E. Uğur, H. Doshi, S. Wilson, Nicole L. Levine, Janet Tingling, Rachel Y. Yang, B. Hoang, D. Geller, Rui Yang
The Albert Einstein College of Medicine, Bronx, NY, USA; Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA; Hunter College High School, New York, NY, USA Contributions: (I) Concept and design: R Yang, BH Hoang, DS Geller; (II) Administrative support: R Yang, BH Hoang, DS Geller; (III) Provision of study materials or patients: H Doshi, E Ugur, NL Levine; (IV) Collection and assembly of data: H Doshi, E Ugur, NL Levine, S Wilson, J Tingling, RY Yang; (V) Data analysis and interpretation: H Doshi, E Ugur, NL Levine, S Wilson, J Tingling, RY Yang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Rui Yang, MD. Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 6th floor, Bronx, NY 10467, USA. Email: ryan@montefiore.org.
{"title":"Can the Katagiri scoring system predict prognosis for surgically-managed patients with metastatic bone disease?","authors":"E. Uğur, H. Doshi, S. Wilson, Nicole L. Levine, Janet Tingling, Rachel Y. Yang, B. Hoang, D. Geller, Rui Yang","doi":"10.21037/AOJ-20-111","DOIUrl":"https://doi.org/10.21037/AOJ-20-111","url":null,"abstract":"The Albert Einstein College of Medicine, Bronx, NY, USA; Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA; Hunter College High School, New York, NY, USA Contributions: (I) Concept and design: R Yang, BH Hoang, DS Geller; (II) Administrative support: R Yang, BH Hoang, DS Geller; (III) Provision of study materials or patients: H Doshi, E Ugur, NL Levine; (IV) Collection and assembly of data: H Doshi, E Ugur, NL Levine, S Wilson, J Tingling, RY Yang; (V) Data analysis and interpretation: H Doshi, E Ugur, NL Levine, S Wilson, J Tingling, RY Yang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Rui Yang, MD. Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 6th floor, Bronx, NY 10467, USA. Email: ryan@montefiore.org.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41416900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Du, Jichuan Wang, Jie Xu, Zhiqing Zhao, Siyao Liu, Liu Yang, Rui Yang, Shu Wang, Weiling Guo
Background: Breast cancer is the most common malignancy in the female. Survival for patients with breast cancer has improved substantially over the past two decades, accompanied by increased patients with skeletal-related events. Since surgery is most commonly needed for complete or pending pathological fractures, an accurate preoperative survival estimation for patients with symptomatic bone metastases is crucial in surgical decision making. Several prognostic models for survival estimation in metastatic cancer patients have been developed in western centers without external validation in Asian patient populations and breast cancer-specific cohorts. Methods: Seven survival prediction models were externally validated by a cohort of metastatic breast cancer patients from an Asian center. The prediction ability and accuracy were valued using receiver operating characteristic analysis and Brier score at different time points. Univariate and multivariate Cox regression was used to identify independent prognostic factors. A multivariable prediction model was further established and validated. Results: In our metastatic breast cancer patients cohort, the PathFx model demonstrated superior accuracy at predicting 3- and 6-month survival while the SSG model showed the highest accuracy at 12-month. None of these models exhibit accurate predictions beyond 12-month. Cox regression further identified five independent prognostic factors. A prognostic scoring system with breast cancer-specific prognostic factors was established. Internal validation showed consistent discrimination and accuracy. Conclusions: Current prognostic models showed inconsistent and limited accuracy in Asian metastatic breast cancer patients, especially for more prolonged estimated survival. A disease-based predicting model with cancer-specific prognostic factors would increase the prediction accuracy and help with surgical decision making.
