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Chang K, Albright JA, Quinn M, Khatri S, Zhao L, Byrne RA, Daniels AH, Owens BD. A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Primary Patellar Instability and Need for Recurrent Surgical Stabilization. Sports Health 2024; 16:465-472. [PMID: 37208906 PMCID: PMC11025508 DOI: 10.1177/19417381231172726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Vitamin D has been proven experimentally to affect musculoskeletal health. The purpose of this study was to identify the relationship between vitamin D deficiency and patellar instability. HYPOTHESIS Vitamin D deficiency is associated with an increased risk of experiencing primary patellar instability and recurrent patellar dislocation after primary surgical stabilization. STUDY DESIGN Retrospective comparative study. LEVEL OF EVIDENCE Level 3. METHODS A 1:1 matched retrospective study of 328,011 patients diagnosed with vitamin D deficiency was performed using the PearlDiver database. Incidence of primary patellar instability was calculated according to sex and age. Rates of primary patellar instability and surgical stabilization for recurrent dislocation were calculated with sex- and age-specific stratifications. Multivariable logistic regression was used to compare the rates of primary injury and recurrent stabilization while controlling for demographics and medical comorbidities. RESULTS A total of 656,022 patients were analyzed. The overall 1-year incidence rate of patellar instability in patients with vitamin D deficiency was 82.6 per 100,000 person-years (95% CI, 73.2-92.9), compared with 48.5 (95% CI, 41.4-56.5) in the matched control. Women were significantly more likely to experience primary patellar instability within 1 (adjusted odds ratio [aOR] = 1.45; 95% CI, 1.12-1.88) and 2 years (aOR, 1.31; 95% CI, 1.07-1.59) of hypovitaminosis D diagnosis. Patients aged 10 to 25 years with hypovitaminosis D were at greater risk of requiring recurrent patellar stabilization for both men (aOR, 2.48; 95% CI, 1.06-5.80) and women (aOR, 1.77; 95% CI, 1.04-3.02). CONCLUSION Patients diagnosed with vitamin D deficiency experienced higher rates of primary patellar instability and have greater risk of requiring recurrent surgical stabilization for subsequent dislocations. CLINICAL RELEVANCE These results suggest that monitoring and proactively treating vitamin D deficiency in the physically active patient may lower the risk of suffering primary patellar instability or recurrence after surgical stabilization.
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Affiliation(s)
- Kenny Chang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - J. Alex Albright
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew Quinn
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery, Providence, Rhode Island
| | - Surya Khatri
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leon Zhao
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rory A. Byrne
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery, Providence, Rhode Island
| | - Alan H. Daniels
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery, Providence, Rhode Island
| | - Brett D. Owens
- Warren Alpert Medical School of Brown University, Department of Orthopaedic Surgery, Providence, Rhode Island
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Khatod M, Chan PH, Prentice HA, Fasig BH, Paxton EW, Reddy NC, Kelly MP. Can Dual Mobility Cups Reduce Revision and Dislocation Risks? An Analysis of 107,528 Primary Total Hip Arthroplasties in the United States. J Arthroplasty 2024; 39:1279-1284.e1. [PMID: 38042378 DOI: 10.1016/j.arth.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Dual mobility acetabular cups (DMC) were designed to increase the effective femoral head size and improve stability with the goal of reducing revision risk at the potential cost of polyethylene thickness. We sought to evaluate revision risk following primary elective total hip arthroplasty with DMC compared to highly cross-linked polyethylene (XLPE). METHODS A cohort study was conducted using data from a Kaiser Permanente's total joint arthroplasty registry. Patients ≥18 years who underwent primary elective total hip arthroplasty using DMC, unipolar Metal-on-XLPE (MoXLPE), or unipolar Ceramic-on-XLPE (CoXLPE) were identified (2010 to 2021). The final sample comprised 2,219 DMC, 48,251 MoXLPE, and 57,058 CoXLPE. Multiple Cox proportional hazard regressions were used to evaluate aseptic revision and any dislocation regardless of revision within 6 years follow-up. RESULTS In adjusted analyses, no differences in aseptic revision risk were observed for MoXLPE (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 0.72 to 1.51) or CoXLPE (HR = 0.98, 95% CI = 0.69 to 1.40) compared to DMC. No differences in dislocation risk were observed for MoXLPE (HR = 1.42, 95% CI = 0.93 to 2.15) or CoXLPE (HR = 1.25, 95% CI = 0.84 to 1.87) compared to DMC. CONCLUSIONS In a US-based cohort, 6-year aseptic revision risk of DMC was similar to metal or ceramic femoral head unipolar constructs. Furthermore, no difference in dislocation risk was observed. Continued longer-term follow-up may reveal if there is a reduced risk of dislocation that comes at the cost of increased late revision. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Monti Khatod
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Los Angeles, California
| | - Priscilla H Chan
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Heather A Prentice
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Brian H Fasig
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Elizabeth W Paxton
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Nithin C Reddy
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, California
| | - Matthew P Kelly
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California
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Schneider KN, Zafeiris T, Gosheger G, Klingebiel S, Rickert C, Schachtrup T, Theil C. Shoulder dislocations in professional male football (soccer): A retrospective epidemiological analysis of the German Bundesliga from season 2012/2013 until 2022/2023. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38643395 DOI: 10.1002/ksa.12199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay-off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player-, match- and injury-related parameters. METHODS All shoulder dislocations within the highest three German football leagues (1.-3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player-, injury- and match-related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05. RESULTS A total of 90 first-time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23-28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty-four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12-43) following conservative and 103 days (IQR: 85-135) following surgical treatment (p < 0.001). Twenty-two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2-22) and 7 months (IQR: 3-23) following surgical treatment (n.s.). CONCLUSION The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Theodoros Zafeiris
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Sebastian Klingebiel
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Carolin Rickert
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Tim Schachtrup
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
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Karasavvidis T, Pagan CA, Sharma AK, Jerabek SA, Mayman DJ, Vigdorchik JM. Decreased Instability in High-Risk (Hip-Spine 2B) Patients After Modifications of Surgical Planning and Technique. J Arthroplasty 2024:S0883-5403(24)00366-8. [PMID: 38642849 DOI: 10.1016/j.arth.2024.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Patients undergoing primary total hip arthroplasty (THA) who have spinal deformity and a stiff spine are the highest-risk group for instability. Despite the increasing use of dual-mobility cups and large femoral heads, dislocation remains a major complication after THA. Preoperative planning becomes a critical aspect of ensuring precise component positioning within a safe zone. The purpose of this study was to investigate dislocation rates over a 9-year period. METHODS A retrospective review of 4,731 THAs performed by three orthopaedic surgeons between January 2014 and March 2023 was performed. Spino-pelvic measurements were conducted to determine the Hip-Spine Classification group for each patient. Only patients classified as 2B (Pelvic Incidence-Lumbar Lordosis > 10° and ΔSacral Slope < 10°) were eligible. Both absolute and relative dislocation frequencies were then analyzed using time-series analysis techniques and Fisher's exact tests. RESULTS A total of 281 Hip-Spine 2B patients undergoing primary THA were eligible for analysis (57% women; mean age, range: 66 years, 23 to 87; mean BMI, range: 28, 16 to 45). The overall dislocation rate was 4.3%. Use of femoral head sizes ≥ 40 mm increased from 4% in 2014 to 2019 to 37% in 2020 to 2023 (P < 0.001), while the use of dual-mobility cups decreased from 100% in 2014 to 2019 to 37% in 2020 to 2023 (P < 0.001). Acetabular component planning was changed from the supine plane to the standing plane in February 2020. Those changes in surgical practice were notably correlated with a significant decrease in dislocation rates from 6.8% in 2014 to 2019 to 1.5% in 2020 to 2023 (P = 0.03). CONCLUSION Our study demonstrates that the introduction of advanced preoperative THA planning to the standing plane, coupled with precise intra-operative technology for implant placement, can significantly reduce the risk of instability in high-risk THA patients. Notably, we observed a significant decrease in dislocation rates, which aligned with the shift in surgical practice.
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Affiliation(s)
- Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
| | - Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Abhinav K Sharma
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA
| | - Seth A Jerabek
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Huebschmann NA, Lawrence KW, Robin JX, Rozell JC, Hepinstall MS, Schwarzkopf R, Aggarwal VK. Does Surgical Approach Affect Dislocation Rate After Total Hip Arthroplasty in Patients Who Have Prior Lumbar Spinal Fusion? A Retrospective Analysis of 16,223 Cases. J Arthroplasty 2024:S0883-5403(24)00312-7. [PMID: 38604275 DOI: 10.1016/j.arth.2024.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Lumbar spinal fusion (LSF) is a risk factor for dislocation following total hip arthroplasty (THA). The effect of the surgical approach on this association has not been investigated. This study examined the association between the surgical approach and dislocation following THA in patients who had prior LSF. METHODS We retrospectively reviewed 16,223 primary elective THAs at our institution from June 2011 to September 2022. Patients who had LSF prior to THA were identified using International Classification of Diseases (ICD) codes. Patients were stratified by LSF history, surgical approach, and intraoperative robot or navigation use to compare dislocation rates. There were 8,962 (55.2%) posterior, 5,971 (36.8%) anterior, and 1,290 (8.0%) laterally based THAs. Prior LSF was identified in 323 patients (2.0%). Binary logistic regressions were used to assess the association of patient factors with dislocation risk. RESULTS There were 177 dislocations identified in total (1.1%). In nonadjusted analyses, the dislocation rate was significantly higher following the posterior approach among all patients (P = .003). Prior LSF was associated with a significantly higher dislocation rate in all patients (P < .001) and within the posterior (P < .001), but not the anterior approach (P = .514) subgroups. Multivariate regressions demonstrated anterior (OR [odds ratio] = 0.64, 95% CI [confidence interval] 0.45 to 0.91, P = .013), and laterally based (OR = 0.42, 95% CI 0.18 to 0.96, P = .039) approaches were associated with decreased dislocation risk, whereas prior LSF (OR = 4.28, 95% CI 2.38 to 7.69, P < .001) was associated with increased dislocation risk. Intraoperative technology utilization was not significantly associated with dislocation in the multivariate regressions (OR = 0.72, 95% CI 0.49 to 1.06, P = .095). CONCLUSIONS The current study confirmed that LSF is a significant risk factor for dislocation following THA; however, anterior and laterally based approaches may mitigate dislocation risk in this population. In multivariate analyses, including surgical approach, LSF, and several perioperative variables, intraoperative technology utilization was not found to be significantly associated with dislocation risk.
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Affiliation(s)
- Nathan A Huebschmann
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Joseph X Robin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
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Sheehan FT, Shah P, Boden BP. The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults. Am J Sports Med 2024; 52:1282-1291. [PMID: 38557261 DOI: 10.1177/03635465241233732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. PURPOSE/HYPOTHESIS The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). RESULTS The LPD group demonstrated reduced medial patellar width (Δ = -3.6 mm; P < .001) and medial facet length (Δ = -3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = -3.2 mm; P = .009), decreased patellar volume (Δ = -0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. CONCLUSION The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.
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Affiliation(s)
- Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Paras Shah
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Barry P Boden
- The Orthopaedic Center, a Division of CAO, Rockville, Maryland, USA
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Vercruysse LYG, Milne LP, Harries DTC, de Steiger RN, Wall CJ. Lower Revision Rates and Improved Stability With a Monoblock Ceramic Acetabular Cup. J Arthroplasty 2024; 39:985-990. [PMID: 37871861 DOI: 10.1016/j.arth.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Monoblock ceramic cups are designed to accommodate large-diameter femoral heads. This has the potential to offer the advantages of an increased range of motion and enhanced joint stability. These features could benefit younger and high-demand patients in need of total hip arthroplasty. The aim of this study was to assess the survival rate and the reasons for revision of the DeltaMotion cup. METHODS Data from the AOANJRR were analyzed for all patients who had undergone a primary conventional THA performed between January 1, 2001 and December 31, 2021. Only prostheses with ceramic/ceramic, ceramic/XLPE, metal/XLPE, or CM/XLPE bearing surfaces were included. The primary outcome measure was the cumulative percent revision for all causes. Secondary outcome measures were revision for dislocation/instability, ceramic breakage, or noise. A subanalysis for cup size was also performed. RESULTS There were 486,946 primary conventional THA procedures undertaken for any reason. Of these, 4,033 used the DeltaMotion cup and 482,913 were modular designs. The DeltaMotion cup had the lowest CPR for all diagnoses compared to the modular bearings at all time points, had a significantly lower revision rate for prosthesis dislocation and no revisions for squeaking compared to other modular bearings. There were 175 ceramic breakages recorded in the modular bearing group and 1 ceramic breakage in the DeltaMotion group. CONCLUSIONS The DeltaMotion cup had a low rate of all-cause revision, and for dislocation, ceramic breakage, and noise. Although this cup is no longer manufactured, ongoing follow-up of newer monoblock ceramic cups will determine their suitability for younger and more active patients.
