Pub Date : 2024-11-01DOI: 10.1016/j.jor.2024.10.048
Michelle R. Shimizu , Whisper Grayson , Sara Winfrey , Nicholas M. Brown
Background
The anterior approach for total hip arthroplasty (THA) carries a higher risk of wound complications, which can significantly affect patient outcomes and increase healthcare costs. There is limited research comparing infection rates based on closure techniques in patients who undergo THA. Therefore, this study aims to compare wound complications based on interrupted or continuous sutures for skin closure after anterior approach THA.
Methods
This single-surgeon retrospective study extracted data from 388 patients who had undergone a primary THA using the anterior approach. Patient demographics, comorbidities, perioperative factors, and infection-related complications were recorded. All variables associated with a given infection complication were controlled for in a binary logistic regression model.
Results
After controlling for confounding variables, wound closure type was not associated with any infectious complications. BMI was a strongly associated factor in PJI (p = 0.028; 95 % CI = 1.02–1.34), prolonged drainage (p < 0.001; 95 % CI = 1.08–1.28), readmission (p = 0.023; 95 % CI = 1.01–1.20), and I&D and revision surgery (p = 0.021; 95 % CI = 1.02–1.31).
Conclusion
Body mass index was the sole factor associated with a higher risk of wound complications postoperatively. These findings suggest a non-inferiority between continuous and interrupted suture closure techniques regarding wound-related infectious complications in anterior total hip arthroplasty.
背景前路进行全髋关节置换术（THA）的伤口并发症风险较高，会严重影响患者的预后并增加医疗费用。根据闭合技术对接受全髋关节置换术患者的感染率进行比较的研究十分有限。因此，本研究旨在比较前方入路 THA 术后基于间断缝合或连续缝合进行皮肤闭合的伤口并发症。研究记录了患者的人口统计学特征、合并症、围手术期因素和感染相关并发症。结果在控制了混杂变量后，伤口闭合类型与任何感染并发症都无关。体重指数是PJI（p = 0.028; 95 % CI = 1.02-1.34）、引流时间延长（p < 0.001; 95 % CI = 1.08-1.28）、再入院（p = 0.023; 95 % CI = 1.01-1.20）以及I&D和翻修手术（p = 0.021; 95 % CI = 1.02-1.31）的强相关因素。这些研究结果表明，在前路全髋关节置换术中，连续缝合和间断缝合技术在伤口相关感染并发症方面没有劣势。
{"title":"Wound complication rates after anterior total hip arthroplasty: A case series comparison of interrupted vs. continuous sutures for skin closure","authors":"Michelle R. Shimizu , Whisper Grayson , Sara Winfrey , Nicholas M. Brown","doi":"10.1016/j.jor.2024.10.048","DOIUrl":"10.1016/j.jor.2024.10.048","url":null,"abstract":"<div><h3>Background</h3><div>The anterior approach for total hip arthroplasty (THA) carries a higher risk of wound complications, which can significantly affect patient outcomes and increase healthcare costs. There is limited research comparing infection rates based on closure techniques in patients who undergo THA. Therefore, this study aims to compare wound complications based on interrupted or continuous sutures for skin closure after anterior approach THA.</div></div><div><h3>Methods</h3><div>This single-surgeon retrospective study extracted data from 388 patients who had undergone a primary THA using the anterior approach. Patient demographics, comorbidities, perioperative factors, and infection-related complications were recorded. All variables associated with a given infection complication were controlled for in a binary logistic regression model.</div></div><div><h3>Results</h3><div>After controlling for confounding variables, wound closure type was not associated with any infectious complications. BMI was a strongly associated factor in PJI (p = 0.028; 95 % CI = 1.02–1.34), prolonged drainage (p < 0.001; 95 % CI = 1.08–1.28), readmission (p = 0.023; 95 % CI = 1.01–1.20), and I&D and revision surgery (p = 0.021; 95 % CI = 1.02–1.31).</div></div><div><h3>Conclusion</h3><div>Body mass index was the sole factor associated with a higher risk of wound complications postoperatively. These findings suggest a non-inferiority between continuous and interrupted suture closure techniques regarding wound-related infectious complications in anterior total hip arthroplasty.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jor.2024.10.059
Eric Kholodovsky , Dylan Luxenburg , William Marmor , Ashleigh Gibula , Giselle Hernandez
Background
Current guidelines call for the use of a first-generation cephalosporin with or without an aminoglycoside for the treatment of open fractures. Due to its superior safety profile and single-dose administration, Piperacillin/tazobactam (PT) may be an effective alternative. The present systematic literature review aimed to evaluate the hypothesis that PT antibiotic prophylaxis does not differ in clinical outcomes as compared to the current guidelines in the treatment of open fractures.
Methods
Five databases were queried for literature pertaining to PT administration for open fractures. A 2-author screening process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodologic index for non-randomized studies criteria was used to objectively assess the methodologic quality of the studies reviewed. Retrospective cohort studies that compared PT to current guidelines in open fractures were included.
