Pub Date : 2024-12-27DOI: 10.1016/j.jor.2024.12.028
Hsuan-Wei Liu , Shin-Da Lee
Background
Meta-analysis assesses the safety and efficacy of Tranexamic Acid (TXA) in patients with hip fracture surgery compared to placebo.
Methods
On September 28, 2023, qualified RCT studies, including randomized control trials and cohort study, of intravenous Tranexamic Acid (TXA) in patients undergoing hip fracture surgery was searched. Review Manager was used for the meta-analysis.
Results
The TXA group had significantly lower intraoperative total blood loss and overall blood loss across eighteen investigations. The blood transfusion rate in the TXA group was lower than that in placebo group. TXA maintained higher hemoglobin levels on the postoperative first and third day. TXA did not raise any possible complication or problems such as deep vein thrombosis, pulmonary embolism, and mortality.
Conclusion
The TXA treatment in patients undergoing hip fracture surgery reduced intraoperative blood loss, overall blood loss, transfusion rate, and length of hospital stay effectively and appeared to be safe to use without significant complication or problems.
{"title":"Tranexamic acid in Patients with hip fracture surgery: A systematic review and meta-analysis of efficacy and safety","authors":"Hsuan-Wei Liu , Shin-Da Lee","doi":"10.1016/j.jor.2024.12.028","DOIUrl":"10.1016/j.jor.2024.12.028","url":null,"abstract":"<div><h3>Background</h3><div>Meta-analysis assesses the safety and efficacy of Tranexamic Acid (TXA) in patients with hip fracture surgery compared to placebo.</div></div><div><h3>Methods</h3><div>On September 28, 2023, qualified RCT studies, including randomized control trials and cohort study, of intravenous Tranexamic Acid (TXA) in patients undergoing hip fracture surgery was searched. Review Manager was used for the meta-analysis.</div></div><div><h3>Results</h3><div>The TXA group had significantly lower intraoperative total blood loss and overall blood loss across eighteen investigations. The blood transfusion rate in the TXA group was lower than that in placebo group. TXA maintained higher hemoglobin levels on the postoperative first and third day. TXA did not raise any possible complication or problems such as deep vein thrombosis, pulmonary embolism, and mortality.</div></div><div><h3>Conclusion</h3><div>The TXA treatment in patients undergoing hip fracture surgery reduced intraoperative blood loss, overall blood loss, transfusion rate, and length of hospital stay effectively and appeared to be safe to use without significant complication or problems.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 154-164"},"PeriodicalIF":1.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080437","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 : 2024-12-27DOI: 10.1016/j.jor.2024.12.036
Brandon Leon, Evan L. Honig, Samir Kaveeshwar, Dominic J. Ventimiglia, Leah E. Henry, Alexandra Baker Lutz, Natalie L. Leong, Sean J. Meredith, Jonathan D. Packer, R. Frank Henn III
Introduction
Higher preoperative patient expectations correlate with better early postoperative outcomes and satisfaction after orthopaedic surgery. However, it is unclear if this association is maintained past one year after knee surgery. It was hypothesized that greater preoperative expectations would be predictive of better patient-reported pain and function two years after knee surgery.
Materials and methods
460 patients undergoing knee surgery between June 2015 and April 2018 were reviewed retrospectively. Baseline and two-year follow-up questionnaires were administered consisting of six Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing domains, the International Knee Documentation Committee (IKDC) score, a numeric pain scale (NPS), the Tegner Activity Scale (TAS), and the Marx Activity Rating Scale (MARS). Preoperative expectations were measured using the Musculoskeletal Outcomes and Data Evaluation Management System (MODEMS) preoperative expectations domain, and satisfaction was measured via the Surgical Satisfaction Questionnaire (SSQ-8). Statistical analysis was performed to identify associations between preoperative expectations and patient-reported outcomes at two years postoperatively.
Results
The mean (SD) preoperative expectations score was 91.0 (17.9). Greater preoperative expectations were associated with various demographic factors as well as baseline PROMIS Social Satisfaction, NPS body, and MARS lower extremity scores. Greater preoperative expectations were associated with both significantly better two-year and improvement in PROMIS Physical Function, PROMIS Pain Interference, and IKDC. Additionally, greater preoperative expectations were associated with better two-year PROMIS Fatigue, PROMIS Anxiety, whole body NPS, and Met Expectations, as well as greater improvement in PROMIS Social Satisfaction. Multivariable analysis found that greater preoperative expectations were predictive of improvement in PROMIS Pain Interference and IKDC.
Conclusion
Greater preoperative expectations are independently predictive of improvement in pain and function two years after knee surgery. The impact of patient expectations on outcomes after knee surgery appear to be long-lasting; therefore, optimization of expectations prior to surgery may help maximize postoperative outcomes.
