Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: This study aimed to compare short-term outcomes following Total Shoulder Arthroplasty (TSA) and Humeral Head Resurfacing (HHR) in patients with glenohumeral osteoarthritis (GHOA).

Methods: A retrospective analysis included patients who had undergone either TSA or HHR for GHOA at a single institution. Baseline demographics, complications, range of motion (active forward flexion, FF and active external rotation, ER), visual analog scores (VAS), and Subjective Shoulder Values (SSV) were collected.

Results: A total of 69 TSA and 56 HHR patients were analyzed. More HHR patients were laborers (44% versus 21%, P=0.01). There were more smokers in the TSA group (25% versus 11%, P=0.04) and more cardiovascular disease in the HHR cohort (64% versus. 6%, p<0.0001). Postoperative FF was similar, but ER was greater in the HHR (47° ± 15°) vs. TSA group (40° ± 12°, P = 0.01). VAS was lower after TSA vs. HHR (median 0, IQR 1 versus median 3.7, IQR 6.9, p<0.0001), and SSV was higher after TSA (89% ± 13% vs. 75% ± 20% after HHR; p<0.0001). Post-operative impingement was more common after HHR (32% vs. 3% for TSA, p<0.0001). All other complications were equivalent.

Conclusion: While younger patients and heavy laborers had improved ER following HHR, their pain relief was greater after TSA. Decisions on surgical technique should be based on patient-specific demographic and anatomic factors.

Despite recent advancements in bionic upper limb prostheses technology, the rejection rate by users remains unacceptably high. Various factors contribute to this issue, such as limited functionality, complex control mechanisms, and discomfort, with most of these concerns being documented solely through self-assessment surveys. In this article, we introduce our proposed four components for an integrated bionic hand aimed at making it closely resemble a natural hand. These components include an integrated intramedullary stem, a kineticomyographic motor control system, sensory feedback for stereognosis, and sensory feedback for proprioception.

Objectives: Knee osteoarthritis is common among older individuals, necessitating Total Knee Arthroplasty (TKA) for end-stage cases. The aging population has increased TKA demand, leading to a rise in revision surgeries. Genu recurvatum, a rare complication, often requires surgical intervention, with late-onset cases linked to neuromuscular conditions. This case series focuses on the infrequent occurrence of late-onset genu recurvatum resulting from spinal stenosis in patients without other predisposing conditions.

Methods: A retrospective case series of 10 patients (11 knees) referred between February 2016 and August 2020 due to late recurvatum instability. Exclusion criteria encompassed neuromuscular diseases other than spinal stenosis, prosthetic joint infection, and pre-existing recurvatum deformity. Data, including demographics, medical history, imaging findings, and surgical details, were collected retrospectively. Patient performance was assessed using the Knee Society Score (KSS) at specified postoperative intervals.

Results: The study cohort, exhibiting hyperextension ranging from 11 to 30 degrees, underwent successful revision surgery using rotating hinge knee (RHK) implants after failed conservative measures. Follow-up assessments at 6, 18, and 24 months showed no recurrence of genu recurvatum.

Conclusion: Late-onset genu recurvatum poses a challenge, necessitating surgical intervention. Identifying predisposing factors is crucial, with spinal stenosis emerging as a rare cause. The use of posterior stabilized (PS) implants in primary surgery aligns with higher revision rates, possibly linked to PCL removal. Limited literature explores the spinal-genu recurvatum relationship. A stepwise screening protocol is proposed for high-risk patients, emphasizing history, physical examination, and imaging. Strategic considerations include lower constraining, a tighter extension gap, and potential use of Hinge implants.

Objectives: Septic arthritis of the hip, if not managed early and adequately, leads to degenerative arthritis with pain and debility. Various treatment options have been recommended, but no guidelines for the same have been established. Aim of the study is to evaluate the efficacy of our protocol for timing of staging using serological markers, rate of periprosthetic joint infection, midterm implant survivorship and functional outcomes.