Results
Four retrospective cohort studies consisting of 752 patients were included. The injury severity score (ISS) score was higher for the PT group, 18.1, versus the control group, 14.5 (p = .0008). Seventy-eight patients developed a surgical site infection (SSI) in the PT group versus 67 patients in the control group (p = .82). Twenty-one patients developed an acute kidney injury (AKI) in the PT group versus 19 in the control group (p = .51). There was no difference in the number of patients who developed resistant pathogens (6 (PT group) vs. 1 (control group); p = .99). Length of stay was greater in the PT group, 16.4 days, compared to the control group, 10.5 days (p=<0.00001).
Conclusion
The use of piperacillin/tazobactam for open fractures does not differ from first-generation cephalosporins with or without an aminoglycoside in regard to SSI, AKI, return to operating room, 1-year mortality, non-union, and development of resistant pathogens. LOS was significantly longer in the PT group but may be explained by a greater ISS. PT may be a non-inferior alternative to current guidelines due to its better safety profile and single-dose administration method, however, this review is limited by the lack of side effect reporting and underscores the need for larger prospective studies that compare side effect profiles between PT and control groups.
{"title":"Comparing piperacillin/tazobactam to current guidelines for the treatment of open fractures: A systematic review","authors":"Eric Kholodovsky , Dylan Luxenburg , William Marmor , Ashleigh Gibula , Giselle Hernandez","doi":"10.1016/j.jor.2024.10.059","DOIUrl":"10.1016/j.jor.2024.10.059","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines call for the use of a first-generation cephalosporin with or without an aminoglycoside for the treatment of open fractures. Due to its superior safety profile and single-dose administration, Piperacillin/tazobactam (PT) may be an effective alternative. The present systematic literature review aimed to evaluate the hypothesis that PT antibiotic prophylaxis does not differ in clinical outcomes as compared to the current guidelines in the treatment of open fractures.</div></div><div><h3>Methods</h3><div>Five databases were queried for literature pertaining to PT administration for open fractures. A 2-author screening process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodologic index for non-randomized studies criteria was used to objectively assess the methodologic quality of the studies reviewed. Retrospective cohort studies that compared PT to current guidelines in open fractures were included.</div></div><div><h3>Results</h3><div>Four retrospective cohort studies consisting of 752 patients were included. The injury severity score (ISS) score was higher for the PT group, 18.1, versus the control group, 14.5 (p = .0008). Seventy-eight patients developed a surgical site infection (SSI) in the PT group versus 67 patients in the control group (p = .82). Twenty-one patients developed an acute kidney injury (AKI) in the PT group versus 19 in the control group (p = .51). There was no difference in the number of patients who developed resistant pathogens (6 (PT group) vs. 1 (control group); p = .99). Length of stay was greater in the PT group, 16.4 days, compared to the control group, 10.5 days (p=<0.00001).</div></div><div><h3>Conclusion</h3><div>The use of piperacillin/tazobactam for open fractures does not differ from first-generation cephalosporins with or without an aminoglycoside in regard to SSI, AKI, return to operating room, 1-year mortality, non-union, and development of resistant pathogens. LOS was significantly longer in the PT group but may be explained by a greater ISS. PT may be a non-inferior alternative to current guidelines due to its better safety profile and single-dose administration method, however, this review is limited by the lack of side effect reporting and underscores the need for larger prospective studies that compare side effect profiles between PT and control groups.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jor.2024.10.056
Y.S. Kishore , B.M. Sreedhara , A. Manoj , R.M. Raveesh , B. Rakesh , S. Bhaskar , Geetha Kuntoji , B.A. Chethan
Lower Back Pain (LBP) is a global health issue, with increasing prevalence, partly attributed to vehicular vibrations experienced by motorcyclists. The L4 lumbar vertebra is responsible for greater mobility and flexibility of the body, but also is the most crucial body element affected by vehicular vibrations. Anthropometric properties, types of speed humps, and vehicle types are the critical variables that impact bone health during riding, need to be studied. To understand the potential zones of injury, computational simulation can be performed under the influence of vehicle vibrations while crossing different types of speed humps at varying speeds. In the present study, finite element method (FEM) is used to evaluate stress and deformation in the bone. The L4 cortical bone is modelled by considering the CT-Scan data and assumed to be homogeneous and isotropic material. Vibration data is collected using two vehicle types (Type I and Type II) on four different humps (Trapezoidal, Bitumen Semi-circular, Rubber Semi-circular, and Rumble strip). The bone's dynamic behavior is studied using FEM simulation, which involved static structural, modal and transient dynamic analyses. The findings from static analysis indicate that the most concentrated stress is located in the lower pedicle region and is an expected commonplace for injuries because of vibrations. In transient dynamic analysis, Type I vehicle showed a 25 % higher stress than Type II.
