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Akbulut D, Coşkun M, Alpay Y, Mirzazada J. Treatment of hip instability after total hip replacement with pelvic osteotomy using a modified Stoppa approach. Int J Surg Case Rep 2024; 118:109579. [PMID: 38583280 PMCID: PMC11015443 DOI: 10.1016/j.ijscr.2024.109579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Hip dislocation remains a significant complication following total hip arthroplasty, even though its incidence has decreased. While closed reduction is typically performed for early dislocations, delayed or chronic dislocations often necessitate acetabular or femoral component revision. CASE PRESENTATION This document describes the treatment of hip dislocation in a 56-year-old patient through pelvic osteotomy without component revision. An acetabular component malposition was identified, exhibiting an 80-degree inclination and 20-degree cup anteversion. Owing to limited bone stock, a modified Stoppa approach was used for pelvic osteotomy to reduce acetabular inclination. The patient displayed remarkable clinical improvement, achieving a Harris Hip Score of 85 at the two-year check-up with no signs of dislocation. CLINICAL DISCUSSION Recurrent hip dislocation is difficult to manage. It frequently necessitates component revision, presenting a challenge due to issues with cup extraction and limited bone stock. Preoperative detection of loosened components is crucial. If it goes undetected, the extraction process can result in bone loss, potentially leading to pelvic insufficiency. CONCLUSION Successful revisions of hip arthroplasties can be achieved with geometric modifications to the pelvis.
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Affiliation(s)
| | | | - Yakup Alpay
- Istanbul Baltalimani Metin Sabanci Osteopathic Training And Research Hospital, Turkey
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2
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Komatsu M, Iwami T, Kijima H, Kawano T, Miyakoshi N. What is the most fixable intramedullary implant for basicervical fracture and transcervical shear fracture? - A finite element study. J Clin Orthop Trauma 2022; 34:102015. [PMID: 36203783 PMCID: PMC9529975 DOI: 10.1016/j.jcot.2022.102015] [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: 01/24/2022] [Revised: 07/16/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The objectives of this study are 1) to biomechanically compare six different intramedullary fixations for basicervical fracture (AO 31-B3, Type 2 in area classification) and transcervical shear fracture (AO 31-B2.3, Type 1-2 in area classification) using the finite element (FE) method, and 2) to investigate the effects of two different unstable fracture types on fixation. Methods FE models of two different types of proximal femoral fractures are constructed from CT scan images of a patient with osteoporosis. The fracture models are fixed with a short femoral nail with a single lag screw, short femoral nail with a single blade, and short femoral nail with double lag screws, and then fixed with long femoral nails for each of the three nail types. Subsequently, the maximum loads during walking and stair climbing, as well as the minimum principal strain and compressive failure elements are calculated to assess the fixation of each implant. Results In both fracture types, the long nail with double lag screws show the smallest volume of compressive failure elements (basicervical fracture, 2 mm3; transcervical shear fracture, 217 mm3). In all types of implants, the volume of the compressive failure elements is larger in the transcervical shear fracture than in the basicervical fracture. A similar trend is observed for the minimum principal strain (compressive strain). Conclusion The present study shows that a long nail with double lag screws is the most fixative intramedullary nail device for basicervical fracture and transcervical shear fracture in any condition. Furthermore, it is shown that transcervical shear fracture is considerably more unstable than basicervical fracture.
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Affiliation(s)
| | - Takehiro Iwami
- Graduate School of Engineering Science, Akita University, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Akita Hip Research Group (AHRG), Akita, Japan
| | - Tetsuya Kawano
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Akita Hip Research Group (AHRG), Akita, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
- Akita Hip Research Group (AHRG), Akita, Japan
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3
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Schott EM, Farnsworth CW, Grier A, Lillis JA, Soniwala S, Dadourian GH, Bell RD, Doolittle ML, Villani DA, Awad H, Ketz JP, Kamal F, Ackert-Bicknell C, Ashton JM, Gill SR, Mooney RA, Zuscik MJ. Targeting the gut microbiome to treat the osteoarthritis of obesity. JCI Insight 2018; 3:95997. [PMID: 29669931 DOI: 10.1172/jci.insight.95997] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 03/14/2018] [Indexed: 01/07/2023] Open
Abstract
Obesity is a risk factor for osteoarthritis (OA), the greatest cause of disability in the US. The impact of obesity on OA is driven by systemic inflammation, and increased systemic inflammation is now understood to be caused by gut microbiome dysbiosis. Oligofructose, a nondigestible prebiotic fiber, can restore a lean gut microbial community profile in the context of obesity, suggesting a potentially novel approach to treat the OA of obesity. Here, we report that - compared with the lean murine gut - obesity is associated with loss of beneficial Bifidobacteria, while key proinflammatory species gain in abundance. A downstream systemic inflammatory signature culminates with macrophage migration to the synovium and accelerated knee OA. Oligofructose supplementation restores the lean gut microbiome in obese mice, in part, by supporting key commensal microflora, particularly Bifidobacterium pseudolongum. This is associated with reduced inflammation in the colon, circulation, and knee and protection from OA. This observation of a gut microbiome-OA connection sets the stage for discovery of potentially new OA therapeutics involving strategic manipulation of specific microbial species inhabiting the intestinal space.