Methods: Thirteen patients aged 25 years and above, suffering from degenerative hip arthritis secondary to septic hip, were treated with 2 stage total hip replacement according to our protocol and serological markers were assessed for the timing of stages and follow up of infection control. Outcome of success of two stage total hip arthroplasty was assessed using modified Delphi criteria.

Results: Both the acetabulum and femur head were involved in all cases. Two patients had a history of previous hip surgery. The most common micro-organism detected in intraoperative cultures was Staphylococcus aureus. The mean Harris Hip Score at the final follow-up was 82.33. The outcome was deemed excellent in 84.6 % and good in 15.4 % of cases.

Conclusion: Septic arthritis of the hip leading to end stage degenerative joint disease can be effectively managed with two stage total hip arthroplasty with good to excellent clinical and functional results.

Objectives: This study aimed to estimate post-operative rod angles in both concave and convex sides of scoliosis curvature in patients who had undergone posterior surgery, using neural networks and support vector machine (SVM) algorithms.

Methods: Radiographs of 72 scoliotic individuals were obtained to predict post-operative rod angles at all fusion levels (all spinal joints fused by rods). Pre-operative radiographical indices and pre-operatively resolved net joint moments of the apical vertebrae were employed as inputs for neural networks and SVM with biomechanical modeling using inverse dynamics analysis. Various group combinations were considered as inputs, based on the number of pre-operative angles and moments. Rod angles on both the concave and convex sides of the Cobb angle were considered as outputs. To assess the outcomes, root mean square errors (RMSEs) were evaluated between actual and predicted rod angles.

Results: Among eight groups with various combinations of radiographical and biomechanical parameters (such as Cobb, kyphosis, and lordosis, as well as joint moments), RMSEs of groups 4 (with seven radiographical angles in each case, which is greater in quantity) and 5 (with four radiographical angles and one biomechanical moment in each case, which is the least possible number of inputs with both radiographical and biomechanical parameters) were minimum, particularly in prediction of the concave rod kyphosis angle (errors were 5.5° and 6.3° for groups 4 and 5, respectively). Rod lordosis angles had larger estimation errors than rod kyphosis ones.

Conclusion: Neural networks and SVM can be effective techniques for the post-operative estimation of rod angles at all fusion levels to assist surgeons with rod bending procedures before actual surgery. However, since rod lordosis fusion levels vary widely across scoliosis cases, it is simpler to predict rod kyphosis angles, which is more essential for surgeons.

Journal club is crucial in medical professions education, especially residency training. Critical evaluation allows learners to read, understand, and apply the evidence to bridge the gap between research and practice. Academic members of the Tehran University of Medical Sciences (TUMS) Orthopedic Department have held about 2,300 weekly sessions for around 50 years, even in times of crises, to review the latest publications in orthopedics and sometimes linked their journal clubs to hospitalized cases. Considering the educational and research-related nature of journal clubs, educational planning is necessary for running effective sessions for academicians, residents, and the Continuing Medical Education (CME) program participants.

Objectives: Previous studies of the association between tibial slope and meniscal tear have led to contradictory results. In this regard, the present study aimed to examine the effect of medial tibial plateau slope on the incidence of isolated medial meniscal tear.

Methods: This study was performed on 75 patients with a posterior horn medial meniscal tear and 150 matched control subjects. Two different observers evaluated the slope of the medial tibial plateau on the lateral radiographs. Reliability of radiographic evaluation was investigated in a pilot study using the intraclass correlation coefficient (ICC) test.

