Sol Qurashi, Supreet Bajwa, Sam Aktas, W. B. Bestic, Jason Chinnappa
Introduction: In today’s post COVID 19 world, many healthcare systems have been pushed past the brink of economic sustainability. With Total Hip (THR) and Knee Replacements (TKR) being a few of the biggest ticket items, the need to adopt methods that improve quality of care & reduce unnecessary costs, is imperative. In this context, we report our experience with a Short Stay / Overnight joint replacement model using an ERAS (Enhanced Recovery After Surgery) Protocol which promotes rapid post-operative recovery and a decreased LOS without an increase in complications or readmission rates. Method: Retrospective collection of clinical & demographic data was undertaken for 114 consecutive patients undergoing primary THR or TKR by a single surgeon between 1 January 2018 and 19 March 2020 at 2 hospitals (1 public, 1 private). The data was analyzed for LOS, complications & readmission rates within 90 days after surgery. Results: In THR (n=93) and TKR (n=21), mean LOS was1.54 nights (range 0 - 4). 8 patients were discharged to a rehabilitation facility, the remaining 106 were discharged home. 2 patients were readmitted within 90 days of surgery - one with a periprosthetic fracture and the other for an unrelated respiratory illness. Conclusion: The implementation of a Short Stay model and associated ERAS protocols in both the public and private hospital settings reduced LOS without a concomitant increase in postoperative complications or readmission rates.
{"title":"Overnight or Short Stay Joint Replacements in the Public and Private settings: An Australian Experience.","authors":"Sol Qurashi, Supreet Bajwa, Sam Aktas, W. B. Bestic, Jason Chinnappa","doi":"10.15438/rr.11.1.283","DOIUrl":"https://doi.org/10.15438/rr.11.1.283","url":null,"abstract":"Introduction: In today’s post COVID 19 world, many healthcare systems have been pushed past the brink of economic sustainability. With Total Hip (THR) and Knee Replacements (TKR) being a few of the biggest ticket items, the need to adopt methods that improve quality of care & reduce unnecessary costs, is imperative. In this context, we report our experience with a Short Stay / Overnight joint replacement model using an ERAS (Enhanced Recovery After Surgery) Protocol which promotes rapid post-operative recovery and a decreased LOS without an increase in complications or readmission rates. Method: Retrospective collection of clinical & demographic data was undertaken for 114 consecutive patients undergoing primary THR or TKR by a single surgeon between 1 January 2018 and 19 March 2020 at 2 hospitals (1 public, 1 private). The data was analyzed for LOS, complications & readmission rates within 90 days after surgery. Results: In THR (n=93) and TKR (n=21), mean LOS was1.54 nights (range 0 - 4). 8 patients were discharged to a rehabilitation facility, the remaining 106 were discharged home. 2 patients were readmitted within 90 days of surgery - one with a periprosthetic fracture and the other for an unrelated respiratory illness. Conclusion: The implementation of a Short Stay model and associated ERAS protocols in both the public and private hospital settings reduced LOS without a concomitant increase in postoperative complications or readmission rates.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67679673","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}
Melissa Jackels, Samantha N. Andrews, Maya Y. Matsumoto, Kristin A Mathews, Cass K. Nakasone
Background: Despite significant evaluation, no consensus has been reach for best clinical practice for resurfacing the patella during total knee arthroplasty. Further complicating the ability to reach a conclusion is the inclusion of several different implant types used in previous research. Questions/Purpose: The purpose of this study was to compare post-TKA outcomes between two cruciate retaining implants with or without patella resurfacing. Methods: This retrospective review included 289 patients (380 knees) with a minimum six-month follow-up. All patients received a CR implant, with either a symmetric or an asymmetric tibial baseplate. Post-TKA knee flexion was categorized as <120° and ≥120° and knee extension classified as 0° or >0° and required knee manipulations were noted. Descriptive, nonparametric statistics were performed and a multivariate logistic regression was performed to determine risk of poor range of motion and manipulations. Results: Age was significantly lower in the resurfaced group (p=0.001) and the resurfaced group had longer tourniquet time (p=0.003). The symmetric-resurfaced group had ≥120° of flexion and full extension in 72% and 98.7% of patients, respectively. Compared to symmetric-resurfaced, all other groups had a significantly greater risk of not reaching 120° of knee flexion (p<0.05). There were no significant differences in the risk of requiring a MUA between groups (p>0.06). Conclusions: The effect of resurfacing the patella on post-TKA outcomes may be influenced by tibial implant design. Compared to all other combinations, a symmetric tibial baseplate and resurfaced patella resulted in the highest percentage of patients reaching ≥120°, with a low incidence of manipulations.