{"title":"Greater preoperative expectations predict improvement in pain and function two years after knee surgery","authors":"Brandon Leon, Evan L. Honig, Samir Kaveeshwar, Dominic J. Ventimiglia, Leah E. Henry, Alexandra Baker Lutz, Natalie L. Leong, Sean J. Meredith, Jonathan D. Packer, R. Frank Henn III","doi":"10.1016/j.jor.2024.12.036","DOIUrl":"10.1016/j.jor.2024.12.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Higher preoperative patient expectations correlate with better early postoperative outcomes and satisfaction after orthopaedic surgery. However, it is unclear if this association is maintained past one year after knee surgery. It was hypothesized that greater preoperative expectations would be predictive of better patient-reported pain and function two years after knee surgery.</div></div><div><h3>Materials and methods</h3><div>460 patients undergoing knee surgery between June 2015 and April 2018 were reviewed retrospectively. Baseline and two-year follow-up questionnaires were administered consisting of six Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing domains, the International Knee Documentation Committee (IKDC) score, a numeric pain scale (NPS), the Tegner Activity Scale (TAS), and the Marx Activity Rating Scale (MARS). Preoperative expectations were measured using the Musculoskeletal Outcomes and Data Evaluation Management System (MODEMS) preoperative expectations domain, and satisfaction was measured via the Surgical Satisfaction Questionnaire (SSQ-8). Statistical analysis was performed to identify associations between preoperative expectations and patient-reported outcomes at two years postoperatively.</div></div><div><h3>Results</h3><div>The mean (SD) preoperative expectations score was 91.0 (17.9). Greater preoperative expectations were associated with various demographic factors as well as baseline PROMIS Social Satisfaction, NPS body, and MARS lower extremity scores. Greater preoperative expectations were associated with both significantly better two-year and improvement in PROMIS Physical Function, PROMIS Pain Interference, and IKDC. Additionally, greater preoperative expectations were associated with better two-year PROMIS Fatigue, PROMIS Anxiety, whole body NPS, and Met Expectations, as well as greater improvement in PROMIS Social Satisfaction. Multivariable analysis found that greater preoperative expectations were predictive of improvement in PROMIS Pain Interference and IKDC.</div></div><div><h3>Conclusion</h3><div>Greater preoperative expectations are independently predictive of improvement in pain and function two years after knee surgery. The impact of patient expectations on outcomes after knee surgery appear to be long-lasting; therefore, optimization of expectations prior to surgery may help maximize postoperative outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 14-19"},"PeriodicalIF":1.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153740","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 : 2024-12-26DOI: 10.1016/j.jor.2024.12.032
Felix B. Ankomah , Aaron C. Spaulding , Ingrid L. Rodgers , Rebecca A. Klingbeil , Alberto E. Ardon , Luke S. Spencer-Gardner , Cameron K. Ledford
Background
Intraoperative hypothermia (HT) is commonly experienced among patients undergoing total joint arthroplasty (TJA) and may be associated with increased blood loss, pain, and complications. Our study evaluated acute outcomes of patients with and without HT after primary total hip (THA) and knee arthroplasty (TKA).
Methods
We identified 220 postoperative HT TJA cases (119 THAs and 101 TKAs) at a single institution as defined by a body temperature of <96.8° Fahrenheit (F) immediately in the post-anesthesia care unit (PACU). Cases were matched to non-hypothermia (NHT) controls 1:2 based on procedure type, age, sex, and body mass index. Intraoperative, immediate PACU, and 90-day outcomes were compared, including vital signs, blood loss, pain scores, opioid use, length of stay (LOS), complications, reoperations, Hip Osteoarthritis Outcome Score, Jr (HOOS), and Knee Osteoarthritis Outcome Score, Jr (KOOS).
Results
HT patients after THA and TKA did not experience significant differences in immediate PACU or hospital-based outcomes, including vital signs, pain scores, opioid consumption, LOS, or home discharge (P ≥ 0.1). Additionally, there were no differences in readmissions, VTEs, or HOOS/KOOS at 90 days (P ≥ 0.2). Although not statistically significant, HT THA patients trended toward more reoperations compared to NHT (5 versus 1.7 %, respectively, P = 0.08), but not for TKA (P = 0.5). Wound debridement for debridement for superficial wound dehiscence was the most common reoperation in HT cohorts.
Conclusion
TJA patients experiencing perioperative HT do not have clinically significant different acute recovery and 90-day outcomes compared to NHT controls. While surgical patient normothermia remains important, both anesthetic and surgical considerations should be factored into determining the most optimal operating room temperature.