{"title":"Comparison and modification of survival predicting system for breast cancer patients with bone metastases","authors":"W. Du, Jichuan Wang, Jie Xu, Zhiqing Zhao, Siyao Liu, Liu Yang, Rui Yang, Shu Wang, Weiling Guo","doi":"10.21037/AOJ-20-120","DOIUrl":"https://doi.org/10.21037/AOJ-20-120","url":null,"abstract":"Background: Breast cancer is the most common malignancy in the female. Survival for patients with breast cancer has improved substantially over the past two decades, accompanied by increased patients with skeletal-related events. Since surgery is most commonly needed for complete or pending pathological fractures, an accurate preoperative survival estimation for patients with symptomatic bone metastases is crucial in surgical decision making. Several prognostic models for survival estimation in metastatic cancer patients have been developed in western centers without external validation in Asian patient populations and breast cancer-specific cohorts. Methods: Seven survival prediction models were externally validated by a cohort of metastatic breast cancer patients from an Asian center. The prediction ability and accuracy were valued using receiver operating characteristic analysis and Brier score at different time points. Univariate and multivariate Cox regression was used to identify independent prognostic factors. A multivariable prediction model was further established and validated. Results: In our metastatic breast cancer patients cohort, the PathFx model demonstrated superior accuracy at predicting 3- and 6-month survival while the SSG model showed the highest accuracy at 12-month. None of these models exhibit accurate predictions beyond 12-month. Cox regression further identified five independent prognostic factors. A prognostic scoring system with breast cancer-specific prognostic factors was established. Internal validation showed consistent discrimination and accuracy. Conclusions: Current prognostic models showed inconsistent and limited accuracy in Asian metastatic breast cancer patients, especially for more prolonged estimated survival. A disease-based predicting model with cancer-specific prognostic factors would increase the prediction accuracy and help with surgical decision making.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45661440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hong-jie Huang, Fan Yang, Xiao-Yan Zheng, Xin Zhang, Jian-quan Wang, Yan Xu
The avulsion fracture of the ischial tuberosity is uncommon and relatively specific in children or teenagers. Without proper imaging and/or clinical suspicion, this injury can be mismanaged and cause nonunion or displacement of the bony avulsion, which may require surgery. Although surgical intervention is rarely necessary, it has a high degree of success when it is used. Several minimally invasive interventions have been reported, but there are no arthroscopic techniques in the literature for reference. Here we report an unusual case of nonunion avulsion fractures of ischial tuberosity in a 19-year-old male dancer. The injury was missed initially and delayed for 5 years. Under hip arthroscopy, we removed the nonunion bone and repaired the insertion of the hamstring tendon. The patient was satisfied and returned to sports within 6 months. Although there is only one patient, this is the first time that the arthroscopic technique has been introduced to treat this unusual injury. All experiences based on this case, including positioning, approach, intraoperative targeting, manipulation and tendon fixation, and a brief review will be present.
{"title":"Arthroscopic management of the nonunion avulsion fracture of ischial tuberosity for a teenager dancer: a case report","authors":"Hong-jie Huang, Fan Yang, Xiao-Yan Zheng, Xin Zhang, Jian-quan Wang, Yan Xu","doi":"10.21037/AOJ-20-122","DOIUrl":"https://doi.org/10.21037/AOJ-20-122","url":null,"abstract":"The avulsion fracture of the ischial tuberosity is uncommon and relatively specific in children or teenagers. Without proper imaging and/or clinical suspicion, this injury can be mismanaged and cause nonunion or displacement of the bony avulsion, which may require surgery. Although surgical intervention is rarely necessary, it has a high degree of success when it is used. Several minimally invasive interventions have been reported, but there are no arthroscopic techniques in the literature for reference. Here we report an unusual case of nonunion avulsion fractures of ischial tuberosity in a 19-year-old male dancer. The injury was missed initially and delayed for 5 years. Under hip arthroscopy, we removed the nonunion bone and repaired the insertion of the hamstring tendon. The patient was satisfied and returned to sports within 6 months. Although there is only one patient, this is the first time that the arthroscopic technique has been introduced to treat this unusual injury. All experiences based on this case, including positioning, approach, intraoperative targeting, manipulation and tendon fixation, and a brief review will be present.