Pub Date : 2022-04-11DOI: 10.1177/22104917221092162
Andrei Agius Anastasi, Stephen J. Zammit
Purpose: To analyse data related to the referral, selection and admission processes for inpatient rehabilitation at Karin Grech Hospital, Malta. Examining pre-pandemic challenges faced can guide reform towards a more sustainable use of inpatient rehabilitation services. Methods: Referrals and outcomes of all patients referred for inpatient rehabilitation between April and August, 2018 were analysed. Results: 47% of patients referred for inpatient rehabilitation were accepted, with an average time to transfer of 4.84 days. Of the 53% deemed unsuitable, the commonest reasons were: excessively high level of independence (22%), non-weight-bearing restriction (12%) and patient refusal (12%). 90% of inpatients in rehabilitation were discharged home, 7% were transferred back due to acute complications and 1 patient was transferred to a residential home. Out of all referrals, 14 passed away within 1 year, two of these within 8 days of referral. Conclusions: Identifying unsuitable referrals for inpatient rehabilitation can avoid inappropriate admissions that would otherwise decrease bed availability and increase waiting times. Basing patient selection on key principles can thence ensure efficient and sustainable rehabilitation services moving forward.
{"title":"Referrals for inpatient rehabilitation and the patient selection processes: Pre-pandemic challenges as a guide towards reforms moving forward","authors":"Andrei Agius Anastasi, Stephen J. Zammit","doi":"10.1177/22104917221092162","DOIUrl":"https://doi.org/10.1177/22104917221092162","url":null,"abstract":"Purpose: To analyse data related to the referral, selection and admission processes for inpatient rehabilitation at Karin Grech Hospital, Malta. Examining pre-pandemic challenges faced can guide reform towards a more sustainable use of inpatient rehabilitation services. Methods: Referrals and outcomes of all patients referred for inpatient rehabilitation between April and August, 2018 were analysed. Results: 47% of patients referred for inpatient rehabilitation were accepted, with an average time to transfer of 4.84 days. Of the 53% deemed unsuitable, the commonest reasons were: excessively high level of independence (22%), non-weight-bearing restriction (12%) and patient refusal (12%). 90% of inpatients in rehabilitation were discharged home, 7% were transferred back due to acute complications and 1 patient was transferred to a residential home. Out of all referrals, 14 passed away within 1 year, two of these within 8 days of referral. Conclusions: Identifying unsuitable referrals for inpatient rehabilitation can avoid inappropriate admissions that would otherwise decrease bed availability and increase waiting times. Basing patient selection on key principles can thence ensure efficient and sustainable rehabilitation services moving forward.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"231 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77458461","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 : 2022-04-11DOI: 10.1177/22104917221092161
Matthias Rohringer, C. Fink, J. Kellerer, E. Schulc
Purpose To assess health literacy (HL) of patients with total knee arthroplasty (TKA) and evaluate its impact on patient reported outcome measures (PROMs) as well as investigating outcome differences in inpatient and outpatient rehabilitation. Methods In this study, HL and PROMs of older patients were assessed preoperatively (T0) and after 3 (T1), 6 (T2), and 12 (T3) months. HL was assessed with the short form of the European HL Questionnaire; pain scores, functional restrictions, and activity levels with standardized PROMs. Results Limited HL was observed in 70.6% of patients at T0. HL improved from baseline to follow-ups (p < 0.001). There was no impact of HL on PROMs. Pain scores were higher in patients undergoing outpatient rehabilitation (p = 0.022). No differences were found between the rehabilitation settings for the other outcomes. Conclusion The study shows that limited HL is prevalent in patients with scheduled TKA. Rehabilitation seems to have a positive effect on increasing HL.