{"title":"Does perioperative hypothermia after primary total hip and knee arthroplasty affect acute outcomes?","authors":"Felix B. Ankomah , Aaron C. Spaulding , Ingrid L. Rodgers , Rebecca A. Klingbeil , Alberto E. Ardon , Luke S. Spencer-Gardner , Cameron K. Ledford","doi":"10.1016/j.jor.2024.12.032","DOIUrl":"10.1016/j.jor.2024.12.032","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative hypothermia (HT) is commonly experienced among patients undergoing total joint arthroplasty (TJA) and may be associated with increased blood loss, pain, and complications. Our study evaluated acute outcomes of patients with and without HT after primary total hip (THA) and knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>We identified 220 postoperative HT TJA cases (119 THAs and 101 TKAs) at a single institution as defined by a body temperature of <96.8° Fahrenheit (F) immediately in the post-anesthesia care unit (PACU). Cases were matched to non-hypothermia (NHT) controls 1:2 based on procedure type, age, sex, and body mass index. Intraoperative, immediate PACU, and 90-day outcomes were compared, including vital signs, blood loss, pain scores, opioid use, length of stay (LOS), complications, reoperations, Hip Osteoarthritis Outcome Score, Jr (HOOS), and Knee Osteoarthritis Outcome Score, Jr (KOOS).</div></div><div><h3>Results</h3><div>HT patients after THA and TKA did not experience significant differences in immediate PACU or hospital-based outcomes, including vital signs, pain scores, opioid consumption, LOS, or home discharge (<em>P</em> ≥ 0.1). Additionally, there were no differences in readmissions, VTEs, or HOOS/KOOS at 90 days (<em>P</em> ≥ 0.2). Although not statistically significant, HT THA patients trended toward more reoperations compared to NHT (5 versus 1.7 %, respectively, <em>P</em> = 0.08), but not for TKA (<em>P</em> = 0.5). Wound debridement for debridement for superficial wound dehiscence was the most common reoperation in HT cohorts.</div></div><div><h3>Conclusion</h3><div>TJA patients experiencing perioperative HT do not have clinically significant different acute recovery and 90-day outcomes compared to NHT controls. While surgical patient normothermia remains important, both anesthetic and surgical considerations should be factored into determining the most optimal operating room temperature.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 49-53"},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080403","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 : 2024-12-26DOI: 10.1016/j.jor.2024.12.033
Ryan W. Paul , Alim Osman , Jordan T. Windsor , Charlotte Slavick , Anthony A. Romeo , Brandon J. Erickson
Introduction
Surveys such as the Shoulder Instability-Return to Sport after Injury (SIRSI) scores can help identify athletes who are better prepared to return to sport (RTS) after arthroscopic Bankart repair (ABR). Therefore, the purpose of this systematic review was to clarify how psychologically ready athletes are to RTS after ABR, with the secondary purpose of evaluating the impact of psychological readiness on athletes’ ability to RTSS after ABR.
Methods
The Ovid Medline, PubMed, and SportDiscus databases were searched from inception until January 2023 using keywords such as Bankart, anterior labral repair, shoulder stabilization, return to play, and return to sport. Original studies were included if both RTS outcomes after ABR and a psychological factor were reported, with potential psychological factors being psychological readiness to RTS and reasons of failing to RTS.
Results
Overall, 707 studies were screened and 16 met criteria for inclusion. The mean MINORS score of included studies was 13.3 ± 4.1. In patients who failed to RTS, most (74 %) patients failed due to recurrent shoulder instability, pain, or injury, while 26 % reported failing to RTS due to non-shoulder related causes such as apprehension and fear of reinjury. Eight studies evaluated post-operative SIRSI scores with a mean of 65.4 (95 % CI: 62.9–72.8) at an average of 5.4 years post-operatively.
Conclusion
Most athletes fail to RTS due to shoulder-related causes, with apprehension and fear of reinjury as common causes as shoulder-independent causes for failed RTS. The mean SIRSI score after ABR was 65.4, and athletes with higher post-operative SIRSI scores were more likely to RTS.
Level of evidence
IV.
