Pub Date : 2024-07-05eCollection Date: 2024-01-01DOI: 10.21037/aoj-23-67
Pierangelo Za, Giuseppe Francesco Papalia, Fabrizio Russo, Sebastiano Vasta, Gianluca Vadalà, Rocco Papalia
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019 (COVID-19). Patients with COVID-19 manifested symptoms mainly related to the respiratory system, but also the musculoskeletal system can be involved. COVID-19 has been described as a possible cause of knee osteonecrosis (ON). A systematic review was performed to investigate the hypothetical correlation between COVID-19 and knee ON.
Methods: Inclusion criteria were all articles reporting cases of knee ON after a diagnosis of SARS-CoV-2 infection. Considering that COVID-19 is an emerging disease, all levels of evidence studies were included.
Results: Finally, two case series and three case reports were included. We extracted data regarding demographic and clinical characteristics, details of magnetic resonance imaging (MRI), use of corticosteroids (CCS), temporal correlation between ON and COVID-19, treatment of the lesion and its outcomes. A total of seven cases of post-COVID knee ON have been described. Knee pain arose on average 11 weeks after the diagnosis of COVID-19. All patients had knee MRI showing ON. CCS were used to treat COVID-19-related symptoms in four cases. Conservative treatment was successful in five patients.
Conclusions: The correlation between COVID-19 and ON remains unclear. Probably post-COVID-19 ON has a multifactorial origin in which factors related to the patient, consequences of COVID-19 and CCS therapy add up to cause a reduction of blood supply and bone vitality until ON is triggered. A greater number of patients is needed to clarify the role of COVID-19 in the etiopathogenesis of knee ON.
{"title":"Knee osteonecrosis after SARS-CoV-2 infection: a systematic case-based review.","authors":"Pierangelo Za, Giuseppe Francesco Papalia, Fabrizio Russo, Sebastiano Vasta, Gianluca Vadalà, Rocco Papalia","doi":"10.21037/aoj-23-67","DOIUrl":"10.21037/aoj-23-67","url":null,"abstract":"<p><strong>Background: </strong>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019 (COVID-19). Patients with COVID-19 manifested symptoms mainly related to the respiratory system, but also the musculoskeletal system can be involved. COVID-19 has been described as a possible cause of knee osteonecrosis (ON). A systematic review was performed to investigate the hypothetical correlation between COVID-19 and knee ON.</p><p><strong>Methods: </strong>Inclusion criteria were all articles reporting cases of knee ON after a diagnosis of SARS-CoV-2 infection. Considering that COVID-19 is an emerging disease, all levels of evidence studies were included.</p><p><strong>Results: </strong>Finally, two case series and three case reports were included. We extracted data regarding demographic and clinical characteristics, details of magnetic resonance imaging (MRI), use of corticosteroids (CCS), temporal correlation between ON and COVID-19, treatment of the lesion and its outcomes. A total of seven cases of post-COVID knee ON have been described. Knee pain arose on average 11 weeks after the diagnosis of COVID-19. All patients had knee MRI showing ON. CCS were used to treat COVID-19-related symptoms in four cases. Conservative treatment was successful in five patients.</p><p><strong>Conclusions: </strong>The correlation between COVID-19 and ON remains unclear. Probably post-COVID-19 ON has a multifactorial origin in which factors related to the patient, consequences of COVID-19 and CCS therapy add up to cause a reduction of blood supply and bone vitality until ON is triggered. A greater number of patients is needed to clarify the role of COVID-19 in the etiopathogenesis of knee ON.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"31"},"PeriodicalIF":0.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In recent years, to save the meniscus and prevent the progression of knee osteoarthritis, the indications for meniscus repair have been expanding instead of partial menisectomy. Accordingly, various repair techniques for meniscus tears have been developed. The conventional inside-out and outside-in meniscus repair techniques and all-inside repair technique with an implant/anchor can be classified as trans-capsular (TC) repair from the perspective of suture with penetrating capsule. Recently, new suture passers for all-inside meniscus repair have been developed. To distinguish from conventional all-inside repair with implant/anchors, all-inside repair with only suture using these suture passers was described as all-inside suture (AIS) repair. This AIS repair could achieve meniscus-to-meniscus suture across the tear without interposition of soft tissues including the capsule between suture and meniscus, leading direct gap closing of torn edges. In this respect, AIS repair is considered to be "anatomical meniscus repair". Actually, some reports showed biomechanical and clinical advantages of AIS repair. However, there is still limited evidence in clinical practice. Moreover, there are some disadvantages for AIS repair. Not only further studies but also development of new devices and surgical techniques for AIS should be required. This review describes the current status of AIS repair for each type of tear.