下背痛（LBP）是一个全球性的健康问题，发病率越来越高，部分原因是摩托车驾驶员所经历的车辆振动。L4腰椎负责身体更大的活动性和灵活性，但也是受车辆振动影响最严重的身体部位。人体测量特性、减速带类型和车辆类型是骑行过程中影响骨骼健康的关键变量，需要加以研究。为了了解潜在的受伤区域，可以在不同速度穿越不同类型减速带时，在车辆振动的影响下进行计算模拟。本研究采用有限元法（FEM）评估骨骼的应力和变形。考虑到 CT 扫描数据，对 L4 皮质骨进行建模，并假定其为均质和各向同性材料。在四种不同的驼峰（梯形、沥青半圆形、橡胶半圆形和隆起条）上使用两种车辆类型（I 型和 II 型）收集振动数据。使用有限元模拟对骨的动态行为进行了研究，包括静态结构、模态和瞬态动态分析。静态分析结果表明，应力最集中的部位是下椎弓根区域，这也是由于振动造成损伤的常见原因。在瞬态动态分析中，I 型车辆的应力比 II 型车辆高 25%。
{"title":"Effect of vehicular vibrations on L-4 lumbar vertebrae – A finite element study","authors":"Y.S. Kishore , B.M. Sreedhara , A. Manoj , R.M. Raveesh , B. Rakesh , S. Bhaskar , Geetha Kuntoji , B.A. Chethan","doi":"10.1016/j.jor.2024.10.056","DOIUrl":"10.1016/j.jor.2024.10.056","url":null,"abstract":"<div><div>Lower Back Pain (LBP) is a global health issue, with increasing prevalence, partly attributed to vehicular vibrations experienced by motorcyclists. The L4 lumbar vertebra is responsible for greater mobility and flexibility of the body, but also is the most crucial body element affected by vehicular vibrations. Anthropometric properties, types of speed humps, and vehicle types are the critical variables that impact bone health during riding, need to be studied. To understand the potential zones of injury, computational simulation can be performed under the influence of vehicle vibrations while crossing different types of speed humps at varying speeds. In the present study, finite element method (FEM) is used to evaluate stress and deformation in the bone. The L4 cortical bone is modelled by considering the CT-Scan data and assumed to be homogeneous and isotropic material. Vibration data is collected using two vehicle types (Type I and Type II) on four different humps (Trapezoidal, Bitumen Semi-circular, Rubber Semi-circular, and Rumble strip). The bone's dynamic behavior is studied using FEM simulation, which involved static structural, modal and transient dynamic analyses. The findings from static analysis indicate that the most concentrated stress is located in the lower pedicle region and is an expected commonplace for injuries because of vibrations. In transient dynamic analysis, Type I vehicle showed a 25 % higher stress than Type II.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jor.2024.10.054
Mohammad Daher, Mariah Balmaceno-Criss, Jonathan Liu, Manjot Singh, Michael J. Kuharski, Alan H. Daniels, Eric M. Cohen
Background
Patients with atrial fibrillation (AF) often require lifetime anticoagulation using drugs such as Warfarin and Direct-acting Oral Anticoagulants (DOAC). It is important to assess the impact that prior anticoagulant use has on the post-operative complications in patients with AF undergoing TKA.
Methods
This is a retrospective analysis of the PearlDiver database querying all patients who underwent an inpatient TKA. Patients who had AF and filled a prescription for at least 30 days of either Warfarin or a DOAC were matched to control cohorts. Medical and surgical complications 30 and 90 days post-operatively were compared between the two groups.
Results
4396 patients made up the group with AF on warfarin, while 5383 patients made up the cohort with AF on DOAC and their corresponding controls. Patients on anticoagulation had more AKI (OR 2.70, OR: 2.37), pneumonia (OR: 2.89, OR: 2.46), MI (OR: 2.70, OR: 3.14), transfusion (OR: 6.94, OR: 3.16), sepsis (OR: 2.47, OR: 1.96), and aseptic loosening at 90 days (OR: 17.06, OR:7.01). However, PE (OR: 3.32) and hematoma (OR: 1.71) were only higher in the warfarin cohort. TKA instability was higher in the DOAC cohort (OR: 6.00). Conversely, patients in the control group exhibited more wound dehiscence compared to the warfarin group (OR: 0.28), and higher rates of revision surgery compared to both the DOAC (OR:0.27) and Warfarin (OR:0.31) groups at 90 days.
Conclusion
Patients on DOAC and Warfarin for AF, and undergoing TKA are exposed to a higher risk of post-operative complications.