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Affiliation(s)
- Loïc Y G Vercruysse
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Department of Development and Regeneration KU Leuven, Institute for Orthopaedic Research and Training KU Leuven, Leuven, Belgium
| | - Lachlan P Milne
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Dylan T C Harries
- Registry Science, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia; Department of Surgery, Epworth Healthcare, University of Melbourne, Richmond, Victoria, Australia
| | - Christopher J Wall
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia; Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia; University of Queensland Rural Clinical School, Toowoomba, Queensland, Australia
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Nieboer MJ, Cancio-Bello A, Mallett KE, Velasquez Garcia AR, Hidden KA, Yuan BJ, Morrey ME, Sanchez-Sotelo J, O'Driscoll SW, Barlow JD. Trans-ulnar fracture dislocations of the elbow: a systematic review and clarification of classification systems. J Shoulder Elbow Surg 2024; 33:975-983. [PMID: 38036255 DOI: 10.1016/j.jse.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Complex elbow dislocations in which the dorsal cortex of the ulna is fractured can be difficult to classify and therefore treat. These have variably been described as either Monteggia variant injuries or trans-olecranon fracture dislocations. Additionally, O'Driscoll et al classified coronoid fractures that exit the dorsal cortex of the ulna as "basal coronoid, subtype 2" fractures. The Mayo classification of trans-ulnar fracture dislocations categorizes these injuries in 3 types according to what the coronoid remains attached to: trans-olecranon fracture dislocations, Monteggia variant fracture dislocations, and trans-ulnar basal coronoid fracture dislocations. The purpose of this study was to evaluate the outcomes of these injury patterns as reported in the literature. Our hypothesis was that trans-ulnar basal coronoid fracture dislocations would have a worse prognosis. MATERIALS AND METHODS We conducted a systematic review to identify studies with trans-ulnar fracture dislocations that had documentation of associated coronoid injuries. A literature search identified 16 qualifying studies with 296 fractures. Elbows presenting with basal subtype 2 or Regan/Morrey III coronoid fractures and Jupiter IIA and IID injuries were classified as trans-ulnar basal coronoid fractures. Patients with trans-olecranon or Monteggia fractures were classified as such if the coronoid was not fractured or an associated coronoid fracture had been classified as O'Driscoll tip, anteromedial facet, basal subtype I, or Regan Morrey I/II. RESULTS The 296 fractures reviewed were classified as trans-olecranon in 44 elbows, Monteggia variant in 82 elbows, and trans-ulnar basal coronoid fracture dislocations in 170 elbows. Higher rates of complications and reoperations were reported for trans-ulnar basal coronoid injuries (40%, 25%) compared to trans-olecranon (11%, 18%) and Monteggia variant injuries (25%, 13%). The mean flexion-extension arc for basal coronoid fractures was 106° compared to 117° for Monteggia (P < .01) and 121° for trans-olecranon injuries (P = .02). The mean Mayo Elbow Performance Score was 84 points for trans-ulnar basal coronoid, 91 for Monteggia (P < .01), and 93 for trans-olecranon fracture dislocations (P < .05). Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 22 and 80 for trans-ulnar basal coronoid, respectively, compared to 23 and 89 for trans-olecranon fractures. American Shoulder and Elbow Surgeons was not available for any Monteggia injuries, but the mean Disabilities of the Arm, Shoulder and Hand was 13. DISCUSSION Trans-ulnar basal coronoid fracture dislocations are associated with inferior patient reported outcome measures, decreased range of motion, and increased complication rates compared to trans-olecranon or Monteggia variant fracture dislocations. Further research is needed to determine the most appropriate treatment for this difficult injury pattern.
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Affiliation(s)
- Micah J Nieboer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ausberto R Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile
| | - Krystin A Hidden
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brandon J Yuan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Matar HE, van Duren BH, Bloch BV, Berber R, James PJ, Manktelow ARJ. Lower Risk of Revision With 32- and 36-Millimeter Femoral Heads Compared With 28-mm Heads in Primary Total Hip Arthroplasty: A Comparative Single-Center Study (10,104 Hips). J Arthroplasty 2024; 39:991-996. [PMID: 38661490 DOI: 10.1016/j.arth.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND We aimed to compare the clinical outcomes of different head sizes (28-, 32-, and 36- millimeter) in primary total hip arthroplasty (THA) at mean 6 years follow-up (range, 1 to 17.5 years). METHODS This was a retrospective consecutive study of primary THA at our institution (2003 to 2019). Demographic and surgical data were collected. The primary outcome measures were all-cause revision, revision for dislocation, and all-cause revision excluding dislocation. Continuous descriptive statistics used means, median values, ranges, and 95% confidence intervals, where appropriate. Kaplan-Meier survival curves were used to estimate time to revision. Cox proportional hazard regression analyses were used to compare revision rates between the femoral head size groups. Adjustments were made for age at surgery, sex, primary diagnosis, American Society of Anesthesiologists score, articulation type, and fixation methods. There were 10,104 primary THAs included; median age was 69 years (range, 13 to 101) with 61.5% women. A posterior approach was performed in 71.6%. There were 3,295 hips with 28-mm heads (32.6%), 4,858 (48.1%) with 32-mm heads, and 1,951 (19.3%) with 36-mm heads. RESULTS Overall rate of revision was 1.7% with the lowest rate recorded for the 36-mm group (2.7 versus 1.3 versus 1.1%). Cox regression analyses showed a decreased risk of all-cause revision for 32 and 36-mm head sizes as compared to 28-mm; this was statistically significant for the 32-mm group (P = .01). Risk of revision for dislocation was significantly reduced in both 32-mm (P = .03) and 36-mm (P = .03) head sizes. Analysis of all cause revision excluding dislocation showed no significant differences between head sizes. CONCLUSIONS We found a significantly reduced risk of revision for all causes, but particularly revision for dislocation with larger head sizes. Concerns regarding increased risk of early revision for aseptic loosening, polyethylene wear, or taper corrosion with larger heads appear to be unfounded in this cohort of 10,104 patients with up to 17 years follow-up.
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Affiliation(s)
- Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Bernard H van Duren
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Peter J James
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Andrew R J Manktelow
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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An Z, Yang T, Shi C, Mao S, Wang L, Li A, Li W, Xue X, Sun M, Bai Y, He Y, Ren F, Lu Z, Yan M, Ren Y, Liu CT, Zhang Z, Han X. Negative enthalpy alloys and local chemical ordering: a concept and route leading to synergy of strength and ductility. Natl Sci Rev 2024; 11:nwae026. [PMID: 38405434 PMCID: PMC10890820 DOI: 10.1093/nsr/nwae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/27/2024] Open
Abstract
Solid solutions are ubiquitous in metals and alloys. Local chemical ordering (LCO) is a fundamental sub-nano/nanoscale process that occurs in many solid solutions and can be used as a microstructure to optimize strength and ductility. However, the formation of LCO has not been fully elucidated, let alone how to provide efficient routes for designing LCO to achieve synergistic effects on both superb strength and ductility. Herein, we propose the formation and control of LCO in negative enthalpy alloys. With engineering negative enthalpy in solid solutions, genetic LCO components are formed in negative enthalpy refractory high-entropy alloys (RHEAs). In contrast to conventional 'trial-and-error' approaches, the control of LCO by using engineering negative enthalpy in RHEAs is instructive and results in superior strength (1160 MPa) and uniform ductility (24.5%) under tension at ambient temperature, which are among the best reported so far. LCO can promote dislocation cross-slip, enhancing the interaction between dislocations and their accumulation at large tensile strains; sustainable strain hardening can thereby be attained to ensure high ductility of the alloy. This work paves the way for new research fields on negative enthalpy solid solutions and alloys for the synergy of strength and ductility as well as new functions.
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Affiliation(s)
- Zibing An
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Tao Yang
- Department of Materials Science and Engineering, City University of Hong Kong, Hong Kong, China
| | - Caijuan Shi
- Key Laboratory of Partial Acceleration Physics & Technology, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China
| | - Shengcheng Mao
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Lihua Wang
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Ang Li
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Wei Li
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Xianmeng Xue
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Ming Sun
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Yifan Bai
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Yapeng He
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
| | - Fuzeng Ren
- Department of Materials Science & Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Zhouguang Lu
- Department of Materials Science & Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Ming Yan
- Department of Materials Science & Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Yang Ren
- Department of Physics, City University of Hong Kong, Hong Kong, China
| | - Chain-Tsuan Liu
- Department of Materials Science and Engineering, City University of Hong Kong, Hong Kong, China
| | - Ze Zhang
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
- State Key Laboratory of Silicon Materials, Department of Materials Science and Engineering, Zhejiang University, Hangzhou 310058, China
| | - Xiaodong Han
- Beijing Key Lab of Microstructure and Property of Advanced Materials, College of Materials Science & Engineering, Beijing University of Technology, Beijing 100124, China
- Department of Materials Science & Engineering, Southern University of Science and Technology, Shenzhen 518055, China
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11
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Guo R, Ding J, Wang Y, Feng H, Chen L, Yang J, Xia X, Zhao Y, Li J, Ji S, Luo J. Oxidation Behavior of Pre-Strained Polycrystalline Ni 3Al-Based Superalloy. Materials (Basel) 2024; 17:1561. [PMID: 38612076 PMCID: PMC11012565 DOI: 10.3390/ma17071561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
The harsh service environment of aeroengine hot-end components requires superalloys possessing excellent antioxidant properties. This study investigated the effect of pre-strain on the oxidation behavior of polycrystalline Ni3Al-based superalloys. The growth behaviors of oxidation products were analyzed by scanning electron microscope, transmission electron microscope, X-ray Photoelectron Spectroscopy and Raman spectroscopy. The results indicated that the 5% pre-strained alloys exhibited lower mass gain, shallower oxidation depth and more compact oxide film structures compared to the original alloy. This is mainly attributed to the formation of rapid diffusion paths for Al atoms diffusing to the surface under 5% pre-strain, which promotes the faster formation of protective Al2O3 film while continuing to increase the pre-strain to 25% results in less protective transient oxidation behavior being aggravated due to the increase in dislocation density within the alloy, which prevents the timely formation of the protective Al2O3 film, resulting in uneven oxidation behavior on the alloy.
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Affiliation(s)
- Rui Guo
- School of Material Science and Engineering, Hebei University of Technology, Tianjin 300130, China; (R.G.); (H.F.); (J.Y.)
| | - Jian Ding
- School of Material Science and Engineering, Hebei University of Technology, Tianjin 300130, China; (R.G.); (H.F.); (J.Y.)
| | - Yujiang Wang
- National Key Laboratory for Remanufacturing, Army Academy of Armored Forces, Beijing 100072, China;
| | - Haomin Feng
- School of Material Science and Engineering, Hebei University of Technology, Tianjin 300130, China; (R.G.); (H.F.); (J.Y.)
| | - Linjun Chen
- Advanced Technology & Materials Co., Ltd., Beijing 101318, China; (L.C.); (J.L.); (J.L.)
| | - Jie Yang
- School of Material Science and Engineering, Hebei University of Technology, Tianjin 300130, China; (R.G.); (H.F.); (J.Y.)
| | - Xingchuan Xia
- School of Material Science and Engineering, Hebei University of Technology, Tianjin 300130, China; (R.G.); (H.F.); (J.Y.)
| | - Yingli Zhao
- HBIS Group Co., Ltd., Shijiazhuang 050023, China; (Y.Z.); (S.J.)
| | - Jun Li
- Advanced Technology & Materials Co., Ltd., Beijing 101318, China; (L.C.); (J.L.); (J.L.)
| | - Shuang Ji
- HBIS Group Co., Ltd., Shijiazhuang 050023, China; (Y.Z.); (S.J.)
| | - Junyi Luo
- Advanced Technology & Materials Co., Ltd., Beijing 101318, China; (L.C.); (J.L.); (J.L.)
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Procházka O, Sánchez T, Kašpárková K. Fracture Dislocation of the Pisiform Bone in 14-Year-Old Boy-A Case Report. Medicina (Kaunas) 2024; 60:532. [PMID: 38674178 PMCID: PMC11052046 DOI: 10.3390/medicina60040532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024]
Abstract
We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and proximal phalanx of the thumb due to high-energy trauma directly to the extended wrist. This combination of fractures has not been previously reported in the literature. Currently, there is no consensus in the literature regarding the optimal treatment approach for such cases. In our management, initial attempts at closed and open reduction were unsuccessful, leading to the decision for primary pisiformectomy. Our report includes a follow-up of 3.5 years, demonstrating a very good outcome. Based on this case and a few similar published cases, primary pisiformectomy appears to be a viable and well-accepted option, particularly among young patients. Additionally, we conducted a review of radiographic criteria and management strategies for this specific injury and related conditions.
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Affiliation(s)
- Ondřej Procházka
- Department of Hand Surgery, Canton Hospital Olten, 4600 Olten, Switzerland; (T.S.); (K.K.)