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Affiliation(s)
- Eric M Schott
- Center for Musculoskeletal Research.,Department of Pathology & Laboratory Medicine, and
| | | | - Alex Grier
- Genomics Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Jacquelyn A Lillis
- Genomics Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Soniwala
- Center for Musculoskeletal Research.,Department of Biology and
| | - Gregory H Dadourian
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Richard D Bell
- Center for Musculoskeletal Research.,Department of Pathology & Laboratory Medicine, and
| | - Madison L Doolittle
- Center for Musculoskeletal Research.,Department of Pathology & Laboratory Medicine, and
| | - David A Villani
- Center for Musculoskeletal Research.,Department of Pathology & Laboratory Medicine, and
| | - Hani Awad
- Center for Musculoskeletal Research.,Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - John P Ketz
- Center for Musculoskeletal Research.,Department of Orthopaedics & Rehabilitation and
| | - Fadia Kamal
- Center for Musculoskeletal Research.,Department of Orthopaedics & Rehabilitation and
| | | | - John M Ashton
- Genomics Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Steven R Gill
- Department of Microbiology & Immunology, University of Rochester Medical Center, Rochester, New York, USA
| | - Robert A Mooney
- Center for Musculoskeletal Research.,Department of Pathology & Laboratory Medicine, and
| | - Michael J Zuscik
- Center for Musculoskeletal Research.,Department of Orthopaedics & Rehabilitation and
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Kulkarni K, Karssiens T, Kumar V, Pandit H. Obesity and osteoarthritis. Maturitas 2016; 89:22-8. [DOI: 10.1016/j.maturitas.2016.04.006] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 01/23/2023]
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Henschel J, Eberle S, Augat P. Load distribution between cephalic screws in a dual lag screw trochanteric nail. J Orthop Surg Res 2016; 11:41. [PMID: 27039374 PMCID: PMC4818857 DOI: 10.1186/s13018-016-0377-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been observed clinically that the Z-effect is a potential cause of failure of an intramedullary nail with two cephalic screws. It describes the migration behavior of the cephalic screws in the femoral head. The primary objective was to examine different cephalic screw configurations and test the load distribution between them as a function of their relative placement and their relative movement in the nail. It has been hypothesized that different cephalic screw positions may have an influence on the stress in the implant and bone and therefore on implant failures, such as the Z-effect. METHODS To quantify the load distribution of a dual cephalic screw intramedullary femoral nail (Citieffe, Calderara di Reno, BO, Italy), a finite element model of the femur, focusing on the loading of the cephalic screws, was prepared. Four different screw lengths (90-105 mm) were examined. The investigation considered the stresses and strains in the bone and implant as well as the relative movement of the screws. RESULTS If the inferior cephalic screw had a shorter length, then the superior one and the femoral nail had to bear higher loads. In that case, the "equivalent von Mises stress" increased up to 10 % at the superior cephalic screw and up to 5 % at the femoral nail. The analysis of the relative movement showed that sliding of the inferior cephalic screw occurred in the nail. The total movement ranged from 0.47 to 0.73 mm for the different screw configurations. CONCLUSIONS The stresses were distributed more equally between the two cephalic screws in the bone and the implant if a longer inferior screw was used. The stresses in the bone and implant were reduced with a longer inferior cephalic screw. Therefore, a configuration using a longer inferior cephalic screw is preferable for trochanteric fracture fixation with a dual cephalic screw intramedullary device.