{"title":"Anticoagulation in patients with atrial fibrillation undergoing inpatient total knee arthroplasty: A matched analysis","authors":"Mohammad Daher, Mariah Balmaceno-Criss, Jonathan Liu, Manjot Singh, Michael J. Kuharski, Alan H. Daniels, Eric M. Cohen","doi":"10.1016/j.jor.2024.10.054","DOIUrl":"10.1016/j.jor.2024.10.054","url":null,"abstract":"<div><h3>Background</h3><div>Patients with atrial fibrillation (AF) often require lifetime anticoagulation using drugs such as Warfarin and Direct-acting Oral Anticoagulants (DOAC). It is important to assess the impact that prior anticoagulant use has on the post-operative complications in patients with AF undergoing TKA.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of the PearlDiver database querying all patients who underwent an inpatient TKA. Patients who had AF and filled a prescription for at least 30 days of either Warfarin or a DOAC were matched to control cohorts. Medical and surgical complications 30 and 90 days post-operatively were compared between the two groups.</div></div><div><h3>Results</h3><div>4396 patients made up the group with AF on warfarin, while 5383 patients made up the cohort with AF on DOAC and their corresponding controls. Patients on anticoagulation had more AKI (OR 2.70, OR: 2.37), pneumonia (OR: 2.89, OR: 2.46), MI (OR: 2.70, OR: 3.14), transfusion (OR: 6.94, OR: 3.16), sepsis (OR: 2.47, OR: 1.96), and aseptic loosening at 90 days (OR: 17.06, OR:7.01). However, PE (OR: 3.32) and hematoma (OR: 1.71) were only higher in the warfarin cohort. TKA instability was higher in the DOAC cohort (OR: 6.00). Conversely, patients in the control group exhibited more wound dehiscence compared to the warfarin group (OR: 0.28), and higher rates of revision surgery compared to both the DOAC (OR:0.27) and Warfarin (OR:0.31) groups at 90 days.</div></div><div><h3>Conclusion</h3><div>Patients on DOAC and Warfarin for AF, and undergoing TKA are exposed to a higher risk of post-operative complications.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jor.2024.10.046
Owais Ahmed , Suresh R Prabhu , Ajoy Prasad Shetty , A. Nousy , Mohamed Zackariya , Dheenadhayalan Jayaramaraju , Abishek Sivan , Rajasekaran Shanmuganathan
Introduction
Diabetes-mellitus (DM) has transcended the boundaries and affected populations across globe, it predisposes individual to stiffness and musculoskeletal-pain due to accumulation of glycation-end-products. Musculoskeletal-pain is a common yet frequently neglected complication. Pain mechanisms have been categorized as nociceptive, neuropathic, nociplastic, and idiopathic. Four criteria were put by Kosek-et-al to identify nociplastic pain that affects the musculoskeletal-system. Study aimed to evaluate prevalence of chronic musculoskeletal (cMSK) pain and its association with diabetes and glycaemic control and to evaluate comorbid conditions of cMSK pain.
Methods and materials
A prospective case-control study was conducted at a level-1-tertiary-care-facility. Patients with type-2 DM above 30-years-age who visited outpatient department participated in the study (study group). Age-matched equal number of healthy individuals (control-cohort) were recruited in the study. We collected data from 300 participants in each group. Analysis was done based-on HbA1c-levels, random-blood-sugar (RBS),clinical-history, and comorbidities. Information regarding cMSK-pain was gathered using modified version of Nordic standard questionnaire.
Results
Overall prevalence of cMSK pain was 23.3 % (140 out of 600). Among Group-1/Diabetic group, it was 27.7 % and among group-2/Healthy Cohort it was 19 % and the odds ratio was 1.6. Most commonly reported region with cMSK among group-1 and group-2 was shoulder (32.5 %) and knee (36.8 %) respectively. We found a significant association between cMSK-pain and HbA1c levels (p < 0.005). and individuals with HbA1c levels of more than 12 reported involvements in multiple regions. We didn't find significant association between cMSK and DM, HTN, dyslipidemia, or hypothyroidism (P > 0.05).
Conclusion
Study highlights higher-prevalence and significant impact of cMSK pain in diabetic patients compared to non-diabetic individuals. Addressing musculoskeletal-pain is crucial for improving overall quality-of-life in diabetic patients. Clinicians should adopt a proactive and comprehensive approach to pain management in diabetics. Using a simple Nordic questionnaire during routine check-ups helps with screening of joint and surrounding soft tissue pathology, preventing future complications that could lead to disability.
