Efort Open Reviews最新文献

The indication for femoral stem cementation should be made on a patient-specific basis, taking physical activity, femoral geometry, and bone tissue quality into account. Age alone should not be the sole justification for cementation. The Dorr classification can serve as decision support for whether a cemented fixation should be used. Femoral neck fractures should generally be cemented. Familiarize yourself with the applied stem philosophy. Force-closed stems typically have a polished surface that allows for subsidence, especially in the first 2 years postoperatively. Stems following the shape-closed philosophy have rougher surfaces and do not allow subsidence. There are various types of cement that differ in viscosity and can be categorized accordingly. These cement types go through four temperature-dependent phases: mixing phase, waiting phase, working phase, and curing phase. Rough implants should be implanted quickly, using wetter cement. For a polished stem, the cement should be slightly firmer. To avoid complications like bone cement implantation syndrome, it is essential to adhere to the state-of-the-art retrograde cementation technique, which recommends pulsatile lavage and vacuum mixing of the cement. Additionally, cement restrictors and pressurizers are used. A thorough understanding of cementation techniques is crucial to ensure a favorable outcome with a uniformly thick cement mantle that encompasses the entire stem. Incorrect cementing can lead to the premature failure of the endoprosthesis.

Tumors of the foot are a heterogeneous group of neoplasms that either affect soft tissues or bone, with a predominance being benign. Mistakes in the diagnosis of neoplastic conditions are common. A correct diagnostic approach supported by radiological and histological examination is mandatory. In this review, we highlight current standards in diagnosis, clinicopathological presentation, and imaging features.

Purpose: This study employed meta-analysis to evaluate whether the application of intraoperative wound irrigation (IOWI) with povidone-iodine (PI) in spine surgery effectively reduces the incidence of postoperative surgical site infection (SSI).

Methods: The present study was conducted strictly following the methodological guidance provided by the Cochrane Handbook. The protocol of this work was registered with PROSPERO. Two researchers independently conducted electronic searches in Medline via PubMed, Embase, Cochrane Library, and Web of Science. The bias risk of each included study was evaluated by two assessors. We performed statistical analysis on the dataset using STATA software.

Results: Fourteen studies involving a total of 6777 patients were included in the present work. The risk of bias of six included randomized controlled trials (RCTs) was considered as low-to-moderate risk, and the quality scores of the eight included retrospective cohort studies were rated as high quality. The results of this meta-analysis indicated a significant difference in the incidence of postoperative SSI between the two groups (RR = 0.29, 95% CI: (0.18, 0.47)). Moreover, patients who underwent IOWI with PI had lower rates of deep and superficial infections after spine surgery compared with the controlled group (superficial infection: RR = 0.28, 95%CI: (0.14, 0.54); Deep infection: RR = 0.24, 95%CI: (0.10, 0.60)). The sensitivity analysis results indicated good robustness and high evidence strength after data consolidation in the overall rate of postoperative SSI and the incidence of deep/superficial infection.

Conclusions: IOWI with PI solution during spinal surgery can effectively reduce the incidence of postoperative SSI.

Mixed reality refers to the integration of virtual reality into the real-world environment. This digital content can be interacted with in real time. The emergence of mixed reality technology has been made possible by the introduction of head-mounted displays, which are being utilized across multiple surgical specialties. In upper extremity surgery, mixed reality has widespread applications in trauma, corrective surgery, arthroplasty, arthroscopy, and oncology. Preoperatively, mixed reality allows for complex 3D planning. Intraoperatively, surgeons can access this 3D data in a sterile environment. While in its infant stages, mixed reality is likely to become a powerful tool for intraoperative guidance and navigation. Mixed reality can change the paradigm of communication, as it allows the sharing of visual data from the surgeon's perspective, enabling remote assistance and participation.

Purpose: Different deep-learning models have been employed to aid in the diagnosis of musculoskeletal pathologies. The diagnosis of tendon pathologies could particularly benefit from applying these technologies. The objective of this study is to assess the performance of deep learning models in diagnosing tendon pathologies using various imaging modalities.