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Affiliation(s)
- Julia Henschel
- Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany. .,Paracelsus Medical University, Salzburg, Austria.
| | - Sebastian Eberle
- Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany.,Paracelsus Medical University, Salzburg, Austria
| | - Peter Augat
- Institute of Biomechanics, Trauma Center Murnau, Murnau, Germany.,Paracelsus Medical University, Salzburg, Austria
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Zazgyva A, Zuh SG, Roman CO, Gergely I, Pop TS. Acetabular reconstruction with a reinforcement device and bone grafting in revision arthroplasty-a mean five years of follow-up. INTERNATIONAL ORTHOPAEDICS 2015; 40:1631-1638. [PMID: 26546063 DOI: 10.1007/s00264-015-3030-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/21/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the clinical and radiological outcomes of acetabular reconstruction using a reinforcement device (RD) in combination with bone grafting in Paprosky type 2 and 3 acetabular bone defects. METHODS Morselised bone grafts were used to fill cavitary defects and a structural graft placed in the superior part of the acetabulum in cases of cranial bone defects, with a proximally fixed RD (Protetim, Hódmezővásárhely, Hungary) implanted in all cases. Construct stability, device positioning, hip centre of rotation and medial acetabular wall thickness were evaluated radiologically. Survival rates were estimated with aseptic loosening and revision for any reason as endpoints. RESULTS The 28 patients (29 hips) were followed for 4.8 ± 2.7 years (range, 2-10.4 years). Hip centre of rotation was lowered in all cases, with no significant differences between the mean values obtained post-operatively and at the last follow-up. Medial acetabular wall thickness and RD abduction angle were maintained up to the last evaluation. Bone grafts integrated by two years post-operatively in the majority of cases. Kaplan-Meier survival rates were 85.2 % and 82.1 % for the two endpoints at ten years. CONCLUSIONS Acetabular reconstruction using a proximally fixed RD in combination with bone grafting offered good mid-term results in the treatment of acetabular bone defects. In cases of severe bone loss, the structural allograft allowed placement of the RD with ischial contact, rendering survival rates similar to RDs with both iliac and ilioischial fixation. The technique was successful in restoring and maintaining medial acetabular bone stock and construct stability for up to ten years.
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Affiliation(s)
- Ancuța Zazgyva
- Clinic of Orthopaedics and Traumatology, Mureș County Hospital, 31 Mihai Viteazul Street, Tîrgu Mureș, 540096, Romania
| | - Sándor-György Zuh
- Department of Orthopaedics and Traumatology I, University of Medicine and Pharmacy Tîrgu Mureș, 31 Mihai Viteazul Street, Tîrgu Mureș, 540096, Romania.
| | - Ciprian Oliviu Roman
- Department of Orthopaedics and Traumatology I, University of Medicine and Pharmacy Tîrgu Mureș, 31 Mihai Viteazul Street, Tîrgu Mureș, 540096, Romania
| | - István Gergely
- Department of Orthopaedics and Traumatology I, University of Medicine and Pharmacy Tîrgu Mureș, 31 Mihai Viteazul Street, Tîrgu Mureș, 540096, Romania
| | - Tudor Sorin Pop
- Department of Orthopaedics and Traumatology I, University of Medicine and Pharmacy Tîrgu Mureș, 31 Mihai Viteazul Street, Tîrgu Mureș, 540096, Romania
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Gumieiro DN, Pereira GJC, Minicucci MF, Ricciardi CEI, Damasceno ER, Funayama BS. Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur. Rev Bras Ortop 2015; 50:153-8. [PMID: 26229909 PMCID: PMC4519647 DOI: 10.1016/j.rboe.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/04/2014] [Indexed: 12/31/2022] Open
Abstract
Objective To assess whether serum vitamin D concentration is associated with gait status and mortality among patients with fractures of the proximal femur, six months after suffering the fracture. Methods Consecutive patients aged ≥65 years with fractures of the proximal femur, who were admitted to the orthopedics and traumatology ward of our service between January and December 2011, were prospectively evaluated. Clinical, radiological, epidemiological and laboratory analyses were performed, including vitamin D. The patients underwent surgery and were followed up as outpatients, with return visits 15, 30, 60 and 180 days after discharge, at which the outcomes of gait and mortality were evaluated. Results Eighty-eight patients were evaluated. Two of them were excluded because they presented oncological fractures. Thus, 86 patients of mean age 80.2 ± 7.3 years were studied. In relation to serum vitamin D, the mean was 27.8 ± 14.5 ng/mL, and 33.7% of the patients presented deficiency of this vitamin. In relation to gait, univariate and multivariate logistic regression showed that vitamin D deficiency was not associated with gait recovery, even after adjustment for gender, age and type of fracture (OR: 1.463; 95% CI: 0.524–4.088; p = 0.469). Regarding mortality, Cox regression analysis showed that vitamin D deficiency was not related to its occurrence within six months, even in multivariate analysis (HR: 0.627; 95% CI: 0.180–2.191; p = 0.465). Conclusion Serum vitamin D concentration was not related to gait status and/or mortality among patients with fractures of the proximal femur, six months after suffering the fracture.