{"title":"Psychological readiness of return to sport after arthroscopic Bankart repair: A systematic review","authors":"Ryan W. Paul , Alim Osman , Jordan T. Windsor , Charlotte Slavick , Anthony A. Romeo , Brandon J. Erickson","doi":"10.1016/j.jor.2024.12.033","DOIUrl":"10.1016/j.jor.2024.12.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Surveys such as the Shoulder Instability-Return to Sport after Injury (SIRSI) scores can help identify athletes who are better prepared to return to sport (RTS) after arthroscopic Bankart repair (ABR). Therefore, the purpose of this systematic review was to clarify how psychologically ready athletes are to RTS after ABR, with the secondary purpose of evaluating the impact of psychological readiness on athletes’ ability to RTSS after ABR.</div></div><div><h3>Methods</h3><div>The Ovid Medline, PubMed, and SportDiscus databases were searched from inception until January 2023 using keywords such as Bankart, anterior labral repair, shoulder stabilization, return to play, and return to sport. Original studies were included if both RTS outcomes after ABR and a psychological factor were reported, with potential psychological factors being psychological readiness to RTS and reasons of failing to RTS.</div></div><div><h3>Results</h3><div>Overall, 707 studies were screened and 16 met criteria for inclusion. The mean MINORS score of included studies was 13.3 ± 4.1. In patients who failed to RTS, most (74 %) patients failed due to recurrent shoulder instability, pain, or injury, while 26 % reported failing to RTS due to non-shoulder related causes such as apprehension and fear of reinjury. Eight studies evaluated post-operative SIRSI scores with a mean of 65.4 (95 % CI: 62.9–72.8) at an average of 5.4 years post-operatively.</div></div><div><h3>Conclusion</h3><div>Most athletes fail to RTS due to shoulder-related causes, with apprehension and fear of reinjury as common causes as shoulder-independent causes for failed RTS. The mean SIRSI score after ABR was 65.4, and athletes with higher post-operative SIRSI scores were more likely to RTS.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 43-48"},"PeriodicalIF":1.5,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080434","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}
This study examines the relationship between the anterior offset of the tibial intramedullary nail (TIN) entry point and the tibial shaft axis to enhance the fit and alignment of TINs, using transparent 3D-CT in an accurate lateral view to minimize rotational artifacts.
Methods
Data were collected from 100 adult patients undergoing tibial CT scans. Measurements included the anterior offset from the tibial axis to the entry point, tibial tubercle offset, tibial plateau length, posterior slope, tibial length, isthmus diameter, and the isthmus-to-tibial length ratio.
Results
Key findings reveal a median anterior offset of 9.8 mm from the tibial axis to the entry point, with 7 % of cases having an offset of less than 5 mm—potentially insufficient for standard TINs. The tibial tubercle offset was 16.7 mm, and the distance between the entry point and tubercle was 24.5 mm. The median tibial plateau length was 44.8 mm, and the posterior slope was 7.7°. The tibial length measured 330.4 mm, with a median isthmus diameter of 10.4 mm and an isthmus-to-tibial length ratio of 39.7 %. Correlations were found between entry point offset and tibial plateau length, tubercle offset, and age. The entry point was positioned 1.2 mm (median) anteroposteriorly and 6.5 mm mediolaterally from the anterior edge of the tibia.
Conclusion
The median anterior offset from the tibial axis to the starting point was approximately 10 mm, with 7 % of cases having an offset of less than 5 mm, which is too small for most TINs available. Surgeons should be cautious about cases with a small anterior offset to minimize risks during intramedullary nail insertion.
{"title":"The anterior offset of the standard entry point for tibial intramedullary nails: A transparent 3D-CT image based analysis","authors":"Shozo Kanezaki , Masashi Miyazaki , Taro Ishida , Akihiro Hino , Masahiro Kawagishi , Tomonori Sakamoto , Nobuhiro Kaku","doi":"10.1016/j.jor.2024.12.030","DOIUrl":"10.1016/j.jor.2024.12.030","url":null,"abstract":"<div><h3>Background</h3><div>This study examines the relationship between the anterior offset of the tibial intramedullary nail (TIN) entry point and the tibial shaft axis to enhance the fit and alignment of TINs, using transparent 3D-CT in an accurate lateral view to minimize rotational artifacts.</div></div><div><h3>Methods</h3><div>Data were collected from 100 adult patients undergoing tibial CT scans. Measurements included the anterior offset from the tibial axis to the entry point, tibial tubercle offset, tibial plateau length, posterior slope, tibial length, isthmus diameter, and the isthmus-to-tibial length ratio.</div></div><div><h3>Results</h3><div>Key findings reveal a median anterior offset of 9.8 mm from the tibial axis to the entry point, with 7 % of cases having an offset of less than 5 mm—potentially insufficient for standard TINs. The tibial tubercle offset was 16.7 mm, and the distance between the entry point and tubercle was 24.5 mm. The median tibial plateau length was 44.8 mm, and the posterior slope was 7.7°. The tibial length measured 330.4 mm, with a median isthmus diameter of 10.4 mm and an isthmus-to-tibial length ratio of 39.7 %. Correlations were found between entry point offset and tibial plateau length, tubercle offset, and age. The entry point was positioned 1.2 mm (median) anteroposteriorly and 6.5 mm mediolaterally from the anterior edge of the tibia.</div></div><div><h3>Conclusion</h3><div>The median anterior offset from the tibial axis to the starting point was approximately 10 mm, with 7 % of cases having an offset of less than 5 mm, which is too small for most TINs available. Surgeons should be cautious about cases with a small anterior offset to minimize risks during intramedullary nail insertion.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 8-13"},"PeriodicalIF":1.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028824","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 : 2024-12-25DOI: 10.1016/j.jor.2024.12.026
Alexander Nielsen , Jesua Law , Lauren Homolka , D. Alex Forrester , Aaron Hofmann
We evaluated a unique implant system that included a universal femoral component (UFC) design and instrumentation that would accommodate the UFC on both the left and right femur. There was a commitment to test two hypotheses: firstly, that the results of this 10-year follow-up study maintained patient outcomes compared to the initial 6-year follow-up assessment and secondly that this unique Q-angle design maintained patella tracking over the 10-year period. The results of the 10-year follow-up period determined that the two hypotheses were supported with the Knee Society Score (KSS) data and continued to support the use of this UFC.