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Goto K, Sanada T, Honda E, Sameshima S, Murakami T, Inagawa M, Ishida Y, Kuzuhara R, Iwaso H. Fibular morphology is not associated with incidence of peroneal tendon dislocation. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38509788 DOI: 10.1002/ksa.12160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The association of peroneal tendon dislocation with peroneal bone morphology and postoperative redislocation rates remains unknown. This study compared the fibula morphology in patients with peroneal tendon dislocation with that in a control population. METHODS The study enrolled 48 patients who underwent surgery for peroneal tendon dislocation at our institution during between 2018 and 2023. Thirty-five patients with preoperative magnetic resonance imaging of the ankle were defined as Group D and 35 with magnetic resonance imaging of the ankle for other reasons and with similar background data were selected as the control group (Group C). The posterior tilting angle of the fibula, posterolateral angle and posterolateral edge angle were evaluated at the plafond level. The posterior tilting angle, posterolateral angle and retromalleolar bone shape according to the Rosenberg classification (flat, convex, concave) were evaluated at the midpoint between the plafond and the tip. RESULTS At the plafond level, the posterior tilting, posterolateral and posterolateral edge angles were 57.7 ± 11.1°, 123.8 ± 12.3° and 90.8 ± 13.7°, respectively, in Group D and 64.1 ± 15.4°, 121.1 ± 12.3° and 88.7 ± 12.2°, respectively, in Group C, with no significant differences. No significant between-group differences existed in the posterior tilting and posterolateral angles at the midpoint level. Moreover, no significant differences existed in distribution of the bone geometry according to the Rosenberg classification. CONCLUSION There were no differences in morphology between patients with peroneal tendon dislocation and controls. This study provides useful information on the indications for primary surgery and whether bony approach is useful for peroneal tendon dislocation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kazumi Goto
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Takaki Sanada
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Eisaburo Honda
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Shin Sameshima
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Tomoki Murakami
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Miyu Inagawa
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Yutaro Ishida
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Ryota Kuzuhara
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Hiroshi Iwaso
- Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
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14
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Acuña AJ, Forlenza EM, Serino J, Terhune EB, Della Valle CJ. Body Mass Index Does Not Drive the Risk for Early Postoperative Instability After Total Hip Arthroplasty: A Matched Cohort Analysis. J Arthroplasty 2024:S0883-5403(24)00239-0. [PMID: 38499164 DOI: 10.1016/j.arth.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Instability remains the leading cause of revision following total hip arthroplasty (THA). The objective of the present investigation was to determine whether an elevated body mass index (BMI) is associated with an increased risk of instability after primary THA. METHODS An administrative claims database was queried for patients undergoing elective, primary THA for osteoarthritis between 2010 and 2022. Patients who underwent THA for a femoral neck fracture were excluded. Patients who had an elevated BMI were grouped into the following cohorts: 25 to 29.9 (n = 2,313), 30 to 34.9 (n = 2,230), 35 to 39.9 (n = 1,852), 40 to 44.9 (n = 1,450), 45 to 49.9 (n = 752), and 50 to 59.9 (n = 334). Patients were matched 1:1 based on age, sex, and Elixhauser Comorbidity Index, as well as a history of spinal fusion, neurodegenerative disorders, and alcohol abuse, to controls with a normal BMI (20 to 24.9). A multivariate logistic regression controlling for age, sex, Elixhauser Comorbidity Index, and additional risk factors for dislocation was used to evaluate dislocation rates at 30 days, 90 days, 6 months, 1 year, and 2 years. Rates of revision for instability were similarly compared at 1 year and 2 years postoperatively. RESULTS No significant differences in dislocation rate were observed between control patients and each of the evaluated BMI classes at all evaluated postoperative intervals (all P values > .05). Similarly, the risk of revision for instability was comparable between the normal weight cohort and each evaluated BMI class at 1 year and 2 years postoperatively (all P values > .05). CONCLUSIONS Controlling for comorbidities and known risk factors for instability, the present analysis demonstrated no difference in rates of dislocation or revision for instability between normal-weight patients and those in higher BMI classes.
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Affiliation(s)
- Alexander J Acuña
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Enrico M Forlenza
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joseph Serino
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - E Bailey Terhune
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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15
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Scanlon CM, Christensen T, Bieganowski T, Buehring W, Meftah M, Hepinstall MS. "Stuck in the middle": the missing lumbosacral link in total hip arthroplasty. Hip Int 2024:11207000231223706. [PMID: 38469810 DOI: 10.1177/11207000231223706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Spinopelvic mobility drives functional acetabular position, influencing dislocation risk after total hip arthroplasty (THA). Patients have been described as "stuck sitting" or "stuck standing" based on pelvic tilt (PT). We hypothesised that some patients are "stuck in the middle," meaning their PT changes minimally from sitting to standing - increasing their risk of dislocation. METHODS We reviewed 195 patients with standing and sitting whole body radiographs prior to THA. Standing anterior pelvic plane tilt (APPT) and standing and sitting sacral slope (SS) were measured and used to calculate sitting APPT. Normal standing and sitting were defined as APPT >-10° and <-20°, respectively. Spinal stiffness was classified as <10° change in sacral slope between sitting and standing. Patients were categorised as: (A) able to fully sit and stand; (B) "stuck sitting" - able to fully sit; unable to fully stand; (C) "stuck standing" - able to fully stand; unable to fully sit; or (D) "stuck in the middle" - unable to sit or stand fully. RESULTS 84 patients could sit and stand normally (A), 22 patients were stuck sitting (B), 76 patients were stuck standing (C), and 13 patients were stuck in the middle (D). While 111 patients (56.9%) were considered stuck, only 58 patients (29.7%) met criteria for spinal stiffness. DISCUSSION We identified a subset of patients with stiff spines and abnormal PT in both sitting and standing, including 37.1% of patients who would be classified as "stuck sitting" based only on standing radiographs. Placing acetabular components in less than anatomic anteversion in these patients may increase posterior dislocation risk.
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Affiliation(s)
| | - Thomas Christensen
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas Bieganowski
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Weston Buehring
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Morteza Meftah
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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Mallett KE, Guarin Perez SF, Hooke AW, Tanner AM, Bland JT, Fitzsimmons JS, Taunton MJ, Sierra RJ. The Frank Stinchfield Award: Assembly and Dissociation Forces Differ Between Commonly Used Dual Mobility Implants: A Biomechanical Study. J Arthroplasty 2024:S0883-5403(24)00205-5. [PMID: 38479635 DOI: 10.1016/j.arth.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Intraprosthetic dissociation (IPD) is a complication unique to dual mobility (DM) implants where the outer polyethylene head dissociates from the inner femoral head. Increasing reports of IPD at the time of closed reduction of large head DM dislocations prompted this biomechanical study evaluating the assembly and dissociation forces of DM heads. METHODS We tested 17 polyethylene DM heads from 5 vendors. Of the heads, 12 were highly cross-linked polyethylene (4 vendors) and 5 were infused with vitamin E (2 vendors). Heads were between 46 and 47 mm in diameter, accepting a 28 mm-inner ceramic head. Implants were assembled and disassembled using a servohydraulic machine that recorded the forces and torques applied during testing. Dissociation was tested via both axial pull-out and lever-out techniques, where lever-out simulated stem-on-acetabular component impingement. RESULTS The initial maximum assembly force was significantly different between all vendors (P < .01) and decreased for all implants with subsequent assembly. Vendor 4-E (Link with vitamin E) heads required the highest assembly force (1,831.9 ± 81.95 N), followed by Vendor 3 (Smith & Nephew), Vendor 5 (DePuy Synthes), Vendor 1-E (Zimmer Biomet with vitamin E), Vendor 2 (Stryker), and Vendor 1 (Zimmer Biomet Arcom). Vendor 4-E implants showed the greatest dissociation resistance in both pull-out (2,059.89 N, n = 1) and lever-out (38.95 ± 2.79 Nm) tests. Vendor 1-E implants with vitamin E required higher assembly force, dissociation force, and energy than Vendor 1 heads without vitamin E. CONCLUSIONS There were notable differences in DM assembly and dissociation forces between implants. Diminishing force was required for assembly with each additional trial across vendors. Vendor 4-E DM heads required the highest assembly and dissociation forces. Vitamin E appeared to increase the assembly and dissociation forces. Based on these results, DM polyethylene heads should not be reimplanted after dissociation, and there may be a role for establishing a minimum dissociation energy standard to minimize IPD risk.
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Affiliation(s)
| | | | | | - Allison M Tanner
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
| | - Joshua T Bland
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
| | | | | | - Rafael J Sierra
- Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota
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Verweij LPE, Dobbe JGG, Kerkhoffs GMMJ, Streekstra GJ, van den Bekerom MPJ, Blankevoort L, van Deurzen DFP. Minimal but potentially clinically relevant anteroinferior position of the humeral head following traumatic anterior shoulder dislocations: A 3D-CT analysis. J Orthop Res 2024. [PMID: 38465730 DOI: 10.1002/jor.25831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
In unstable shoulders, excessive anteroinferior position of the humeral head relative to the glenoid can lead to a dislocation. Measuring humeral head position could therefore be valuable in quantifying shoulder laxity. The aim of this study was to measure (1) position of the humeral head relative to the glenoid and (2) joint space thickness during passive motion in unstable shoulders caused by traumatic anterior dislocations and in contralateral uninjured shoulders. A prospective cross-sectional CT-study was performed in patients with unilateral anterior shoulder instability. Patients underwent CT scanning of both injured and uninjured side in supine position (0° abduction and 0° external rotation) and in 60°, 90°, and 120° of abduction with 90° of external rotation without an external load. Subsequently, 3D virtual models were created of the humerus and the scapula to create a glenoid coordinate system to identify poster-anterior, inferior-superior, and lateral-medial position of the humeral head relative to the glenoid. Joint space thickness was defined as the average distance between the subchondral bone surfaces of the humeral head and glenoid. Fifteen consecutive patients were included. In supine position, the humeral head was positioned more anteriorly (p = 0.004), inferiorly (p = 0.019), and laterally (p = 0.021) in the injured compared to the uninjured shoulder. No differences were observed in any of the other positions. A joint-space thickness map, showing the bone-to-bone distances, identified the Hill-Sachs lesion footprint on the glenoid surface in external rotation and abduction, but no differences on average joint space thickness were observed in any position.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
| | - Johannes G G Dobbe
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
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Pour AE, Innmann MM, Reichel F, Schaper B, Renkawitz T, Merle C, Grammatopoulos G. How Do Spinopelvic Characteristics Change Post-Total Hip Arthroplasty? A Longitudinal Assessment Raising Awareness of the Postoperative Period. J Arthroplasty 2024:S0883-5403(24)00199-2. [PMID: 38460739 DOI: 10.1016/j.arth.2024.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Spinopelvic characteristics, including sacral slope (SS), are commonly evaluated in different positions pre-total hip arthroplasty (THA). This study aimed to: 1) investigate the change in spinopelvic parameters at 7 days (early) and 1-year post-THA; and 2) identify patient characteristics associated with a change in SS of more than 7° post-THA. METHODS We prospectively studied 250 patients who underwent unilateral THA [132 women, age 66 years (range, 32 to 88)] and underwent biplanar images preoperatively and at 7 days and 1-year post-THA. Parameters measured included pelvic incidence, standing lumbar lordosis, SS, and proximal femoral angle (PFA). A SS change ≥ 7° was considered the threshold as it would result in more than a 5° change in cup orientation. RESULTS Early post-THA SSstanding remained within ± 6º from preoperative measurements in 75% of patients, reduced by ≥ 7° in 9%, and increased by ≥ 7° in 16%. Those that showed a reduction in SS had the lowest PFA and the highest SS pre-THA (P = .028, .107, and < 0.001, respectively). From 7 days until the 1-year mark, pelvic tilt increased, SS reduced (mean: -4º, range: -29 to 17º, P < .001), and patients stood with greater hip extension ΔPFAstanding (mean 7°, range: -34 to 37°, P < .001). At 1 year, SSseated had remained within ± 6º, relative to the pre-THA value, in 49% of patients. CONCLUSIONS Standing spinopelvic characteristics, especially SSstanding, remain within ±6° in three-quarters of patients both early- and at 1-year post-THA. In the remaining cases, pelvic tilt changes significantly. In 9% of cases, SS reduces ≥ 7° early THA, probably due to the alleviation of fixed-flexion contractures. The SSseated changes by ≥ ± 7° in almost 50% of cases in this study, and its clinical value as a preoperative planning tool should be questioned. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Aidin E Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut
| | - Moritz M Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ontario, Canada; Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Bibiane Schaper
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christian Merle
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ontario, Canada; Diakonie Klinikum Stuttgart, Stuttgart, Germany
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Streck LE, Chiu YF, Haralambiev L, Boettner F. The Surgical Approach Impacts Component Selection in Total Hip Arthroplasty: A Matched Cohort Study of 7,460 Hips. J Arthroplasty 2024; 39:739-743. [PMID: 37633508 DOI: 10.1016/j.arth.2023.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND A higher risk of dislocation following total hip arthroplasty (THA) has been reported for the posterior approach (PA) compared to the anterior approach (AA). Dual mobility implants, larger head sizes, and elevated or face-changing liners can reduce the risk for dislocation. It remains unclear whether the component selection is influenced by the surgical approach. METHODS This is a retrospective study of 7,048 patients who underwent 7,460 primary THA with either AA or PA for primary hip osteoarthritis or osteonecrosis of the femoral head between 2019 and 2021. A propensity score model based on age, body mass index, height, and American Association of Anesthesiologists Score was applied. There were 2,502 AA-THA matched with 4,958 PA-THA (2,456 1:2, and 46 1:1). Groups were compared with multiple linear regression analyses/multivariate logistic regressions after controlling for American Association of Anesthesiologists Score and body mass index. In a second step, only hips operated by surgeons using both approaches were matched 1:1 (1,204 PA and AA, respectively). The same statistics were performed after controlling for "surgeon". RESULTS The PA was associated with a more frequent use of dual mobility implants, elevated liners, face-changing liners, as well as heads with 36 mm or larger diameters, and the implanted cups were significantly larger (P < .001, respectively). These findings were consistent for both matched cohorts. CONCLUSION The surgical approach impacts the component selection in THA. Patients undergoing PA-THA are more likely to receive implants with larger head size or stabilizing features compared to AA-THA.