{"title":"Longitudinal observational study on health literacy and clinical outcomes in older adults with total knee arthroplasty in the context of inpatient and outpatient rehabilitation","authors":"Matthias Rohringer, C. Fink, J. Kellerer, E. Schulc","doi":"10.1177/22104917221092161","DOIUrl":"https://doi.org/10.1177/22104917221092161","url":null,"abstract":"Purpose To assess health literacy (HL) of patients with total knee arthroplasty (TKA) and evaluate its impact on patient reported outcome measures (PROMs) as well as investigating outcome differences in inpatient and outpatient rehabilitation. Methods In this study, HL and PROMs of older patients were assessed preoperatively (T0) and after 3 (T1), 6 (T2), and 12 (T3) months. HL was assessed with the short form of the European HL Questionnaire; pain scores, functional restrictions, and activity levels with standardized PROMs. Results Limited HL was observed in 70.6% of patients at T0. HL improved from baseline to follow-ups (p < 0.001). There was no impact of HL on PROMs. Pain scores were higher in patients undergoing outpatient rehabilitation (p = 0.022). No differences were found between the rehabilitation settings for the other outcomes. Conclusion The study shows that limited HL is prevalent in patients with scheduled TKA. Rehabilitation seems to have a positive effect on increasing HL.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"46 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88147103","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 : 2022-04-11DOI: 10.1177/22104917221092166
Kento Hirota, Kota Watanabe, Yuki Saito, Hiroki Miyamoto, Keisuke Negishi, A. Teramoto, M. Katayose
Background/Purpose To investigate the relationship between anatomical variation of the toe flexor muscles and the resulting variation of toe flexion angle from tendon excursion. Methods Six cadaveric lower extremities preserved by Thiel’s embalming method were evaluated. The toe flexor muscles were distracted individually and toe flexion angles measured. The anatomic variation were observed by gross anatomical dissection. Results The toes with tendinous slips of flexor hallucis longus (FHL) showed similar flexion angles between the FHL and flexor digitorum longus. However, there were differences observed regarding toe flexion and tendon excursion of the flexor digitorum muscle and quadratus plantae due to the anatomic variations. Conclusion The anatomical variation of the toe flexor muscles should be taken into account when evaluating toe function and applying exercise therapy for foot disorders.
{"title":"Toe flexion movement with tendon excursion based on anatomical variation: A cadaver study","authors":"Kento Hirota, Kota Watanabe, Yuki Saito, Hiroki Miyamoto, Keisuke Negishi, A. Teramoto, M. Katayose","doi":"10.1177/22104917221092166","DOIUrl":"https://doi.org/10.1177/22104917221092166","url":null,"abstract":"Background/Purpose To investigate the relationship between anatomical variation of the toe flexor muscles and the resulting variation of toe flexion angle from tendon excursion. Methods Six cadaveric lower extremities preserved by Thiel’s embalming method were evaluated. The toe flexor muscles were distracted individually and toe flexion angles measured. The anatomic variation were observed by gross anatomical dissection. Results The toes with tendinous slips of flexor hallucis longus (FHL) showed similar flexion angles between the FHL and flexor digitorum longus. However, there were differences observed regarding toe flexion and tendon excursion of the flexor digitorum muscle and quadratus plantae due to the anatomic variations. Conclusion The anatomical variation of the toe flexor muscles should be taken into account when evaluating toe function and applying exercise therapy for foot disorders.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84292831","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 : 2022-04-11DOI: 10.1177/22104917221082313
Irsan Fahmi Almuhtarihan, S Suharjono, Primadenny Ariesa Airlangga, E. Padolo
Background Increased demand for arthroplasty also increases the number of complications of arthroplasty, especially surgical site infection (SSI). One of the effective strategies in preventing surgical site infection is the use of appropriate prophylactic antibiotics. Objective To identify and analyse information from clinical studies regarding factors affecting the effectiveness of prophylactic antibiotics in arthroplasty patients. Methods A scoping review was conducted through the PubMed, Scopus, and Google Scholar databases within a publication range from January 2004 to August 2020. Study data are extracted and analysed by a minimum of two reviewers. Results The search results found 2.419 articles, with 39 articles were included for further analysis. Cefazolin monotherapy was the most frequently studied antibiotic (15 articles) followed by vancomycin monotherapy (8 articles). Most widely used antibiotics in arthroplasty were cefazolin mono-therapy (997.599 procedures with SSI incidence range: 0,20–16,05%) followed