{"title":"All-inside suture meniscal repair using suture passer.","authors":"Ryohei Uchida, Shuji Horibe, Tomoki Ohori, Konsei Shino","doi":"10.21037/aoj-24-4","DOIUrl":"10.21037/aoj-24-4","url":null,"abstract":"<p><p>In recent years, to save the meniscus and prevent the progression of knee osteoarthritis, the indications for meniscus repair have been expanding instead of partial menisectomy. Accordingly, various repair techniques for meniscus tears have been developed. The conventional inside-out and outside-in meniscus repair techniques and all-inside repair technique with an implant/anchor can be classified as trans-capsular (TC) repair from the perspective of suture with penetrating capsule. Recently, new suture passers for all-inside meniscus repair have been developed. To distinguish from conventional all-inside repair with implant/anchors, all-inside repair with only suture using these suture passers was described as all-inside suture (AIS) repair. This AIS repair could achieve meniscus-to-meniscus suture across the tear without interposition of soft tissues including the capsule between suture and meniscus, leading direct gap closing of torn edges. In this respect, AIS repair is considered to be \"anatomical meniscus repair\". Actually, some reports showed biomechanical and clinical advantages of AIS repair. However, there is still limited evidence in clinical practice. Moreover, there are some disadvantages for AIS repair. Not only further studies but also development of new devices and surgical techniques for AIS should be required. This review describes the current status of AIS repair for each type of tear.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"29"},"PeriodicalIF":0.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-28eCollection Date: 2024-01-01DOI: 10.21037/aoj-24-3
Evan Boyd, Nathan K Endres, Andrew G Geeslin
Injury to the anterior cruciate ligament (ACL) is a devastating injury to athletes of all ages. The current gold standard treatment following complete rupture of the ACL is reconstruction of the torn ligament with autograft or allograft tendon. Commonly used tendon grafts include patellar tendon, hamstring tendon, and quadriceps tendon. Although ligaments and tendons have similar collagen and proteoglycan compositions, they maintain a unique composition and arrangement of cells to serve their unique biomechanical needs. Therefore, following ACL reconstruction (ACLR), the implanted tendon tissue undergoes a process of remodeling which is termed "ligamentization". The process of ligamentization is divided into three main phases, which include the early healing phase, the proliferative phase, and the maturation phase. Following the process of ligamentization, the graft tissue closely mimics the appearance of ligament tissue on an ultrastructural level. Successful outcome following ACLR is contingent upon adequate remodeling of the tissue as well as healing of the graft within the bone tunnels in the femur and tibia. Choice of graft has individual implications regarding their associated risk of complications, failure, and infection. The purpose of this review is to summarize the process of ligamentization and graft healing and to discuss how graft type influences the rate and types of complications, failures, and infections.