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Affiliation(s)
- Laura E Streck
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Hospital for Special Surgery, Biostats Core, Research Administration, New York, New York
| | - Lyubomir Haralambiev
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, New York, New York
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, New York, New York
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20
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Söylemez MS, Taşcı M, Özer M, Hakyoldaş MM, Aydın MT, Vezirhüyük M. Treatment of Posterior Hip Dislocation due to Juvenile Idiopathic Arthritis. Report of Two Cases. J Orthop Case Rep 2024; 14:61-67. [PMID: 38560299 PMCID: PMC10976526 DOI: 10.13107/jocr.2024.v14.i03.4288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/04/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Juvenile idiopathic arthritis ( JIA) is a persistent autoimmune-inflammatory disease that affects children younger than 16. Aggressive synovitis of the hip may cause joint destruction, hip protrusion, erosion, pseudosubluxation, dysplasia, and osteoarthritis. Subluxation of the hip had been reported previously. However, dislocation of the hip in JIA is an extremely rare situation, and only two cases have been reported up to date. Reduction of the dislocated hip has to be performed in any way. However, there is no algorithm to be followed for the treatment of hip dislocations caused by JIA. Case Presentation In this study, we presented two cases of hip dislocation caused by JIA.Case 1: An 11-year-old boy had JIA and chronic recurrent multifocal osteomyelitis (CRMO). X-rays and computed tomography (CT) revealed a posterior dislocation of the left hip. An urgent operation was planned for the reduction of the hip. Avascular necrosis, dysplasia, or erosions were not evident at the last follow-up.Case 2: An 11-year-old girl was referred to the hospital with excessive left hip pain starting 24 h ago. A limited synovectomy with joint irrigation was performed. However, pathological examination of the synovium showed chronic inflammation consistent with JIA. On the post-operative 10th day, the patient was consulted for an increase in hip pain and deformity of the left hip. X-rays and MRI revealed posterior dislocation of the left hip with synovial hypertrophy. An urgent operation was planned. The hip could be reduced under anesthesia with mild traction, and a pelvipedal cast was applied only for 3 weeks. Avascular necrosis, dysplasia, destruction, or erosions were not evident at the last follow-up. Conclusion For early diagnosed patient reduction under anesthesia and medial soft-tissue contracture release; for late diagnosed patient medial soft-tissue contracture release, capsulotomy and synovectomy were effective to prevent destruction and early degenerative changes of the hip joint for treatment of dislocation caused by JIA.
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Affiliation(s)
- Mehmet Salih Söylemez
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Murat Taşcı
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Özer
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Murat Hakyoldaş
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Talha Aydın
- Department of Orthopedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Vezirhüyük
- Department of Orthopedics and Traumatology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
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21
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White C, Abdalla W, Awasthi P, Iranpour F, Subramanian P. Outcomes of Dual Mobility Bearings in Revision Total Hip Replacements. Cureus 2024; 16:e55585. [PMID: 38576664 PMCID: PMC10993088 DOI: 10.7759/cureus.55585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/06/2024] Open
Abstract
Background Dual mobility bearings have gained attention in the prevention of instability in revision total hip replacement. This study aimed to evaluate the use of dual mobility bearings in revision total hip replacement. The primary outcome was the rate of dislocation. Secondary outcomes included the rate of re-operation for any reason, surgical complications, serious medical adverse events, and 90-day mortality rate. Methods A single-centre case series of 55 consecutive operations in 49 patients who underwent revision total hip replacement using dual mobility bearings with a minimum follow-up of three months was studied. Results Early dislocation occurred in one case (2%), and there were no intra-prosthetic dislocations at a mean follow-up of 16 months. The rate of re-operation for any reason was 6/55 (11%) cases, and the post-operative infection rate was 2/55 (4%) cases. Serious medical adverse events occurred in 2/55 (4%) cases. The 90-day mortality rate was 1/55 (2%) cases. Two cases (2%) had cup abduction or anteversion angles outside of the safe zones although there were no dislocations in these patients. Conclusion This case series demonstrates a low dislocation rate in the early post-operative period for dual mobility bearings in revision total hip replacement. Dual mobility bearings show promise as an early low dislocation implant in revision total hip replacement. It remains to be determined whether dual mobility bearings are low-wear implants in the long term.
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Affiliation(s)
- Christopher White
- Department of Trauma and Orthopaedic Surgery, Imperial College Healthcare NHS Trust, London, GBR
| | - Waleed Abdalla
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, GBR
| | - Prashant Awasthi
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, GBR
| | - Farhad Iranpour
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, GBR
| | - Padmanabhan Subramanian
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, GBR
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22
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Hoehmann CL, Mubin NF, Hinnenkamp G, Modica EJ, Eckardt PA, Cuellar JC. Predicting Instability Risk Following Hemiarthroplasty for Femoral Neck Hip Fractures in Geriatric Patients. J Arthroplasty 2024; 39:708-715. [PMID: 37776983 DOI: 10.1016/j.arth.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Although a rare complication, dislocation following hemiarthroplasty (HA) for a femoral neck hip fracture is associated with increased mortality, readmission, and possible revision surgery. To date many of the specific risk factors have been difficult to demonstrate. Patient factors, surgical factors, as well as morphological factors need to be assessed. Therefore, the purpose of this study was to elucidate the risk factors for dislocation of HA following femoral neck hip fractures in the geriatric population. METHODS This was a retrospective review of 270 patients who had hip fractures. Medical records between the years 2016 and 2022 informed binomial regression predictive models. The discriminative ability of variables in the final model and acetabular anteversion to predict dislocation was assessed with area under the curve (AUC) estimates. RESULTS Center edge angle (odds ratio 1.23), abduction angle (odds ratio 1.17), and depth width ratio (2.96e-11) were significant predictors of dislocation (P = .003, .028, and <.001, respectively). Center edge angle and depth width ratio (<44.1 ° and .298), respectively, were cut scores for risk. Dementia had a high discriminative of ability, as did men (AUC = 0.617, 0.558, respectively). Acetabular anteversion was not predictive of dislocation (P = .259) and theorized anteversion safe zones had poor discriminative ability with AUCs of 0.510 and 0.503, respectively. CONCLUSIONS Morphological factors related to hip dysplasia and a shallow acetabulum, which can be assessed with a radiograph alone, were found to be predictors of instability following HA in the elderly. Hemiarthroplasty implant design and manufacturer, and also acetabular version did not contribute to instability risk.
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Affiliation(s)
- Christopher L Hoehmann
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, New York
| | - Nailah F Mubin
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, New York
| | - Glyn Hinnenkamp
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, New York
| | - Edward J Modica
- Department of Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | | | - John C Cuellar
- Department of Orthopaedic Surgery, Good Samaritan Hospital, West Islip, New York
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23
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Hubert J, Ritter J, Krüger L, Simon A, Beil FT, Jandl NM, Rolvien T. Are Synovial Inflammatory Markers Increased in Patients Who Have Aseptic Total Hip Arthroplasty Dislocation Indicated for Revision? J Arthroplasty 2024; 39:787-794.e1. [PMID: 37611677 DOI: 10.1016/j.arth.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Previous studies have speculated on elevated synovial inflammatory markers in patients undergoing surgical revision for total hip arthroplasty (THA) dislocation. However, this assumption is based on small patient series and a full investigation according to International Consensus Meeting (ICM) criteria has not yet been performed. METHODS Patients who had aseptic THA dislocation indicated for revision surgery were identified retrospectively. Only patients who had available diagnostic workup according to ICM 2018 criteria, including preoperative and intraoperative parameters, were included. For comparison, we analyzed a matched cohort of patients indicated for aseptic THA revision for other conditions. The 2 cohorts each consisted of 55 patients and were not different regarding age, sex, BMI, or implant fixation. RESULTS There was no difference in synovial white blood cell count (2,238 ± 2,544 versus 2,533 ± 3,448 c/μL; P = .601), alpha-defensin quotient (0.14 ± 0.11 versus 0.19 ± 0.28; P = .207), or polymorphonuclear neutrophil percentage (% PMN) (36.7 ± 22.6 versus 31.3 ± 24.5%; P = .312) between the groups. In the dislocation cohort, 20% of patients had a synovial white blood cell count of 3,000 c/μL or higher, compared with 18% in the control cohort. However, all patients in the dislocation cohort were below the cutoff for alpha-defensin or % PMN. CONCLUSION In patients who have aseptic THA dislocation, synovial inflammatory markers are not elevated compared with patients undergoing aseptic revision for other complications. A detailed preoperative analysis of synovial inflammatory markers using ICM criteria appears critical in patients who have a THA dislocation to exclude periprosthetic joint infection. LEVEL OF EVIDENCE Level III, retrospective, comparative study.
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Affiliation(s)
- Jan Hubert
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jacob Ritter
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Krüger
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Simon
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nico Maximilian Jandl
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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24
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Jauffrit D, Heraudet P, Tibbo M, Erbland A, Carlier Y, Mansat P, Laumonerie P. Simple acute postero-lateral elbow dislocation: A historical perspective. Injury 2024; 55:111353. [PMID: 38266328 DOI: 10.1016/j.injury.2024.111353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/31/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE The aims of this study were to summarize (1) the historical knowledge of the posterolateral elbow dislocation (PLED) pattern and the biomechanical, radiographic, and clinical data that engendered its evolution; and (2) to help clinicians better understand the management of PLED. METHODS A literature search was performed using Ovid, Scopus and Cochrane Library, and the Medical Subject Headings vocabulary. Results are discussed as a chronologic review of the relevant literature between 1920-2022. RESULTS In 1966 Osborn and Cotterill were the first to describe posterolateral rotatory instability (PLRI) causing the PLED. Several theories on PLED were then published by others surgeons as our understanding of elbow biomechanics continued to improve. Multiple treatment protocols have been designed based on the aforementioned theories. Conservative and surgical treatment for PLED provides excellent functional outcomes. However, high rates of persistent pain stiffness and instability have been reported long-term, and no single approach to treatment has been widely accepted. CONCLUSION Despite a growing body of biomechanical evidence, there is no consensus surgical indication for the treatment of PLED. Both conservative and surgical management result in satisfactory functional outcomes after PLED. However, elevated rates of residual pain, and instability have also been described and may limit heavy labor and sports participation. The next challenge for elbow surgeons will be to identify those patients who would benefit from surgical stabilization following PLED.
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Affiliation(s)
- Daphné Jauffrit
- Department of orthopedic surgery, Hôpital Pellegrin, Bordeaux 31600 France
| | - Paul Heraudet
- Department of orthopedic surgery, Hôpital Pellegrin, Bordeaux 31600 France
| | - Meagan Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, US
| | - Alexandra Erbland
- Department of orthopedic surgery, Hôpital Pellegrin, Bordeaux 31600 France
| | - Yacine Carlier
- Centre de l'Arthrose, Clinique du Sport, Mérignac 33700, France
| | - Pierre Mansat
- Department of orthopedic surgery, Hôpital Pierre Paul Riquet, Toulouse 31300 France
| | - Pierre Laumonerie
- Department of orthopedic surgery, Hôpital Pellegrin, Bordeaux 31600 France.
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25
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Nini K, Opango ADC, Nshimirimana B, Rabaa GE, Aziz Z, Hattab NM. Anterior dislocation of the coronoid process above a ZMC fracture: case report and a technical note. J Surg Case Rep 2024; 2024:rjae144. [PMID: 38495053 PMCID: PMC10941974 DOI: 10.1093/jscr/rjae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/17/2024] [Indexed: 03/19/2024] Open
Abstract
Zygomaticomaxillary complex fractures are very common in maxillofacial trauma and may be associated with fractures of the coronoid process. We report a case of dislocation of the coronoid process above a zygomaticomaxillary complex fracture locking the mandible. We also report the surgical management of this uncommon case and its follow-up.
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Affiliation(s)
- Khaoula Nini
- Oral and Maxillofacial Surgery Department, Mohamed VI University Hospital, Ibn Tofail Hospital, Marrakech, 40000, Morocco
| | - Alban Déo Christian Opango
- Oral and Maxillofacial Surgery Department, Mohamed VI University Hospital, Ibn Tofail Hospital, Marrakech, 40000, Morocco
| | - Bosco Nshimirimana
- Oral and Maxillofacial Surgery Department, Mohamed VI University Hospital, Ibn Tofail Hospital, Marrakech, 40000, Morocco
| | - Ghassane Elidrissi Rabaa
- Oral and Maxillofacial Surgery Department, Mohamed VI University Hospital, Ibn Tofail Hospital, Marrakech, 40000, Morocco
| | - Zakaria Aziz
- Oral and Maxillofacial Surgery Department, Mohamed VI University Hospital, Ibn Tofail Hospital, Marrakech, 40000, Morocco
| | - Nadia Mansouri Hattab
- Oral and Maxillofacial Surgery Department, Mohamed VI University Hospital, Ibn Tofail Hospital, Marrakech, 40000, Morocco
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Kreulen RT, Anderson G, Yalcin S, Hart JM, Shank K, Fury MS, Elias JJ, Tanaka MJ, Farrow LD, Diduch DR, Cosgarea AJ. Evaluation of Differences in Patellar Height After Patellar Stabilization Procedures Not Intended to Address Patella Alta: A Multicenter Study. Orthop J Sports Med 2024; 12:23259671241235597. [PMID: 38515605 PMCID: PMC10956155 DOI: 10.1177/23259671241235597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 03/23/2024] Open
Abstract
Background Recent studies have reported conflicting results as to whether isolated medial patellofemoral ligament reconstruction (MPFLr) leads to decreased patellar height. Purpose To investigate if patellar stabilization surgery not intended to address patella alta influences patellar height. Study Design Cohort study; Level of evidence, 3. Methods A multicenter retrospective chart review was conducted, and patients who underwent MPFLr, medializing tibial tuberosity osteotomy (TTO), and/or trochleoplasty between 2016 and 2020 were included. The Caton-Deschamps index (CDI) was calculated from radiographs obtained preoperatively, 2 weeks postoperatively, and 3 months postoperatively. The preoperative CDI value was compared with the 2-week postoperative and 3-month postoperative values according to stabilization procedure (isolated MPFLr, isolated TTO, MPFLr + TTO, MPFLr + trochleoplasty, and MPFLr + trochleoplasty + TTO) using the paired t test. Analyses of the 1-bundle versus 2-bundle MPFLr technique and the presence of lateral retinacular release or lateral retinacular lengthening were conducted on the isolated MPFLr and combined MPFLr + TTO cohorts. Results A total of 356 knees were included. Statistically significant pre- to postoperative decreases in CDI were seen in all stabilization procedures analyzed (P≤ .017 for all). Within the isolated MPFLr cohort, this significant decrease was seen at 2 weeks postoperatively with the 2-bundle technique (ΔCDI = -0.09; P < .001) but not with the 1-bundle technique (ΔCDI = -0.01; P = .621). Conclusion The different surgical techniques analyzed in the current study affected patellar height, even when a distalizing TTO was not performed. The decrease was dependent on surgical technique, with a 2-bundle MPFLr leading to a statistically significant decrease and a 1-bundle MPFLr effecting no change.