by vancomycin mono-therapy (125.170 procedures with SSI incidence range: 0.27–3,88%) The correct antibiotic dose has a lower percentage of the SSI than the wrong antibiotic dose. Meanwhile, administration of antibiotics within single dose or <24 h had a lower SSI percentage than administration of antibiotics >24 h. Administration antibiotics before incision also have a lower SSI percentage than after incision. There were no studies that discussed re-dosing of antibiotics in this scoping review. Conclusions There is still a need for further research related to the duration and specific timing of first dose of prophylactic antibiotics, especially regarding single dose or multiple dose antibiotics to obtain maximum effectiveness of antibiotic prophylaxis
{"title":"Use of prophylactic antibiotics on surgical site infections in arthroplasty patients (Scoping Review)","authors":"Irsan Fahmi Almuhtarihan, S Suharjono, Primadenny Ariesa Airlangga, E. Padolo","doi":"10.1177/22104917221082313","DOIUrl":"https://doi.org/10.1177/22104917221082313","url":null,"abstract":"Background Increased demand for arthroplasty also increases the number of complications of arthroplasty, especially surgical site infection (SSI). One of the effective strategies in preventing surgical site infection is the use of appropriate prophylactic antibiotics. Objective To identify and analyse information from clinical studies regarding factors affecting the effectiveness of prophylactic antibiotics in arthroplasty patients. Methods A scoping review was conducted through the PubMed, Scopus, and Google Scholar databases within a publication range from January 2004 to August 2020. Study data are extracted and analysed by a minimum of two reviewers. Results The search results found 2.419 articles, with 39 articles were included for further analysis. Cefazolin monotherapy was the most frequently studied antibiotic (15 articles) followed by vancomycin monotherapy (8 articles). Most widely used antibiotics in arthroplasty were cefazolin mono-therapy (997.599 procedures with SSI incidence range: 0,20–16,05%) followed by vancomycin mono-therapy (125.170 procedures with SSI incidence range: 0.27–3,88%) The correct antibiotic dose has a lower percentage of the SSI than the wrong antibiotic dose. Meanwhile, administration of antibiotics within single dose or <24 h had a lower SSI percentage than administration of antibiotics >24 h. Administration antibiotics before incision also have a lower SSI percentage than after incision. There were no studies that discussed re-dosing of antibiotics in this scoping review. Conclusions There is still a need for further research related to the duration and specific timing of first dose of prophylactic antibiotics, especially regarding single dose or multiple dose antibiotics to obtain maximum effectiveness of antibiotic prophylaxis","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"323 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76299026","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 : 2022-04-08DOI: 10.1177/22104917221085723
Mahmoud Fahmy, A. Seifeldin
Introduction Although better surgical exposure is encountered with the excision of infrapatellar pad of fat (IPPF) during total knee replacement (TKR), some studies showed an increase in anterior knee pain and other specific complications associated with such a step. The purpose of this study was to add in literature a new comparison between IPPF excision and preservation during TKR, focusing on the anterior knee pain, functional range, oxford knee score and patellar height through a randomized clinical trial Methods This prospective randomized study was conducted from 2016 to 2019 on 90 patients with knee osteoarthritis treated with elective primary TKA by same surgeons at one hospital with the same implant design with a mean follow up of 18 month. Patients were randomized into two groups: one group including patients with IPPF complete excision and the other group include patients with IPPF preservation. No patella resurfacing was done. Pre and postoperative anterior knee pain was recorded and compared using VAS score in addition to Oxford knee score. Results At 6 months follow-up, 10 knees and 14 knees (27%) had anterior aching discomfort with a mean postoperative extension were −5.3 and −5.2 in IPPF preservation and excision group patients, respectively. There was no statistically significant differences between both groups regarding anterior knee pain, range of motion, oxford knee score or patellar height measurement through the follow up period. No patellar complications were recorded in all cases. Conclusion Although Infrapatellar fat pad excision in TKA resulted in a minor increase in number of patients with postoperative anterior knee pain, it was of no statistically significant difference. Hence, whenever a better surgical exposure is needed, IPPF excision should be considered. Additional large scale randomized studies should be added to the calling literature for more result validation and guidelines formulation.