{"title":"Postoperative healing and complications based on anterior cruciate ligament reconstruction graft type.","authors":"Evan Boyd, Nathan K Endres, Andrew G Geeslin","doi":"10.21037/aoj-24-3","DOIUrl":"10.21037/aoj-24-3","url":null,"abstract":"<p><p>Injury to the anterior cruciate ligament (ACL) is a devastating injury to athletes of all ages. The current gold standard treatment following complete rupture of the ACL is reconstruction of the torn ligament with autograft or allograft tendon. Commonly used tendon grafts include patellar tendon, hamstring tendon, and quadriceps tendon. Although ligaments and tendons have similar collagen and proteoglycan compositions, they maintain a unique composition and arrangement of cells to serve their unique biomechanical needs. Therefore, following ACL reconstruction (ACLR), the implanted tendon tissue undergoes a process of remodeling which is termed \"ligamentization\". The process of ligamentization is divided into three main phases, which include the early healing phase, the proliferative phase, and the maturation phase. Following the process of ligamentization, the graft tissue closely mimics the appearance of ligament tissue on an ultrastructural level. Successful outcome following ACLR is contingent upon adequate remodeling of the tissue as well as healing of the graft within the bone tunnels in the femur and tibia. Choice of graft has individual implications regarding their associated risk of complications, failure, and infection. The purpose of this review is to summarize the process of ligamentization and graft healing and to discuss how graft type influences the rate and types of complications, failures, and infections.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"30"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25eCollection Date: 2024-01-01DOI: 10.21037/aoj-24-2
Jun Lu, Bing Wei, Jihao Xu, Zhuang Li
Background: Metabolic syndrome (MetS) is a combination of interconnected conditions, including insulin resistance, abdominal obesity, high blood pressure, and abnormal blood lipid levels. The objective of this research was to investigate the impact of MetS on the quality of life and clinical outcomes following total knee arthroplasty (TKA) in patients with osteoarthritis (OA).
Methods: A retrospective descriptive study was conducted to enroll OA patients who underwent primary TKA at Zhongda Hospital, Southeast University from January 2015 to August 2019. A total of 83 OA patients who did and 144 (MetS group) who did not have MetS (non-MetS group) were included. An analysis was conducted on the patient's clinical data.
Results: The two groups had similar results in terms of lengths of stay (P=0.93), hospital costs (P=0.24), and overall complication rates (P=0.99). There was no significant difference in the average erythrocyte sedimentation rate and C-reactive protein levels between the groups. However, the MetS group exhibited notably lower Hospital for Special Surgery knee scores and Short Form [36] health survey (SF-36) scores compared to the non-MetS group (both P>0.05) during the one-year follow-up period.
Conclusions: OA patients who have MetS had significantly worse knee joint function and quality of life after TKA. There are certain constraints in the current research. First, it belongs to a single-center retrospective study. Further study will be necessary to determine the generality of this conclusion. Second, this study is retrospective, and the number of patients included is not large. Third, due to the diverse clinical groups in our hospital, it is challenging to comprehensively document all the clinical data of the patients involved in this study. Forth, this study did not compare the preoperative differences between the two groups, as well as analyze the postoperative improvement changes in depth. We will compare the preoperative and postoperative differences between the two groups in more depth in future large sample studies.
背景:代谢综合征(MetS)是包括胰岛素抵抗、腹部肥胖、高血压和血脂异常在内的一系列相互关联的病症的组合。本研究旨在探讨 MetS 对骨关节炎(OA)患者全膝关节置换术(TKA)后的生活质量和临床疗效的影响:采用回顾性描述性研究方法,招募2015年1月至2019年8月在东南大学附属中大医院接受初次TKA手术的OA患者。共纳入83例接受TKA治疗的OA患者和144例未接受MetS治疗的OA患者(MetS组)(非MetS组)。对患者的临床数据进行了分析:在住院时间(P=0.93)、住院费用(P=0.24)和总体并发症发生率(P=0.99)方面,两组结果相似。两组的平均红细胞沉降率和 C 反应蛋白水平无明显差异。然而,与非 MetS 组相比,MetS 组在一年随访期间的医院特殊外科膝关节评分和短表[36]健康调查(SF-36)评分明显较低(均为 P>0.05):结论:患有 MetS 的 OA 患者在 TKA 术后膝关节功能和生活质量明显较差。目前的研究存在一定的局限性。首先,这是一项单中心回顾性研究。要确定这一结论的普遍性,还需要进一步的研究。第二,本研究为回顾性研究,纳入的患者人数不多。第三,由于本医院的临床群体多种多样,要全面记录本研究中所有患者的临床数据具有挑战性。第四,本研究没有比较两组患者术前的差异,也没有深入分析术后的改善变化。我们将在今后的大样本研究中更深入地比较两组患者术前和术后的差异。