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Affiliation(s)
- R. Timothy Kreulen
- Department of Orthopaedic Surgery, Johns Hopkins, School of Medicine, Baltimore, Maryland, USA
| | - Gregory Anderson
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sercan Yalcin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph M. Hart
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kaitlyn Shank
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew S. Fury
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John J. Elias
- Department of Health Sciences, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Miho J. Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lutul D. Farrow
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Andrew J. Cosgarea
- Department of Orthopaedic Surgery, Johns Hopkins, School of Medicine, Baltimore, Maryland, USA
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Imai N, Miyasaka D, Ibuchi S, Kimura K, Hirano Y, Horigome Y, Kawashima H. The Long-Term Efficacy of Computed Tomography-Navigated Total Hip Arthroplasty: An 18-Year Follow-Up Study. J Clin Med 2024; 13:1374. [PMID: 38592236 PMCID: PMC10932160 DOI: 10.3390/jcm13051374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Backgroumd: There have been few reports on the long-term survival of computed tomography (CT)-navigated total hip arthroplasty (THA), which should lead to a lower incidence of dislocation and loosening. In this study, we examined survivorship, dislocation, and loosening incidence using plain radiographs over a minimum 15-year follow-up after CT-navigated THA. METHODS We retrospectively reviewed 145 consecutive CT-navigated THAs for >15 years. We surveyed the angles placed in both the acetabular and femoral components, survivorship, the occurrence of dislocation, the revision rate, and the fixation grade of the acetabular component. RESULTS The mean follow-up duration was 18.4 years. Overall, 73.8% of THAs were within the safe zone of Lewinnek. There were four dislocations (2.8%), with three occurring within 1 month after surgery and the other within 7 years after surgery. Revision THA was performed in one case (0.69%); consequently, the survival rate was 99.3%. The fixation grade was evaluated in 144 hips, and those were evaluated as having "no loosening". CONCLUSIONS CT-navigated THA was speculated to contribute to long-term survivorship, with a low rate of loosening, even after 18 years of follow-up. It was speculated that the acetabular component was placed at an acceptable insertion angle and a suitable position for stable initial fixation.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Dai Miyasaka
- Department of Orthopedic Surgery, Niigata Bandai Hospital, Niigata 950-0909, Japan
| | - Shinya Ibuchi
- Department of Orthopedic Surgery, Uonuma Kikan Hospital, Minami Uonuma 949-7302, Japan
| | - Keishi Kimura
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Yuki Hirano
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Yoji Horigome
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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Haugaard KB, Bak K, Ryberg D, Muharemovic O, Hölmich P, Barfod KW. Acromioclavicular joint dislocation Rockwood type III and V show no difference in functional outcome and 91% recovered well without the need for surgery. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38372155 DOI: 10.1002/ksa.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Acromioclavicular (AC) joint dislocations are common injuries, but the indication for and timing of surgery is debated. The objective of the study was to evaluate the results after acute AC joint dislocations Rockwood type III and V treated nonsurgically with the option of delayed surgical intervention. METHODS This is a prospective cohort study with clinical, radiological and patient-reported outcome assessment at baseline, 6 weeks, 3 months, 6 months and 1 year after acute AC joint dislocation. Patients aged 18-60 with acute AC joint dislocation and a baseline panorama (Zanca) radiograph with an increase in the coracoclavicular distance of >25% compared to the uninjured side were eligible for inclusion. All patients were treated nonsurgically with 3 months of home-based training and with the option of delayed surgical intervention. The primary outcome was the Western Ontario Shoulder Instability Index (WOSI). Secondary outcomes were surgery yes/no and the Shoulder Pain and Disability Index (SPADI). RESULTS Ninety-five patients were included. Fifty-seven patients were Rockwood type III and 38 patients were type V. There were no statistically significant differences in WOSI and SPADI between patients with type III and V injuries at any time point. Nine patients (9.5%) were referred for surgery; seven type III and two type V (ns). CONCLUSION Ninety-one percent of patients with acute AC joint dislocation Rockwood type III and V recovered without surgery and there were no differences in outcome scores between type III and V at any time point. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kristine B Haugaard
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Klaus Bak
- Adeas Private Hospital, Copenhagen, Denmark
| | - Dorthe Ryberg
- Department of Physical and Occupational Therapy, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Omar Muharemovic
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Kristoffer W Barfod
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Dong Q, Lu H, Wang Y, Yang X, Zhang L, Dong H. The Influence of Strain Aging at Different Temperatures on the Mechanical Properties of Cold-Drawn 10B21 Steel Combined with an Electron Microscope Study of the Structures. Materials (Basel) 2024; 17:826. [PMID: 38399076 PMCID: PMC10890677 DOI: 10.3390/ma17040826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
The effect of aging treatments at various temperatures on the mechanical properties and microstructure of 10B21 cold heading steel with a 20% reduction in area (ε = 0.1) was investigated. The mechanical properties were evaluated based on tensile tests and hardness tests, while the evolution of microstructure was observed by using an optical microscope (OM), scanning electron microscope (SEM), transmission electron microscope (TEM) and X-ray diffraction (XRD). The results reveal that aging treatment enhance the strength and hardness of 10B21 cold heading steel after drawing, and the highest values of strength and hardness are attained at an aging temperature of 300 °C. Specifically, the yield and ultrahigh tensile strength after aging at 300 °C are measured at 620 MPa and 685 MPa, respectively, which are 30 MPa and 50 MPa higher than the cold-drawn sample. Moreover, the hardness after aging at 300 °C reaches 293 HV, which has an increase of 30 HV compared to the cold-drawn state. The improvement in mechanical properties may be related to the strain-aging mechanism and the increased density of dislocations. In addition, the analysis of the TEM results reveal that the presence of the second-phase Ti(C,N) contributes to pinning the dislocations, whereas the dislocations are pinned between the cementite (Fe3C) lamellar and stacked at the grain boundaries, leading to strain hardening of the material.
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Affiliation(s)
- Qiuyao Dong
- School of Materials and Science Engineering, Shanghai University, Shanghai 200444, China; (Q.D.); (Y.W.); (H.D.)
| | - Hengchang Lu
- School of Materials and Science Engineering, Shanghai University, Shanghai 200444, China; (Q.D.); (Y.W.); (H.D.)
- Zhejiang Institute of Advanced Materials, Shanghai University, Jiaxing 314100, China;
| | - Yangxin Wang
- School of Materials and Science Engineering, Shanghai University, Shanghai 200444, China; (Q.D.); (Y.W.); (H.D.)
| | - Xianliang Yang
- Zhejiang Institute of Advanced Materials, Shanghai University, Jiaxing 314100, China;
| | - Linxiang Zhang
- Technology Centre of Jiangsu Yonggang Group Company Limited, Suzhou 215600, China;
| | - Han Dong
- School of Materials and Science Engineering, Shanghai University, Shanghai 200444, China; (Q.D.); (Y.W.); (H.D.)
- Zhejiang Institute of Advanced Materials, Shanghai University, Jiaxing 314100, China;
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Parsons M, Elwell J, Muh S, Wright T, Flurin P, Zuckerman J, Roche C. Impact of Accumulating Risk Factors on the Incidence of Dislocation After Primary Reverse Total Shoulder Arthroplasty Using a Medial Glenoid Lateral Humerus Onlay Prosthesis. J Shoulder Elbow Surg 2024:S1058-2746(24)00084-3. [PMID: 38316238 DOI: 10.1016/j.jse.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION The aim of this study is to facilitate preoperative identification of patients at-risk for dislocation after reverse total shoulder arthroplasty (rTSA) using the Equinoxe rTSA prosthesis (medialized glenoid, lateralized onlay humerus with a 145° neck angle) and quantify the impact of accumulating risk factors on the occurrence of dislocation. METHODS We retrospectively analyzed 10,023 primary rTSA patients from an international multi-center database of a single platform shoulder prosthesis and quantified the dislocation rate associated with multiple combinations of previously identified risk factors. To adapt our statistical results for prospective identification of patients most at-risk for dislocation, we stratified our dataset by multiple risk factor combinations and calculated the odds ratio for each cohort to quantify the impact of accumulating risk factors on dislocation. RESULTS 136 (52F/83M/1UNK) of 10,023 primary rTSA patients were reported to have a dislocation for a rate of 1.4%. Patients with zero risk factors were rare, where only 12.7% of patients (1,268 of 10,023) had no risk factors, and only 0.5% of these (6 of 1,268) had a report of dislocation. The dislocation rate increased in patient cohorts with an increasing number of risk factors. Specifically, the dislocation rate increased from 0.9% for a patient cohort with 1 risk factor to 1.0% for 2 risk factors, 1.6% for 3 risk factors, 2.7% for 4 risk factors, 5.3% for 5 risk factors, and 7.3% for 6 risk factors. Stratifying dislocation rate by multiple risk factor combinations identified numerous cohorts with either an elevated risk or a diminished risk for dislocation. DISCUSSION This 10,023 rTSA multi-center study demonstrated that 1.4% of rTSA patients experienced dislocation with one specific medialized glenoid/lateralized humerus onlay rTSA prosthesis. Stratifying patients by multiple combinations of risk factors demonstrated the impact of accumulating risk factors on incidence of dislocation. rTSA patients with the greatest risk of dislocation were: male gender, age ≤67 years at the time of surgery, patients with BMI ≥31, patients who received cemented humeral stems, patients who received glenospheres having a diameter >40mm, and/or patients who received expanded/laterally offset glenospheres. Patients with these risk factors who are considering rTSA using a medial glenoid/lateral humerus, should be made aware of their elevated dislocation risk profile.
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Affiliation(s)
- Moby Parsons
- King and Parsons Orthopedic Center, Portsmouth, NH, USA.
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Stegelmann SD, Butler JT, Hiatt JL, Bullock MW. Safe Sex After Total Hip Arthroplasty: Using Computed Tomography-Based Robotics to Evaluate "At-Risk" Sexual Positions. J Arthroplasty 2024; 39:433-440.e4. [PMID: 37572725 DOI: 10.1016/j.arth.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) can improve sexual satisfaction, but fear of dislocation can lead to sexual difficulties following this procedure. Previous kinematic research identified 4 sexual positions in women and 2 in men that were considered at risk for impingement. This study aimed to validate these findings using current robotic THA simulations. METHODS The 3-dimensional renderings from 12 patients who received computed tomography (CT)-based robotic THA were used to assess for prosthetic and/or bony impingement among 12 popular sexual positions. There were 9 cup orientations tested for each position (a combination of anteversion [0 °, 15 °, and 30 °] and inclination [40 °, 45 °, and 60 °]). The at-risk positions were tested again using the unique hip positions and cup orientations where previous geometric modeling data found impingement to occur. RESULTS Using mean hip positions, impingement occurred in at least 1 patient in 1 of the 12 positions for women (position 5) and 5 of the 12 positions for men (positions 1, 5, 8, 10, and 11). Among the at-risk positions, impingement occurred in none of the 2 at-risk women positions (0 of 17 cup orientations) and in both at-risk men positions (9 of 9 cup orientations for position 8 and 1 of 1 for position 11). CONCLUSION Recreating popular and at-risk sexual positions following THA with a CT-based robotics system yielded results that were inconsistent with previous geometric modeling data. Resolving these discrepancies is crucial for surgeons to provide accurate postoperative patient education. The CT-based robotic systems may provide necessary input to feasibly individualize such recommendations, but current limitations in CT-based robotics require continued attention and innovation.
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Affiliation(s)
| | - Justin T Butler
- Department of Orthopedic Surgery, Mercy Health Saint Vincent Medical Center, Toledo, Ohio
| | - John L Hiatt
- Department of Orthopedic Surgery, Mercy Health Saint Vincent Medical Center, Toledo, Ohio
| | - Matthew W Bullock
- Department of Orthopaedic Surgery, Marshall University, Joan C. Edwards School of Medicine, Huntington, West Virginia
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Rashid MS, Tsuchiya S, More KD, LeBlanc J, Bois AJ, Kwong CA, Lo IKY. Validating the Glenoid Track Concept Using Dynamic Arthroscopic Assessment. Orthop J Sports Med 2024; 12:23259671241226943. [PMID: 38390400 PMCID: PMC10883128 DOI: 10.1177/23259671241226943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 02/24/2024] Open
Abstract
Background Failure after isolated Bankart repair has led surgeons to consider when to address the Hill-Sachs lesion, which is thought to be a contributor to recurrent instability. One approach utilizes the glenoid track concept to determine whether a Hill-Sachs lesion is classified as "off-track," suggesting that the addition of a remplissage procedure may aid stability. However, the accuracy and reliability of using this approach require validation using an appropriate reference. Purpose To determine the accuracy and reliability of using the glenoid track concept against dynamic arthroscopic assessment of Hill-Sachs lesion engagement. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods A total of 49 patients undergoing arthroscopic Bankart repair surgery for recurrent traumatic anterior shoulder instability were enrolled in this diagnostic validation study. Shoulders were classified as on-track or off-track using 3-dimensional computed tomography (3DCT) and static arthroscopic measurements. These classifications were compared with dynamic arthroscopic assessment (engagement of the Hill-Sachs lesion on the anterior glenoid rim in the 'athletic position') to determine their accuracy and reliability. Results The 3DCT-based measurements to determine glenoid track status had a higher positive predictive value (66% vs 42%), higher specificity (47% vs 42%), and higher accuracy (65% vs 59%) compared with static arthroscopic measurements. Static arthroscopic measurements to determine glenoid track status had a higher negative predictive value (96% vs 64%) and higher sensitivity (96% vs 81%) compared with 3DCT-based measurements. Interrater reliability (Krippendorff α) was 'fair' for determining the glenoid track status using 3DCT (0.368; 95% CI, 0.217-0.519) and 'moderate' for static arthroscopic measurements (0.523; 95% CI, 0.364-0.666). Intrarater reliability (intraclass correlation coefficient [ICC] 3,k) was 'moderate' for 3DCT measurements (0.660; 95% CI, 0.444-0.798) and 'good' for static arthroscopic measurements (0.769; 95% CI, 0.629-0.862). Conclusion Determining glenoid track status using either 3DCT or static arthroscopic measurements yielded moderate accuracy and reliability. Surgeons using the glenoid track concept to aid surgical decision-making in traumatic recurrent anterior shoulder instability should utilize 3DCT or static arthroscopic measurements with caution.
