Archives of Bone and Joint Surgery-ABJS最新文献

Unicompartmental knee arthroplasty (UKA) is an increasingly common procedure. Patients with persistent or new postoperative pain can present a challenge for surgeons to accurately diagnose and treat. The purpose of this study is to provide a comprehensive review of the presentation, diagnosis, and management of the various pathologies contributing to pain after UKA. The most common causes of a painful UKA include aseptic component loosening and progression of osteoarthritis. Both of these conditions may be treated with either revision UKA or conversion to total knee arthroplasty. While technically challenging, these procedures are often associated with favorable outcomes. Other causes of pain after UKA include infection, atraumatic tibial component subsidence, periprosthetic fracture and malalignment. Careful clinical, radiographic, and laboratory evaluation is therefore critical to accurately identify the source of pain and guide appropriate management.

Objectives: Pediatric upper extremity fractures are seen frequently and sometimes lead to malunion. Three-dimensional (3D) surgery planning is an innovative addition to surgical treatment for the correction of post-traumatic arm deformities. The detailed planning in three dimensions allows for optimization of correction and provides planning of the exact osteotomies which include the advised material for correction and fixation. However, no literature is available on the precision of this computerized sizing of implants and screws. This study aimed to investigate the differences between 3D planned and surgically implanted screws in patients with a corrective osteotomy of the arm.

Methods: Planned and implanted screw lengths were evaluated in patients who underwent a 3D planned corrective osteotomy of the humerus or forearm using patient-specific 3D printed drill- and sawblade guides. Postoperative information on implanted hardware was compared to the original planned screw lengths mentioned in the 3D planned surgery reports.

Results: Of the 159 included screws in 17 patients, 45% differed >1 mm from the planned length (P<0.001). Aberrant screws in the radius and ulna were often longer, while those in the humerus were often shorter. Most aberrant screws were seen in the proximity of the elbow joint.

Conclusion: This study showed that 3D-planned screws in corrective osteotomies of the humerus and forearm differ significantly from screw lengths used during surgery. This illustrates that surgeons should be cautious when performing osteotomies with 3D techniques and predefined screw sizes.

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: The anterior cruciate ligament (ACL) reconstruction surgery improves mechanical stability; however, functional stability remains impaired. Balance exercises can help improve functional stability. The effect of cognitive dual-task balance exercises has not been studied in people with ACL reconstruction surgery; therefore, this study aimed to compare the effect of cognitive dual-task and single-task balance exercises on the static balance indices in these individuals.

Methods: This study was a randomized clinical trial. After a period of conventional physiotherapy and applying inclusion criteria, 28 patients with ACL reconstruction surgery were randomly divided into two groups of cognitive dual-task and single-task balance exercises. Each group received the relevant exercises for four weeks, three times a week, with each session lasting 20 min. Center of pressure variables, including mean displacement in anterior-posterior and medial-lateral directions, total path length, mean velocity of displacement, root mean square of displacement and velocity, and the elliptical area, were measured using the FDM pressure platform before and after the interventions as the primary outcomes. Knee Injury and Osteoarthritis Outcome Score (KOOS) scale was completed by the participants before and after the interventions.

Results: The measured static balance variables and KOOS subscales had significant differences before and after intervention in both groups (P<0.05); however, no statistically significant difference was observed in these variables between the two groups. There was no significant correlation between KOOS subscales and measured static balance variables.

Conclusion: Both cognitive dual-task and single-task balance exercises improved the indicators related to static balance and the level of functional disability of the knee. However, cognitive dual-task balance exercises had no superiority over single-task balance exercises in ACL-reconstructed individuals.

Osteoarthritis (OA) can arise from various factor including trauma, overuse, as well as degeneration resulting from age or disease. The specific treatment options will vary based on the severity of the condition, and the affected joints. Some common treatments for OA include lifestyle modifications, medications, physical therapy, surgery and tissue engineering (TE). For cartilage tissue engineering (CTE), three-dimension (3D) scaffolds are made of biocompatible natural polymers, which allow for the regeneration of new cartilage tissue. An ideal scaffold should possess biological and mechanical properties that closely resemble those of the cartilage tissue, and lead to improved functional of knee. These scaffolds are specifically engineered to serve as replacements for damaged and provide support to the knee joint. 3D-bioprinted scaffolds are made of biocompatible materials natural polymers, which allow for the regeneration of new cartilage. The utilization of 3D bioprinting method has emerged as a novel approach for fabricating scaffolds with optimal properties for CTE applications. This method enables the creation of scaffolds that closely mimic the native cartilage in terms of mechanical characteristics and biological functionality. Alginate, that has the capability to fabricate a cartilage replacement customized for each individual patient. This polymer exhibits hydrophilicity, biocompatibility, and biodegradability, along with shear-thinning properties. These unique properties enable Alginate to be utilized as a bio-ink for 3D bioprinting method. Furthermore, chondrogenesis is the complex process through which cartilage is formed via a series of cellular and molecular signaling. Signaling pathway is as a fundamental mechanism in cartilage formation, enhanced by the incorporation of biomolecules and growth factors that induce the differentiation of stem cells. Accordingly, ongoing review is focusing to promote of 3D bioprinting scaffolds through the utilization of advanced biomolecules-loading of Alginate-based that has the capability to fabricate a cartilage replacement tailored specifically to each patient's unique needs and anatomical requirements.