{"title":"Range of Motion Comparison Following Total Knee Arthroplasty with and without Patella Resurfacing","authors":"Melissa Jackels, Samantha N. Andrews, Maya Y. Matsumoto, Kristin A Mathews, Cass K. Nakasone","doi":"10.15438/rr.11.1.286","DOIUrl":"https://doi.org/10.15438/rr.11.1.286","url":null,"abstract":"Background: Despite significant evaluation, no consensus has been reach for best clinical practice for resurfacing the patella during total knee arthroplasty. Further complicating the ability to reach a conclusion is the inclusion of several different implant types used in previous research. Questions/Purpose: The purpose of this study was to compare post-TKA outcomes between two cruciate retaining implants with or without patella resurfacing. Methods: This retrospective review included 289 patients (380 knees) with a minimum six-month follow-up. All patients received a CR implant, with either a symmetric or an asymmetric tibial baseplate. Post-TKA knee flexion was categorized as <120° and ≥120° and knee extension classified as 0° or >0° and required knee manipulations were noted. Descriptive, nonparametric statistics were performed and a multivariate logistic regression was performed to determine risk of poor range of motion and manipulations. Results: Age was significantly lower in the resurfaced group (p=0.001) and the resurfaced group had longer tourniquet time (p=0.003). The symmetric-resurfaced group had ≥120° of flexion and full extension in 72% and 98.7% of patients, respectively. Compared to symmetric-resurfaced, all other groups had a significantly greater risk of not reaching 120° of knee flexion (p<0.05). There were no significant differences in the risk of requiring a MUA between groups (p>0.06). Conclusions: The effect of resurfacing the patella on post-TKA outcomes may be influenced by tibial implant design. Compared to all other combinations, a symmetric tibial baseplate and resurfaced patella resulted in the highest percentage of patients reaching ≥120°, with a low incidence of manipulations.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67679793","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}
Jonathan Liu, Alister Hart, Brendan M. Holderread, T. Clyburn
Metal-on-metal (MoM) hip arthroplasty was re-popularized in the 1990s to resolve osteolysis and wear associated with metal-on-polyethylene products. Despite early success, registries began reporting high failure rates due to adverse reactions to metal debris (ARMD), manifesting as pseudotumors, hip effusions and osteolysis. Evaluation includes clinical exam, advanced imaging, and blood metal ions and infectious markers. This review provides physicians with an evidence-based update on the 1) clinical workup and management of patients with existing MoM implants, 2) risk and prognostic factors associated with suboptimal results and 3) the precipitating events and lessons learned applicable to future orthopedic prosthesis.
