Orthopedic Research and Reviews最新文献

Introduction: Numerous thermal free radical stabilization techniques are used in the production of highly cross-linked polyethylene (HXLPE) to improve oxidative stability. Little knowledge exists on the effects of in vivo time on the mechanical properties of HXLPE. The purpose of this study was to determine if free radical stabilization of HXLPE impacts mechanical properties as well as oxidative stability of acetabular liner rims after extended in vivo time.

Methods: Retrieved and control remelted, single annealed and sequentially annealed HXLPE liner rims were tested for mechanical properties. Oxidation was measured with FTIR spectroscopy and crystalline phase composition measured with Raman spectroscopy.

Results: No correlation was found between in vivo, ex vivo time and hardness for annealed groups. A statistically significant difference in hardness was identified between free radical stabilization groups. No correlation between maximum rim oxidation and in vivo time was found. Detectable levels of rim oxidation were present in 100% of single annealed, 75% of sequentially annealed, and 25% of remelted retrieved liners. Single and sequentially annealed liners demonstrated oxidation and increased crystallinity. Rim mechanical properties change in vivo for implant types. With in vivo time, retrieved remelted HXLPE demonstrated decreased mechanical properties, whereas retrieved single and sequentially annealed HXLPE properties remained stable. All liner cohorts demonstrated evidence of rim oxidation. Subsequent changes in crystallinity were only observed in oxidized annealed liners.

Conclusion: HXLPE acetabular liner rims show evidence of in vivo mechanical property degradation, notably in remelted HXLPE, which may be a risk factor in rim fracture and catastrophic implant failure.

Background: Vertebral osteomyelitis is rare. Finding the right etiological agent is important to administer antibiotic regimen accordingly. The occurrence of this disease in endemic countries raises the susceptibility of a more common infection such as tuberculosis and pyogenic bacteria. Salmonella spp. infection is also common in endemic countries; however, extra-intestinal manifestation is very rare.

Methods: We present an extremely rare case of salmonella vertebral osteomyelitis (SVO) in the upper thoracic vertebrae of a 64-year-old patient with history of cardiac surgery and other pre-existing comorbidities. SVO was treated by antibiotics, surgical debridement and spinal stabilization.

Results: Three weeks after surgery and intravenous antibiotics, the patient recovered and was discharged without fever and back pain, with excellent motoric improvement.

Conclusion: Salmonella infection must be considered to be one of possible etiological agents in patients with suggestive spondylitis in emerging countries, especially in those with comorbidities.

Although total knee arthroplasty (TKA) is considered one of the most successful procedures, however, a subset of patients are unsatisfied with the results, even with the introduction of new technologies and implant designs. Radiological assessment of TKA is still considered the most prevalent imaging modality for evaluating the knee joint pre-and postoperatively. Assessment of various angles and indices which could be measured in different radiographic views of the knee provides valuable information about the alignment of the entire limb and the individual prosthetic components, more so in the light of recent nuanced concepts of technique, alignment, and balance. This review article aims to present a comprehensive yet systematic approach to the most useful radiographic parameters for assessing the knee preoperatively and post-TKA by explaining the tools and techniques used for measuring various angles, indices and ratios in the coronal, sagittal and axial planes for diagnosis, preoperative planning, postoperative assessment, and routine follow-up. The protocol we followed in this review entailed first reporting the possible applications and software which could help in measuring these variables, then we mentioned the required series of knee radiographs. For the desired variables, we divided the assessment according to each plane, and in each, we reported the optimum position of the desired radiographic view followed by determining the axis and lines which will later form the desired angles to be measured; finally, we collected all the measurements in a table with the native knee values and the most accepted values after TKA.