{"title":"Positive clinical outcomes at 10 Years with the universal femoral component in total knee arthroplasty","authors":"Alexander Nielsen , Jesua Law , Lauren Homolka , D. Alex Forrester , Aaron Hofmann","doi":"10.1016/j.jor.2024.12.026","DOIUrl":"10.1016/j.jor.2024.12.026","url":null,"abstract":"<div><div>We evaluated a unique implant system that included a universal femoral component (UFC) design and instrumentation that would accommodate the UFC on both the left and right femur. There was a commitment to test two hypotheses: firstly, that the results of this 10-year follow-up study maintained patient outcomes compared to the initial 6-year follow-up assessment and secondly that this unique Q-angle design maintained patella tracking over the 10-year period. The results of the 10-year follow-up period determined that the two hypotheses were supported with the Knee Society Score (KSS) data and continued to support the use of this UFC.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 67-70"},"PeriodicalIF":1.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080433","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 : 2024-12-25DOI: 10.1016/j.jor.2024.12.019
PhakamaniG. Mthethwa , L.C. Marais
Background
Disease progression (DP) of osteosarcomas, albeit with aggressive treatments, hinders improving survival. The DP patterns are unique in low- and middle-income countries like South Africa. We determine the prognostic factors associated with disease progression (DP) of the appendicular skeleton's central high-grade conventional osteosarcoma (COS).
Methods
This is a retrospective study of 77 patients, with a minimum 3-year follow-up period diagnosed with histological biopsy-confirmed COS. Descriptive statistics, Cox proportional regression modelling, and the Kaplan-Meier method were employed for the analysis.
Results
DP occurred in 75 % of patients (58/77), either as a local progression - LP 32 % (25/77), systemic progression – SP 61 % (47/77) or both 32 % (24/77). In the univariate analysis, the factors associated with DP were proximal humerus tumor site (hazard ratio [HR] 2.48; 95 % confidence interval [CI], 1.02 to 6.04; p < 0.046), metastasis at diagnosis (HR 1.91; 95 % CI, 1.10 to 3.32; p < 0.022), multiple metastatic lesions (HR 2.58; 95 % CI, 1.13 to 5.88; p < 0.024), curative treatment (HR 0.33; 95 % CI 0.17 to 0.62; p < 0.001), palliative treatment (HR 2.17; 95 % CI 1.24 to 3.78; p < 0.007), and wide surgical resection (HR 0.48, 95 % CI 0.27 to 0.86; p < 0.013). On multivariate analysis, only age >19 years was an independent risk factor (HR 1.04; 95 % CI 1.00 to 1.08; p < 0.034). The median survival time was 24 months, with an overall survival (OS) of 57.1 % at 3 years. The projected Kaplan- Meier 5-year OS rate was 29.78 %, with a progression-free survival (PFS) rate of 10.28 % (HR 0.76; 95 % CI 0.52 to 1.112; p < 0.128).
Conclusion
In this series of central high-grade conventional osteosarcoma of the appendicular skeleton from South Africa, we observed a uniquely high proportion of disease progression (DP). Age >19, metastatic disease, and no chemotherapy response yielded poor outcomes; in contrast, wide surgical resection is beneficial. Further elucidation is needed at a larger scale in this region.
Study evidence level
IV.