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Affiliation(s)
- Mustafa S Rashid
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Saho Tsuchiya
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Kristie D More
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
| | - Justin LeBlanc
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Aaron J Bois
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Cory A Kwong
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian K Y Lo
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Corpus-Zuñiga FM, Muramatsu K, Tani Y, Kobayashi M, Sugimoto H, Tec LM. Use of Mini TightRope® for Delayed Presentation of a Fifth Carpometacarpal Joint Dislocation. J Orthop Case Rep 2024; 14:49-53. [PMID: 38420221 PMCID: PMC10898683 DOI: 10.13107/jocr.2024.v14.i02.4214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/28/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Isolated dislocations of the fifth carpometacarpal joint (CMCJ) are uncommon injuries of the hand that is often missed but can be diagnosed correctly with a high index of suspicion and adequate imaging. Treatment for chronic cases is usually open reduction with temporary fixation using Kirschner wires, but for this case, we used Mini TightRope® as well to allow for early finger exercise. The case presented here is unique because of a delayed dislocation of a CMCJ detected 9 weeks from initial injury which was treated with a novel form of fixation with Mini TightRope®. Case Report A 70-year-old, right-hand dominant, male farmer injured his left hand when he slipped and fell on a concrete surface, landing on the ulnar side of his left hand. He was immediately seen in the clinic, just with a swollen left hand but no obvious deformity and with apparently normal PA and oblique radiographs of the hand. Nine weeks later, he came back due to persistent ulnar-sided hand pain; repeat radiographs and a CT scan of the left hand showed ulno-palmar dislocation of the fifth CMCJ. He then underwent trial closed reduction of the 5th CMCJ dislocation but failed. Open reduction, temporary K-wire fixation, and fixation using Mini TightRope® through the 4th and 5th metacarpals were done. A full range of motion of the hand was allowed immediately post-operative. Reduction was maintained and no complications were noted on subsequent follow-up visits. Conclusion This paper presents a brief literature review on 5th CMCJ dislocation, discussing the anatomic considerations contributing to joint stability, helpful radiographic parameters for diagnosis, and enumeration of treatment options.
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Affiliation(s)
| | - Keiichi Muramatsu
- Department of Orthopedic Surgery, Nagato General Hospital, 85 Higashi-Fukawa, Nagato, Yamaguchi, Japan
| | - Yasuhiro Tani
- Department of Orthopedic Surgery, Nagato General Hospital, 85 Higashi-Fukawa, Nagato, Yamaguchi, Japan
| | - Masato Kobayashi
- Department of Orthopedic Surgery, Nagato General Hospital, 85 Higashi-Fukawa, Nagato, Yamaguchi, Japan
| | - Hideaki Sugimoto
- Department of Orthopedic Surgery, Nagato General Hospital, 85 Higashi-Fukawa, Nagato, Yamaguchi, Japan
| | - Lou Mervyn Tec
- Department of Orthopedic Surgery, Nagato General Hospital, 85 Higashi-Fukawa, Nagato, Yamaguchi, Japan
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Pour AE, Donnelley CA, Tung WS, Tommasini SM, Wiznia D. Some Offset Restoration Options Can Paradoxically Lead to Decreased Range of Motion in Primary Total Hip Arthroplasty: A 3-Dimensional Computer Simulation Study. J Arthroplasty 2024; 39:514-519.e3. [PMID: 37625464 PMCID: PMC10843541 DOI: 10.1016/j.arth.2023.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In total hip arthroplasty (THA), femoral offset restoration results in optimal biomechanics and range of motion (ROM) without bone-bone impingement. We hypothesized that differences in implant design features significantly affect bone-bone impingement risk in primary THA. METHODS This retrospective computer simulation study included a cohort of 43 primary robotic arm-assisted THA. Considering sagittal pelvic tilt, we measured the maximum external rotation at 0° hip flexion and the maximum internal rotation at both 90° and 100° hip flexion before any bone-bone impingement occurred. To influence the offset, we included neutral or extended polyethylene liners, neutral or plus prosthetic heads, standard or high-offset stems, and stems with 132° or 127° neck angles. RESULTS Extended polyethylene liner use resulted in decreased bone-bone impingement for both stems but also decreased prosthetic ROM in hip extension (mean -4.5 to 5°, range -10 to 0°) and hip flexion (mean -3 to 3.7°, range -10 to 0°) due to decreases in head diameter. Using a plus head or different stem offset/neck angle options resulted in either (1) no improvement in ROM (stem 1: 60%; stem 2: 28%) or (2) a paradoxical increase in bone-bone impingement (stem 1 with 127°: 19% and stem 2 with high offset option: 7%). CONCLUSION Counterintuitively, a subset of patients experience a paradoxical increase in bone-bone impingement when transitioning from standard to high-offset or varus necks due to the pelvic and proximal femoral bone shape. For this group of patients, preoperative personalized 3-dimensional modeling may help guide implant choice for optimizing outcomes.
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Affiliation(s)
- Aidin E Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut
| | - Claire A Donnelley
- Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut
| | - Wei Shao Tung
- Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut
| | - Steven M Tommasini
- Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut
| | - Daniel Wiznia
- Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut
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Vasireddi N, Chandi SK, Neitzke CC, Cororaton AD, Vigdorchik JM, Blevins JL, McLawhorn AS, Gausden EB. Does Approach Matter in Robotic-Assisted Total Hip Arthroplasty? A Comparison of Early Reoperations Between Direct Anterior and Postero-Lateral Approach. J Arthroplasty 2024:S0883-5403(24)00059-7. [PMID: 38301980 DOI: 10.1016/j.arth.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND There is no consensus on whether direct anterior approach (DAA) or postero-lateral approach (PLA) total hip arthroplasty (THA) confers a lower risk of postoperative complications. Robotic assistance in THA results in a more consistently accurate component position compared to manual THA. The objective of this study was to compare rates of dislocation, reoperation, revision, and patient-reported outcome measures between patients undergoing DAA and PLA robotic-assisted primary THA. METHODS We identified 2,040 consecutive robotic-assisted primary THAs performed for primary osteoarthritis, using DAA (n = 497) or PLA (n = 1,542) between 2017 and 2020. The mean follow-up was 18 months. Kaplan-Meier analysis estimated survivorship free of dislocation, reoperation, and revision. Achievement of patient acceptable symptom state and minimum clinically important difference were used to compare changes in the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) and Visual Analog Scale. RESULTS Dislocation was rare in this series (14 in 2,040, 0.7%), including 1 of 497 (0.2%) in the DAA cohort and 13 of 1,542 (0.8%) in the PLA cohort (P = .210). There was no difference in 2-year reoperation-free survivorship (97.8 versus 98.6%, P = .59) or revision-free survivorship (98.8 versus 99.0%, P = .87) at any time point. After controlling for age, sex, and body mass index, there was no difference in dislocation, reoperation, or revision. At 6-week follow-up, after controlling for age, sex, and body mass index, patients in the DAA cohort had higher odds of achieving HOOS JR minimum clinically important difference (odds ratio = 2.01, P = .012) and HOOS JR patient acceptable symptom state (odds ratio = 1.72, P = .028). There were no differences in patient-reported outcome measures by 3 months. CONCLUSIONS For robotic-assisted primary THA, DAA may confer enhanced early (<6 weeks) functional recovery compared to the PLA, but there was no significant difference in postoperative dislocation, reoperation, or revision rates.
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Affiliation(s)
- Nikhil Vasireddi
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sonia K Chandi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Colin C Neitzke
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Agnes D Cororaton
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Jason L Blevins
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Zhang K, Su Q, Shi W, Lv Y, Zhu R, Wang Z, Zhao W, Zhang M, Ding S, Ma S, Du G, Xu B. Copious Dislocations Defect in Amorphous/Crystalline/Amorphous Sandwiched Structure P-NiMoO 4 Electrocatalyst toward Enhanced Hydrogen Evolution Reaction. ACS Nano 2024; 18:3791-3800. [PMID: 38226921 DOI: 10.1021/acsnano.3c12049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The design and synthesis of efficient, inexpensive, and long-term stable heterostructured electrocatalysts with high-density dislocations for hydrogen evolution reaction in alkaline media and seawater are still a great challenge. An amorphous/crystalline/amorphous sandwiched structure with abundant dislocations were synthesized through thermal phosphidation strategies. The dislocations play an important role in the hydrogen evolution reactions. Copious dislocation defects, combined with cracks, and the synergistic interfacial effect between crystalline phase and amorphous phase regulate the electronic structure of electrocatalyst, provide more active sites, and thus endow the electrocatalysts with excellent catalytic activity under alkaline water and seawater. The overpotentials of P-NiMoO4 at 10 mA/cm2 in 1 M KOH aqueous solution and seawater are 45 and 75 mV, respectively. Additionally, the P-NiMoO4 electrocatalyst exhibits long-term stability over 100 h. This study provides a simple approach for synthesizing amorphous/crystalline/amorphous sandwiched non-noble-metal electrocatalysts with abundant dislocations for hydrogen evolution reaction.
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Affiliation(s)
- Kai Zhang
- School of Materials Science & Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Qingmei Su
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Weihao Shi
- School of Materials Science & Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Yvjie Lv
- School of Materials Science & Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Rongrong Zhu
- School of Materials Science & Engineering, Shaanxi University of Science and Technology, Xi'an 710021, China
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Zhiyong Wang
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
- Beijing University of Technology, Chaoyang District, Beijing 100124, China
| | - Wenqi Zhao
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Miao Zhang
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Shukai Ding
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Shufang Ma
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Gaohui Du
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
| | - Bingshe Xu
- Materials Institute of Atomic and Molecular Science, Shaanxi University of Science and Technology, Xi'an 710021, China
- Key Laboratory of Interface Science and Engineering in Advanced Materials, Taiyuan University of Technology, Taiyuan 030024, China
- Shanxi-Zheda Institute of Advanced Materials and Chemical Engineering, Taiyuan 030032, China
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Ni K, Wang H, Guo Q, Wang Z, Liu W, Huang Y. The Construction of a Lattice Image and Dislocation Analysis in High-Resolution Characterizations Based on Diffraction Extinctions. Materials (Basel) 2024; 17:555. [PMID: 38591400 PMCID: PMC10856733 DOI: 10.3390/ma17030555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 04/10/2024]
Abstract
This paper introduces a method for high-resolution lattice image reconstruction and dislocation analysis based on diffraction extinction. The approach primarily involves locating extinction spots in the Fourier transform spectrum (reciprocal space) and constructing corresponding diffraction wave functions. By the coherent combination of diffraction and transmission waves, the lattice image of the extinction planes is reconstructed. This lattice image is then used for dislocation localization, enabling the observation and analysis of crystal planes that exhibit electron diffraction extinction effects and atomic jump arrangements during high-resolution transmission electron microscopy (HRTEM) characterization. Furthermore, due to the method's effectiveness in localizing dislocations, it offers a unique advantage when analyzing high-resolution images with relatively poor quality. The feasibility of this method is theoretically demonstrated in this paper. Additionally, the method was successfully applied to observed edge dislocations, such as 1/6[211-], 1/6[2-11-], and 1/2[01-1], which are not easily observable in conventional HRTEM characterization processes, in electro-deposited Cu thin films. The Burgers vectors were determined. Moreover, this paper also attempted to observe screw dislocations that are challenging to observe in high-resolution transmission electron microscopy. By shifting a pair of diffraction extinction spots and superimposing the reconstructed images before and after the shift, screw dislocations with a Burgers vector of 1/2[011-] were successfully observed in electro-deposited Cu thin films.
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Affiliation(s)
| | | | | | | | | | - Yuan Huang
- School of Materials Science and Engineering, Tianjin University, Tianjin 300354, China
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Fani M, Jian WR, Su Y, Xu S. Confined Layer Slip Process in Nanolaminated Ag and Two Ag/Cu Nanolaminates. Materials (Basel) 2024; 17:501. [PMID: 38276440 DOI: 10.3390/ma17020501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
The exceptional strength of nanolaminates is attributed to the influence of their fine stratification on the movement of dislocations. Through atomistic simulations, the impact of interfacial structure on the dynamics of an edge dislocation, which is compelled to move within a nanoscale layer of a nanolaminate, is examined for three different nanolaminates. In this study, we model confined layer slip in three structures: nanolaminated Ag and two types of Ag/Cu nanolaminates. We find that the glide motion is jerky in the presence of incoherent interfaces characterized by distinct arrays of misfit dislocations. In addition, the glide planes exhibit varying levels of resistance to dislocation motion, where planes with intersection lines that coincide with misfit dislocation lines experience greater resistance than planes without such intersection lines.