{"title":"The impact of metabolic syndrome on clinical outcomes following total knee arthroplasty in osteoarthritis patients.","authors":"Jun Lu, Bing Wei, Jihao Xu, Zhuang Li","doi":"10.21037/aoj-24-2","DOIUrl":"10.21037/aoj-24-2","url":null,"abstract":"<p><strong>Background: </strong>Metabolic syndrome (MetS) is a combination of interconnected conditions, including insulin resistance, abdominal obesity, high blood pressure, and abnormal blood lipid levels. The objective of this research was to investigate the impact of MetS on the quality of life and clinical outcomes following total knee arthroplasty (TKA) in patients with osteoarthritis (OA).</p><p><strong>Methods: </strong>A retrospective descriptive study was conducted to enroll OA patients who underwent primary TKA at Zhongda Hospital, Southeast University from January 2015 to August 2019. A total of 83 OA patients who did and 144 (MetS group) who did not have MetS (non-MetS group) were included. An analysis was conducted on the patient's clinical data.</p><p><strong>Results: </strong>The two groups had similar results in terms of lengths of stay (P=0.93), hospital costs (P=0.24), and overall complication rates (P=0.99). There was no significant difference in the average erythrocyte sedimentation rate and C-reactive protein levels between the groups. However, the MetS group exhibited notably lower Hospital for Special Surgery knee scores and Short Form [36] health survey (SF-36) scores compared to the non-MetS group (both P>0.05) during the one-year follow-up period.</p><p><strong>Conclusions: </strong>OA patients who have MetS had significantly worse knee joint function and quality of life after TKA. There are certain constraints in the current research. First, it belongs to a single-center retrospective study. Further study will be necessary to determine the generality of this conclusion. Second, this study is retrospective, and the number of patients included is not large. Third, due to the diverse clinical groups in our hospital, it is challenging to comprehensively document all the clinical data of the patients involved in this study. Forth, this study did not compare the preoperative differences between the two groups, as well as analyze the postoperative improvement changes in depth. We will compare the preoperative and postoperative differences between the two groups in more depth in future large sample studies.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"22"},"PeriodicalIF":0.5,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25eCollection Date: 2024-01-01DOI: 10.21037/aoj-24-13
Nicholas N DePhillipo
{"title":"Inflammation of the tibiofemoral joint: inflammatory mediators, treatment, and long-term effects.","authors":"Nicholas N DePhillipo","doi":"10.21037/aoj-24-13","DOIUrl":"https://doi.org/10.21037/aoj-24-13","url":null,"abstract":"","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"32"},"PeriodicalIF":0.5,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-11eCollection Date: 2024-01-01DOI: 10.21037/aoj-23-59
Mitchell Iung Kennedy, Conner P Olson, Nicholas N DePhillipo, Adam J Tagliero, Robert F LaPrade, Nicholas I Kennedy
Background: The healing process is initiated by injurious stimuli in response to cellular damage. Upon recruiting proinflammatory biomarkers to the tissue site of injury, the release of additional biomarkers occurs, including the likes of cytokines, matrix molecules, macrophages, neutrophils, and others. This influx of immune system mediators can occur for chronic periods, and though its intention is for healing the original injurious stimuli, it is also suspected of causing long term cartilage impairment following internal structure damage. The objective of this narrative review is to identify which inflammatory factors have the leading roles in the progression of osteoarthritis (OA) following knee injuries and how they fluctuate throughout the healing process, both acutely and chronically.
Methods: This narrative review was performed following a computerized search of the electronic database on PubMed in May 2023. Abstracts related to the inflammatory biomarkers of the post-traumatic knee were included for review.
Key content and findings: The chronic low-level inflammation that leads to OA leads to the destruction of the cartilage extracellular matrix, which new and developing orthopedic research is still attempting to find resolve for. Some of this damage is attributed to the biomechanical alterations that occurs following injury, though with most procedures capable of joint biomechanical restoration, focus has rather been shifted toward the environment of inflammatory biomarkers.