{"title":"The impact of infrapatellar fat pad excision versus preservation after total knee replacement on anterior knee pain, functional outcome and patellar height: Randomized controlled trial","authors":"Mahmoud Fahmy, A. Seifeldin","doi":"10.1177/22104917221085723","DOIUrl":"https://doi.org/10.1177/22104917221085723","url":null,"abstract":"Introduction Although better surgical exposure is encountered with the excision of infrapatellar pad of fat (IPPF) during total knee replacement (TKR), some studies showed an increase in anterior knee pain and other specific complications associated with such a step. The purpose of this study was to add in literature a new comparison between IPPF excision and preservation during TKR, focusing on the anterior knee pain, functional range, oxford knee score and patellar height through a randomized clinical trial Methods This prospective randomized study was conducted from 2016 to 2019 on 90 patients with knee osteoarthritis treated with elective primary TKA by same surgeons at one hospital with the same implant design with a mean follow up of 18 month. Patients were randomized into two groups: one group including patients with IPPF complete excision and the other group include patients with IPPF preservation. No patella resurfacing was done. Pre and postoperative anterior knee pain was recorded and compared using VAS score in addition to Oxford knee score. Results At 6 months follow-up, 10 knees and 14 knees (27%) had anterior aching discomfort with a mean postoperative extension were −5.3 and −5.2 in IPPF preservation and excision group patients, respectively. There was no statistically significant differences between both groups regarding anterior knee pain, range of motion, oxford knee score or patellar height measurement through the follow up period. No patellar complications were recorded in all cases. Conclusion Although Infrapatellar fat pad excision in TKA resulted in a minor increase in number of patients with postoperative anterior knee pain, it was of no statistically significant difference. Hence, whenever a better surgical exposure is needed, IPPF excision should be considered. Additional large scale randomized studies should be added to the calling literature for more result validation and guidelines formulation.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"48 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78832340","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 : 2022-04-07DOI: 10.1177/22104917221082315
Hin Ting Victor Yick, P. Chan, Chunyi Wen, W. C. Fung, C. Yan, K. Chiu
Current practice of osteoarthritis has its insufficiencies which researchers are tackling with artificial intelligence (AI). This article discusses three kinds of AI models, namely diagnostic models, prediction models and morphological models. Diagnostic models enhance efficiency in diagnosis by providing an automated algorithm in knee images processing. Prediction models utilize behavioral and radiological data to assess the risk of osteoarthritis before symptom onset and needs to perform surgery. Morphological models detect biomechanical changes to facilitate understanding of pathophysiology and provide personalized intervention. Through reviewing present evidence, we demonstrate that AI could assist doctors in diagnosis, predict osteoarthritis and guide future research.
{"title":"Artificial intelligence reshapes current understanding and management of osteoarthritis: A narrative review","authors":"Hin Ting Victor Yick, P. Chan, Chunyi Wen, W. C. Fung, C. Yan, K. Chiu","doi":"10.1177/22104917221082315","DOIUrl":"https://doi.org/10.1177/22104917221082315","url":null,"abstract":"Current practice of osteoarthritis has its insufficiencies which researchers are tackling with artificial intelligence (AI). This article discusses three kinds of AI models, namely diagnostic models, prediction models and morphological models. Diagnostic models enhance efficiency in diagnosis by providing an automated algorithm in knee images processing. Prediction models utilize behavioral and radiological data to assess the risk of osteoarthritis before symptom onset and needs to perform surgery. Morphological models detect biomechanical changes to facilitate understanding of pathophysiology and provide personalized intervention. Through reviewing present evidence, we demonstrate that AI could assist doctors in diagnosis, predict osteoarthritis and guide future research.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"18 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81600822","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 : 2022-04-07DOI: 10.1177/22104917221080561
Divesh Jalan, A. Gupta, P. Khera, Suvinay Saxena, D. Maley, A. Elhence
Background The degree of joint space narrowing measured on radiographs provide a reliable estimate of the extent and severity of Osteoarthritis (OA) of the knee. While the standing antero-posterior (AP) view radiographs have been used traditionally, recent studies suggest that the Lyon-Schuss (LS) view is able to detect early OA changes better. The present study was, therefore, conducted to make an objective comparison between the two views with respect to their corelation with the patient's clinical and radiological scores. Methods Forty patients (80 knees) were included in this cross-sectional study. Medial as well as lateral tibiofemoral joint space widths (JSW) were measured using vernier callipers on printed, calibrated radiographic images. Knee Society Score (Function) (KSS-F) was used as the clinical outcome measure while Ahlbäck grade was used for determining radiological severity. JSW was correlated with KSS-F and the Ahlbäck grade using Spearman's rho correlation coefficient. Reproducibility of the method was assessed using the intra-class correlation coefficient (ICC). Results Average age of the participants was 60 ± 7.65 (range 50–78) years, with 18 males and 22 females. ICC for intraobserver reliability was 0.97 and for inter-observer reliability, was 0.91 (AP view) and 0.92 (LS view), respectively. Medial JSW measurements taken on the AP view were found to have a significantly higher degree of correlation with both KSS-F and Ahlbäck grade (p < 0.05) than those obtained from the LS view. Conclusion Although the LS view may be more sensitive for detecting early OA changes in knee, particularly in the lateral tibiofemoral compartment, the present study shows that AP view correlates better with the patient's overall clinical and radiological profile.