Osteoarthritis (OA) is a common pathology affecting the knee joint. Twenty percent of the cartilaginous tumors of bone are in the distal femur. This presents a challenge for treating patients with knee OA who also have ipsilateral distal femur cartilage tumors. We propose a classification system for knee OA with ipsilateral cartilaginous tumor and a treatment approach to address this issue. Intramedullary guides are avoided when performing total knee arthroplasty (TKA) in these patients so as not to further contaminate the femur with tumor cells. A non-image-based stereotactic surgical system is favored at our institution to achieve this goal. Seven patients underwent classification and treatment with TKA utilizing this approach. Average final follow-up was 15.3 months. Component alignment averaged 89.2° and all patients had 0° of extension with an average flexion to 107.5°. There were no postoperative complications and no radiographic evidence of component complication, tumor recurrence, or tumor expansion. Few studies have reported on the treatment of knee OA with concurrent cartilaginous tumor of the distal femur. All patients treated with the proposed approach had their OA successfully treated without complication related to their cartilaginous tumor or TKA components. This case series presents a novel classification and treatment algorithm to potentially guide arthroplasty surgeons in approaching these often-concurrent occurring pathologies.

Introduction: Trialling is a key step in total knee arthroplasty (TKA) and helps the surgeon assess for adequate balancing, range of motion, and stability. Despite this, there are no studies investigating knee kinematics when using trial versus final polyethylene tibial inserts.

Materials and methods: Fourteen fresh frozen cadaveric specimens were cycled in a VIVO joint motion simulator. Using both simple compression and simulated muscle loads, joints were tested after TKA with a trial insert or a final tibial poly insert. Anterior/posterior (AP), internal/external (IE), and varus/valgus (VV) kinematics and laxities were analyzed.

Results: Knees with trial poly inserts had significantly greater AP hysteresis (difference between flexion and extension motion) than those with final poly inserts (p=0.001). There was no significant difference in IE (p=0.563) or VV (p=0.580) hysteresis. There was no difference in AP, IE, or VV motion or laxities when considering the flexion path alone. Prosthetic joints followed different paths in flexion versus extension.

Conclusion: While trial tibial inserts impart valuable information, they may not accurately reproduce the same joint kinematics as final inserts. Balancing of the knee at specific degrees of flexion may depend on the path taken to get there.

Background: Pelvic fractures are high-risk injuries that require careful evaluation due to significant patient morbidity and mortality associated with damage to major blood vessels, nerves, and organs. Thus, the aim of this study was to assess pelvic fractures and associated injuries among patients presented at the emergency department of Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia.

Methods: This is a cross-sectional study with a retrospective facility-based data collection technique. All patients who were managed for pelvic fracture from September 2018 to February 2021 were included. The patient's chart number was collected from the orthopedics surgery morning register sheet and their case folders were retrieved from the medical record department. We used a structured and pretested checklist, and chart review for data collection. The collected data were cleaned, coded, and entered into Epi Info version 7 and exported to SPSS version 24 for analysis. Binary logistic regression analysis was used to identify factors associated with a pelvic fracture.

Results: We studied 64 cases of pelvic fracture during the study period. Pelvic was common among males with a ratio of 7:1 and young population (15-35 years). The most common associated injuries were lower extremity 23 (35.9%), abdominal injuries 16 (25.0%), and urethral injury in 13 (20.3%). Moreover, most patients with pelvic fracture have Tile A fracture 56.3%, Tile C in 20 (31.3%), and Tile B in 8 (12.5%) patients. The road traffic accident was the most common cause of pelvic fracture in 56.3%, followed by fall down accident (28.1%), and bullet injury (12.5%).

Conclusion: The incidence of pelvic fracture was high in the study area. It reflects the need for strong and multi-sectoral collaboration to prevent pelvic fracture. Additionally, it needs a careful, systematic management approach for survival, healing, and to address the associated complexities and the polytrauma nature.

We describe the case of a 76-year-old Asian female patient who presented with severe pain and a valgus deformity of the right knee. Her past medical history included neurofibromatosis, which resulted in a severe anterior slope of the right knee, limb shortening, and congenital pseudarthrosis. She was diagnosed with severe anterolateral osteoarthritis and eburnation of the right knee that was treated surgically with a lateral unicompartmental knee arthroplasty (UKA). Bone and cartilage fragments were removed from the joint space and a UKA implant (Zimmer^®) with dimensions of 29 mm × 50 mm was inserted. Perioperative imaging revealed that the procedure resulted in the correction of the valgus deformity. Pain was reduced and the patient was able to walk for 10 meters with support during the immediate postoperative period. One week post-surgery, the patient sustained an oblique tibial fracture that extended from the medial edge of the implant to the medial slope of the proximal tibia. This complication may have been attributed to large implant size or sagittal overcutting. The fracture was treated surgically with a rotated anterolateral locking plate (A.L.P.S^®) inserted into the distal tibia. The patient was capable of ambulation at full weight load at two months after the second procedure. It is critical to recognize that there are no standard protocols that can be used to guide the treatment of neurofibromatosis-induced osteoarthritis. The specific preoperative condition of the individual patient plays a large role in determining the appropriate treatment option. In this case, the availability of custom-fitted UKA implants might have improved outlook, we understand that these devices are costly and may not be available at all hospitals. However, we strongly believe that the "gold standard" in these cases is patient-specific treatment that addresses the issues of the highest concern using the resources that are available at that time.