Conclusions: Future studies will be aiming to improve the diagnostics of OA, focusing on a consistent correlation of inflammatory biomarkers with imaging. Additionally, biochemical treatments will need to focus on validating reproducible modulation of signaling molecules, in attempts to lessen the chronic elevations of destructive biomarkers.
背景:愈合过程是由细胞损伤时的损伤性刺激启动的。在损伤组织部位招募到促炎生物标志物后,会释放出更多生物标志物,包括细胞因子、基质分子、巨噬细胞、中性粒细胞等。这种免疫系统介质的涌入可能会长期存在,虽然其目的是为了治愈最初的损伤性刺激,但也被怀疑会在内部结构受损后造成长期的软骨损伤。本综述旨在确定哪些炎症因子在膝关节损伤后骨关节炎(OA)的发展过程中起主导作用,以及这些因子在急性和慢性愈合过程中的波动情况:本综述是在 2023 年 5 月对 PubMed 电子数据库进行计算机检索后完成的。主要内容和研究结果:导致 OA 的慢性低水平炎症会导致软骨细胞外基质的破坏,新的和发展中的骨科研究仍在试图找到解决这一问题的方法。这种破坏的部分原因是损伤后发生的生物力学改变,尽管大多数手术都能恢复关节生物力学,但重点已转向炎症生物标志物的环境:结论:未来的研究将以改善 OA 诊断为目标,重点关注炎症生物标志物与成像的一致性相关性。此外,生化治疗还需要重点验证信号分子调节的可重复性,以减少破坏性生物标志物的长期升高。
{"title":"Inflammatory biomarkers and state of the tibiofemoral joint in the osteoarthritic knee: a narrative review.","authors":"Mitchell Iung Kennedy, Conner P Olson, Nicholas N DePhillipo, Adam J Tagliero, Robert F LaPrade, Nicholas I Kennedy","doi":"10.21037/aoj-23-59","DOIUrl":"10.21037/aoj-23-59","url":null,"abstract":"<p><strong>Background: </strong>The healing process is initiated by injurious stimuli in response to cellular damage. Upon recruiting proinflammatory biomarkers to the tissue site of injury, the release of additional biomarkers occurs, including the likes of cytokines, matrix molecules, macrophages, neutrophils, and others. This influx of immune system mediators can occur for chronic periods, and though its intention is for healing the original injurious stimuli, it is also suspected of causing long term cartilage impairment following internal structure damage. The objective of this narrative review is to identify which inflammatory factors have the leading roles in the progression of osteoarthritis (OA) following knee injuries and how they fluctuate throughout the healing process, both acutely and chronically.</p><p><strong>Methods: </strong>This narrative review was performed following a computerized search of the electronic database on PubMed in May 2023. Abstracts related to the inflammatory biomarkers of the post-traumatic knee were included for review.</p><p><strong>Key content and findings: </strong>The chronic low-level inflammation that leads to OA leads to the destruction of the cartilage extracellular matrix, which new and developing orthopedic research is still attempting to find resolve for. Some of this damage is attributed to the biomechanical alterations that occurs following injury, though with most procedures capable of joint biomechanical restoration, focus has rather been shifted toward the environment of inflammatory biomarkers.</p><p><strong>Conclusions: </strong>Future studies will be aiming to improve the diagnostics of OA, focusing on a consistent correlation of inflammatory biomarkers with imaging. Additionally, biochemical treatments will need to focus on validating reproducible modulation of signaling molecules, in attempts to lessen the chronic elevations of destructive biomarkers.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"27"},"PeriodicalIF":0.5,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-22eCollection Date: 2024-01-01DOI: 10.21037/aoj-23-34
C Michael Goplen, Jacob Munro
Removing well-fixed uncemented components can be challenging. With thoughtful surgical planning, appropriate surgical instruments, and proper surgical techniques, most implants can be removed expeditiously with little bone loss and minimal impact on the subsequent reconstruction. Preoperative planning is one of the most essential steps to remove uncemented implants. Obtaining previous surgical records, although tedious, should always be attempted preoperatively to determine if specific instruments will be required and to help anticipate which steps may need special attention. These include the presence of ceramic or metal bearings and the presence of acetabular screws or stem collars. Without proper preparation and available tools, the removal of implants can negatively impact the subsequent reconstruction and patient outcomes. We will describe techniques and practical tips for removing uncemented stems from the top (intramedullary) or transfemoral using an extended trochanteric osteotomy. We will also describe techniques and tools to remove uncemented acetabular shells efficiently. Case examples will highlight these clinical situations where careful planning is necessary and potential problems that may be encountered with the recurring theme of preparing for the worst but hoping for the best. We have also included cases such as removing well-fixed cementless collared stems, broken stems, and fully coated stems.