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45627550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meniscal tears are one of the most common injuries of the knee and regularly identified in both youth and adult patient populations (1,2). For many years, these injuries were commonly addressed arthroscopically with partial and subtotal meniscectomy. However, over the past few decades, there has been a paradigm shift in surgical management with a focus on preservation due to increased understanding of its structural role in joint preservation, load distribution, proprioception and knee stabilization (3). As meniscal deficiency has been associated with the development of early osteoarthritis, there has been a substantial increase in meniscal repair procedures being performed by orthopaedic Review Article
{"title":"Narrative review of lateral meniscus repair: techniques and outcomes","authors":"Kelms Amoo-Achampong, R. Amendola, A. Amendola","doi":"10.21037/AOJ-20-110","DOIUrl":"https://doi.org/10.21037/AOJ-20-110","url":null,"abstract":"Meniscal tears are one of the most common injuries of the knee and regularly identified in both youth and adult patient populations (1,2). For many years, these injuries were commonly addressed arthroscopically with partial and subtotal meniscectomy. However, over the past few decades, there has been a paradigm shift in surgical management with a focus on preservation due to increased understanding of its structural role in joint preservation, load distribution, proprioception and knee stabilization (3). As meniscal deficiency has been associated with the development of early osteoarthritis, there has been a substantial increase in meniscal repair procedures being performed by orthopaedic Review Article","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49589006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The proximal femur is the most common site of skeletal metastases in the appendicular skeleton. Pain relief and early mobilization are the goals of surgery for such lesions. Intramedullary nail and endoprosthesis (EP) are the commonly used implants to stabilize proximal femur metastatic lesions. There are no guided protocols determining the use of one implant over the other. Methods: A retrospective review was performed on the prospectively collected institutional database of 117 patients who underwent surgery for proximal femur metastases between January 2012 and December 2017. For the analyses, patients with the following conditions were excluded from the study: (I) metastases of the femoral head or neck without trochanteric extension, which is not an indication for intramedullary fixation (n=18); (II) previous surgery to the ipsilateral femur (n=8); (III) surgeries other than intramedullary nailing (IMN) or EP reconstruction (n=7); and (IV) concomitant metastases in the contralateral or ipsilateral femur warranting surgery (n=6). Of the remaining 78 patients, 8 patients with <3 months of follow-up postoperatively were excluded, leaving 70 patients for the analyses. The following factors were compared between the patients undergoing IMN and those undergoing EP reconstruction: incidence of postoperative complications, overall survival, local recurrence-free survival, implant survival, Musculoskeletal Tumor Society scores at 6 months and 1 year following surgery, maximum ambulatory ability of the patient following surgery, and time taken to ambulate independently without support. Results: Apart from local recurrence, 24.3% (9 of 37) of patients in the intramedullary nail group and 15.1% (5 of 33) of patients in the EP group developed complications at the operative site (P=0.658). The intramedullary nail group showed significantly higher local recurrence rate than the EP group (29.7% vs. 9.1%, P=0.030). On Kaplan-Meier analysis, the intramedullary nail group had significantly lower local recurrence-free survival than the EP group (P=0.002). There was no statistically significant difference in the maximum ambulatory ability between the two groups (P=0.082). On Kaplan-Meier analysis, the implant survival at 2 years postoperatively was significantly better in the endoprosthesis group (83%) compared to that in the intramedullary nail group (54%) (log rank, P=0.030). Conclusions: The local recurrence-free survival and implant survival are better with endoprosthetic reconstruction over intramedullary devices for proximal femoral metastatic lesions. As the complication rates and functional outcome of patients with both implants are comparable, endoprosthetic reconstruction can be safely used to provide better durability even in patients with a shorter life span to obtain the best quality of life. 11