{"title":"“Exploring The Nexus”: Chronic musculoskeletal pain in diabetic vs non-diabetic population","authors":"Owais Ahmed , Suresh R Prabhu , Ajoy Prasad Shetty , A. Nousy , Mohamed Zackariya , Dheenadhayalan Jayaramaraju , Abishek Sivan , Rajasekaran Shanmuganathan","doi":"10.1016/j.jor.2024.10.046","DOIUrl":"10.1016/j.jor.2024.10.046","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetes-mellitus (DM) has transcended the boundaries and affected populations across globe, it predisposes individual to stiffness and musculoskeletal-pain due to accumulation of glycation-end-products. Musculoskeletal-pain is a common yet frequently neglected complication. Pain mechanisms have been categorized as nociceptive, neuropathic, nociplastic, and idiopathic. Four criteria were put by Kosek-et-al to identify nociplastic pain that affects the musculoskeletal-system. Study aimed to evaluate prevalence of chronic musculoskeletal (cMSK) pain and its association with diabetes and glycaemic control and to evaluate comorbid conditions of cMSK pain.</div></div><div><h3>Methods and materials</h3><div>A prospective case-control study was conducted at a level-1-tertiary-care-facility. Patients with type-2 DM above 30-years-age who visited outpatient department participated in the study (study group). Age-matched equal number of healthy individuals (control-cohort) were recruited in the study. We collected data from 300 participants in each group. Analysis was done based-on HbA1c-levels, random-blood-sugar (RBS),clinical-history, and comorbidities. Information regarding cMSK-pain was gathered using modified version of Nordic standard questionnaire.</div></div><div><h3>Results</h3><div>Overall prevalence of cMSK pain was 23.3 % (140 out of 600). Among Group-1/Diabetic group, it was 27.7 % and among group-2/Healthy Cohort it was 19 % and the odds ratio was 1.6. Most commonly reported region with cMSK among group-1 and group-2 was shoulder (32.5 %) and knee (36.8 %) respectively. We found a significant association between cMSK-pain and HbA1c levels (p < 0.005). and individuals with HbA1c levels of more than 12 reported involvements in multiple regions. We didn't find significant association between cMSK and DM, HTN, dyslipidemia, or hypothyroidism (P > 0.05).</div></div><div><h3>Conclusion</h3><div>Study highlights higher-prevalence and significant impact of cMSK pain in diabetic patients compared to non-diabetic individuals. Addressing musculoskeletal-pain is crucial for improving overall quality-of-life in diabetic patients. Clinicians should adopt a proactive and comprehensive approach to pain management in diabetics. Using a simple Nordic questionnaire during routine check-ups helps with screening of joint and surrounding soft tissue pathology, preventing future complications that could lead to disability.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jor.2024.10.055
Whisper Grayson, Carlo Eikani, Nicholas M. Brown, Daniel Schmitt
Background
Periprosthetic fractures and mechanical failure following total hip arthroplasty (THA) are not uncommon occurrences in elderly patients, especially with the use of cementless implants. The utilization of collared, triple-tapered femoral stems has demonstrated good clinical outcomes and results comparable to other femoral stems. There remains a paucity of literature on the use of these stems in older patients. In this study, we evaluated post-operative outcomes following primary THA in patients ≥70-years old using a collared, triple-tapered femoral stem.
Methods
Retrospective study including 91 primary THAs in patients ≥70-years old using a triple-tapered femoral stem, between September 2017 and July 2024. Primary outcomes included intraoperative or post-operative periprosthetic fractures and subsidence of the femoral stem. Subsidence was measured on x-rays as the distance between the most proximal aspect of the greater trochanter and the shoulder of the femoral stem.
Results
A total of 91 patients were included, with no periprosthetic fractures observed intraoperatively or post-operatively. The average femoral stem subsidence at 6-weeks post-operative was 1.1 mm (std dev, 0.9) compared to baseline post-operative imaging. At that time point three patients had subsidence ≥3 mm, with no clinically significant symptoms. There was one prosthetic joint infection requiring revision and three superficial surgical site infections. The overall average follow-up time was 12.5 months (std dev, 12.7).
Conclusion
In this study, we found low rates of subsidence and no periprosthetic fractures following primary THA with triple-taper stems in patients ≥70-years old. Of note, no revision surgeries were performed for mechanical failure.
{"title":"The short-term outcomes of cementless collared triple-tapered stem for primary total hip arthroplasty in patients ≥70-years old","authors":"Whisper Grayson, Carlo Eikani, Nicholas M. Brown, Daniel Schmitt","doi":"10.1016/j.jor.2024.10.055","DOIUrl":"10.1016/j.jor.2024.10.055","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic fractures and mechanical failure following total hip arthroplasty (THA) are not uncommon occurrences in elderly patients, especially with the use of cementless implants. The utilization of collared, triple-tapered femoral stems has demonstrated good clinical outcomes and results comparable to other femoral stems. There remains a paucity of literature on the use of these stems in older patients. In this study, we evaluated post-operative outcomes following primary THA in patients ≥70-years old using a collared, triple-tapered femoral stem.</div></div><div><h3>Methods</h3><div>Retrospective study including 91 primary THAs in patients ≥70-years old using a triple-tapered femoral stem, between September 2017 and July 2024. Primary outcomes included intraoperative or post-operative periprosthetic fractures and subsidence of the femoral stem. Subsidence was measured on x-rays as the distance between the most proximal aspect of the greater trochanter and the shoulder of the femoral stem.</div></div><div><h3>Results</h3><div>A total of 91 patients were included, with no periprosthetic fractures observed intraoperatively or post-operatively. The average femoral stem subsidence at 6-weeks post-operative was 1.1 mm (std dev, 0.9) compared to baseline post-operative imaging. At that time point three patients had subsidence ≥3 mm, with no clinically significant symptoms. There was one prosthetic joint infection requiring revision and three superficial surgical site infections. The overall average follow-up time was 12.5 months (std dev, 12.7).</div></div><div><h3>Conclusion</h3><div>In this study, we found low rates of subsidence and no periprosthetic fractures following primary THA with triple-taper stems in patients ≥70-years old. Of note, no revision surgeries were performed for mechanical failure.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jor.2024.10.053
Victoria E. Bergstein, Walter L. Taylor IV, Aaron I. Weinblatt, William J. Long
Background
Aspirin has been shown to be equally or more effective than factor Xa inhibitors for thromboprophylaxis following total knee arthroplasty (TKA). Cefazolin has been proven more effective than vancomycin in preventing prosthetic joint infection (PJI) after TKA. This study aimed to compare costs between different drug combinations for prevention of venous thromboembolism (VTE) and PJI following TKA, focusing on costs associated with PJI management.