{"title":"Metal-on-Metal Total Hip Arthroplasty: Current Recommendations and Lessons Learned","authors":"Jonathan Liu, Alister Hart, Brendan M. Holderread, T. Clyburn","doi":"10.15438/rr.11.1.282","DOIUrl":"https://doi.org/10.15438/rr.11.1.282","url":null,"abstract":"Metal-on-metal (MoM) hip arthroplasty was re-popularized in the 1990s to resolve osteolysis and wear associated with metal-on-polyethylene products. Despite early success, registries began reporting high failure rates due to adverse reactions to metal debris (ARMD), manifesting as pseudotumors, hip effusions and osteolysis. Evaluation includes clinical exam, advanced imaging, and blood metal ions and infectious markers. This review provides physicians with an evidence-based update on the 1) clinical workup and management of patients with existing MoM implants, 2) risk and prognostic factors associated with suboptimal results and 3) the precipitating events and lessons learned applicable to future orthopedic prosthesis.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67679665","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}
Zachary C. Hanson, Donald Davis, J. Robison, J. Minter
We report a case of a 23-year-old female with a history of congenital proximal femoral deformity and malunion of a prior proximal femoral corrective osteotomy, who presented seeking treatment for debilitating end-stage arthritis of her hip. Consideration for total hip arthroplasty (THA) for this patient was complicated by her young age and the complexity of her proximal femoral deformity. A 3-dimensional bone model of the patient’s femur was created using digital reconstructive software based on preoperative CT-imaging and used to plan our corrective osteotomy and arthroplasty component specifications. Using the detailed characterization of the femoral morphology, custom cutting guides were designed to fit uniquely into the correct position and ensure a high degree of accuracy with our osteotomy cuts. This unique case highlights the use of 3D-modeling software and printing technology for detailed surgical planning and precise execution in patients with complex deformities or otherwise abnormal anatomy.
{"title":"Addressing a Complex Proximal Femoral Deformity With Custom Cutting Guides Using 3D-Computer Design Software: A Case Report and 2-year Follow-Up","authors":"Zachary C. Hanson, Donald Davis, J. Robison, J. Minter","doi":"10.15438/rr.11.1.281","DOIUrl":"https://doi.org/10.15438/rr.11.1.281","url":null,"abstract":"We report a case of a 23-year-old female with a history of congenital proximal femoral deformity and malunion of a prior proximal femoral corrective osteotomy, who presented seeking treatment for debilitating end-stage arthritis of her hip. Consideration for total hip arthroplasty (THA) for this patient was complicated by her young age and the complexity of her proximal femoral deformity. A 3-dimensional bone model of the patient’s femur was created using digital reconstructive software based on preoperative CT-imaging and used to plan our corrective osteotomy and arthroplasty component specifications. Using the detailed characterization of the femoral morphology, custom cutting guides were designed to fit uniquely into the correct position and ensure a high degree of accuracy with our osteotomy cuts. This unique case highlights the use of 3D-modeling software and printing technology for detailed surgical planning and precise execution in patients with complex deformities or otherwise abnormal anatomy.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67679658","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}
Matthew C. Sweet, T. Snoap, B. Roehr, Jason Roberts
Background: There is a growing body of recent literature regarding the occurrence of pseudotumors associated with modular junctions and various bearing surfaces after total hip arthroplasty (THA). Revision surgery is often technically challenging and high complication rates have been reported. The optimal management of these patients and outcomes after operative treatment remain poorly understood. Methods: We report the case of a 77-year-old male with progressive unilateral lower extremity swelling, pain, and neuropathy 9 years after revision THA for polyethylene liner wear. Imaging and biopsy confirmed a massive intrapelvic pseudotumor exerting compressive effects. Radiographs demonstrated extensive femoral and pelvic osteolysis without evidence of component loosening. Debulking of the intrapelvic portion of the pseudotumor was performed via the lateral window of the ilioinguinal approach with component retention. Results: Debulking of the intrapelvic mass resulted in resolution of symptoms. One year postoperatively the patient reported pain free ambulation using a walker and no recurrence of symptoms. Radiographs demonstrated stable THA components in comparison with preoperative films. Discussion and Conclusion: This case demonstrates a rare finding of intrapelvic pseudotumor causing neurovascular compression after revision THA. Clinicians should be aware of intrapelvic pseudotumor as a possible cause of limb swelling and neuropathy, and that debulking of the mass is a potential treatment option in the setting of well-fixed implants.