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Affiliation(s)
- Mahshad Fani
- School of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Wu-Rong Jian
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
| | - Yanqing Su
- Department of Mechanical and Aerospace Engineering, Utah State University, Logan, UT 84322, USA
| | - Shuozhi Xu
- School of Aerospace and Mechanical Engineering, University of Oklahoma, Norman, OK 73019, USA
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Cnudde PHJ, Nåtman J, Rolfson O, Hailer NP. The True Dislocation Incidence following Elective Total Hip Replacement in Sweden: How Does It Relate to the Revision Rate? J Clin Med 2024; 13:598. [PMID: 38276104 PMCID: PMC10816596 DOI: 10.3390/jcm13020598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: The true dislocation incidence following THA is difficult to ascertain in population-based cohorts. In this study, we explored the cumulative dislocation incidence (CDI), the relationship between the incidence of dislocation and revision surgery, patient- and surgery-related factors in patients dislocating once or multiple times, and differences between patients being revised for dislocation or not. (2) Methods: We designed an observational longitudinal cohort study linking registers. All patients with a full dataset who underwent an elective unilateral THA between 1999 and 2014 were included. The CDI and the time from the index THA to the first dislocation or to revision were estimated using the Kaplan-Meier (KM) method, giving cumulative dislocation and revision incidences at different time points. (3) Results: 136,810 patients undergoing elective unilateral THA were available for the analysis. The 30-day CDI was estimated at 0.9% (0.9-1.0). The revision rate for dislocation throughout the study period remained much lower. A total of 51.2% (CI 49.6-52.8) suffered a further dislocation within 1 year. Only 10.9% of the patients with a dislocation within the first year postoperatively underwent a revision for dislocation. (4) Discussion: The CDI after elective THA was expectedly considerably higher than the revision incidence. Further studies investigating differences between single and multiple dislocators and the criteria by which patients are offered revision surgery following dislocation are urgently needed.
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Affiliation(s)
- Peter H. J. Cnudde
- Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden; (J.N.); (O.R.); (N.P.H.)
- School of Management, Swansea University, Bay Campus, Swansea SA1 8EN, UK
- Department of Orthopaedics, Hywel Dda University Healthboard, Prince Philip Hospital, Bryngwynmawr, Llanelli SA14 8QF, UK
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Göteborgsvägen 37, 431 80 Mölndal, Sweden
| | - Jonatan Nåtman
- Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden; (J.N.); (O.R.); (N.P.H.)
| | - Ola Rolfson
- Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden; (J.N.); (O.R.); (N.P.H.)
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Göteborgsvägen 37, 431 80 Mölndal, Sweden
| | - Nils P. Hailer
- Swedish Arthroplasty Register, Registercentrum Västra Götaland, 413 45 Gothenburg, Sweden; (J.N.); (O.R.); (N.P.H.)
- Orthopaedics, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ingång 61, 751 85 Uppsala, Sweden
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Li WC, Liu L, Chen H, Wang ZD, Zhou HX. Traumatic irreducible dislocation of the fifth metatarsophalangeal joint in pediatrics: case report and clinical experience. Front Pediatr 2024; 12:1242082. [PMID: 38312921 PMCID: PMC10834623 DOI: 10.3389/fped.2024.1242082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Dislocation of the metatarsophalangeal joint (MTPJ) by trauma commonly occurs in adults. Most dislocations of the MTPJ could be reduced by closed reduction. However, isolated traumatic irreducible dislocation of the fifth MTPJ is an extremely rare injury, particularly in children. We report the case of a 10-year-old boy with irreducible dislocation of the fifth MTPJ who presented with a dorsiflexion injury of the right foot 1 year previously. Closed reduction was attempted but failed. Computed tomography showed the dorsolateral dislocation of the fifth MTPJ. We performed an open reduction and metatarsal bone osteotomy, with a short osteotomy at approximately 0.8 cm. The osteotomy was adjusted to a reduction of the MTPJ and fixation by a lock compression plate. The distal growth plate in the metatarsal bone was protected to avoid pre-closure of the growth plate. There were no instances of dislocation or signs of avascular necrosis of the head of the metatarsal bone. The results of this study demonstrated that open reduction and metatarsal bone osteotomy could be an optional treatment for irreducible dislocation of the fifth MTPJ in children. We should pay more attention to the distal growth plate in the metatarsal bone to avoid pre-closure of the growth plate.
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Affiliation(s)
- Wen Chao Li
- Senior Department of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Li Liu
- Senior Department of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hui Chen
- Senior Department of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhen Dong Wang
- Senior Department of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hui Xia Zhou
- Senior Department of Pediatrics, The Seventh Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Yasui K, Hamamoto K. Possibility of High Ionic Conductivity and High Fracture Toughness in All- Dislocation-Ceramics. Materials (Basel) 2024; 17:428. [PMID: 38255595 PMCID: PMC10817447 DOI: 10.3390/ma17020428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Based on the results of numerical calculations as well as those of some related experiments which are reviewed in the present paper, it is suggested that solid electrolytes filled with appropriate dislocations, which is called all-dislocation-ceramics, are expected to have considerably higher ionic conductivity and higher fracture toughness than those of normal solid electrolytes. Higher ionic conductivity is due to the huge ionic conductivity along dislocations where the formation energy of vacancies is considerably lower than that in the bulk solid. Furthermore, in all-dislocation- ceramics, dendrite formation could be avoided. Higher fracture toughness is due to enhanced emissions of dislocations from a crack tip by pre-existing dislocations, which causes shielding of a crack tip, energy dissipation due to plastic deformation and heating, and crack-tip blunting. All-dislocation-ceramics may be useful for all-solid-state batteries.
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Affiliation(s)
- Kyuichi Yasui
- National Institute of Advanced Industrial Science and Technology (AIST), Nagoya 463-8560, Japan;
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Diop B, Mendy O, Tene Nde AF, Dione AB, Diop M, Diouf PA, Sow M, Sarr N, Faye I, Ndoye AY, Konate I. Anterior dislocation of the shoulder associated with a diaphyseal fracture of the ipsilateral humerus: a case report. Ann Med Surg (Lond) 2024; 86:477-480. [PMID: 38222728 PMCID: PMC10783212 DOI: 10.1097/ms9.0000000000001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/11/2023] [Indexed: 01/16/2024] Open
Abstract
Background Anterior dislocation of the shoulder associated with a diaphyseal fracture of the ipsilateral humerus is a rare and controversial occurrence, with very few cases reported in the literature. Case presentation We present a case of a 39-year-old right-handed driver who presented with an anterior dislocation of the shoulder associated with a diaphyseal fracture of the ipsilateral humerus following a road traffic accident. The lateral approach to the fracture allowed us to use two forceps to gain a good grip on the proximal fragment and perform the maneuver to reduce the dislocation. The fracture was reduced and fixed with a molded Lecestre-type plate. Conclusion In this case, we employed the approach of initially reducing the shoulder dislocation with forceps, followed by osteosynthesis of the humeral fracture. The functional results were excellent after 6 months.
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Affiliation(s)
- Badara Diop
- Department of Surgery, Gaston Berger University, Saint-Louis
| | - Ountyess Mendy
- Department of Surgery, Gaston Berger University, Saint-Louis
| | | | - Alioune B. Dione
- Department of Orthopedic Surgery, Cheikh Anta Diop University, Dakar, Senegal
| | - Malick Diop
- Department of Orthopedic Surgery, Cheikh Anta Diop University, Dakar, Senegal
| | - Pape A. Diouf
- Department of Orthopedic Surgery, Cheikh Anta Diop University, Dakar, Senegal
| | - Mayoro Sow
- Department of Orthopedic Surgery, Cheikh Anta Diop University, Dakar, Senegal
| | - Ndiame Sarr
- Department of Surgery, Gaston Berger University, Saint-Louis
| | - Ibrahima Faye
- Department of Surgery, Gaston Berger University, Saint-Louis
| | - Abdou Y. Ndoye
- Department of Surgery, Gaston Berger University, Saint-Louis
| | - Ibrahima Konate
- Department of Surgery, Gaston Berger University, Saint-Louis
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Jelti O, Barzouq A, El Alaoui O, Abdeljaouad N, Yacoubi H. Concurrent Palmar Lunate Dislocation and Posterior Elbow Dislocation With a Distal Radius Fracture: A Rare Case Report. Cureus 2024; 16:e52609. [PMID: 38374856 PMCID: PMC10875395 DOI: 10.7759/cureus.52609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/21/2024] Open
Abstract
We present an unusual case involving the simultaneous dislocation of the trans-scapho-retro-lunate in the right wrist and a posterolateral dislocation in the right elbow joint with a distal radius fracture in a 23-year-old male with no notable medical history. These injuries occurred when he fell from a height of around 12 meters onto his outstretched right hand. The patient presented to the hospital in a normal upper limb trauma position with no discomfort to critical functions. Predominant symptoms at the emergency department were discomfort in the right wrist, hand, and ipsilateral elbow, as well as the entire upper limb functional impairment. Both the wrist and the elbow seemed distorted on examination, with considerable edema and loss of bone landmarks. Passive mobilization was hampered by pain, but peripheral pulses were detectable. The radial, ulnar, and median nerves' autonomous sensory-motor domains were intact, with a cutaneous opening classified as stage 2 by the Cauchoix-Duparc classification. The elbow dislocation was successfully treated using a closed reduction method. External manipulation was employed to reduce the trans-scaphoid perilunate dislocation, which was subsequently stabilized through percutaneous screw fixation of the scaphoid using a triquetrum-lunate pin. Additionally, a styloid pin was utilized to address and manage a distal radius fracture, followed by the implementation of a radiometacarpal external fixator. After one year and three months, the patient reported no pain in his elbow and minimal wrist discomfort during heavy lifting.
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Affiliation(s)
- Ousama Jelti
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Abdelilah Barzouq
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Centre Hospitalier Universitaire (CHU) Mohammed VI, Oujda, MAR
| | - Oussama El Alaoui
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Centre Hospitalier Universitaire (CHU) Mohammed VI, Mohammed First University, Oujda, MAR
| | - Najib Abdeljaouad
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
| | - Hicham Yacoubi
- Department of Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Mohammed First University, Oujda, MAR
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Chen M, Wu Z, Hu L, Li X, Yang H, Liu Z, Xiao Y, Liu Q, Zhou S. The effectiveness and safety of temporary transvenous cardiac pacing leads placement into coronary sinus vein in patients with sick sinus syndrome. Ann Noninvasive Electrocardiol 2024; 29:e13099. [PMID: 37997537 PMCID: PMC10770809 DOI: 10.1111/anec.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/04/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The temporary pacing lead routinely is placed into right ventricular (RV), which pose a risk of dislocation and cardiac perforation. OBJECTIVE We aim to evaluate the effectiveness and safety of temporary transvenous cardiac pacing (TTCP) leads placement into the coronary sinus vein (CSV) in patients with sick sinus syndrome (SSS). METHODS We investigated patients with SSS who underwent TTCP lead placement into the CSV under the guidance of X-ray between January 2013 and May 2023. Patients were randomly divided into two groups: RV group (n = 33) and CSV group (n = 22). The ordinary passive bipolar electrodes were applied in both groups. In RV groups, electrodes were placed into RV. In CSV group, electrodes were placed into CSV. We evaluated the operation duration, fluoroscopic exposure, first-attempt success rate of leads placement, pacing threshold, success rate of leads placement, rate of leads displacement, and complications. RESULTS Compared with that in RV group, the procedure time, fluoroscopic exposure was significantly prolonged, while the first-attempt success rate of lead placement was obviously increased in CSV group (both p < .05). Compared with that in RV group, the rate of leads displacement is lower in CSV group (both p < .05). There were three patients occurred cardiac perforation in RV group, but no cardiac perforation was reported in CSV group (p > .05). CONCLUSION TTCP leads placement into the CSV is an effective and safe strategy in patients with SSS. It indicates a high rate of pacing effectiveness with low device replacement and complication rates.
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Affiliation(s)
- Mingxian Chen
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Zhihong Wu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Lin Hu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Xuping Li
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Hui Yang
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Zhenjiang Liu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Yichao Xiao
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Qiming Liu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Shenghua Zhou
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
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Nakazawa K, Manaka T, Minoda Y, Hirakawa Y, Ito Y, Iio R, Nakamura H. Impact of constrained humeral liner on impingement-free range of motion and impingement type in reverse shoulder arthroplasty using a computer simulation. J Shoulder Elbow Surg 2024; 33:181-191. [PMID: 37598837 DOI: 10.1016/j.jse.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Dislocation is a major complication of reverse total shoulder arthroplasty (RSA). The humeral liner may be changed to a constrained type when stability does not improve by increasing glenosphere size or lateralization with implants, and patients, particularly women with obesity, have risks of periprosthetic instability that may be secondary to hinge adduction on the thorax, but there are few reports on its impact on the range of motion (ROM). This study aimed to determine the influence of humeral liner constraint on impingement-free ROM and impingement type using an RSA computer simulation model. METHODS A virtual simulation model was created using 3D measurement software for conducting a simulation study. This study included 25 patients with rotator cuff tears and rotator cuff tear arthropathy. Impingement-free ROM and impingement patterns were measured during flexion, extension, abduction, adduction, external rotation, and internal rotation. Twenty-five cases with a total of 4 patterns of 2 multiplied by 2, making a total of 100 simulations: glenosphere (38 mm normal type vs. lateralized type) and humeral liner constraint (normal type vs. constrained type). There were 4 combinations: normal glenosphere and normal humeral liner, normal glenosphere and constrained humeral liner, lateralized glenosphere and normal humeral liner, and lateralized glenosphere and constrained humeral liner. RESULTS Significant differences were found in all impingement-free ROM in 1-way analysis of variance (abduction: P = .01, adduction: P < .01, flexion: P = .01, extension: P = .02, external rotation: P < .01, and internal rotation: P < .01). Tukey's post hoc tests showed that the impingement-free ROM was reduced during abduction, external rotation, and internal rotation with the combination of the normal glenosphere and constrained humeral liner compared with the other combinations, and improved by glenoid lateralization compared with the combination of the lateralized glenosphere and constrained humeral liner. In the impingement pattern, the Pearson χ2 test showed significantly greater proportion of impingement of the humeral liner into the superior part of the glenoid neck in abduction occurring in the combination of the normal glenosphere and constrained humeral liner group compared with the other groups (P < .01). Bonferroni post hoc tests revealed that the combination of the normal glenosphere and constrained humeral liner was significantly different from that of the lateralized glenosphere and constrained humeral liner (P < .01). Using constrained liners resulted in early impingement on the superior part of the glenoid neck in the normal glenosphere, whereas glenoid lateralization increased impingement-free ROM. CONCLUSION This RSA computer simulation model demonstrated that constrained humeral liners led to decreased impingement-free ROM. However, using the lateralized glenosphere improved abduction ROM.