Methods
We used published PJI rates for TKA patients treated with aspirin or factor Xa inhibitors for thromboprophylaxis, as well as for those who received prophylactic cefazolin or vancomycin. Unit prices for each drug and labor costs associated with vancomycin administration were obtained from our hospital's pharmacy service. The PJI cost model included the price of 2-stage septic TKA revision and national projections of future TKA volume.
Results
The least expensive average per-patient cost resulted from the combination of aspirin and cefazolin, equating to $521.19 given a 0.8 % PJI rate. The most expensive average per-patient cost was the combination of a factor Xa inhibitor and vancomycin, equaling $5,714.96 given a 1.8 % PJI rate. This extrapolates to an annual cost burden of $19.5 billion by 2040.
Conclusion
The average per-patient cost of using a combination of a factor Xa inhibitor and vancomycin is 711 % greater than the combination of aspirin and cefazolin. In this era of value-based care, aspirin and cefazolin should be considered gold standards for TKA thromboprophylaxis and PJI prophylaxis, as they reduce costs and improve patient outcomes.
{"title":"Hidden costs of first choice alternatives: A financial model of thromboprophylaxis and prosthetic joint infection prophylaxis in total knee arthroplasty","authors":"Victoria E. Bergstein, Walter L. Taylor IV, Aaron I. Weinblatt, William J. Long","doi":"10.1016/j.jor.2024.10.053","DOIUrl":"10.1016/j.jor.2024.10.053","url":null,"abstract":"<div><h3>Background</h3><div>Aspirin has been shown to be equally or more effective than factor Xa inhibitors for thromboprophylaxis following total knee arthroplasty (TKA). Cefazolin has been proven more effective than vancomycin in preventing prosthetic joint infection (PJI) after TKA. This study aimed to compare costs between different drug combinations for prevention of venous thromboembolism (VTE) and PJI following TKA, focusing on costs associated with PJI management.</div></div><div><h3>Methods</h3><div>We used published PJI rates for TKA patients treated with aspirin or factor Xa inhibitors for thromboprophylaxis, as well as for those who received prophylactic cefazolin or vancomycin. Unit prices for each drug and labor costs associated with vancomycin administration were obtained from our hospital's pharmacy service. The PJI cost model included the price of 2-stage septic TKA revision and national projections of future TKA volume.</div></div><div><h3>Results</h3><div>The least expensive average per-patient cost resulted from the combination of aspirin and cefazolin, equating to $521.19 given a 0.8 % PJI rate. The most expensive average per-patient cost was the combination of a factor Xa inhibitor and vancomycin, equaling $5,714.96 given a 1.8 % PJI rate. This extrapolates to an annual cost burden of $19.5 billion by 2040.</div></div><div><h3>Conclusion</h3><div>The average per-patient cost of using a combination of a factor Xa inhibitor and vancomycin is 711 % greater than the combination of aspirin and cefazolin. In this era of value-based care, aspirin and cefazolin should be considered gold standards for TKA thromboprophylaxis and PJI prophylaxis, as they reduce costs and improve patient outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jor.2024.10.050
Arne De Smet , Jan Truijen , Luc Vanlommel
Purpose
Many patients remain unsatisfied after total knee arthroplasty (TKA). Personalized alignment strategies have gained popularity in the search to improve patient satisfaction and function. This study aimed to examine the impact of limb overcorrection in the coronal plane on patient satisfaction and functional outcome. The secondary aim was to investigate how a change in knee phenotype following TKA affects clinical outcome.
Methods
A retrospective matched case-control study was designed between patients with limb overcorrection (N = 37) and a control group (N = 104). Mean follow-up was 68 months. Satisfaction and function were compared by means of the new 2011 Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Radiological evaluation was performed on weight-bearing full-leg radiographs. Overcorrection was defined as a mechanical HKA (mHKA) angle of 2° or more and opposite to the preoperative alignment. The control group consisted of TKAs that were corrected to neutral or left in slight undercorrection. Finally, component alignment (lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA)) and Coronal Plane Alignment of the knee (CPAK) phenotypes were evaluated.