{"title":"Intrapelvic Pseudotumor Causing Neuropathy and Vascular Obstruction After Revision Total Hip Arthroplasty: A Case Report","authors":"Matthew C. Sweet, T. Snoap, B. Roehr, Jason Roberts","doi":"10.15438/rr.11.1.285","DOIUrl":"https://doi.org/10.15438/rr.11.1.285","url":null,"abstract":"Background: There is a growing body of recent literature regarding the occurrence of pseudotumors associated with modular junctions and various bearing surfaces after total hip arthroplasty (THA). Revision surgery is often technically challenging and high complication rates have been reported. The optimal management of these patients and outcomes after operative treatment remain poorly understood. Methods: We report the case of a 77-year-old male with progressive unilateral lower extremity swelling, pain, and neuropathy 9 years after revision THA for polyethylene liner wear. Imaging and biopsy confirmed a massive intrapelvic pseudotumor exerting compressive effects. Radiographs demonstrated extensive femoral and pelvic osteolysis without evidence of component loosening. Debulking of the intrapelvic portion of the pseudotumor was performed via the lateral window of the ilioinguinal approach with component retention. Results: Debulking of the intrapelvic mass resulted in resolution of symptoms. One year postoperatively the patient reported pain free ambulation using a walker and no recurrence of symptoms. Radiographs demonstrated stable THA components in comparison with preoperative films. Discussion and Conclusion: This case demonstrates a rare finding of intrapelvic pseudotumor causing neurovascular compression after revision THA. Clinicians should be aware of intrapelvic pseudotumor as a possible cause of limb swelling and neuropathy, and that debulking of the mass is a potential treatment option in the setting of well-fixed implants.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67679745","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}
Michael Le, D. Maestri, Bob Jang, Jason Chinnappa, Sol Qurashi
Background: Serum Cobalt (Co) and Chromium (Cr) forms part of the diagnostic process for metallosis following Total Hip Arthroplasty (THA). While knowledge exists on longer term metal ion levels, expected early post-operative rises in serum Co and Cr in Metal-on-Polyethylene (MoP) THAs are currently unknown. This study aims to describe early rises in serum Co and Cr at 6 months postoperatively. Methods: A prospective cohort study of 84 consecutive patients with an uncemented titanium stem from a single THA manufacturer was performed. Patients had either a metal (n=43) or ceramic (n=41) head articulating with a highly cross-linked polyethylene. Serum Co and Cr levels were measured six months post-operatively. Analysis compared mean values between groups and to determined baseline levels. Subgroup analysis investigated the effect of femoral head size and offset on metal ion levels. Results: A mean difference of 0.002259 ppb (95% CI 0.000449-0.004069 ppb; p=0.015) was found when comparing 6-month serum Co in the metal head group compared to baseline. No significant differences were found in serum Cr (p=0.943) at six months post-surgery compared to baseline. Mean serum Co levels were higher in the MoP group compared to the CoP (Ceramic-on-Polyethylene) and auxiliary control group (p=0.012). There were no differences in serum Cr (p=0.976) between the MoP and CoP groups at 6 months post-surgery. Variations in femoral head size and offset did not impact metal ion levels. Conclusion: At six months post-surgery, a higher magnitude of serum Co exists in metal heads when compared to baseline (p=0.015) and to ceramic heads (p=0.012). Further study is required to determine whether serum concentrations of metal ions will continue to increase over time which might leads to implant failure and revision.