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Affiliation(s)
- David Nicoletti Gumieiro
- Hip Surgery Group, Discipline of Orthopedics and Traumatology, Department of Surgery and Orthopedics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Gilberto José Cação Pereira
- Hip Surgery Group, Discipline of Orthopedics and Traumatology, Department of Surgery and Orthopedics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Marcos Ferreira Minicucci
- Hip Surgery Group, Discipline of Orthopedics and Traumatology, Department of Surgery and Orthopedics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Carlos Eduardo Inácio Ricciardi
- Hip Surgery Group, Discipline of Orthopedics and Traumatology, Department of Surgery and Orthopedics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Erick Ribeiro Damasceno
- Hip Surgery Group, Discipline of Orthopedics and Traumatology, Department of Surgery and Orthopedics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Bruno Schiavoni Funayama
- Hip Surgery Group, Discipline of Orthopedics and Traumatology, Department of Surgery and Orthopedics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
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9
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Nicoletti Gumieiro D, Cação Pereira GJ, Ferreira Minicucci M, Inácio Ricciardi CE, Ribeiro Damasceno E, Schiavoni Funayama B. Associação da deficiência de vitamina D com mortalidade e marcha pós‐operatória em paciente com fratura de fêmur proximal. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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10
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Stambough JB, Clohisy JC, Barrack RL, Nunley RM, Keeney JA. Increased risk of failure following revision total knee replacement in patients aged 55 years and younger. Bone Joint J 2014; 96-B:1657-62. [DOI: 10.1302/0301-620x.96b12.34486] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aims of this retrospective study were to compare the mid-term outcomes following revision total knee replacement (TKR) in 76 patients (81 knees) < 55 years of age with those of a matched group of primary TKRs based on age, BMI, gender and comorbid conditions. We report the activity levels, functional scores, rates of revision and complications. Compared with patients undergoing primary TKR, those undergoing revision TKR had less improvement in the mean Knee Society function scores (8.14 (–55 to +60) vs 23.3 points (–40 to +80), p < 0.001), a similar improvement in UCLA activity level (p = 0.52), and similar minor complication rates (16% vs 13%, p = 0.83) at a mean follow-up of 4.6 years (2 to 13.4). Further revision surgery was more common among revised TKRs (17% vs 5%, p = 0.02), with deep infection and instability being the most common reasons for failure. As many as one-third of patients aged < 55 years in the revision group had a complication or failure requiring further surgery. Young patients undergoing revision TKR should be counselled that they can expect somewhat less improvement and a higher risk of complications than occur after primary TKR. Cite this article: Bone Joint J 2014; 96-B:1657–62
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Affiliation(s)
- J. B. Stambough
- Washington University in St. Louis, 660
South Euclid Ave, Campus Box 8233, Saint Louis, Missouri
63110, USA
| | - J. C. Clohisy
- Washington University in St. Louis, 660
South Euclid Ave, Campus Box 8233, Saint Louis, Missouri
63110, USA
| | - R. L. Barrack
- Washington University in St. Louis, 660
South Euclid Ave, Campus Box 8233, Saint Louis, Missouri
63110, USA
| | - R. M. Nunley
- Washington University in St. Louis, 660
South Euclid Ave, Campus Box 8233, Saint Louis, Missouri
63110, USA
| | - J. A. Keeney
- Washington University in St. Louis, 660
South Euclid Ave, Campus Box 8233, Saint Louis, Missouri
63110, USA