{"title":"Surgery for proximal femur metastases: endoprosthesis reconstruction or intramedullary nailing?","authors":"S. Hindiskere, Han-Soo Kim, Yong Sung Kim, I. Han","doi":"10.21037/AOJ-20-96","DOIUrl":"https://doi.org/10.21037/AOJ-20-96","url":null,"abstract":"Background: The proximal femur is the most common site of skeletal metastases in the appendicular skeleton. Pain relief and early mobilization are the goals of surgery for such lesions. Intramedullary nail and endoprosthesis (EP) are the commonly used implants to stabilize proximal femur metastatic lesions. There are no guided protocols determining the use of one implant over the other. Methods: A retrospective review was performed on the prospectively collected institutional database of 117 patients who underwent surgery for proximal femur metastases between January 2012 and December 2017. For the analyses, patients with the following conditions were excluded from the study: (I) metastases of the femoral head or neck without trochanteric extension, which is not an indication for intramedullary fixation (n=18); (II) previous surgery to the ipsilateral femur (n=8); (III) surgeries other than intramedullary nailing (IMN) or EP reconstruction (n=7); and (IV) concomitant metastases in the contralateral or ipsilateral femur warranting surgery (n=6). Of the remaining 78 patients, 8 patients with <3 months of follow-up postoperatively were excluded, leaving 70 patients for the analyses. The following factors were compared between the patients undergoing IMN and those undergoing EP reconstruction: incidence of postoperative complications, overall survival, local recurrence-free survival, implant survival, Musculoskeletal Tumor Society scores at 6 months and 1 year following surgery, maximum ambulatory ability of the patient following surgery, and time taken to ambulate independently without support. Results: Apart from local recurrence, 24.3% (9 of 37) of patients in the intramedullary nail group and 15.1% (5 of 33) of patients in the EP group developed complications at the operative site (P=0.658). The intramedullary nail group showed significantly higher local recurrence rate than the EP group (29.7% vs. 9.1%, P=0.030). On Kaplan-Meier analysis, the intramedullary nail group had significantly lower local recurrence-free survival than the EP group (P=0.002). There was no statistically significant difference in the maximum ambulatory ability between the two groups (P=0.082). On Kaplan-Meier analysis, the implant survival at 2 years postoperatively was significantly better in the endoprosthesis group (83%) compared to that in the intramedullary nail group (54%) (log rank, P=0.030). Conclusions: The local recurrence-free survival and implant survival are better with endoprosthetic reconstruction over intramedullary devices for proximal femoral metastatic lesions. As the complication rates and functional outcome of patients with both implants are comparable, endoprosthetic reconstruction can be safely used to provide better durability even in patients with a shorter life span to obtain the best quality of life. 11","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45115341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Female gender is not a contraindication for resurfacing. In this article evidence to support the routine use of metal on metal (MoM) hip resurfacing in young women will be presented. When implant survivorship is studied in registries, hip resurfacing arthroplasty (HRA) often fares poorly when compared to total hip replacement (THR) because of a bias of inexperience of most surgeons with HRA. In HRA expert surgeon series implant survivorship is at least as good as in expert series of THR. Early in the development of HRA, it became clear that women had worse implant survivorship than men. For this reason, both surgeons and implant manufacturers began discouraging the use of HRA in women. But patient age is an even more crucial variable than gender in implant survivorship. With decreasing age, THR implant survivorship drops precipitously, while HRA implant survivorship is robust. For this reason, in young women, HRA implant survivorship actually surpasses THR implant survivorship. In retrospect, it may have been an error to deny HRA to young women. In this article, I will describe improvements in technique that have served to narrow the disparity of outcomes between genders (current Kaplan-Meier 12-year: 99.5% men and 98.5% women, 99% overall). Specifically, I will describe how failures due to metallosis have been overcome. These advances, which have disproportionately benefitted women, have driven my overall 10-year implant survivorship up from 89% to 99% in the last 20 years. When these refinements have been incorporated in the practice of a skilled HRA surgeon, there is no reason to deny young women the opportunity to enjoy the other benefits of HRA: bone preservation, less instability, no thigh pain, less unexplained pain, higher function, and lower all-cause mortality than stemmed THR. Unfortunately, most young patients are never informed of the option of HRA.