背景:血清钴(Co)和铬(Cr)是全髋关节置换术(THA)后金属中毒诊断过程的一部分。虽然对长期金属离子水平有了解，但术后早期在金属对聚乙烯(MoP) tha中血清Co和Cr的预期升高目前尚不清楚。本研究旨在描述术后6个月血清Co和Cr的早期升高。方法:一项前瞻性队列研究，对84例连续使用来自单一THA制造商的未胶结钛干的患者进行了研究。患者采用金属头(n=43)或陶瓷头(n=41)与高度交联聚乙烯连接。术后6个月测定血清Co和Cr水平。分析比较各组之间的平均值和确定的基线水平。亚组分析探讨股骨头大小和偏移量对金属离子水平的影响。结果:平均差值为0.002259 ppb (95% CI 0.000449-0.004069 ppb;p=0.015)，比较金属头组6个月血清Co与基线的差异。术后6个月血清Cr与基线比较无显著差异(p=0.943)。MoP组的平均血清Co水平高于CoP (ceramic -on-聚乙烯)组和辅助对照组(p=0.012)。术后6个月MoP组与CoP组血清Cr差异无统计学意义(p=0.976)。股骨头大小和偏移量的变化对金属离子水平没有影响。结论:术后6个月，金属头的血清Co浓度高于基线(p=0.015)和陶瓷头(p=0.012)。需要进一步的研究来确定血清金属离子浓度是否会随着时间的推移而继续增加，这可能导致种植体失败和翻修。
{"title":"Early Post-operative Rises in Serum Metal Ion Levels in Total Hip Arthroplasty","authors":"Michael Le, D. Maestri, Bob Jang, Jason Chinnappa, Sol Qurashi","doi":"10.15438/rr.10.1.238","DOIUrl":"https://doi.org/10.15438/rr.10.1.238","url":null,"abstract":"Background: Serum Cobalt (Co) and Chromium (Cr) forms part of the diagnostic process for metallosis following Total Hip Arthroplasty (THA). While knowledge exists on longer term metal ion levels, expected early post-operative rises in serum Co and Cr in Metal-on-Polyethylene (MoP) THAs are currently unknown. This study aims to describe early rises in serum Co and Cr at 6 months postoperatively. Methods: A prospective cohort study of 84 consecutive patients with an uncemented titanium stem from a single THA manufacturer was performed. Patients had either a metal (n=43) or ceramic (n=41) head articulating with a highly cross-linked polyethylene. Serum Co and Cr levels were measured six months post-operatively. Analysis compared mean values between groups and to determined baseline levels. Subgroup analysis investigated the effect of femoral head size and offset on metal ion levels. Results: A mean difference of 0.002259 ppb (95% CI 0.000449-0.004069 ppb; p=0.015) was found when comparing 6-month serum Co in the metal head group compared to baseline. No significant differences were found in serum Cr (p=0.943) at six months post-surgery compared to baseline. Mean serum Co levels were higher in the MoP group compared to the CoP (Ceramic-on-Polyethylene) and auxiliary control group (p=0.012). There were no differences in serum Cr (p=0.976) between the MoP and CoP groups at 6 months post-surgery. Variations in femoral head size and offset did not impact metal ion levels. Conclusion: At six months post-surgery, a higher magnitude of serum Co exists in metal heads when compared to baseline (p=0.015) and to ceramic heads (p=0.012). Further study is required to determine whether serum concentrations of metal ions will continue to increase over time which might leads to implant failure and revision.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42704165","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}
Ali Etemad-Rezaie, Tori A. Edmiston, S. Kearns, Philip H. Locker, D. Bohl, Andrew C Sexton, R. Frank, B. Levine
Background: While total knee arthroplasty (TKA) is a successful treatment for debilitating arthritis, up to 20% of patients may be dissatisfied with their outcome. One hypothesis for dissatisfaction is the distortion of native knee kinematics following sacrifice of the anterior cruciate ligament (ACL) during TKA. The purpose of this study was to determine the impact of ACL status at the time of surgery in patients undergoing Posterior Stabilized (PS) TKA for osteoarthritis (OA). Methods: A consecutive prospective series of patients undergoing TKA by a single surgeon underwent prospective intraoperative assessment of their ACL status divided into three different groups:1) intact, 2) attenuated, or 3) deficient. Demographic, preoperative, intraoperative, and postoperative data were collected for each patient by two blinded, independent observers. Outcomes included patient satisfaction and Knee Society Score for Pain (KSS) and Function (KSF), Kellgren and Lawrence (K&L), UCLA Activity Score (UCLA), Short Form-12 (SF12), EuroQol (EQ5D) and patient satisfaction. Results: Of 116 patients, 33 (28.4%) patients had an ACL deficient knee, 40 (34.5%) patients had an attenuated ACL, and 43 (37.1%) patients had an intact ACL. Those with absent ACL were significantly more likely to have a higher BMI (p=.007) and be male (p=.003). Patient with a deficient ACL had significantly lower preoperative KSF and higher K&L scores (p=.009, p=1.26 x 10-7). Attenuated and deficient groups had the greatest change in SF12PCS scores at their one-year follow-up with increases of 9.9 (±10.0) and 10.8 (±8.0), respectively (p=.037). No significant differences in overall postoperative KSS, KSF and satisfaction scores based on ACL status (p=.574 and p=.529, respectively) were found. Conclusion: In a relatively large series, patient with ACL deficiency were more likely to have worse pre-operative outcome scores and similar or better post-operative outcome scores. This suggests that those with ACL insufficiency may experience more subjective improvement from TKA. ACL status can be used as an additional surgical marker to help orthopaedic surgeons identify which patients would most benefit from TKA.