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Gumieiro DN, Rafacho BPM, Gonçalves AF, Santos PP, Azevedo PS, Zornoff LAM, Pereira GJC, Matsubara LS, Paiva SAR, Minicucci MF. Serum metalloproteinases 2 and 9 as predictors of gait status, pressure ulcer and mortality after hip fracture. PLoS One 2013; 8:e57424. [PMID: 23437384 PMCID: PMC3577718 DOI: 10.1371/journal.pone.0057424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 01/21/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study is to evaluate the serum activity of metalloproteinases (MMPs) -2 and -9 as predictors of pressure ulcer (PU), gait status and mortality 6 months after hip fracture. Methods Eighty-seven patients over the age of 65 admitted to the orthopedic unit from January to December 2010 with hip fracture were prospectively evaluated. Upon admission, patient demographic information, including age, gender and concomitant diseases, was recorded. Blood samples were taken for analysis of MMP -2 and -9 activity by gel zymography and for biochemical examination within the first 72 hours of the patient’s admission, after clinical stabilization. The fracture pattern (neck, trochanteric or subtrochanteric), time from admission to surgery, surgery duration and length of hospital stay were also recorded. Results Two patients were excluded due to the presence of pathological fractures (related to cancer), and three patients were excluded due to the presence of PU before admission. Eighty-two patients, with a mean age of 80.4 ± 7.3 years, were included in the analysis. Among these patients, 75.6% were female, 59.8% had PU, and 13.4% died 6 months after hip fracture. All patients underwent hip fracture repair. In a univariate analysis, there were no differences in serum MMP activity between hip fracture patients with or without PU. In addition, the multiple logistic regression analysis models, which were adjusted by age, gender, length of hospital stay and C-reactive protein, showed that the pro-MMP-9 complexed with neutrophil gelatinase-associated lipocalin form (130 kDa) was associated with gait status recovery 6 months after hip fracture. Conclusions In conclusion, serum pro-MMP-9 is a predictor of gait status recovery 6 months after hip fracture.
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Affiliation(s)
- David N. Gumieiro
- Surgery and Orthopedic Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - Bruna P. M. Rafacho
- Internal Medicine Department, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu, Brazil
| | - Andrea F. Gonçalves
- Internal Medicine Department, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu, Brazil
| | - Priscila P. Santos
- Internal Medicine Department, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu, Brazil
| | - Paula S. Azevedo
- Internal Medicine Department, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu, Brazil
| | - Leonardo A. M. Zornoff
- Internal Medicine Department, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu, Brazil
| | - Gilberto J. C. Pereira
- Surgery and Orthopedic Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - Luiz S. Matsubara
- Internal Medicine Department, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu, Brazil
| | - Sergio A. R. Paiva
- Internal Medicine Department, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu, Brazil
| | - Marcos F. Minicucci
- Internal Medicine Department, Botucatu Medical School, UNESP – Univ Estadual Paulista, Botucatu, Brazil
- * E-mail:
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Crooks VA, Cameron K, Chouinard V, Johnston R, Snyder J, Casey V. Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients. BMC Health Serv Res 2012; 12:417. [PMID: 23170924 PMCID: PMC3515802 DOI: 10.1186/1472-6963-12-417] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 11/21/2012] [Indexed: 01/11/2023] Open
Abstract
Background Medical tourism is the term that describes patients’ international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients’ decision-making in and experiences of these same procedures in their home countries. Methods Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery. Results Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives. Conclusions Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients’ pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes. Arthritis care providers can use the attitudinal characteristics identified here to better advise osteoarthritis patients who are considering seeking care abroad.
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Affiliation(s)
- Valorie A Crooks
- Department of Geography, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada.
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Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture. Br J Nutr 2012; 109:1657-61. [DOI: 10.1017/s0007114512003686] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.