{"title":"Removal of uncemented components: hope for the best, prepare for the worst-technical tips and tricks.","authors":"C Michael Goplen, Jacob Munro","doi":"10.21037/aoj-23-34","DOIUrl":"10.21037/aoj-23-34","url":null,"abstract":"<p><p>Removing well-fixed uncemented components can be challenging. With thoughtful surgical planning, appropriate surgical instruments, and proper surgical techniques, most implants can be removed expeditiously with little bone loss and minimal impact on the subsequent reconstruction. Preoperative planning is one of the most essential steps to remove uncemented implants. Obtaining previous surgical records, although tedious, should always be attempted preoperatively to determine if specific instruments will be required and to help anticipate which steps may need special attention. These include the presence of ceramic or metal bearings and the presence of acetabular screws or stem collars. Without proper preparation and available tools, the removal of implants can negatively impact the subsequent reconstruction and patient outcomes. We will describe techniques and practical tips for removing uncemented stems from the top (intramedullary) or transfemoral using an extended trochanteric osteotomy. We will also describe techniques and tools to remove uncemented acetabular shells efficiently. Case examples will highlight these clinical situations where careful planning is necessary and potential problems that may be encountered with the recurring theme of preparing for the worst but hoping for the best. We have also included cases such as removing well-fixed cementless collared stems, broken stems, and fully coated stems.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"24"},"PeriodicalIF":0.5,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20eCollection Date: 2024-01-01DOI: 10.21037/aoj-23-62
Mattia Alessio-Mazzola, Nicolo' Biavardi, Giuseppe Solarino, Giuseppe Marongiu, Vincenzo Salini, Giacomo Placella
Background and objective: Knee replacement following anterior cruciate ligament (ACL) reconstruction can be demanding due to altered anatomy, soft tissue scars, bone loss, extensor mechanism complications, and knee instability. This narrative review summarizes the strategies and approaches to managing operative challenges in total knee arthroplasty (TKA) following ACL reconstruction.
Methods: Studies reporting outcomes of patients who underwent TKA after ACL reconstruction were retrieved and assessed to be included in this review that synthesizes the available evidence highlighting the pitfalls encountered during surgery, the intraoperative challenges posed by ligament balancing and exposure, and the leading role of modular and retained implants.
Key content and findings: TKA following ACL reconstruction has a high rate of intra-operative complications such as instability, bone loss, difficult exposure and demanding soft tissue balancing, representing a revision surgery rather than routine primary knee arthroplasty and a revision-oriented skill set and modular components are recommended to significantly optimize both surgical strategy and patient outcomes. With a rising incidence of ACL injuries and growing reconstructions, anticipating an increase in TKA procedures, this review aims to provide a call for rethinking clinical approaches to ensure effective and patient-centric care.
Conclusions: This narrative review seems to indicate that TKA after ACL reconstruction should be considered as revision surgery and modular components should be used. However, future prospective and high-quality studies are required to better clarify risk factors and give strong recommendations for this complex surgery.