Results
The overcorrection group performed better than the control group in terms of KSS subscores satisfaction and functional activities, total KSS score, all KOOS subcategories, and total KOOS score. Subdivision of the control group into a neutral and undercorrection group, and the overcorrection group into mild and severe overcorrection, revealed similar findings.
A chance in knee phenotype as per aHKA, JLO or CPAK did not result in worse clinical outcomes.
Conclusion
Accidental limb overcorrection after TKA does not result in inferior clinical outcomes or patient satisfaction at midterm follow-up.
The present study could not identify an optimal coronal alignment target. This suggests that coronal alignment as a predictor of patient satisfaction and function is likely less important than previously believed.
{"title":"Is limb overcorrection following total knee arthroplasty compromising functional outcome?","authors":"Arne De Smet , Jan Truijen , Luc Vanlommel","doi":"10.1016/j.jor.2024.10.050","DOIUrl":"10.1016/j.jor.2024.10.050","url":null,"abstract":"<div><h3>Purpose</h3><div>Many patients remain unsatisfied after total knee arthroplasty (TKA). Personalized alignment strategies have gained popularity in the search to improve patient satisfaction and function. This study aimed to examine the impact of limb overcorrection in the coronal plane on patient satisfaction and functional outcome. The secondary aim was to investigate how a change in knee phenotype following TKA affects clinical outcome.</div></div><div><h3>Methods</h3><div>A retrospective matched case-control study was designed between patients with limb overcorrection (N = 37) and a control group (N = 104). Mean follow-up was 68 months. Satisfaction and function were compared by means of the new 2011 Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Radiological evaluation was performed on weight-bearing full-leg radiographs. Overcorrection was defined as a mechanical HKA (mHKA) angle of 2° or more and opposite to the preoperative alignment. The control group consisted of TKAs that were corrected to neutral or left in slight undercorrection. Finally, component alignment (lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA)) and Coronal Plane Alignment of the knee (CPAK) phenotypes were evaluated.</div></div><div><h3>Results</h3><div>The overcorrection group performed better than the control group in terms of KSS subscores satisfaction and functional activities, total KSS score, all KOOS subcategories, and total KOOS score. Subdivision of the control group into a neutral and undercorrection group, and the overcorrection group into mild and severe overcorrection, revealed similar findings.</div><div>A chance in knee phenotype as per aHKA, JLO or CPAK did not result in worse clinical outcomes.</div></div><div><h3>Conclusion</h3><div>Accidental limb overcorrection after TKA does not result in inferior clinical outcomes or patient satisfaction at midterm follow-up.</div><div>The present study could not identify an optimal coronal alignment target. This suggests that coronal alignment as a predictor of patient satisfaction and function is likely less important than previously believed.</div></div><div><h3>Level of evidence</h3><div>Level III, retrospective case-control study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/j.jor.2024.10.039
Edmund Jia Xi Zhang , William Yeo , Eric Xuan Liu , Jerry Yongqiang Chen , Hee Nee Pang , Seng Jin Yeo , Lincoln Ming Han Liow
Objectives
Total knee arthroplasty (TKA) is the established treatment for severe knee osteoarthritis, with robotic-assisted TKA (rTKA) proposed to enhance surgical precision and potentially improve outcomes. This study investigates whether functionally-aligned rTKA using the ROSA Knee System results in superior functional outcomes and patient satisfaction compared to conventional mechanically aligned TKA (mTKA).
Methods
We conducted a retrospective, propensity-score matched cohort study including 154 patients (46 rTKA, 108 mTKA) who underwent primary TKA by a single surgeon from October 2020 to October 2023. Functionally-aligned (FA) rTKA was performed using the ROSA Knee System. Patients were assessed using the Short-Form 36 (SF36), Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Oxford Knee Score (OKS) preoperatively and at 6 months postoperatively. Immediate postoperative outcomes such as pain at rest and movement, ambulation distance, and range of motion were measured. Statistical analysis evaluated results at a 95 % confidence interval, with significance at P < 0.05.
Results
No significant differences were observed in immediate postoperative pain at rest (P = 0.988), pain during movement (P = 0.634), ambulation distance (P = 0.243), and range of motion (P = 0.752) between the groups. At 6 months, there were no significant differences between rTKA and mTKA in achieving the minimal clinically important difference for SF36 (P = 0.996), KSKS (P = 0.150), KSFS (P = 0.091), and OKS (P = 0.949). No significant differences were noted for satisfaction levels (P = 0.315) and fulfilled expectations (P = 0.557) between both groups.
Conclusions
At 6 months postoperatively, FA rTKA demonstrated equivalent outcomes and satisfaction levels compared to mTKA. Future research should focus on examining longer-term follow-up outcomes, quantifying gap balance in MA mTKA to allow direct comparison with rTKA and studying alternative personalised alignment rTKA strategies to enhance patient outcomes.