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Zakani S, Venne G, Smith EJ, Bicknell R, Ellis RE. Analyzing shoulder translation with navigation technology. Int J Comput Assist Radiol Surg 2012; 7:853-60. [PMID: 22855410 DOI: 10.1007/s11548-012-0782-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 07/03/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Asymmetric stress imposed on the shoulder can lead to anterior shoulder instability in young athletes who perform repetitive overhead motions. A common treatment, surgical anterior capsule tightening, assumes that the instability is caused by abnormal anterior laxity. This study investigated the possibility that one element of overall imbalance, posterior capsular tightness, could be an underlying reason for shoulder instability. Surgical navigation technology, which is more accurate than whole-body motion-capture systems, was used to study anterior translational motions. METHOD The study was used four cadaver shoulders, with the scapula and rotator cuff muscles intact. Opto-electronic surgical navigation localization devices were mounted on the scapula and humerus to accurately capture positions and orientations. The shoulders were passively moved through 7 motions, 5 of simple angulation and 2 combinations of clinical interest. Each motion was repeated in 4 different soft-tissue states: rotator cuff intact, capsule intact, and surgically induced capsular tightnesses of 5 and 10mm. RESULTS The shoulders had significantly greater anterior translation when the posterior capsule was artificially tightened (p < 0.05); this was particularly in movements that combined abduction with internal or external rotation, which are typical overhead sports motions. Overall translation was indifferent to whether the shoulders were intact or dissected down to the capsule, as was translation during flexion was indifferent to dissection state (p > 0.95). CONCLUSION Surgical navigation technology can easily be used to analyze cadaveric shoulder motion, with opportunities for adaptation to anesthetized patients. Results suggest that the inverse of artificial tightening, such as surgical release of the posterior capsule, may be an effective minimally invasive treatment of chronic shoulder dislocation subsequent to sports motions.
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Affiliation(s)
- S Zakani
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada.
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Taylor ED, Browne JA. Reconstruction options for acetabular revision. World J Orthop 2012; 3:95-100. [PMID: 22816064 PMCID: PMC3399017 DOI: 10.5312/wjo.v3.i7.95] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/31/2012] [Accepted: 07/10/2012] [Indexed: 02/06/2023] Open
Abstract
This article summarizes reconstruction options available for acetabular revision following total hip arthroplasty. A thoughtful methodology to the evaluation and treatment of patients with implant failure after joint replacement is essential to guarantee accurate diagnoses, appropriate triage to reconstruction options, and optimal clinical outcomes. In the majority of patients who undergo acetabular revision, factors such as bone loss and pelvic discontinuity provide a challenge in the selection and implementation of the proper reconstruction option. With advanced evaluation algorithms, imaging techniques, and implant designs, techniques have evolved to rebuild the compromised acetabulum at the time of revision surgery. However, clinical outcomes data for these techniques continue to lag behind the exponential increase in revision hip arthroplasty cases predicted to occur over the next several years. We encourage those involved in the treatment of patients undergoing hip replacement surgery to participate in well-designed clinical studies to enhance evidence-based knowledge regarding revision acetabular reconstruction options.
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Sridhar MS, Jarrett CD, Xerogeanes JW, Labib SA. Obesity and symptomatic osteoarthritis of the knee. ACTA ACUST UNITED AC 2012; 94:433-40. [PMID: 22434455 DOI: 10.1302/0301-620x.94b4.27648] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Given the growing prevalence of obesity around the world and its association with osteoarthritis of the knee, orthopaedic surgeons need to be familiar with the management of the obese patient with degenerative knee pain. The precise mechanism by which obesity leads to osteoarthritis remains unknown, but is likely to be due to a combination of mechanical, humoral and genetic factors. Weight loss has clear medical benefits for the obese patient and seems to be a logical way of relieving joint pain associated with degenerative arthritis. There are a variety of ways in which this may be done including diet and exercise, and treatment with drugs and bariatric surgery. Whether substantial weight loss can delay or even reverse the symptoms associated with osteoarthritis remains to be seen. Surgery for osteoarthritis in the obese patient can be technically more challenging and carries a risk of additional complications. Substantial weight loss before undertaking total knee replacement is advisable. More prospective studies that evaluate the effect of significant weight loss on the evolution of symptomatic osteoarthritis of the knee are needed so that orthopaedic surgeons can treat this patient group appropriately.
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Affiliation(s)
- M S Sridhar
- Emory University, Department of Orthopaedic Surgery, 59 Executive Park South, Atlanta, Georgia 30329, USA.