{"title":"Correlation of tibiofemoral joint-space width with the clinico-radiological scoring of knee osteoarthritis – a comparison between anteroposterior and lyon-schuss radiographic views","authors":"Divesh Jalan, A. Gupta, P. Khera, Suvinay Saxena, D. Maley, A. Elhence","doi":"10.1177/22104917221080561","DOIUrl":"https://doi.org/10.1177/22104917221080561","url":null,"abstract":"Background The degree of joint space narrowing measured on radiographs provide a reliable estimate of the extent and severity of Osteoarthritis (OA) of the knee. While the standing antero-posterior (AP) view radiographs have been used traditionally, recent studies suggest that the Lyon-Schuss (LS) view is able to detect early OA changes better. The present study was, therefore, conducted to make an objective comparison between the two views with respect to their corelation with the patient's clinical and radiological scores. Methods Forty patients (80 knees) were included in this cross-sectional study. Medial as well as lateral tibiofemoral joint space widths (JSW) were measured using vernier callipers on printed, calibrated radiographic images. Knee Society Score (Function) (KSS-F) was used as the clinical outcome measure while Ahlbäck grade was used for determining radiological severity. JSW was correlated with KSS-F and the Ahlbäck grade using Spearman's rho correlation coefficient. Reproducibility of the method was assessed using the intra-class correlation coefficient (ICC). Results Average age of the participants was 60 ± 7.65 (range 50–78) years, with 18 males and 22 females. ICC for intraobserver reliability was 0.97 and for inter-observer reliability, was 0.91 (AP view) and 0.92 (LS view), respectively. Medial JSW measurements taken on the AP view were found to have a significantly higher degree of correlation with both KSS-F and Ahlbäck grade (p < 0.05) than those obtained from the LS view. Conclusion Although the LS view may be more sensitive for detecting early OA changes in knee, particularly in the lateral tibiofemoral compartment, the present study shows that AP view correlates better with the patient's overall clinical and radiological profile.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"29 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76716744","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 : 2022-04-07DOI: 10.1177/22104917221082310
Mostafa F. Tantawy
Background Osteoporotic vertebral compression fractures constitute a major concern in elderly population who may not tolerate conservative treatment. Although percutaneous vertebroplasty is an alternative minimally invasive procedure that is commonly used nowadays, there is still debate about its efficacy. The study aim is to provide short term experience about efficacy of vertebroplasty for osteoporotic vertebral fractures. Methods Thirty five patients were treated by percutaneous vertebroplasty (the intervention group). The visual analog scale before the intervention (pre VAS), one week after the intervention (post VAS 1), at three months (post VAS 2) after the intervention were compared at each time point with the control group (35 patients). The oswestry disability index before (pre ODI) and three months after the procedure (post ODI) were assessed. The control group received the optimal medical treatment and a regular physiotherapy program for three months. Results Both conservative and vertebroplasty group showed significant improvement in the VAS/ODI with time. With vertebroplasty, the improvement is faster and statistically significant compared with conservative group. There were statistically significant differences between both groups concerning post VAS 1, post VAS 2 and post ODI as the P values were 0.00 in all relationships. Conclusion Patients with osteoporotic compression fractures who were treated with percutaneous vertebroplasty experienced considerable clinical improvement in comparison with those who received the conservative management.