{"title":"Does robotic surgical assistant (ROSA) functionally aligned TKA lead to higher satisfaction than conventional mechanically aligned TKA: A propensity-matched pair analysis","authors":"Edmund Jia Xi Zhang , William Yeo , Eric Xuan Liu , Jerry Yongqiang Chen , Hee Nee Pang , Seng Jin Yeo , Lincoln Ming Han Liow","doi":"10.1016/j.jor.2024.10.039","DOIUrl":"10.1016/j.jor.2024.10.039","url":null,"abstract":"<div><h3>Objectives</h3><div>Total knee arthroplasty (TKA) is the established treatment for severe knee osteoarthritis, with robotic-assisted TKA (rTKA) proposed to enhance surgical precision and potentially improve outcomes. This study investigates whether functionally-aligned rTKA using the ROSA Knee System results in superior functional outcomes and patient satisfaction compared to conventional mechanically aligned TKA (mTKA).</div></div><div><h3>Methods</h3><div>We conducted a retrospective, propensity-score matched cohort study including 154 patients (46 rTKA, 108 mTKA) who underwent primary TKA by a single surgeon from October 2020 to October 2023. Functionally-aligned (FA) rTKA was performed using the ROSA Knee System. Patients were assessed using the Short-Form 36 (SF36), Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Oxford Knee Score (OKS) preoperatively and at 6 months postoperatively. Immediate postoperative outcomes such as pain at rest and movement, ambulation distance, and range of motion were measured. Statistical analysis evaluated results at a 95 % confidence interval, with significance at <em>P</em> < 0.05.</div></div><div><h3>Results</h3><div>No significant differences were observed in immediate postoperative pain at rest (<em>P</em> = 0.988), pain during movement (<em>P</em> = 0.634), ambulation distance (<em>P</em> = 0.243), and range of motion (<em>P</em> = 0.752) between the groups. At 6 months, there were no significant differences between rTKA and mTKA in achieving the minimal clinically important difference for SF36 (<em>P</em> = 0.996), KSKS (<em>P</em> = 0.150), KSFS (<em>P</em> = 0.091), and OKS (<em>P</em> = 0.949). No significant differences were noted for satisfaction levels (<em>P</em> = 0.315) and fulfilled expectations (<em>P</em> = 0.557) between both groups.</div></div><div><h3>Conclusions</h3><div>At 6 months postoperatively, FA rTKA demonstrated equivalent outcomes and satisfaction levels compared to mTKA. Future research should focus on examining longer-term follow-up outcomes, quantifying gap balance in MA mTKA to allow direct comparison with rTKA and studying alternative personalised alignment rTKA strategies to enhance patient outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/j.jor.2024.10.045
Raju Karuppal
As artificial intelligence continues its ascent across numerous sectors, it presents both exciting opportunities and unique challenges for the future of academic publishing. Artificial intelligence (AI) is the way of computer systems to perform tasks that has been done by human brain before, such as learning, problem-solving, and decision-making. In the realm of medical writing, AI is being harnessed through various applications. The increasing amalgamation of AI into medical writing has ignited a fervent debate, with experts and stakeholders divided on whether it represents a valuable tool for progress or a potential threat to the integrity and quality of scientific publications. While proponents celebrate AI's potential to streamline research, enhance efficiency, and broaden access to knowledge, critics voice concerns about ethical implications, the risk of plagiarism, and the potential for deskilling among researchers. Therefore, it is pivotal to acknowledge that AI has the potential to be both a boon and a bane, and its ethical and practical implications must be carefully considered to ensure its responsible and beneficial integration into the spectrum of medical writing.
{"title":"The impact of artificial intelligence on medical article writing: A boon or a bane?","authors":"Raju Karuppal","doi":"10.1016/j.jor.2024.10.045","DOIUrl":"10.1016/j.jor.2024.10.045","url":null,"abstract":"<div><div>As artificial intelligence continues its ascent across numerous sectors, it presents both exciting opportunities and unique challenges for the future of academic publishing. Artificial intelligence (AI) is the way of computer systems to perform tasks that has been done by human brain before, such as learning, problem-solving, and decision-making. In the realm of medical writing, AI is being harnessed through various applications. The increasing amalgamation of AI into medical writing has ignited a fervent debate, with experts and stakeholders divided on whether it represents a valuable tool for progress or a potential threat to the integrity and quality of scientific publications. While proponents celebrate AI's potential to streamline research, enhance efficiency, and broaden access to knowledge, critics voice concerns about ethical implications, the risk of plagiarism, and the potential for deskilling among researchers. Therefore, it is pivotal to acknowledge that AI has the potential to be both a boon and a bane, and its ethical and practical implications must be carefully considered to ensure its responsible and beneficial integration into the spectrum of medical writing.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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