Introduction and purpose: An abnormal patellar position has been proven to be associated with anterior knee pain and several other conditions that affect the patellofemoral joint. The purpose of this study was to determine the incidence of patella alta and patella baja and the applicability of the normal range of the Insall-Salvati ratio in the Vietnamese population.

Methodology: Magnetic resonance imaging (MRI) was used to examine 455 Vietnamese subjects' knees. The Insall-Salvati ratio-the ratio of patellar ligament length (LL) and patellar length (PL)-was measured using sagittal T1-weighted images.

Results: The overall mean LL/PL ratio was 1.02 (standard deviation 0.15). No significant differences in the LL/PL ratio were observed between sexes. The frequencies of patella alta (Insall-Salvati ratio >1.32) and patella baja (Insall-Salvati ratio <0.72) were 0.9% and 2.4%, respectively.

Conclusion: The Insall-Salvati ratio is applicable to Vietnamese populations in which high flexion activities such as kneeling and sitting cross-legged are customary. According to our measurement, the normal range of the ratio among Vietnamese subjects was 0.72 to 1.32.

A high frequency of associated injuries is seen in patients with chronic lateral ankle instability. Comorbidities include intraarticular pathologies (osteochondral lesion, soft tissue or bony impingement syndrome, loose body, synovitis, etc.), peroneal tendon pathologies, neural injuries, and other extraarticular pathologies. Surgeons should have a high index of suspicion for these associated pathologies before operative intervention, correlate with clinical findings, and plan the treatment. Despite the restoration of ankle stability following ligament repair or reconstruction surgery, postoperative residual pain, which can negatively affect clinical outcomes and patient satisfaction, is highly prevalent (13-35%). The aim of this review was to discuss the causes of persistent pain after operative treatment for chronic lateral ankle instability.

Background: Lower limb fractures account for approximately one-third of all fractures. Lower limb fracture complications are one of the major reasons for hospital stays and have high impact on rehabilitation services. Functional limitations with lower extremities fractures are related to decreased functional mobility, the need for long term use of assistive devices, lack of independence, and the long term need for assistive care. This study aimed to assess the functional limitation and identify the possible predictors among lower limb fracture patients by using the Lower Extremity Functional Scale (LEFS).

Methods: A prospective institutional-based cross-sectional study was conducted from July to October 30/2020, at University of Gondar, comprehensive specialized hospital. The data of 226 participants were collected through face-to-face interviews, patient record review and by physical examination with simple random sampling techniques. Binary logistic regression was used to identify predictors of functional limitation among lower limb fracture with SPSS 25. The strength of the association was present by adjusted odds ratios (OR).

Results: One hundred and eighty-two (n = 182 (80.5%): 95% CI (74.8 to 85.8) patients with following lower limb fracture have functional limitation. Level of education (AOR =5.50; 95% CI: 1.707-17.742), presence of hospitalized complication AOR=3.26; 95% CI (1.147-9.294), severity of pain AOR=3.19; 95% CI (1.399-7.259), duration of onset AOR=9.512; 95% CI (3.585-25.237), knee flexion limitation AOR=7.13; 95% CI (1.926-26.368) were the independent risk factors for functional limitation.

Conclusion: The magnitude of functional limitation in following lower limb fracture individual was considerably high in study setup. Level of education, presence of hospitalized complication, severity of pain, duration of onset, knee flexion limitation were the independent risk factors for functional limitation.