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Mooney RA, Sampson ER, Lerea J, Rosier RN, Zuscik MJ. High-fat diet accelerates progression of osteoarthritis after meniscal/ligamentous injury. Arthritis Res Ther 2011; 13:R198. [PMID: 22152451 PMCID: PMC3334649 DOI: 10.1186/ar3529] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/26/2011] [Accepted: 12/06/2011] [Indexed: 01/11/2023] Open
Abstract
Introduction Increasing obesity and type 2 diabetes, in part due to the high-fat (HF) Western diet, parallels an increased incidence of osteoarthritis (OA). This study was undertaken to establish a causal relation between the HF diet and accelerated OA progression in a mouse model and to determine the relative roles of weight gain and metabolic dysregulation in this progression. Methods Five-week-old C57BL/6 mice were placed on HF (60% kcal) or low-fat (lean, 10% kcal) diets for 8 or 12 weeks before transecting the medial collateral ligament and excising a segment of the medial meniscus of the knee to initiate OA. One group was switched from lean to HF diet at the time of surgery. Results Body weight of mice on the HF diet peaked at 45.9 ± 2.1 g compared with 29.9 ± 1.8 g for lean diets, with only those on the HF becoming diabetic. Severity of OA was greater in HF mice, evidenced by the Osteoarthritis Research Society International (OARSI) histopathology initiative scoring method for mice and articular cartilage thickness and area. To assess the importance of weight gain, short- and long-term HF diets were compared with the lean diet. Short- and long-term HF groups outweighed lean controls by 6.2 g and 20.5 g, respectively. Both HF groups became diabetic, and OA progression, evidenced by increased OARSI score, decreased cartilage thickness, and increased osteophyte diameter, was comparably accelerated relative to those of lean controls. Conclusions These results demonstrate that the HF diet accelerates progression of OA in a type 2 diabetic mouse model without correlation to weight gain, suggesting that metabolic dysregulation is a comorbid factor in OA-related cartilage degeneration.
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Affiliation(s)
- Robert A Mooney
- Department of Pathology and Laboratory Medicine, Box 626, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Fayaz HC, Jupiter JB, Pape HC, Smith RM, Giannoudis PV, Moran CG, Krettek C, Prommersberger KJ, Raschke MJ, Parvizi J. Challenges and barriers to improving care of the musculoskeletal patient of the future - a debate article and global perspective. Patient Saf Surg 2011; 5:23. [PMID: 21943304 PMCID: PMC3196685 DOI: 10.1186/1754-9493-5-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 09/25/2011] [Indexed: 03/24/2023] Open
Abstract
Background With greater technological developments in the care of musculoskeletal patients, we are entering an era of rapid change in our understanding of the pathophysiology of traumatic injury; assessment and treatment of polytrauma and related disorders; and treatment outcomes. In developed countries, it is very likely that we will have algorithms for the approach to many musculoskeletal disorders as we strive for the best approach with which to evaluate treatment success. This debate article is founded on predictions of future health care needs that are solely based on the subjective inputs and opinions of the world's leading orthopedic surgeons. Hence, it functions more as a forum-based rather than a scientific-based presentation. This exposé was designed to stimulate debate about the emerging patients' needs in the future predicted by leading orthopedic surgeons that provide some hint as to the right direction for orthopedic care and outlines the important topics in this area. Discussion The authors aim to provide a general overview of orthopedic care in a typical developed country setting. However, the regional diversity of the United States and every other industrialized nation should be considered as a cofactor that may vary to some extent from our vision of improved orthopedic and trauma care of the musculoskeletal patient on an interregional level. In this forum, we will define the current and future barriers in developed countries related to musculoskeletal trauma, total joint arthroplasty, patient safety and injuries related to military conflicts, all problems that will only increase as populations age, become more mobile, and deal with political crisis. Summary It is very likely that the future will bring a more biological approach to fracture care with less invasive surgical procedures, flexible implants, and more rapid rehabilitation methods. This international consortium challenges the trauma and implants community to develop outcome registries that are managed through health care offices and to prepare effectively for the many future challenges that lie in store for those who treat musculoskeletal conditions.
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Affiliation(s)
- Hangama C Fayaz
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Affiliation(s)
- Michael H Huo
- Department of Orthopedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA.
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Poultsides LA, Liaropoulos LL, Malizos KN. The socioeconomic impact of musculoskeletal infections. J Bone Joint Surg Am 2010; 92:e13. [PMID: 20810849 DOI: 10.2106/jbjs.i.01131] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Lazaros A Poultsides
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Biopolis, 41110 Larissa, Greece.
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