{"title":"Prognostic factors for disease progression of central high-grade conventional osteosarcoma of the appendicular skeleton: Single-centre experience within South Africa with minimum 3-year follow-up","authors":"PhakamaniG. Mthethwa , L.C. Marais","doi":"10.1016/j.jor.2024.12.019","DOIUrl":"10.1016/j.jor.2024.12.019","url":null,"abstract":"<div><h3>Background</h3><div>Disease progression (DP) of osteosarcomas, albeit with aggressive treatments, hinders improving survival. The DP patterns are unique in low- and middle-income countries like South Africa. We determine the prognostic factors associated with disease progression (DP) of the appendicular skeleton's central high-grade conventional osteosarcoma (COS).</div></div><div><h3>Methods</h3><div>This is a retrospective study of 77 patients, with a minimum 3-year follow-up period diagnosed with histological biopsy-confirmed COS. Descriptive statistics, Cox proportional regression modelling, and the Kaplan-Meier method were employed for the analysis.</div></div><div><h3>Results</h3><div>DP occurred in 75 % of patients (58/77), either as a local progression - LP 32 % (25/77), systemic progression – SP 61 % (47/77) or both 32 % (24/77). In the univariate analysis, the factors associated with DP were proximal humerus tumor site (hazard ratio [HR] 2.48; 95 % confidence interval [CI], 1.02 to 6.04; p < 0.046), metastasis at diagnosis (HR 1.91; 95 % CI, 1.10 to 3.32; p < 0.022), multiple metastatic lesions (HR 2.58; 95 % CI, 1.13 to 5.88; p < 0.024), curative treatment (HR 0.33; 95 % CI 0.17 to 0.62; p < 0.001), palliative treatment (HR 2.17; 95 % CI 1.24 to 3.78; p < 0.007), and wide surgical resection (HR 0.48, 95 % CI 0.27 to 0.86; p < 0.013). On multivariate analysis, only age >19 years was an independent risk factor (HR 1.04; 95 % CI 1.00 to 1.08; p < 0.034). The median survival time was 24 months, with an overall survival (OS) of 57.1 % at 3 years. The projected Kaplan- Meier 5-year OS rate was 29.78 %, with a progression-free survival (PFS) rate of 10.28 % (HR 0.76; 95 % CI 0.52 to 1.112; p < 0.128).</div></div><div><h3>Conclusion</h3><div>In this series of central high-grade conventional osteosarcoma of the appendicular skeleton from South Africa, we observed a uniquely high proportion of disease progression (DP). Age >19, metastatic disease, and no chemotherapy response yielded poor outcomes; in contrast, wide surgical resection is beneficial. Further elucidation is needed at a larger scale in this region.</div></div><div><h3>Study evidence level</h3><div>IV.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 126-131"},"PeriodicalIF":1.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-25DOI: 10.1016/j.jor.2024.12.022
Neil Jain , Jonathan McKeeman , Kyle Schultz , Wayne Chan , Daniel Aaron , Brian Busconi , Tyler Smith
Background
Tranexamic acid (TXA) use has become the gold standard in total joint arthroplasty to limit intraoperative blood loss and transfusion rates. More recently, the indications for TXA have expanded to knee and shoulder arthroscopy with promising early results. However, the effectiveness of TXA during arthroscopic rotator cuff repair (RCR) is unclear. Therefore, the purpose of this study was to investigate perioperative outcomes following the use of TXA during RCR.
Methods
A systematic review was performed via the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, MEDLINE, Embase, and Cochrane databases in November 2024. Studies were assessed for quality of visual clarity, operative time, mean arterial pressure (MAP), volume of arthroscopy irrigation used, arthroscopic pump pressure, and clinical outcomes.
Results
A total of 12 clinical trials involving 999 patients were included. 9 studies reported on visual clarity and 6 of these reported improvements in visual clarity with TXA administration. Four studies reported improvements in postoperative pain, however outcomes varied greatly depending on when follow-up assessment occurred. A majority of studies did not report differences in operative time, irrigation volume, or postoperative swelling. There were no venous thromboembolism events reported in the included studies.
Conclusion
TXA dosing during RCR surgery may improve visual clarity, however its effect on other perioperative outcomes remains unclear.
Level of evidence
Level I.
{"title":"Tranexamic acid use in rotator cuff repair: A systematic review of perioperative outcomes","authors":"Neil Jain , Jonathan McKeeman , Kyle Schultz , Wayne Chan , Daniel Aaron , Brian Busconi , Tyler Smith","doi":"10.1016/j.jor.2024.12.022","DOIUrl":"10.1016/j.jor.2024.12.022","url":null,"abstract":"<div><h3>Background</h3><div>Tranexamic acid (TXA) use has become the gold standard in total joint arthroplasty to limit intraoperative blood loss and transfusion rates. More recently, the indications for TXA have expanded to knee and shoulder arthroscopy with promising early results. However, the effectiveness of TXA during arthroscopic rotator cuff repair (RCR) is unclear. Therefore, the purpose of this study was to investigate perioperative outcomes following the use of TXA during RCR.</div></div><div><h3>Methods</h3><div>A systematic review was performed via the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, MEDLINE, Embase, and Cochrane databases in November 2024. Studies were assessed for quality of visual clarity, operative time, mean arterial pressure (MAP), volume of arthroscopy irrigation used, arthroscopic pump pressure, and clinical outcomes.</div></div><div><h3>Results</h3><div>A total of 12 clinical trials involving 999 patients were included. 9 studies reported on visual clarity and 6 of these reported improvements in visual clarity with TXA administration. Four studies reported improvements in postoperative pain, however outcomes varied greatly depending on when follow-up assessment occurred. A majority of studies did not report differences in operative time, irrigation volume, or postoperative swelling. There were no venous thromboembolism events reported in the included studies.</div></div><div><h3>Conclusion</h3><div>TXA dosing during RCR surgery may improve visual clarity, however its effect on other perioperative outcomes remains unclear.</div></div><div><h3>Level of evidence</h3><div>Level I.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 119-125"},"PeriodicalIF":1.5,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047029","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 : 2024-12-24DOI: 10.1016/j.jor.2024.12.021
Kyle Paul , John N. Manfredi , Mathew Hargreaves , Mitchell K. Messner , Clay A. Rahaman , Brent Ponce , Amit M. Momaya , Eugene Brabston
Purpose
This study aims to compare the biomechanical performance of elastic and static suture-based cerclage systems to traditional screw constructs in the setting of modeled glenoid bony augmentation.