{"title":"Hip resurfacing: is female gender an absolute or relative contraindication?","authors":"T. Gross","doi":"10.21037/AOJ.2020.04.05","DOIUrl":"https://doi.org/10.21037/AOJ.2020.04.05","url":null,"abstract":"Female gender is not a contraindication for resurfacing. In this article evidence to support the routine use of metal on metal (MoM) hip resurfacing in young women will be presented. When implant survivorship is studied in registries, hip resurfacing arthroplasty (HRA) often fares poorly when compared to total hip replacement (THR) because of a bias of inexperience of most surgeons with HRA. In HRA expert surgeon series implant survivorship is at least as good as in expert series of THR. Early in the development of HRA, it became clear that women had worse implant survivorship than men. For this reason, both surgeons and implant manufacturers began discouraging the use of HRA in women. But patient age is an even more crucial variable than gender in implant survivorship. With decreasing age, THR implant survivorship drops precipitously, while HRA implant survivorship is robust. For this reason, in young women, HRA implant survivorship actually surpasses THR implant survivorship. In retrospect, it may have been an error to deny HRA to young women. In this article, I will describe improvements in technique that have served to narrow the disparity of outcomes between genders (current Kaplan-Meier 12-year: 99.5% men and 98.5% women, 99% overall). Specifically, I will describe how failures due to metallosis have been overcome. These advances, which have disproportionately benefitted women, have driven my overall 10-year implant survivorship up from 89% to 99% in the last 20 years. When these refinements have been incorporated in the practice of a skilled HRA surgeon, there is no reason to deny young women the opportunity to enjoy the other benefits of HRA: bone preservation, less instability, no thigh pain, less unexplained pain, higher function, and lower all-cause mortality than stemmed THR. Unfortunately, most young patients are never informed of the option of HRA.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44905299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ming Lu, Lei Zixiong, Dai Shuangwu, Changhe Hou, Shaohua Du, Wei Chen, Liao Haomiao
Spinal metastasis is one of the common complications in the late stage of cancer, which seriously threatens human life and health. The invasion of malignant tumor often leads to pathological fracture of vertebral body, compression of spinal cord and nerve, etc., which leads to cancer pain and nerve injury symptoms. At present, radiofrequency ablation (RFA) combined with vertebroplasty is a safe and effective minimally invasive method for the treatment of spinal metastases, which has unique advantages in relieving pain, improving neurological function, reducing incidence of fracture and the risk of surgery, and improving life quality in spinal metastases patients. This article reviews the state of art of RFA in the surgical treatment of spinal metastases.
{"title":"A narrative review of the application of radiofrequency ablation in the surgery of spinal metastases","authors":"Ming Lu, Lei Zixiong, Dai Shuangwu, Changhe Hou, Shaohua Du, Wei Chen, Liao Haomiao","doi":"10.21037/AOJ-20-103","DOIUrl":"https://doi.org/10.21037/AOJ-20-103","url":null,"abstract":"Spinal metastasis is one of the common complications in the late stage of cancer, which seriously threatens human life and health. The invasion of malignant tumor often leads to pathological fracture of vertebral body, compression of spinal cord and nerve, etc., which leads to cancer pain and nerve injury symptoms. At present, radiofrequency ablation (RFA) combined with vertebroplasty is a safe and effective minimally invasive method for the treatment of spinal metastases, which has unique advantages in relieving pain, improving neurological function, reducing incidence of fracture and the risk of surgery, and improving life quality in spinal metastases patients. This article reviews the state of art of RFA in the surgical treatment of spinal metastases.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45110782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Mónico, R. Andrade, Pedro M. Matos, Lisete Mónico, J. Mariano, J. Espregueira-Mendes, F. Fonseca
Department of Orthopaedics Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Centro de Saúde Militar de Coimbra, Portuguese Army, Coimbra, Portugal; Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Faculty of Sports, University of Porto, Porto, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; ICVS/3B’s—PT Government Associate Laboratory, Braga/ Guimarães, Portugal; 3B’s Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal; School of Medicine, University of Minho, Braga, Portugal Contributions: (I) Conception and design: JL Mónico, J Cura Mariano, J Espregueira-Mendes, F Fonseca; (II) Administrative support: JL Mónico; (III) Provision of study materials or patients: JL Mónico, R Andrade, P Matos, J Cura Mariano, F Fonseca; (IV) Collection and assembly of data: JL Mónico, R Andrade, P Matos, L Mónico; (V) Data analysis and interpretation: JL Mónico, R Andrade, P Matos, L Mónico; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: José Lito Mónico. Department of Orthopaedics Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Doctor of Medicine, Centro de Saúde Militar de Coimbra, Portuguese Army, Rua Vandelli 2, 3030-405 Coimbra, Portugal. Email: jlmonico@gmail.com.