{"title":"Impact of Anterior Cruciate Ligament Status on Early Satisfaction and Clinical Outcomes Following Total Knee Arthroplasty","authors":"Ali Etemad-Rezaie, Tori A. Edmiston, S. Kearns, Philip H. Locker, D. Bohl, Andrew C Sexton, R. Frank, B. Levine","doi":"10.15438/rr.10.1.236","DOIUrl":"https://doi.org/10.15438/rr.10.1.236","url":null,"abstract":"Background: While total knee arthroplasty (TKA) is a successful treatment for debilitating arthritis, up to 20% of patients may be dissatisfied with their outcome. One hypothesis for dissatisfaction is the distortion of native knee kinematics following sacrifice of the anterior cruciate ligament (ACL) during TKA. The purpose of this study was to determine the impact of ACL status at the time of surgery in patients undergoing Posterior Stabilized (PS) TKA for osteoarthritis (OA). Methods: A consecutive prospective series of patients undergoing TKA by a single surgeon underwent prospective intraoperative assessment of their ACL status divided into three different groups:1) intact, 2) attenuated, or 3) deficient. Demographic, preoperative, intraoperative, and postoperative data were collected for each patient by two blinded, independent observers. Outcomes included patient satisfaction and Knee Society Score for Pain (KSS) and Function (KSF), Kellgren and Lawrence (K&L), UCLA Activity Score (UCLA), Short Form-12 (SF12), EuroQol (EQ5D) and patient satisfaction. Results: Of 116 patients, 33 (28.4%) patients had an ACL deficient knee, 40 (34.5%) patients had an attenuated ACL, and 43 (37.1%) patients had an intact ACL. Those with absent ACL were significantly more likely to have a higher BMI (p=.007) and be male (p=.003). Patient with a deficient ACL had significantly lower preoperative KSF and higher K&L scores (p=.009, p=1.26 x 10-7). Attenuated and deficient groups had the greatest change in SF12PCS scores at their one-year follow-up with increases of 9.9 (±10.0) and 10.8 (±8.0), respectively (p=.037). No significant differences in overall postoperative KSS, KSF and satisfaction scores based on ACL status (p=.574 and p=.529, respectively) were found. Conclusion: In a relatively large series, patient with ACL deficiency were more likely to have worse pre-operative outcome scores and similar or better post-operative outcome scores. This suggests that those with ACL insufficiency may experience more subjective improvement from TKA. ACL status can be used as an additional surgical marker to help orthopaedic surgeons identify which patients would most benefit from TKA.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43044287","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}
Trauma centers in the United States focus on providing care to patients who have suffered injuries and may require critical care. These trauma centers are classified into five different levels: Level I to Level V. Level V trauma centers are the least comprehensive, providing minimal 24hour care and resuscitation, and Level I trauma centers are the most comprehensive, accepting the most severely injured patients and always delivering care through the use of an attending surgeon. However, there is a major inequity in access to trauma centers across the United States, especially amongst rural residents. Level III to Level V trauma centers tend to be dominantly situated in rural and underserved areas. Furthermore, trauma centers tend to be widely dispersed with respect to rural areas. Therefore, these areas tend to have a greater mortality rate in relation to traumatic injuries. Improvements in access to hightier traumatic care must occur in order to reduce mortality due to traumatic injuries in underserved rural areas. Possible improvements to rural trauma care include bolstering the quality of care in Level III trauma centers, increasing Level II center efficiency through the involvement of orthopedic traumatologists, placing medical helicopter bases in more strategic locations that enable transport teams to reach other trauma centers faster, building more Level I and Level II trauma centers, and converting Level III centers into either Level I or Level II centers. Defining Trauma Center Levels