Methods
Biomechanical testing was conducted on polyurethane cellular foam blocks modeling a 20 % glenoid defect repaired with a coracoid graft. Constructs consisted of an elastic suture-based cerclage, static suture-based cerclage, and a two-screw construct. Biomechanical testing was performed on material testing system, using a 7-phase, 100 cycle per phase, 1Hz, sinusoidal cyclic loading protocol, following a stair-step pattern in load control. Failure for cyclic loading was assessed at 0.8 mm linear displacement. The absolute end level for load-to-failure was 7.0 mm.
Results
Static suture-based cerclage failed at 5–50 N (Cycles 2 through 4), 2-screw constructs failed at 25–50 N (Cycle 4), and elastic suture-based cerclage failed at 100–200N (Cycles 6 and 7). Elastic cerclage exhibited superior performance compared to static cerclage beginning in Cycle 2 (p = 0.0440) and compared to SOC 2-screw construct beginning in Cycle 4 (p = 0.0118). 2-screw construct exhibited superior stability performance compared to static cerclage beginning in Cycle 3 (p = 0.0001). Elastic cerclage reached failure at 558.141 ± 4.508 N, while 2-screw construct and static cerclage reached failure at 422.009 ± 24.998 N and 366.770 ± 66.653 N, respectively. Elastic cerclage demonstrated superior biomechanical stability in load-at-failure performance to static cerclage (p < 0.0001) and the screw construct (p < 0.0001), while static cerclage demonstrated inferior biomechanical stability to the screw construct (p = 0.0343).
Conclusion
This biomechanical study comparing the performance of elastic cable and static suture tape cerclage fixation methods identified that the elastic cable cerclage exhibits a higher load-at-failure and less displacement under repetitive stress. In addition, elastic cable cerclage fixation exhibits greater strength and construct rigidity than traditional metal screw fixation.
{"title":"Non-screw glenoid augmentation constructs for shoulder instability with bone loss: A biomechanical assessment of static and elastic cerclage constructs","authors":"Kyle Paul , John N. Manfredi , Mathew Hargreaves , Mitchell K. Messner , Clay A. Rahaman , Brent Ponce , Amit M. Momaya , Eugene Brabston","doi":"10.1016/j.jor.2024.12.021","DOIUrl":"10.1016/j.jor.2024.12.021","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to compare the biomechanical performance of elastic and static suture-based cerclage systems to traditional screw constructs in the setting of modeled glenoid bony augmentation.</div></div><div><h3>Methods</h3><div>Biomechanical testing was conducted on polyurethane cellular foam blocks modeling a 20 % glenoid defect repaired with a coracoid graft. Constructs consisted of an elastic suture-based cerclage, static suture-based cerclage, and a two-screw construct. Biomechanical testing was performed on material testing system, using a 7-phase, 100 cycle per phase, 1Hz, sinusoidal cyclic loading protocol, following a stair-step pattern in load control. Failure for cyclic loading was assessed at 0.8 mm linear displacement. The absolute end level for load-to-failure was 7.0 mm.</div></div><div><h3>Results</h3><div>Static suture-based cerclage failed at 5–50 N (Cycles 2 through 4), 2-screw constructs failed at 25–50 N (Cycle 4), and elastic suture-based cerclage failed at 100–200N (Cycles 6 and 7). Elastic cerclage exhibited superior performance compared to static cerclage beginning in Cycle 2 (p = 0.0440) and compared to SOC 2-screw construct beginning in Cycle 4 (p = 0.0118). 2-screw construct exhibited superior stability performance compared to static cerclage beginning in Cycle 3 (p = 0.0001). Elastic cerclage reached failure at 558.141 ± 4.508 N, while 2-screw construct and static cerclage reached failure at 422.009 ± 24.998 N and 366.770 ± 66.653 N, respectively. Elastic cerclage demonstrated superior biomechanical stability in load-at-failure performance to static cerclage (p < 0.0001) and the screw construct (p < 0.0001), while static cerclage demonstrated inferior biomechanical stability to the screw construct (p = 0.0343).</div></div><div><h3>Conclusion</h3><div>This biomechanical study comparing the performance of elastic cable and static suture tape cerclage fixation methods identified that the elastic cable cerclage exhibits a higher load-at-failure and less displacement under repetitive stress. In addition, elastic cable cerclage fixation exhibits greater strength and construct rigidity than traditional metal screw fixation.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 1-7"},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023777","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 : 2024-12-20DOI: 10.1016/j.jor.2024.12.018
R Manikandan, R Dinesh Iyer, Praveen R. Iyer, Ajoy Prasad Shetty T, KS Sri Vijayanand, Rishi Mugesh Kanna, Rajasekaran Shanmuganathan
Study background
Chronic coccydynia is a difficult pathology to treat due to limited understanding of the etiology and risk factors. Aim of the study was to analyse the clinical and radiological factors associated with poor outcomes in coccydynia.