葡萄牙科英布拉科英布拉中心医院骨科Universitário;Saúde科英布拉军事中心，葡萄牙军队，科英布拉，葡萄牙;葡萄牙波尔图国际足联卓越医疗中心，埃斯普雷盖拉-门德斯体育中心Clínica do drag o;Dom Henrique研究中心，波尔图，葡萄牙;波尔图大学体育学院，波尔图，葡萄牙;葡萄牙科英布拉科英布拉大学医学院;科英布拉大学心理与教育科学学院，葡萄牙科英布拉;ICVS/3B - pt政府联合实验室，布拉加/吉马尔斯，葡萄牙;3B的研究小组——生物材料、可生物降解和仿生学，Minho大学，欧洲卓越组织工程和再生医学研究所总部，Barco, guimar es，葡萄牙;(1)构思与设计:JL Mónico, J Cura Mariano, J Espregueira-Mendes, F Fonseca;(二)行政支持:JL Mónico;(三)提供研究材料或患者:JL Mónico, R Andrade, P Matos, J Cura Mariano, F Fonseca;(四)数据收集和汇编:JL Mónico, R Andrade, P Matos, L Mónico;(五)数据分析与解释:JL Mónico, R Andrade, P Matos, L Mónico;(六)稿件撰写:全体作者;(七)稿件最终审定:全体作者。通讯地址:josousl Lito Mónico。葡萄牙科英布拉科英布拉中心医院骨科Universitário;医学博士，Saúde科英布拉军事中心，葡萄牙军队，Rua Vandelli 2, 3030-405科英布拉，葡萄牙。电子邮件:jlmonico@gmail.com。
{"title":"Tibial plateau fractures osteosynthesis—a case series of 88 patients evaluating surgical approaches, results and complications","authors":"J. Mónico, R. Andrade, Pedro M. Matos, Lisete Mónico, J. Mariano, J. Espregueira-Mendes, F. Fonseca","doi":"10.21037/AOJ-20-95","DOIUrl":"https://doi.org/10.21037/AOJ-20-95","url":null,"abstract":"Department of Orthopaedics Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Centro de Saúde Militar de Coimbra, Portuguese Army, Coimbra, Portugal; Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Faculty of Sports, University of Porto, Porto, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; ICVS/3B’s—PT Government Associate Laboratory, Braga/ Guimarães, Portugal; 3B’s Research Group—Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal; School of Medicine, University of Minho, Braga, Portugal Contributions: (I) Conception and design: JL Mónico, J Cura Mariano, J Espregueira-Mendes, F Fonseca; (II) Administrative support: JL Mónico; (III) Provision of study materials or patients: JL Mónico, R Andrade, P Matos, J Cura Mariano, F Fonseca; (IV) Collection and assembly of data: JL Mónico, R Andrade, P Matos, L Mónico; (V) Data analysis and interpretation: JL Mónico, R Andrade, P Matos, L Mónico; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: José Lito Mónico. Department of Orthopaedics Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Doctor of Medicine, Centro de Saúde Militar de Coimbra, Portuguese Army, Rua Vandelli 2, 3030-405 Coimbra, Portugal. Email: jlmonico@gmail.com.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41835909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Ibrahim, Jason H. Thompson, J. Howard, B. Lanting
: The direct anterior approach (DAA) to the hip is gaining popularity worldwide. It has even become an integral part of orthopaedic training programs across the globe. This approach is well known for its long learning curve, which makes it challenging for residents and fellows to master in a short period of time during their rotations to different subspecialties. There is good evidence to support utilising this approach for a total hip arthroplasty (THA) as it affords patients an improvement in early recovery by way of better gait and kinematics compared to traditional approaches. This approach can be used to expedite patient’s recovery with the aim of an early discharge in the form of an outpatient THA. The enhanced recovery program and day case hip arthroplasty using this approach is our standard practice and works perfectly with this muscle sparing approach. The aim of this article is to present a step-by-step guide for this approach for residents and fellows, and can be adopted by any surgeon working in a teaching setting. This is a full description of our institutional anterior approach to the hip that can be used for primary THA as well as revision cases using a dedicated traction table. This approach can be used for treating femoral neck fractures, periprosthetic infections and periprosthetic fractures. Femoral osteotomy for revision cases can be utilised in a similar fashion to other traditional approaches.