Results: Intra-observer reliability for the slope of the medial tibial plateau was high, with ICC values of 0.961 and 0.957 for the first and second observers, respectively. The interobserver reliability was ‎‎0.947. The mean slope was 10.2±3.7° in the case group and 10.1±4.4° in the control group (P=0.97). Moreover, the mean slopes of the medial tibial plateau were 10.3±4.1º and 10.1±4.2º in participants with tibial bone varus angles of (TBVA) < 4º and ≥ 4.2 (P=0.77). The slope was not ‎statistically ‎correlated with age (r=0.074, 95% CI: -0.05-0.20, P=0.26), gender (r=0.07, P=0.29), BMI (r=0.02, 95% CI: -0.10-0.15, P=0.74), ‎level of ‎joint degeneration (r=-0.023, 95% CI: -0.11-0.15, P=0.73), and TBVA (r=-0.010, 95% CI: -0.14-0.12; P=0.12).‎‎.

Conclusion: No significant difference was found between patients with and without an isolated meniscal tear in terms of the medial tibial plateau slope. These results suggest that the tibial slope may not affect the incidence of isolated medial meniscal tears.

Objectives: Despite an increased demand for total joint arthroplasty (TJA), rising health-care costs and bundling of payments by payers have shifted the focus to improving operating room (OR) efficiency. This study aimed to assess the efficacy of an efficiency model that optimized instrument trays on decreasing OR turnover time (TOT) and the benefits made possible by this improved efficiency.

Methods: All primary TJA procedures performed by a single fellowship-trained surgeon from January 2022 to August 2023 were reviewed. The surgeon partnered with Zimmer Biomet to condense the total knee and total hip arthroplasty instrument trays from seven to three trays each. Patient in OR time and patient out of OR times were collected and used to calculate TOT. Mean TOTs pre-efficiency model implementation (January - October 2022) and post-efficiency model implementation (March - August 2023) were compared. Annual cost savings were calculated based on an average cost per one minute of OR time of $47.99 and an average cost for the Sterile Processing Department (SPD) to process a single TJA tray of $79.41.

Results: Following implementation of the efficiency model, the average OR TOT significantly decreased by 19 minutes (P < 0.0001), a greater than 44% reduction in TOT. At this surgeon's current case volume, conservatively estimated at 280 primary TJA cases per year, annual savings in OR and SPD processing costs were $169,597 and $88,939, respectively. Moreover, this led to increased case volume per operative day.

Conclusion: A small-scale intervention such as optimizing instrument trays for TJA is a valuable and sustainable solution to improve efficiency in the OR by decreasing OR TOT, thereby generating considerable cost-savings and opportunity to increase surgical volume.

Objectives: Pre-operative assessment is routinely performed for all hip fractures, and include a thorough clinical examination and multiple pre-operative tests. While abnormalities are often detected in many tests, they have varied effect on mortality. The purpose of the study was to assess the prevalence and impact of these abnormal tests and comorbidities.

Methods: This was a prospective study of 283 consecutive hip fracture patients aged above 50 years admitted in a major trauma hospital from February 2019 to December 2019. The prevalence of abnormalities in the following tests were assessed: chest x-ray, electrocardiogram, complete blood count, serum electrolytes, renal function test, prothrombin time/international normalized ratio, and serum bilirubin. Also, presence of comorbidities were recorded. Mortality within 90 days of admission was assessed.

Results: 91.5% (N= 259/283) of the patients had at least one abnormal investigation. The most common abnormal investigation was anemia (70.3%, N= 199/283), followed by deranged sodium (36.4%, N= 103/283). 17.7% (N= 50/283) of the patients had at least one new comorbidity diagnosed after admission. The most common newly diagnosed comorbidity was hypertension (10.6%, N= 30/283). Anemia (p=0.044), deranged sodium (p=0.002), raised urea (p=0.018), raised creatinine (p=0.002), renal disease (p=0.015), neurological diseases (p=0.024), and charlson comorbidity index (p=0.004) were associated with increased mortality in multivariate analysis.

Conclusion: Pre-operative hemoglobin, sodium, urea, and creatinine were the most important tests influencing mortality, and derangements of these should therefore be carefully evaluated and managed. Hip fracture care pathways should focus on correction of these abnormalities.