Study design
Prospective observational study.
Methods
Patients who visited the spine outpatient department between September 2019 to August 2021 with coccygeal pain of more than two months were included in the study. Lateral radiographs in seated and standing position were done to evaluate their Intercoccygeal angle (ICA), Sacrococcygeal angle (SCA), Basal Angle (BA) and Coccygeal Length. MRI was done for patients who were not relieved with 2 months of conservative treatment. Baseline VAS and ODI scores were documented at the first visit and at six months follow-up to evaluate the outcomes.
Results
168 patients were included - 106 females and 62 males (M:F ratio 1.76) with a mean age of 41.71 years. 109 out of 168 (64.9 %) were obese and 31(18.5 %) were overweight. Type 2 and 4 coccyges were the most commonly seen morphology (67 patients each). Traumatic coccydynia had a better outcome with a mean VAS score of 3.54 compared to 4.36 in the idiopathic group(p < 0.05). Higher Intercoccygeal angle (ICA) was the only radiographic parameter that had coorelation with the outcomes. Mean ICA in good outcomes group was 34.8° (13.2) compared to 42.1° (14.6) in those with poor outcomes(p < 0.05). All 7 patients with pseudoarthrosis had VAS scores reduction of more than 50 %.
Conclusion
Type 2 and type 4 were the most common coccyx morphology encountered in patients with chronic coccydynia. Outcomes were better in traumatic group compared to idiopathic group and in those with pseudoarthrosis on MRI. Higher Intercoccygeal angle(ICA) was the only radiographic parameter associated with poor outcome of conservative management.
{"title":"Predictors of outcomes of conservative management in chronic coccydynia - Results from a prospective clinicoradiological observational study","authors":"R Manikandan, R Dinesh Iyer, Praveen R. Iyer, Ajoy Prasad Shetty T, KS Sri Vijayanand, Rishi Mugesh Kanna, Rajasekaran Shanmuganathan","doi":"10.1016/j.jor.2024.12.018","DOIUrl":"10.1016/j.jor.2024.12.018","url":null,"abstract":"<div><h3>Study background</h3><div>Chronic coccydynia is a difficult pathology to treat due to limited understanding of the etiology and risk factors. Aim of the study was to analyse the clinical and radiological factors associated with poor outcomes in coccydynia.</div></div><div><h3>Study design</h3><div>Prospective observational study.</div></div><div><h3>Methods</h3><div>Patients who visited the spine outpatient department between September 2019 to August 2021 with coccygeal pain of more than two months were included in the study. Lateral radiographs in seated and standing position were done to evaluate their Intercoccygeal angle (ICA), Sacrococcygeal angle (SCA), Basal Angle (BA) and Coccygeal Length. MRI was done for patients who were not relieved with 2 months of conservative treatment. Baseline VAS and ODI scores were documented at the first visit and at six months follow-up to evaluate the outcomes.</div></div><div><h3>Results</h3><div>168 patients were included - 106 females and 62 males (M:F ratio 1.76) with a mean age of 41.71 years. 109 out of 168 (64.9 %) were obese and 31(18.5 %) were overweight. Type 2 and 4 coccyges were the most commonly seen morphology (67 patients each). Traumatic coccydynia had a better outcome with a mean VAS score of 3.54 compared to 4.36 in the idiopathic group(p < 0.05). Higher Intercoccygeal angle (ICA) was the only radiographic parameter that had coorelation with the outcomes. Mean ICA in good outcomes group was 34.8° (13.2) compared to 42.1° (14.6) in those with poor outcomes(p < 0.05). All 7 patients with pseudoarthrosis had VAS scores reduction of more than 50 %.</div></div><div><h3>Conclusion</h3><div>Type 2 and type 4 were the most common coccyx morphology encountered in patients with chronic coccydynia. Outcomes were better in traumatic group compared to idiopathic group and in those with pseudoarthrosis on MRI. Higher Intercoccygeal angle(ICA) was the only radiographic parameter associated with poor outcome of conservative management.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"65 ","pages":"Pages 132-137"},"PeriodicalIF":1.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181793","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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