Objectives: Identification of modifiable comorbid conditions in the preoperative period is important in optimizing outcomes. We evaluate the association between such risk factors and postoperative outcomes after upper extremity surgery using a national database.

Methods: The National Surgical Quality Improvement Program (NSQIP) 2006-2016 database was used to identify patients undergoing an upper extremity principle surgical procedure using CPT codes. Modifiable risk factors were defined as smoking status, use of alcohol, obesity, recent loss of >10% body weight, malnutrition, and anemia. Outcomes included discharge destination, major complications, bleeding complications, unplanned re-operation, sepsis, and prolonged length of stay. Chi square and multivariable logistic regressions were used to identify significant predictors of outcomes. Significance was defined as P<0.01.

Results: After applying exclusion criteria, 53,780 patients were included in the final analysis. Preoperative malnutrition was significantly associated with non-routine discharge (OR=4.75), major complications (OR=7.27), bleeding complications (OR=7.43), unplanned re-operation (OR=2.44), sepsis (OR=10.22), and prolonged length of stay (OR=5.27). Anemia was associated with non-routine discharge (OR=2.67), bleeding complications (OR=13.27), and prolonged length of stay (OR=3.26). In patients who had a weight loss of greater than 10%, there was an increase of non-routine discharge (OR=2.77), major complications (OR=2.93), and sepsis (OR=3.7). Smoking, alcohol use, and obesity were not associated with these complications.

Conclusion: Behavioral risk factors (smoking, alcohol use, and obesity) were not associated with increased complication rates. Malnutrition, weight loss, and anemia were associated with an increase in postoperative complication rates in patients undergoing upper limb orthopaedic procedures and should be addressed prior to surgery, suggesting nutrition labs should be part of the initial blood work.

Objectives: The prevalence of tendinopathic changes of the distal biceps tendon (DBT) is not clear, in both the general population and patients with symptoms that may be related to distal biceps tendinopathy. The purpose of this study is to retrospectively determine the prevalence of distal biceps tendinopathy in symptomatic and asymptomatic patients undergoing an MRI of the elbow. A secondary aim is to assess the association between age and the prevalence of incidental distal biceps tendinopathy.

Methods: We assessed 1,180 MRI-reports describing the elbow region and calculated prevalence of incidental and symptomatic DBT tendinopathies. Symptomatic DBT tendinopathy was defined as patients that had complaints of anterior elbow pain. With a multivariate logistic regression analysis we tested whether age, sex, and race were independently associated with DBT tendinopathy.

Results: 276 of 1,180 (23%) of the distal biceps tendons showed signal changes on the MRI. Only 114 (10%) showed DBT tendinopathy, of which60 (5% of all tendons, 53% of tendons with tendinopathy) were incidental. The prevalence peaked between 40-49.9 years (37%) and 50-59.9 years (30%). There was no significant association between increasing age and incidental DBT tendinopathy (P= 0.935). However, there was a significant association between increasing age and tendinopathy, whether the tendinopathy was incidental or symptomatic (P< 0.001).

Conclusion: Signal changes in the DBT are common on MRI scans, however 53% of detected tendinopathies are incidental. There is no association between increasing age and prevalence of incidental DBT tendinopathy, though there is a significant association between increasing age and DBT tendinopathy.

Infected segmental bone defects (ISBD) of the femur and tibia pose a significant challenge. Traditionally, bone fixation in the first stage of the Masquelet technique involves external fixation, but intramedullary nail fixation has recently gained popularity. Despite this, little attention has been focused on the elaboration, implantation, and removal of the spacer around the nail. In this technical note, we present gentamicin cement-coated rigid nails as definitive fixation in the first stage. We also detail the technique for placing and removing the one-piece dyed antibiotic spacer around the nail. We highlight its potential benefits in one of the critical steps of this versatile technique.

Periprosthetic joint infection (PJI) is a critical complication following arthroplasties, often treated with a two-stage revision using antibiotic-loaded bone cement spacers. Although these spacers can effectively manage infections, they occasionally cause severe adverse reactions. We reported the case of a 68-year-old female who developed vancomycin flushing syndrome (VFS), previously known as the red man syndrome, following the insertion of a vancomycin-loaded bone cement spacer during the first-stage revision surgery for PJI after undergoing total knee arthroplasty. Six hours postoperatively, she developed pruritus, diffuse rash, tachycardia, and hypotension. VFS was diagnosed based on clinical presentation after excluding other potential causes. She was treated with intravenous epinephrine, antihistamines, steroids, and fluid resuscitation without requiring spacer removal. The patient recovered uneventfully, underwent second-stage reimplantation after 6 weeks, and remained asymptomatic at 2-year follow-up. This highlights the importance of anticipating and managing this potentially severe reaction through a multidisciplinary approach, considering the risks and benefits of retaining versus removing antibiotic-loaded bone-cement spacers.