{"title":"Total knee arthroplasty after anterior cruciate ligament reconstruction: a narrative review.","authors":"Mattia Alessio-Mazzola, Nicolo' Biavardi, Giuseppe Solarino, Giuseppe Marongiu, Vincenzo Salini, Giacomo Placella","doi":"10.21037/aoj-23-62","DOIUrl":"10.21037/aoj-23-62","url":null,"abstract":"<p><strong>Background and objective: </strong>Knee replacement following anterior cruciate ligament (ACL) reconstruction can be demanding due to altered anatomy, soft tissue scars, bone loss, extensor mechanism complications, and knee instability. This narrative review summarizes the strategies and approaches to managing operative challenges in total knee arthroplasty (TKA) following ACL reconstruction.</p><p><strong>Methods: </strong>Studies reporting outcomes of patients who underwent TKA after ACL reconstruction were retrieved and assessed to be included in this review that synthesizes the available evidence highlighting the pitfalls encountered during surgery, the intraoperative challenges posed by ligament balancing and exposure, and the leading role of modular and retained implants.</p><p><strong>Key content and findings: </strong>TKA following ACL reconstruction has a high rate of intra-operative complications such as instability, bone loss, difficult exposure and demanding soft tissue balancing, representing a revision surgery rather than routine primary knee arthroplasty and a revision-oriented skill set and modular components are recommended to significantly optimize both surgical strategy and patient outcomes. With a rising incidence of ACL injuries and growing reconstructions, anticipating an increase in TKA procedures, this review aims to provide a call for rethinking clinical approaches to ensure effective and patient-centric care.</p><p><strong>Conclusions: </strong>This narrative review seems to indicate that TKA after ACL reconstruction should be considered as revision surgery and modular components should be used. However, future prospective and high-quality studies are required to better clarify risk factors and give strong recommendations for this complex surgery.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"25"},"PeriodicalIF":0.5,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20eCollection Date: 2024-01-01DOI: 10.21037/aoj-23-8
Philippe Landreau, Antoine Catteeuw, Ibrahim Altayar
The stability of the glenohumeral joint, known for its remarkable mobility, relies on several factors, including the congruency of the joint's bones and the integrity of capsulolabral structures, encompassing the labrum, the capsule, and the glenohumeral ligaments. In cases of anterior shoulder instability, bone lesions are a common occurrence, most frequently involving glenoid bone loss and Hill-Sachs lesions. When both glenoid and humeral bone lesions coexist, the isolated Bankart procedure has exhibited a significant rate of failure. In such instances, the Latarjet procedure, especially when bone loss is present, retains its position as the gold standard, thanks to its consistent success in both short- and long-term outcomes. Recent advancements in research have explored alternative strategies to address bone loss, including the Remplissage procedure for humeral bone deficits and the use of bone block grafts to manage glenoid bone lesions, with a focus on achieving more anatomical techniques. However, it's crucial to recognize that, beyond bone loss, a multitude of intrinsic and extrinsic factors come into play when determining the most suitable treatment. The patient's profile, including factors like constitutional laxity and activity level, must be carefully considered in the decision-making process. The Latarjet procedure maintains its esteemed status as a benchmark in the field, thanks to its consistent excellence in both short- and long-term results. This article seeks to provide insights into the roles and placement of various surgical techniques within the context of chronic anterior shoulder instability, taking into account the intricate interplay of factors that influence treatment decisions.
{"title":"Chronic anterior shoulder instability with bone loss: a practical approach.","authors":"Philippe Landreau, Antoine Catteeuw, Ibrahim Altayar","doi":"10.21037/aoj-23-8","DOIUrl":"10.21037/aoj-23-8","url":null,"abstract":"<p><p>The stability of the glenohumeral joint, known for its remarkable mobility, relies on several factors, including the congruency of the joint's bones and the integrity of capsulolabral structures, encompassing the labrum, the capsule, and the glenohumeral ligaments. In cases of anterior shoulder instability, bone lesions are a common occurrence, most frequently involving glenoid bone loss and Hill-Sachs lesions. When both glenoid and humeral bone lesions coexist, the isolated Bankart procedure has exhibited a significant rate of failure. In such instances, the Latarjet procedure, especially when bone loss is present, retains its position as the gold standard, thanks to its consistent success in both short- and long-term outcomes. Recent advancements in research have explored alternative strategies to address bone loss, including the Remplissage procedure for humeral bone deficits and the use of bone block grafts to manage glenoid bone lesions, with a focus on achieving more anatomical techniques. However, it's crucial to recognize that, beyond bone loss, a multitude of intrinsic and extrinsic factors come into play when determining the most suitable treatment. The patient's profile, including factors like constitutional laxity and activity level, must be carefully considered in the decision-making process. The Latarjet procedure maintains its esteemed status as a benchmark in the field, thanks to its consistent excellence in both short- and long-term results. This article seeks to provide insights into the roles and placement of various surgical techniques within the context of chronic anterior shoulder instability, taking into account the intricate interplay of factors that influence treatment decisions.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"26"},"PeriodicalIF":0.5,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11eCollection Date: 2024-01-01DOI: 10.21037/aoj-23-50
Xiao-Gang Zhou, Hui He, Kun Yuan
Background: Rheumatoid arthritis (RA), a systemic autoimmune disease with approximately 1% prevalent population worldwide, which the etiology is still unclear. RA cannot be completely cured at present, which seriously affects the quality of life of patients. This study is to compare the peripheral blood α-L-fucosidase (AFU) between RA and healthy persons.