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Affiliation(s)
- Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan; Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Yoichi Ito
- Osaka Shoulder Center, Ito Clinic, Osaka, Japan
| | - Ryosuke Iio
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan; Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Cong T, Charles S, Reddy RP, Fatora G, Fox MA, Barrow AE, Lesniak BP, Rodosky MW, Hughes JD, Popchak AJ, Lin A. Defining Critical Humeral Bone Loss: Inferior Craniocaudal Hill-Sachs Extension as Predictor of Recurrent Instability After Primary Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:181-189. [PMID: 38164666 DOI: 10.1177/03635465231209443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The glenoid track concept for shoulder instability primarily describes the medial-lateral relationship between a Hill-Sachs lesion and the glenoid. However, the Hill-Sachs position in the craniocaudal dimension has not been thoroughly studied. HYPOTHESIS Hill-Sachs lesions with greater inferior extension are associated with increased risk of recurrent instability after primary arthroscopic Bankart repair. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The authors performed a retrospective analysis of patients with on-track Hill-Sachs lesions who underwent primary arthroscopic Bankart repair (without remplissage) between 2007 and 2019 and had a minimum 2-year follow-up. Recurrent instability was defined as recurrent dislocation or subluxation after the index procedure. The craniocaudal position of the Hill-Sachs lesion was measured against the midhumeral axis on sagittal magnetic resonance imaging (MRI) using either a Hill-Sachs bisecting line through the humeral head center (sagittal midpoint angle [SMA], a measure of Hill-Sachs craniocaudal position) or a line tangent to the inferior Hill-Sachs edge (lower-edge angle [LEA], a measure of Hill-Sachs caudal extension). Univariate and multivariate regression were used to determine the predictive value of both SMA and LEA for recurrent instability. RESULTS In total, 176 patients were included with a mean age of 20.6 years, mean follow-up of 5.9 years, and contact sport participation of 69.3%. Of these patients, 42 (23.9%) experienced recurrent instability (30 dislocations, 12 subluxations) at a mean time of 1.7 years after surgery. Recurrent instability was found to be significantly associated with LEA >90° (ie, Hill-Sachs lesions extending below the humeral head equator), with an OR of 3.29 (P = .022). SMA predicted recurrent instability to a lesser degree (OR, 2.22; P = .052). Post hoc evaluation demonstrated that LEA >90° predicted recurrent dislocations (subset of recurrent instability) with an OR of 4.80 (P = .003). LEA and SMA were found to be collinear with Hill-Sachs interval and distance to dislocation, suggesting that greater LEA and SMA proportionally reflect lesion severity in both the craniocaudal and medial-lateral dimensions. CONCLUSION Inferior extension of an otherwise on-track Hill-Sachs lesion is a highly predictive risk factor for recurrent instability after primary arthroscopic Bankart repair. Evaluation of Hill-Sachs extension below the humeral equator (inferior equatorial extension) on sagittal MRI is a clinically facile screening tool for higher-risk lesions with subcritical glenoid bone loss. This threshold for critical humeral bone loss may inform surgical stratification for procedures such as remplissage or other approaches for at-risk on-track lesions.
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Affiliation(s)
- Ting Cong
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaquille Charles
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajiv P Reddy
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabrielle Fatora
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Fox
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aaron E Barrow
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark W Rodosky
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonathan D Hughes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam J Popchak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Albert Lin
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Kruckeberg BM, Wilbur RR, Song BM, Lamba A, Camp CL, Saris DB, Krych AJ, Stuart MJ. Comparison of Failure Rates at Long-term Follow-up Between MPFL Repair and Reconstruction for Recurrent Lateral Patellar Instability. Orthop J Sports Med 2024; 12:23259671231221239. [PMID: 38204932 PMCID: PMC10777783 DOI: 10.1177/23259671231221239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 01/12/2024] Open
Abstract
Background The medial patellofemoral ligament (MPFL) is the primary soft tissue restraint to lateral patellar translation and is often disrupted by lateral patellar dislocation. Surgical management for recurrent patellar instability focuses on restoring the MPFL function with repair or reconstruction techniques. Recent studies have favored reconstruction over repair; however, long-term comparative studies are limited. Purpose To compare long-term clinical outcomes, complications, and recurrence rates of isolated MPFL reconstruction and MPFL repair for recurrent lateral patellar instability. Study Design Cohort study; Level of evidence, 3. Methods A total of 55 patients (n = 58 knees) with recurrent lateral patellar instability were treated between 2005 and 2012 with either MPFL repair or MPFL reconstruction. The exclusion criteria were previous or concomitant tibial tubercle osteotomy or trochleoplasty and follow-up of <8 years. Pre- and postoperative descriptive, surgical, imaging, and clinical data were recorded for each patient. Results MPFL repair was performed on 26 patients (n = 29 knees; 14 women, 15 men), with a mean age of 18.4 years. MPFL reconstruction was performed on 29 patients (n = 29 knees; 18 women, 11 men), with a mean age of 18.2 years. At a mean follow-up of 12 years (range, 8.3-18.9 years), the reconstruction group had a significantly lower rate of recurrent dislocation compared with the repair group (14% vs 41%; P = .019). There were no differences in the number of preoperative dislocations or tibial tubercle-trochlear groove distance. The reconstruction group had significantly more time from initial injury to surgery compared with the repair group (median, 1460 days vs 627 days; P = .007). There were no differences in postoperative Tegner, Lysholm, or Kujala scores at the final follow-up. In addition, no statistically significant differences were detected in return to sport (RTS) rates (repair [81%] vs reconstruction [75%]; P = .610) or reoperation rates for recurrent instability (repair [21%] vs reconstruction [7%]; P = .13). Conclusion MPFL repair resulted in a nearly 3-fold higher rate of recurrent patellar dislocation (41% vs 14%) at the long-term follow-up compared with MPFL reconstruction. Given this disparate rate, the authors recommend MPFL reconstruction over repair because of the lower failure rate and similar, if not superior, clinical outcomes and RTS.
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Affiliation(s)
| | - Ryan R. Wilbur
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryant M. Song
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel B.F. Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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48
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Pour‐Rashidi A, Pahwa B, Khanmirzaie MH, Fallahpour M, Hanif H, Shirani M. Risk factors and surgical approaches in neglected subaxial cervical spine fractures- dislocations: Experiences with two cases and literature review. Clin Case Rep 2024; 12:e8421. [PMID: 38223516 PMCID: PMC10784752 DOI: 10.1002/ccr3.8421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
This case report describes our experience of surgical strategies of two patients with neglected subaxial cervical spine fracture-dislocation that came to our center with subsequent follow-ups. Subaxial cervical spine fracture-dislocation must be immediately diagnosed and treated. However, it can be neglected in some cases, especially in developing health care systems and patients with low socioeconomic status. We reported two neglected subaxial cervical fracture-dislocation with a mean age of 54 years old who presented with axial cervical pain, and decreased muscle forces. In one out of two, cervical closed traction was applied, then unsuccessful result led to circumferential decompression and fixation via anterior-posterior (AP) approach. Accordingly, we used AP approach without applying closed reduction in another patient successfully. Except one of our cases who died after 2 weeks of surgery due to aspiration pneumonia, other one found complete improvement at the end of 6-month follow-up. Our study emphasizes the importance of AP approach in patients with irreducible joint dislocations. The approach can minimize the surgical risks and increase the cost-benefit as compared to three or more staged approaches. Our approach is less intensive than some other AP approaches while is a safe and efficacious procedure since the posterior reduction is not performed before discectomy and decompression.
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Affiliation(s)
- Ahmad Pour‐Rashidi
- Department of Neurosurgery, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Bhavya Pahwa
- University College of Medical Sciences and GTB HospitalDelhiIndia
| | | | - Mahshid Fallahpour
- Department of Public HealthSan Diego State University (SDSU)‐University of California San Diego (UCSD)San DiegoCaliforniaUSA
| | - Hamed Hanif
- Department of Neurosurgery, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Mohammad Shirani
- Department of Neurosurgery, Sina HospitalTehran University of Medical SciencesTehranIran
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49
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Mori T, Amino T, Yokoyama C, Taniguchi S, Yonezawa T, Taniyama A. Observation and quantitative analysis of dislocations in steel using electron channeling contrast imaging method with precise control of electron beam incident direction. Microscopy (Oxf) 2023:dfad061. [PMID: 38113894 DOI: 10.1093/jmicro/dfad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/12/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
Electron channeling contrast imaging (ECCI) was applied by precisely controlling the the primary electron beam incident direction of the crystal plane in scanning electron microscope (SEM), and the dislocation contrast in steel materials was investigated in detail via SEM/ECCI. The dislocation contrast was observed near a channeling condition, where the incident electron beam direction of the crystal plane varied, and the backscattered electron intensity reached a local minimum. Comparing the dislocation contrasts in the visualized electron channeling contrast (ECC) images and transmission electron microscope (TEM) images, the positions of all dislocation lines were coincident. During the SEM/ECCI observation, the dislocation contrast varied depending on the incident electron beam direction of the crystal plane and accelerating voltages, and optimal conditions existed. When the diffraction condition g and the Burgers vector b of dislocation satisfied the condition g b = 0, the screw dislocation contrast in the ECC image disappeared. An edge dislocation line was wider than a screw dislocation line. Thus, the SEM/ECCI method can be used for dislocation characterization and the strain field evaluation around dislocation, like the TEM method. The depth information of SEM/ECCI, where the channeling condition is strictly satisfied, can be obtained from dislocation contrast deeper than 5ξg, typically used for depth of SEM/ECCI.
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Affiliation(s)
- Takashige Mori
- Takashige Mori, Nippon Steel Corporation, 1-8 Fuso-Cho, Amagasaki, Hyogo, Japan
| | - Takafumi Amino
- Takashige Mori, Nippon Steel Corporation, 1-8 Fuso-Cho, Amagasaki, Hyogo, Japan
| | - Chie Yokoyama
- Takashige Mori, Nippon Steel Corporation, 1-8 Fuso-Cho, Amagasaki, Hyogo, Japan
| | - Shunsuke Taniguchi
- Takashige Mori, Nippon Steel Corporation, 1-8 Fuso-Cho, Amagasaki, Hyogo, Japan
| | - Takayuki Yonezawa
- Takashige Mori, Nippon Steel Corporation, 1-8 Fuso-Cho, Amagasaki, Hyogo, Japan
| | - Akira Taniyama
- Takashige Mori, Nippon Steel Corporation, 1-8 Fuso-Cho, Amagasaki, Hyogo, Japan
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50
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Hamilton S, Troupis C, Hong T, Tran A, Troupis J, Leong JCS. Comparison of hamate versus second or third toe osteochondral graft using magnetic resonance imaging for reconstruction of proximal interphalangeal fracture- dislocations. J Hand Surg Eur Vol 2023:17531934231220783. [PMID: 38103169 DOI: 10.1177/17531934231220783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Hemi-hamate arthroplasty is a method used to reconstruct complex fracture-dislocations of the proximal interphalangeal joint of the fingers. Other graft sites, including the toe second and third phalanges, have been proposed as alternatives to hemi-hamate arthroplasty due to variable clinical outcomes and anatomy. Through a prospective magnetic resonance imaging (MRI)-based study in asymptomatic individuals, we aimed to characterize the anatomy of the proximal interphalangeal joint and compare this with the hamate, second and third toes to determine the closest anatomical match using pre-determined measurements. Our results show that the second and third toes have greater anatomical similarity to the proximal interphalangeal joint of the fingers compared to the hamate. High-resolution MRI is a reliable method of characterizing the anatomy of these structures and could be a useful clinical tool in determining reconstructive options in the management of this challenging injury.Level of evidence: II.
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Affiliation(s)
- Sam Hamilton
- Department of Surgery, Monash University, Monash Health, Melbourne, VIC, Australia
| | | | - Trudy Hong
- Department of Surgery, Monash University, Monash Health, Melbourne, VIC, Australia
| | - Anthony Tran
- Monash Imaging, Monash Health, Melbourne, VIC, Australia
| | - John Troupis
- Monash Imaging, Monash Health, Melbourne, VIC, Australia
- Monash University, Department of Radiation Sciences, Faculty of Medicine, Dentistry and Nursing, Melbourne, VIC, Australia
| | - James C S Leong
- Department of Surgery, Monash University, Monash Health, Melbourne, VIC, Australia
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