Methods: A meta-analysis was conducted, with searches performed on MEDLINE/PubMed, SCOPUS, Cochrane Library, Lilacs, and SciELO. The QUADAS-2 tool was employed to assess the quality of the studies. Diagnostic measures, such as sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios, area under the curve, and summary receiver operating characteristic, were included using a random-effects model. Heterogeneity and subgroup analyses were also conducted. All statistical analyses and plots were generated using the R software package. The PROSPERO ID is CRD42024506491.

Results: Eleven deep-learning models from six articles were analyzed. In the random effects models, the sensitivity and specificity of the algorithms for detecting tendon conditions were 0.910 (95% CI: 0.865; 0.940) and 0.954 (0.909; 0.977). The PLR, NLR, lnDOR, and AUC estimates were found to be 37.075 (95%CI: 4.654; 69.496), 0.114 (95%CI: 0.056; 0.171), 5.160 (95% CI: 4.070; 6.250) with a (P < 0.001), and 96%, respectively.

Conclusion: The deep-learning algorithms demonstrated a high level of accuracy level in detecting tendon anomalies. The overall robust performance suggests their potential application as a valuable complementary tool in diagnosing medical images.

Purpose: Low back pain (LBP) has a significant impact on the general population, especially on military personnel. This study aimed to systematically review the relevant literature to determine the prevalence and risk factors of low back pain among military personnel from different military occupational categories.

Methods: For this systematic review, we searched Embase, PubMed, and Cochrane. We performed study selection, data extraction, and assessed the quality of the evidence using the adapted risk of bias assessment tool by Hoy et al. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study is registered on the Center for Open Science, registration DOI: 10.17605/OSF.IO/HRGE8.

Results: Out of 860 papers, 19 studies met the inclusion criteria. More than 360 000 military people with lumbar pain situation were considered for inclusion in this systematic review. The 1-year prevalence of LBP could be up to 81.7% in the Army, 5.2% in the Marines, and 48.1% in the Air Force. Age (OR = 0.494-2.89), history of LBP (OR = 2.2-8.91), and sedentary position (OR = 0.55-3.63) were the most common physical, sociodemographic, and occupational risk factors, respectively.

Conclusions: Low back pain was prevalent among military personnel. There was heterogeneity in studies and a significant difference in prevalence and incidence across various occupational categories. Physical, sociodemographic, and occupational risk factors were researched more than psychological risk factors in the military.

Purpose: The purpose of the present scoping review is to identify sources of heterogeneity in reporting domains that have the potential to improve surgical decision-making in reverse shoulder arthroplasty associated with glenoid bone grafting.

Methods: A scoping review was conducted according to the JBI and PRISMA ScR guidelines. Articles covering glenoid bone grafting at the time of reverse shoulder replacement, published between 2012 and 2022 in MEDLINE, Scopus, Epistemonikos, Web of Science, and Cochrane Database of Systematic Reviews, were searched. Reporting of core outcome measures, as well as prosthesis-related variables, rehabilitation protocols, radiographic evaluation methods, and bone graft incorporation assessments, were collected.

Results: For the final analysis, a total of 14 articles were considered. There were 649 operated shoulders with a mean patient age of 72 years, ranging from 48 to 85 years. Analysis of preoperative ranges of motion and patient-reported outcome measures revealed increased heterogeneity in patient selection between studies. Reporting of implant-related parameters was the most inconsistent. Rehabilitation protocols were scarcely reported. Assessment of graft incorporation and radiographic evaluation of choice revealed that there is no consistent method or measurement and the clinical relevance of radiolucent lines at the graft-glenoid bone interface is unclear.

Conclusion: Addressing implant-related reporting gaps has the highest potential to improve surgical decision-making and provide orthopedic surgeons with a more comprehensive understanding of published results on glenoid bone grafting at the time of primary reverse shoulder arthroplasty.

