Archives of Bone and Joint Surgery-ABJS最新文献

The purpose of this in brief article was to determine the current role of intraarticular injections of hyaluronic acid (HA) and platelet-rich plasma (PRP) for the treatment of painful KOA. It has been reported that the average duration of effectiveness (pain relief) of one injection of extended-release HA is around one year. Kellgren-Lawrence grade (I-II versus III-IV), male gender, and older age are associated with a longer duration of effectiveness. Cartilage degeneration might be improved with a higher number of injections of HA. Intraarticular injections of HA alleviate pain, function, and diminish non-steroidal anti-inflammatory drugs (NSAIDs) consumption. In addition, several studies have indicated that the combination of HA and PRP is more effective than HA alone. Finally, other studies seemed to demonstrate that PRP was more effective than HA.

Objectives: Total joint arthroplasty is an effective treatment for end stage osteoarthritis. As perioperative protocols are developed, outpatient arthroplasty has been gaining traction to facilitate earlier recovery and same day discharge. The aim of this manuscript is to analyze the trends in outpatient arthroplasty over a 17-year duration. This analysis seeks to predict emerging themes in the literature on patient optimization and outcomes in outpatient arthroplasty.

Methods: This study conducted a literature review on outpatient arthroplasty with the Web of Science Core Collection over a 17-year period between 2005 and 2022. Bibliometric data was imported and analyzed with Bibliometrix and VOSviewer.

Results: 198 articles were identified demonstrating an annual growth of 19.61% with notable bursts in 2017 and 2021. United States was the top global contributor followed by Canada and European nations. There were significant contributions across 219 institutions and 758 authors, with the Journal of Arthroplasty being the most productive and influential journals. Key themes identified include the feasibility of outpatient surgery, pain management, and perioperative complications and costs.

Conclusion: This bibliometric analysis highlights the ongoing growth and development within outpatient arthroplasty since 2005. The United States remain the global leader within outpatient related arthroplasty research. Previous, current, and ongoing trends are highlighted within this field for further development as hotspots.

Ulnar nerve compression is commonly seen at the elbow at the cubital tunnel and the wrist at the Guyon canal but is rarely seen in the hand. This case report describes an 18-year-old male presenting with seven months of atraumatic hand weakness and atrophy associated with heavy weightlifting. Exam demonstrated isolated interosseous muscle atrophy mostly sparing the abductor digiti minimi with intact sensation and negative nerve compression tests including Tinel at carpal and ulnar tunnels, Froment sign, Wartenberg test, cross finger test, and Spurling test. Electromyography and nerve conduction studies demonstrated prolonged distal latency, low amplitude potential, and large amplitude fibrillations with severely reduced motor unit firing in the first dorsal interosseous muscle consistent with ulnar nerve deep motor branch compromise. Magnetic resonance imaging revealed a ganglion cyst between the third metacarpal shaft and the flexor profundus tendon. Given the progressive symptoms, ganglion cyst excision and ulnar motor nerve branch neurolysis were performed.

Objectives: This study aims to evaluate whether using a novel antiseptic irrigant solution combined with vancomycin powder can effectively reduce the incidence of surgical site infections (SSIs) in orthopedic trauma patients. Specifically, we seek to determine if this combined approach significantly decreases SSI rates compared to using vancomycin powder alone. The study also aims to assess the safety and efficacy of the phosphate buffer solution, particularly its ability to reduce biofilm formation on surgical implants without causing cytotoxic effects. Ultimately, our goal is to provide insights into potential clinical practice changes that can enhance infection prevention strategies in orthopedic trauma surgeries.

Methods: This retrospective study analyzed 450 orthopedic trauma surgeries for lower extremity fractures at a Level Two hospital in Oregon, USA, between January 2021 and October 2023. Patients were stratified based on intraoperative irrigation with either vancomycin alone or vancomycin combined with a phosphate buffer irrigation solution. Data analysis included demographic characteristics, operative details, and occurrences of SSIs within 90 days postoperatively.

Results: Among the 450 surgeries analyzed, 18 (8.1%) SSIs occurred in the vancomycin cohort compared to 3 (1.3%) in the vancomycin and Phosphate buffer cohort. Adjusted logistic regression revealed an 89% reduction in the odds of SSIs in the vancomycin and Phosphate buffer cohort (OR: 0.11, 95% CI 0.02-0.35, P=0.001), adjusting for age, tobacco use, operative time, and procedure type.

Conclusion: This study underscores the promising role of combined vancomycin and Phosphate buffer irrigation in reducing SSI rates in orthopedic trauma surgeries. Further prospective studies are warranted to validate these findings and explore optimal infection prevention strategies in diverse surgical settings.

Objectives: Lower limb alignment (LLA) measurements are vital for pre-operative assessments and surgical planning in orthopedics. Artificial intelligence (AI) can enhance the precision and consistency of these measurements. This systematic review and meta-analysis evaluates the accuracy and reliability of AI-based approaches in detecting anatomical landmarks and measuring LLA angles, highlighting both their strengths and limitations.

Methods: Adhering to PRISMA guidelines, we searched PubMed, Scopus, Embase, and Web of Science on July 2024 and included observational studies validating AI-driven LLA measurements. Pooled intraclass correlation coefficients (ICCs) were computed to assess inter-rater reliability between AI and manual measurements. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess study quality.