{"title":"Efficacy and safety of percutaneous vertebroplasty for osteoporotic vertebral compression fractures","authors":"Mostafa F. Tantawy","doi":"10.1177/22104917221082310","DOIUrl":"https://doi.org/10.1177/22104917221082310","url":null,"abstract":"Background Osteoporotic vertebral compression fractures constitute a major concern in elderly population who may not tolerate conservative treatment. Although percutaneous vertebroplasty is an alternative minimally invasive procedure that is commonly used nowadays, there is still debate about its efficacy. The study aim is to provide short term experience about efficacy of vertebroplasty for osteoporotic vertebral fractures. Methods Thirty five patients were treated by percutaneous vertebroplasty (the intervention group). The visual analog scale before the intervention (pre VAS), one week after the intervention (post VAS 1), at three months (post VAS 2) after the intervention were compared at each time point with the control group (35 patients). The oswestry disability index before (pre ODI) and three months after the procedure (post ODI) were assessed. The control group received the optimal medical treatment and a regular physiotherapy program for three months. Results Both conservative and vertebroplasty group showed significant improvement in the VAS/ODI with time. With vertebroplasty, the improvement is faster and statistically significant compared with conservative group. There were statistically significant differences between both groups concerning post VAS 1, post VAS 2 and post ODI as the P values were 0.00 in all relationships. Conclusion Patients with osteoporotic compression fractures who were treated with percutaneous vertebroplasty experienced considerable clinical improvement in comparison with those who received the conservative management.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"33 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87971518","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 : 2022-04-04DOI: 10.1177/22104917221088335
C. Vijay, M. Santosh, C. Avinash, T. Adarsh
Purpose The anterior cruciate ligament in the knee is commonly prone to injuries. Reconstruction of this ligament with hamstring tendon has been time-tested but peroneus longus autograft is also gaining popularity. However, very limited literature is available comparing the two grafts. This study aims to compare the functional outcome and donor site morbidity between hamstrings and peroneus longus autograft in anterior cruciate ligament reconstruction. Methods A prospective randomised study was conducted on 45 patients, who underwent anterior cruciate ligament reconstruction. Patients were assigned into Hamstring group and the Peroneus longus group. Functional outcome was assessed using Lysholm score and Modified Cincinnati scores for the knee joint and American Orthopedics Foot and Ankle Scoring for ankle joint. Donor site morbidity was assessed by measuring flexion and extension strength of the knee and plantar flexion and eversion strength of the ankle by handheld dynamometer preoperatively and postoperatively at 6 months and 1 year follow up. Results Functional outcome of the knee showed significant improvement in peroneus longus group (p-value 0.002) compared to hamstring group. Even though there was minimal reduction in functional outcome of the ankle at 6 months follow-up in peroneus longus group, it improved at one year follow-up. While assessing the donor site morbidity at the knee joint, knee flexion strength showed improvement in the group (p-value 0.02) but reduced in the hamstring group where the hamstring tendon was harvested. Knee extension strength in the hamstring group scored marginally better than the peroneus longus group, which was not statistically significant (p-value 0.5). Conclusion Autologous peroneus longus tendon can be used as a graft of choice in anterior cruciate ligament reconstruction which showed promising results without compromising on the ankle function. Its usage as an alternative source of the graft may be more useful in multi-ligament injuries of the knee joint.
