics and 30-day outcomes were compared using χ2 or Fischer's exact test as appropriate for categorical variables and the independent t-test or Mann-Whitney U test as appropriate for continuous variables. The association between anesthesia modality and post-operative outcomes was studied using multivariable logistic regression analysis.

RESULTS

A total of 5,831 patients (4,779 undergoing GA, 1,052 undergoing RA) with a diagnosis of CHF undergoing LEA were identified. On multivariable logistic regression analysis, RA was associated with lower mortality (adjusted odds ratio [aOR] 0.79, 95% CI 0.65-0.97), pneumonia (aOR 0.76, 95% CI 0.58-0.99), septic shock (aOR 0.64, 95% CI 0.47-0.88), post-operative blood transfusion (aOR 0.82, 95% CI 0.70-0.97), and 30-day readmission (aOR 0.79, 95% CI 0.64-0.97).

CONCLUSIONS

This study demonstrates that RA for LEA in patients with CHF is associated with decreased morbidity and mortality compared to GA. While furthermore research is needed to confirm this association, RA should be at least considered in CHF patients undergoing LEA when feasible.

Predictors of Reoperation and Survival Experience (Minimum 1 Year) for Primary Versus Conversion Total Hip Arthroplasty in Young Patients

BACKGROUND

Total hip arthroplasty (THA), including primary and conversion procedures, is commonly used for many types of joint disease in patients aged below 65 years, though few studies have evaluated THA outcomes in young patients (≤ 40 years old). This study examined a large cohort of patients who underwent THA at a young (≤ 40 years old) age to identify predictors of reoperation and compare survivorship between primary and conversion THAs.

METHODS

A retrospective study was conducted on 497 patients who underwent 612 primary and conversion THAs at 40 years old or younger between 1990 and 2020. Medical records were reviewed to collect patient/surgical data. A multivariable logistic regression model identified independent predictors of reoperation, and Kaplan-Meier analysis with log-rank tests was used to compare survival curves by THA type.

RESULTS

The median age at surgery (interquartile range) was 31 years (25 to 36). The median follow-up time was 6.6 years (range, 3.8 to 10.5). Conversion THAs had an increased rate of both revisions (12.3 versus 5.6%, P = 0.02) and nonrevision reoperations (8.9 versus 3.2%, P = 0.03) compared to primary THAs. A ceramic-on-ceramic articulation (odds ratio: 5.17; P = 0.03) and a higher estimated blood loss (odds ratio: 1.0007; P = 0.03) were independent predictors of reoperation for primary and conversion THA, respectively. Conversion THAs had a lower 15-year survival (77.8 versus 90.8%, P = 0.009) compared to primary THAs.

CONCLUSIONS

Patients ≤ 40 years old who underwent primary and conversion THAs demonstrated an impressive 15-year survival comparable to that of older populations (74 to 93%), while conversion procedures had a higher reoperation rate. Although primary THA may be more ideal, there are promising outcomes for patients who need THA at a younger age than typically implemented, especially for those who are very young (≤ 30 years old).