Results: We reviewed 28 studies with 47,200 patients and 61,253 images; AI demonstrated high reliability in measuring 15 lower limb angles, with pooled ICCs ranging from 0.9811 to 1.0597. Angles like the hip-knee-ankle (HKA; ICC = 0.9987, 95% CI: 0.9975-0.9998) and the mechanical tibiofemoral angle (mTFA; ICC = 1.0001, 95% CI: 1.0001-1.0001) showed near-perfect agreement. In contrast, the joint line convergence angle (JLCA) and femoral anatomical-mechanical angle (FAMA) exhibited lower reliability and significant publication bias. Heterogeneity was substantial across most angles (I² = 63%-100%). These findings highlight the potential of AI for clinical applications while also identifying areas that require refinement and standardization.

Conclusion: AI exhibits high reliability and accuracy in measuring key LLA angles, often outperforming manual techniques in both speed and consistency. It holds significant promise as a clinical tool, though challenges with less reliable angles warrant further refinement. Future studies should focus on standardizing landmark definitions and addressing implementation barriers to maximize AI's potential in orthopedic practice.

From the intricate movements that allow us to create art, express emotions, and communicate with others to the tactile sensations that connect us to the world, hands play a vital role in shaping our experiences and interactions. Hand is the bridge between the man's imagination and the physical world, the conduit through which inspiration flows and ideas take shape. However, our hands' remarkable skill and precision didn't simply come into existence; it required significant changes in other body parts and biomechanics to accommodate and support them.

Objectives: This study aims to provide a comprehensive understanding of the unique morphological dimensions and neurovascular pattern of the triangular fibrocartilage complex (TFCC) of the wrist joint, using innovative techniques such as digital Vernier calliper, auramine chloride (Palmgren's method) and immunohistochemistry.

Methods: Samples were collected from 20 formalin-embalmed human cadavers. The morphometric parameters were measured. After gross examination, tissues were placed in 10% neutral buffered formalin for fixation. Paraffin-embedded blocks were prepared, and tissue sections were taken at 5-7 microns thickness. The slides were subjected to Palmgren's and immunohistochemistry staining following a standardised protocol.

Results: The morphometric parameters of the articular disc (AD) and neurovascular pattern of the seven components of TFCC were assessed. There was no significant difference in the morphometric parameters between either sides of the limb. The AD had minimal nerve fibre innervation. Periphery of the complex, which consisted of different ligaments, showed higher nerve density comparatively. The distribution of nerve fibres predominated in the proximal portion compared to distal areas of TFCC. The vascular pattern observed in various components showed fewer blood vessels in the AD than in the periphery. Higher vascularity was observed in the proximal portion of the TFCC complex.

Conclusion: The insights gained from this study, particularly the understanding of the innervation and distribution of nerve fibres of TFCC, can significantly enhance the effectiveness of selective denervation procedures during wrist arthroscopy. Moreover, the knowledge about the vascularity of TFCC is a crucial factor that can influence the end outcomes of wrist surgeries.

Objectives: The primary goal of total knee arthroplasty (TKA) is to restore the neutral mechanical axis of the lower limb using mechanical alignment. However, no studies to date have investigated the risk factors of coronal malalignment (CM) following conventional TKA. In this study, we aimed to determine the incidence of post-TKA CM and identify its potential risk factors.

Methods: We retrospectively reviewed all conventional primary TKAs utilizing cemented posterior-stabilized prostheses in our institute from January 2019 to 2022. The following variables were extracted from the Joint Reconstruction Research Center (JRRC) Knee Registry Database: demographics, varus classification, flexion contracture, femoral and tibial bowing, pre- and postoperative Hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (LDFA), mechanical medial proximal tibial angle (MPTA), joint-line congruency angle (JLCA), and caput-collum-diaphyseal (CCD) angle. Multiple logistic regression was used to develop a predictive model for post-TKA CM.

Results: Among the 402 TKAs analyzed after exclusions, 172 (42.79%) fell outside the acceptable postoperative HKAA range (180° ± 3°). Of the 17 factors studied, the following were associated with an increased risk of postoperative CM: flexion contracture > 10° (OR = 2.95, P < 0.001), femoral bowing > 4.9° (OR= 1.89, P= 0.006), tibial bowing > 2.2° (OR= 2.00, P= 0.002), preoperative MPTA≤ 85° (OR= 1.68, P= 0.037) or HKAA ≥ 20° varus (OR= 5.07, P= 0.017), preoperative JLCA 4°-10° (OR= 2.49, P= 0.023), and CCD ≤ 131° (OR= 1.62, P= 0.044). The results remained almost consistent even after excluding the extreme HKAA outliers (> ±6° varus and valgus).

Conclusion: In mechanically aligned TKAs, the risk of post-TKA CM can be estimated preoperatively based on specific risk factors (e.g., a 40.5% risk for patients with ≥ 3 risk factors). Identifying higher risks can warn the surgeon to address these factors and perform the TKA with greater precision.

A rare case of severe prolonged persistent Teriparatide-induced hypercalcemia (14.3mg/dL on admission) in an osteoporotic patient after ceasing the Teriparatide is reported. This 67-year-old female was admitted with polyuria, xerostomia, constipation, progressive weakness, and a history of Triparatide use due to a previous osteoporotic fracture. Her serum calcium, PTH, and vitamin D levels had been normal before starting Teriparatide. Ninety six hours after ceasing the Teriparatide along with rehydration and Calcitonin treatment, the patient's serum calcium levels returned to normal. Severe Teriparatide-induced hypercalcemia does not follow any defined pattern and may persist for days and can usually be controlled through ceasing the Teriparatide, rehydration, and close monitoring of the serum calcium level and symptoms.