{"title":"An Overview of Trauma Center Levels and Disparities in Rural Trauma Care","authors":"Udit Dave, Brandon Gosine, Ashwin Palaniappan","doi":"10.15438/rr.10.1.234","DOIUrl":"https://doi.org/10.15438/rr.10.1.234","url":null,"abstract":"Trauma centers in the United States focus on providing care to patients who have suffered injuries and may require critical care. These trauma centers are classified into five different levels: Level I to Level V. Level V trauma centers are the least comprehensive, providing minimal 24hour care and resuscitation, and Level I trauma centers are the most comprehensive, accepting the most severely injured patients and always delivering care through the use of an attending surgeon. However, there is a major inequity in access to trauma centers across the United States, especially amongst rural residents. Level III to Level V trauma centers tend to be dominantly situated in rural and underserved areas. Furthermore, trauma centers tend to be widely dispersed with respect to rural areas. Therefore, these areas tend to have a greater mortality rate in relation to traumatic injuries. Improvements in access to hightier traumatic care must occur in order to reduce mortality due to traumatic injuries in underserved rural areas. Possible improvements to rural trauma care include bolstering the quality of care in Level III trauma centers, increasing Level II center efficiency through the involvement of orthopedic traumatologists, placing medical helicopter bases in more strategic locations that enable transport teams to reach other trauma centers faster, building more Level I and Level II trauma centers, and converting Level III centers into either Level I or Level II centers. Defining Trauma Center Levels","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49294205","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}
The worldwide orthopaedic industry lost one of our true giants, as Nik Nikolaev passed away in December of last year. Nik is survived by Sandy, his wife of nearly 60 years, daughter Kimberly and son Cort, of whom he was immensely proud. He is also survived by all of us who had the privilege of knowing and working with him, and by the millions of patients who received the gift of a new prosthesis that Nik was responsible for commercializing.
{"title":"In Memorium Richard D. “Nik” Nikolaev August 24, 1938 – December 19, 2019","authors":"G. Cipolletti","doi":"10.15438/rr.10.1.244","DOIUrl":"https://doi.org/10.15438/rr.10.1.244","url":null,"abstract":"The worldwide orthopaedic industry lost one of our true giants, as Nik Nikolaev passed away in December of last year. Nik is survived by Sandy, his wife of nearly 60 years, daughter Kimberly and son Cort, of whom he was immensely proud. He is also survived by all of us who had the privilege of knowing and working with him, and by the millions of patients who received the gift of a new prosthesis that Nik was responsible for commercializing.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42952121","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}
As a response to the viral pneumonias and severe illnesses that were emerging in patients, an ophthalmologist Dr Li Wenliang, working at Wuhan Central Hospital, voiced his concerns only to be severely admonished by the authorities. The accelerated spread of the Severe Acute Respiratory Syndrome (SARS) in Wuhan, and then globally, as a result of the novel coronavirus was acute and pronounced. China alerted the World Health Organisation to several pneumonia cases at the end of December 2019 and the first death was recorded in early January 2020. The respiratory physician Dr Nanshan Zhong, announced human-to-human spread and a few days later on the 23 January 2020, Wuhan was placed under quarantine. The virus spread outside China and the WHO declared the outbreak a global health emergency on 30 January 2020. Tragically Dr Li Wenliang died on 7 February 2020 as a result of exposure to the virus, leaving a five-year-old son and a pregnant wife. On 11 February 2020, WHO named the novel viral pneumonia as Coronavirus disease 2019 (COVID-19). The International Committee on Taxonomy of Viruses suggested the name ‘SARS-CoV-2’ as a result of their phylogenetic and taxonomic analysis of the virus. Coronaviruses belong to the family of Coronaviridae, and comprise of large, single, plus-stranded RNA with a 29,903 nucleotide genome. There are 4 genera (designated α, β, γ, δ) of coronavirus and β-CoV mainly infects the respiratory, gastrointestinal, and central nervous system of humans and mammals. 