{"title":"Is Peroneus longus autograft a better alternative to the Hamstring autograft for anterior cruciate ligament reconstruction? – A randomised control study","authors":"C. Vijay, M. Santosh, C. Avinash, T. Adarsh","doi":"10.1177/22104917221088335","DOIUrl":"https://doi.org/10.1177/22104917221088335","url":null,"abstract":"Purpose The anterior cruciate ligament in the knee is commonly prone to injuries. Reconstruction of this ligament with hamstring tendon has been time-tested but peroneus longus autograft is also gaining popularity. However, very limited literature is available comparing the two grafts. This study aims to compare the functional outcome and donor site morbidity between hamstrings and peroneus longus autograft in anterior cruciate ligament reconstruction. Methods A prospective randomised study was conducted on 45 patients, who underwent anterior cruciate ligament reconstruction. Patients were assigned into Hamstring group and the Peroneus longus group. Functional outcome was assessed using Lysholm score and Modified Cincinnati scores for the knee joint and American Orthopedics Foot and Ankle Scoring for ankle joint. Donor site morbidity was assessed by measuring flexion and extension strength of the knee and plantar flexion and eversion strength of the ankle by handheld dynamometer preoperatively and postoperatively at 6 months and 1 year follow up. Results Functional outcome of the knee showed significant improvement in peroneus longus group (p-value 0.002) compared to hamstring group. Even though there was minimal reduction in functional outcome of the ankle at 6 months follow-up in peroneus longus group, it improved at one year follow-up. While assessing the donor site morbidity at the knee joint, knee flexion strength showed improvement in the group (p-value 0.02) but reduced in the hamstring group where the hamstring tendon was harvested. Knee extension strength in the hamstring group scored marginally better than the peroneus longus group, which was not statistically significant (p-value 0.5). Conclusion Autologous peroneus longus tendon can be used as a graft of choice in anterior cruciate ligament reconstruction which showed promising results without compromising on the ankle function. Its usage as an alternative source of the graft may be more useful in multi-ligament injuries of the knee joint.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"63 6 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90701099","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 : 2022-03-29DOI: 10.1177/22104917221082317
M. Elkabbani, Feras Haidar, A. Osman, Yosra Adie, A. Dragoș, S. Tarabichi
Background The Insall-Burstein posterior-stabilized knee design was first developed in 1978 by adding a central cam mechanism to the articular surface geometry of the total condylar prosthesis to correct its problems being not “rolling back”. Since then, the use of posterior-stabilized (PS) implants in total knee arthroplasty (TKA) is becoming increasingly popular. However, one of the main disadvantages of PS designs is related to the amount of bone removed during femoral box osteotomy to create the housing of the PS mechanism, the clinical value of removing more or less bone during primary TKA remains to be fully established. The objective of this study was to compare the incidence of early postoperative periprosthetic fractures in the cruciate retaining (CR) and posterior stabilized (PS) knee prosthesis. Methods An institutional high volume arthroplasty unit database was reviewed to identify all patients who sustained a postoperative periprosthetic fracture following primary TKA between January 2014 and May 2018. A retrospective chart review was performed to collect clinical, radiographic, and operative report data. A total of 352 patients with 600 primary TKAs were identified. (300 cases of cruciate retaining TKAs from 178 patients and 300 cases of posterior stabilized TKAs from 174 patients) were retrospectively reviewed. Results Eleven patients (1.83%) sustained periprosthetic fractures in the postoperative setting following primary TKA. All of the fractures were located on the femur and were treated surgically. Only one knee (one patient) from the CR group sustained a periprosthetic fracture, while 10 knees (from 10 patients) from the PS group sustained a fracture. The relative risk of sustaining a fracture in the CR group was 0.10 times relative to the PS group (RR = 0.10, 95% CI 0.0129 – 0.776). Conclusion Posterior stabilized total knee arthroplasties (TKAs) significantly increase the risk of periprosthetic fractures in obese Asian patients compared to cruciate retaining TKAs.
Insall-Burstein后稳定膝关节设计于1978年首次开发，通过在全髁假体的关节面几何形状上增加一个中心凸轮机构来纠正其不“回滚”的问题。从那时起，在全膝关节置换术(TKA)中使用后稳定(PS)植入物越来越受欢迎。然而，PS设计的主要缺点之一与在股骨盒形截骨术中去除的骨量有关，以创建PS机制的外壳，在原发性TKA期间去除更多或更少的骨的临床价值仍有待完全确定。本研究的目的是比较交叉保留(CR)和后路稳定(PS)膝关节假体术后早期假体周围骨折的发生率。方法回顾机构大容量关节置换单元数据库，以确定2014年1月至2018年5月期间原发性TKA术后持续假体周围骨折的所有患者。回顾性回顾图表，收集临床、放射学和手术报告数据。共发现352例600例原发性tka患者。(回顾性分析178例患者中300例十字保留型tka和174例患者中300例后路稳定型tka)。结果11例(1.83%)患者在原发性TKA术后发生假体周围骨折。所有骨折均位于股骨，均行手术治疗。CR组只有1例膝关节(1例)发生假体周围骨折，而PS组有10例膝关节(10例)发生骨折。CR组维持骨折的相对风险是PS组的0.10倍(RR = 0.10, 95% CI 0.0129 - 0.776)。结论与十字保留型全膝关节置换术相比，后路稳定型全膝关节置换术显著增加亚洲肥胖患者假体周围骨折的风险。
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