Purpose: Recurrence of hallux valgus (HV) following corrective surgery is a frequent concern. A recent systematic review estimated recurrence of HV in only 4.9%, which may be an underestimation, as most included studies had short- to mid-term follow-up. The purpose of this systematic review and meta-analysis was to synthesize and critically appraise the literature on the long-term outcomes of shaft osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis, and to assess the long-term HV recurrence rates of studies with a minimum follow-up of 5 years.

Methods: This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of shaft osteotomies of the M1 for non-inflammatory and non-degenerative HV having a minimum follow-up of 5 years were included. We found five eligible studies comprising six datasets, all assessed Scarf osteotomies with a mean follow-up that ranged from 8 to 14 years.

Results: The HV recurrence rate was 40%, considering the threshold of >15° hallux valgus angle (HVA), 30% having >20°, and 2% having >25°.

Conclusion: At a minimum follow-up of 8 years following shaft osteotomies of M1, the HVA was 15.9°, the intermetatarsal angle (IMA) was 7.7°, and the DMAA was 8.3°. Furthermore, the recurrence rates considering the various thresholds of HVA were: 40% having >15°, 20% having >20°, and 2% having >25°.

Level of evidence: Meta-analysis, Level IV.

This review highlights the pivotal role of Kaplan fibers (KFs) in knee stability, particularly in the anterolateral aspect. Studies reveal their complex anatomy with varying attachments to the distal femur, demonstrating a significant impact on knee joint mechanics across different populations. Investigations into the biomechanics of KFs show their crucial role in maintaining rotational stability of the knee, especially during rotational movements. Their synergistic function with other knee structures, like the anterolateral ligament, is emphasized, underscoring their importance in knee integrity and function. MRI emerges as a key tool in detecting KFs, with varying visibility and prevalence of injuries. The review discusses the development of MRI criteria for accurate diagnosis, highlighting the need for further research to refine these criteria and understand the interplay between KF injuries, anterior cruciate ligament (ACL) ruptures, and associated knee pathologies. The review covers various lateral extra-articular tenodesis (LET) techniques used to address residual laxity and instability following ACL reconstruction. Among them, the modified Lemaire technique, which resembles the anatomical and functional characteristics of distal KFs, shows effectiveness in reducing internal rotation and residual laxity. The review emphasizes the need for further research to understand the healing dynamics of KF injuries and the efficacy of different LET techniques. It suggests that a comprehensive approach, considering both biomechanical and clinical aspects, is crucial for advancing knee joint health and rehabilitation.

Purpose: Growing interest surrounds the role of human gut microbiome in the development of degenerative pathologies such as osteoarthritis (OA), but microbes have recently been detected also in other sites previously considered to be sterile. Evidence emerged suggesting that even native and osteoarthritic knee joints may host several microbial species possibly involved in the osteoarthritic degeneration. This is the first systematic review critically collecting all the available evidence on the existence and composition of knee intra-articular microbiome.

Methods: A systematic research on the PubMed, Cochrane and Google Scholar databases was performed. Human clinical studies investigating the presence of intra-articular microbiome in native osteoarthritic knee joints with next-generation sequencing techniques were collected.

Results: A total of eight studies were included reporting data on 255 knees. All the included studies reported evidence supporting the existence of an intra-articular microbiome in native knee joints, with detection rates varying from 5.8% to 100%. Bacteria from the Proteobacteria phylum were found to be among the most identified followed by the Actinobacteria, Firmicutes, Fusobacteria, and Bacteroideta phyla. Proteobacteria phylum were also found to be more common in osteoarthritic knees when compared to healthy joints. Furthermore, several pathways correlating those microbes to knee OA progression have been suggested and summarized in this review.

Conclusions: Evidence collected in this systematic review suggests that the native knee joint, previously presumed to be a sterile environment, hosts a peculiar intra-articular microbiome with a unique composition. Furthermore, its alteration may have a link with the progression of knee osteoarthritis.