{"title":"The direct anterior approach to the hip for total hip arthroplasty: a blind guide (with traction table)","authors":"M. Ibrahim, Jason H. Thompson, J. Howard, B. Lanting","doi":"10.21037/AOJ-20-71","DOIUrl":"https://doi.org/10.21037/AOJ-20-71","url":null,"abstract":": The direct anterior approach (DAA) to the hip is gaining popularity worldwide. It has even become an integral part of orthopaedic training programs across the globe. This approach is well known for its long learning curve, which makes it challenging for residents and fellows to master in a short period of time during their rotations to different subspecialties. There is good evidence to support utilising this approach for a total hip arthroplasty (THA) as it affords patients an improvement in early recovery by way of better gait and kinematics compared to traditional approaches. This approach can be used to expedite patient’s recovery with the aim of an early discharge in the form of an outpatient THA. The enhanced recovery program and day case hip arthroplasty using this approach is our standard practice and works perfectly with this muscle sparing approach. The aim of this article is to present a step-by-step guide for this approach for residents and fellows, and can be adopted by any surgeon working in a teaching setting. This is a full description of our institutional anterior approach to the hip that can be used for primary THA as well as revision cases using a dedicated traction table. This approach can be used for treating femoral neck fractures, periprosthetic infections and periprosthetic fractures. Femoral osteotomy for revision cases can be utilised in a similar fashion to other traditional approaches.","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49657430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Post-traumatic contractures are a frequent complication of elbow fractures or dislocations. Periarticular structures such as ligaments, muscle-tendon units, and the joint capsule undergo a fibrotic reaction in response to the injury. While operative approaches are commonly used to address post-traumatic contractures, the results of these procedures infrequently provide restoration of full range of motion (ROM). Nonsurgical methods offer the potential to prevent the development of post-traumatic contractures following injury, or to be an adjunct to an operation to restore full motion following operative release of established post-traumatic contractures. Using animal models of post-traumatic contractures, several authors have reported on nonsurgical methods to alter collagen, inhibit proliferation of (myo)fibroblasts, or modify hyaluronic acid, inflammation or growth factors. Three small, nonrandomized clinical trials have examined nonsurgical adjunct approaches to prevent contractures after fracture-dislocations or recurrence of contractures after operative releases of established contractures. A review of these articles is followed by a discussion of approaches and platforms to advance the understanding of the pathological processes, identify candidate agents, proof of principle in animal models, clinical trials for efficacy and safety, and adoption into
{"title":"Nonsurgical treatments for post-traumatic elbow contractures: approaches for the prevention of their development and progression","authors":"K. Hildebrand, A. Ademola, D. Hart","doi":"10.21037/AOJ-20-62","DOIUrl":"https://doi.org/10.21037/AOJ-20-62","url":null,"abstract":"Post-traumatic contractures are a frequent complication of elbow fractures or dislocations. Periarticular structures such as ligaments, muscle-tendon units, and the joint capsule undergo a fibrotic reaction in response to the injury. While operative approaches are commonly used to address post-traumatic contractures, the results of these procedures infrequently provide restoration of full range of motion (ROM). Nonsurgical methods offer the potential to prevent the development of post-traumatic contractures following injury, or to be an adjunct to an operation to restore full motion following operative release of established post-traumatic contractures. Using animal models of post-traumatic contractures, several authors have reported on nonsurgical methods to alter collagen, inhibit proliferation of (myo)fibroblasts, or modify hyaluronic acid, inflammation or growth factors. Three small, nonrandomized clinical trials have examined nonsurgical adjunct approaches to prevent contractures after fracture-dislocations or recurrence of contractures after operative releases of established contractures. A review of these articles is followed by a discussion of approaches and platforms to advance the understanding of the pathological processes, identify candidate agents, proof of principle in animal models, clinical trials for efficacy and safety, and adoption into","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2021-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46988940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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