2019-nCOV is the 7th member of the family of coronaviruses. SARS-CoV and MERS-CoV also belong to β-CoV and the nucleotide sequence similarity between SARS-CoV and 2019-nCoV is about 79%. SARS-CoV-2 possesses the typical coronavirus structure with a spike (S) protein in the membrane envelope. This S protein can bind to the receptors of the host to facilitate viral entry into target cells and can also bind to the human angiotensin converting enzyme 2 (ACE2), but cannot bind to the human cells without ACE2. The high affinity between ACE2 and the S protein also suggests that the population with higher expression of ACE2 might be more susceptible to SARS-CoV-2. [1] It is highly likely that the virus originated in its natural host, the horseshoe bat (Rhinolophus affinis) and spilled out via some wild animals such as pangolins, and from a seafood and meat market into humans. The human to human transmission of the virus is via direct transmission (cough, sneeze, droplet dispersal and droplet inhalation) and contact transmission via oral, nasal and eye mucous
{"title":"Year of the Mask; COVID-19 Challenges for Orthopaedic Surgery","authors":"E. Smith","doi":"10.15438/rr.10.1.241","DOIUrl":"https://doi.org/10.15438/rr.10.1.241","url":null,"abstract":"As a response to the viral pneumonias and severe illnesses that were emerging in patients, an ophthalmologist Dr Li Wenliang, working at Wuhan Central Hospital, voiced his concerns only to be severely admonished by the authorities. The accelerated spread of the Severe Acute Respiratory Syndrome (SARS) in Wuhan, and then globally, as a result of the novel coronavirus was acute and pronounced. China alerted the World Health Organisation to several pneumonia cases at the end of December 2019 and the first death was recorded in early January 2020. The respiratory physician Dr Nanshan Zhong, announced human-to-human spread and a few days later on the 23 January 2020, Wuhan was placed under quarantine. The virus spread outside China and the WHO declared the outbreak a global health emergency on 30 January 2020. Tragically Dr Li Wenliang died on 7 February 2020 as a result of exposure to the virus, leaving a five-year-old son and a pregnant wife. On 11 February 2020, WHO named the novel viral pneumonia as Coronavirus disease 2019 (COVID-19). The International Committee on Taxonomy of Viruses suggested the name ‘SARS-CoV-2’ as a result of their phylogenetic and taxonomic analysis of the virus. Coronaviruses belong to the family of Coronaviridae, and comprise of large, single, plus-stranded RNA with a 29,903 nucleotide genome. There are 4 genera (designated α, β, γ, δ) of coronavirus and β-CoV mainly infects the respiratory, gastrointestinal, and central nervous system of humans and mammals. 2019-nCOV is the 7th member of the family of coronaviruses. SARS-CoV and MERS-CoV also belong to β-CoV and the nucleotide sequence similarity between SARS-CoV and 2019-nCoV is about 79%. SARS-CoV-2 possesses the typical coronavirus structure with a spike (S) protein in the membrane envelope. This S protein can bind to the receptors of the host to facilitate viral entry into target cells and can also bind to the human angiotensin converting enzyme 2 (ACE2), but cannot bind to the human cells without ACE2. The high affinity between ACE2 and the S protein also suggests that the population with higher expression of ACE2 might be more susceptible to SARS-CoV-2. [1] It is highly likely that the virus originated in its natural host, the horseshoe bat (Rhinolophus affinis) and spilled out via some wild animals such as pangolins, and from a seafood and meat market into humans. The human to human transmission of the virus is via direct transmission (cough, sneeze, droplet dispersal and droplet inhalation) and contact transmission via oral, nasal and eye mucous","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44658544","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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