Methods: A cross-sectional study was performed using total of 96 patients with RA served as case group and another 94 age-matched healthy volunteers served as a control group. AFU assay is detected by continuous monitoring method using Toshiba TBA-120FR (Tokyo, Japan) fully automatic biochemical analyzer in Japan, and the reagent is purchased from Zhejiang Quark Biological Company (Zhejiang, China). Statistical analysis was performed using SPSS 24.0 (SPSS, Inc., Chicago, IL, USA).
Results: AFU activity in peripheral blood of RA patients were lower than healthy controls. The higher AFU activity, the shorter the course of disease (r=-0.2790, P=0.0065). The activity of lactate dehydrogenase in patients with RA is higher than that of healthy control, but the activity of acetylcholinesterase is lower than that of normal people. Finally, AFU activity was negatively correlated with the activity of lactate dehydrogenase (r=-0.2381, P=0.0208) and positively correlated with the activity of acetylcholinesterase (r=0.2985, P=0.0035).
Conclusions: Changes of peripheral blood AFU activity might be associated with progression of disease in RA patients. The changes of AFU activity may lead to disturbances in glucose and lipid metabolism.
{"title":"Changes of peripheral blood α-L-fucosidase activity in patients with rheumatoid arthritis: a cross-sectional study.","authors":"Xiao-Gang Zhou, Hui He, Kun Yuan","doi":"10.21037/aoj-23-50","DOIUrl":"https://doi.org/10.21037/aoj-23-50","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA), a systemic autoimmune disease with approximately 1% prevalent population worldwide, which the etiology is still unclear. RA cannot be completely cured at present, which seriously affects the quality of life of patients. This study is to compare the peripheral blood α-L-fucosidase (AFU) between RA and healthy persons.</p><p><strong>Methods: </strong>A cross-sectional study was performed using total of 96 patients with RA served as case group and another 94 age-matched healthy volunteers served as a control group. AFU assay is detected by continuous monitoring method using Toshiba TBA-120FR (Tokyo, Japan) fully automatic biochemical analyzer in Japan, and the reagent is purchased from Zhejiang Quark Biological Company (Zhejiang, China). Statistical analysis was performed using SPSS 24.0 (SPSS, Inc., Chicago, IL, USA).</p><p><strong>Results: </strong>AFU activity in peripheral blood of RA patients were lower than healthy controls. The higher AFU activity, the shorter the course of disease (r=-0.2790, P=0.0065). The activity of lactate dehydrogenase in patients with RA is higher than that of healthy control, but the activity of acetylcholinesterase is lower than that of normal people. Finally, AFU activity was negatively correlated with the activity of lactate dehydrogenase (r=-0.2381, P=0.0208) and positively correlated with the activity of acetylcholinesterase (r=0.2985, P=0.0035).</p><p><strong>Conclusions: </strong>Changes of peripheral blood AFU activity might be associated with progression of disease in RA patients. The changes of AFU activity may lead to disturbances in glucose and lipid metabolism.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"9 ","pages":"13"},"PeriodicalIF":0.4,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11058529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}