Acta orthopaedica Belgica最新文献

TKA is routinely done orthopaedic procedure done that aims at improving the quality of patients' life by providing pain relief, functional improvement and deformity correction. This study aims to study the efficacy and safety of a Periarticular analgesic cocktail including ropivacaine injection and epidural ropivacaine for early rehabilitation after a total knee replacement.

Methods: Total of 100 patients divided into two groups, one group received epidural ropivacaine and second group given periarticular cocktail containing ropivacaine. Then postoperatively their pain score comparison using VAS score and their functional status is documented knee society score.

Results: The mean age for the epidural group is 60.28 years, while for the periarticular cocktail group it's 60.88 years. For female patients, 34 (68%) received epidural analgesia, while 24 (48%) received periarticular cocktail. Among male patients, 16 (32%) had epidural analgesia, and 26 (52%) received periarticular cocktail. For pre-operative pain scores, patients receiving Epidural analgesia had a slightly higher mean score of 7.24 compared to those receiving Periarticular Cocktail, who had a mean score of 7.12. Patients in the Epidural group had a higher mean knee flexion of 83.84 degrees compared to the Periarticular Cocktail group, which had a mean flexion of 79.36 degrees. The Knee Society Scores (KSS) for the post-operative scores; The Epidural group had a mean score of 80.16. The Periarticular Cocktail group had a mean score of 88.40.

Conclusion: In conclusion, this study supports the periarticular analgesic cocktail over epidural analgesia for pain management and early rehabilitation following TKR.

Correct treatment of chronic osteomyelitis depends on proper identification of the bone-infecting microorganism, but it is difficult identify the specific etiology in previously treated patients and in those with implants. Small colony variants auxotrophyc for menadione had been related with false-negative results in culture of patient with chronic osteomyelitis, but menadione supplementation can increase bone culture performance. The purpose was to evaluate the effect of menadione supplementation on isolates in bone cultures, in a cohort of patients with osteomyelitis, Medellín- Colombia. We performed a study of a retrospective cohort with 40 adult patients with culture-negative and chronic osteomyelitis, supplemented with 3 doses of menadione. Effect was defined as the proportion of positive bone cultures after treatment administration. The comparison of the effect with clinical variables was made with Chi-square, Fisher and Mann-Whitney U test in SPSS 29.0. Microbiological isolates from bone culture ranged from 0% (pre- treatment) to 62.5% (post-treatment), mainly S. aureus sensitive to methicillin, coagulase-negative Staphylococcus, E. coli and Enterobacter spp. This effect did not present statistical differences according to the clinical characteristics or comorbidities of the patients. We concluded that in patients with chronic osteomyelitis and negative bone cultures, menadione supplementation produces a high proportion of isolates and identification of the etiological agent, which favors correct treatment and reduces readmissions, complications, and resistance to antibiotics.

Delayed fracture healing (DFH), a common complication of post-fracture surgery, exhibits an incompletely understood pathogenesis. The present study endeavors to investigate the roles and underlying mechanisms of miR-656-3p and Bone Morphogenetic Protein-2 (BMP-2) in DFH. It was recruited 94 patients with normal fracture healing (NFH) and 88 patients with DFH of the femoral neck. Serum miR-656-3p and BMP-2 expressions were quantified using RT-qPCR and the diagnostic potential of them for DFH was evaluated using ROC analysis. Factors influencing fracture healing were identified through logistic regression analysis. Osteogenic differentiation of MC3T3-E1 cells was induced, followed by evaluations of cell proliferation, apoptosis, and differentiation capabilities utilizing CCK-8, flow cytometry, and mRNA expression analysis of osteogenic markers. The targeting relationship between miR-656-3p and BMP-2 was validated through luciferase reporter assays. The levels of miR-656-3p were significantly elevated in DFH patients compared to those with NFH, whereas BMP-2 levels exhibited a decrease, a negative correlation between their expression patterns. Logistic regression analysis revealed that miR-656-3p and BMP-2 serve as influential factors in fracture healing, with their combined assessment exhibiting enhanced predictive value for DFH. Downregulation of miR-656-3p promoted proliferation and differentiation of MC3T3-E1 cells while inhibiting apoptosis. BMP-2, identified as a target of miR-656-3p, negated the effects of miR-656-3p downregulation when BMP-2 expression was inhibited. miR-656-3p modulates osteoblast function by targeting BMP-2, offering novel therapeutic and diagnostic targets for the management of DFH.

Dislocation is the second most common indication for revision total hip arthroplasty (THA). In revision cases the dislocation rate can be as high as 5-30%. The aim of this study was to assess the outcome, specifically the dislocation rate in revision THA where a dual mobility cup was used. We retrospectively reviewed all the revision THAs where a dual mobility cup (G7) was used. The pre-operative and post-operative oxford hip scores were recorded. Patients' electronic records and radiographs were studied for the indications, approaches used, post-operative complications, re-operation rates, and re-revision surgery. Between 2016 and 2020, we performed 59 revision total hip replacements where a dual mobility cup (G7) was used. There were 23 males and 36 females. The average age was 74 years (range, 64-89). Acetabular components were revised in 47 (80%) cases and both the femoral and the acetabular components were revised in 12 (20%) cases. The average follow-up time was 4 years (range, 2-6 years). Average pre-operative and post-operative oxford hip scores were 17 and 36 respectively. The improvement was significant with P value of <.001. Complications were noted in 5 (8%) patients. One patient had dislocation. This patient required re-revision with constrained liner. One patient had intraoperative fracture of the femur and was treated with plate and cables. We conclude that the dual mobility cup can significantly reduce the risk of dislocation when used in revision THA.

Despite advancements in surgical techniques for rotator cuff repair, retear rates remain a significant concern. This study systematically reviews the evidence on the effectiveness of the Regeneten Bioinductive Implant in improving healing outcomes. A systematic review of the literature was conducted by searching on PubMed, Embase, Web of Science Core Collection and Cochrane Library. Studies reporting on effectiveness, safety, radiological, clinical outcomes, or patient- reported outcomes after Regeneten use, with at least 12 months of follow-up, were considered. 17 articles were included in this review, encompassing data on 1062 rotator cuff tears, of which 966 were treated with Regeneten. The implant use resulted in retear rates of 0% up to 18% after 5 years in PT tears and 0% up to 35% after 2 years in FT tears. In 1 randomised trial, the retear rate was significantly lower in the implant group compared to the control group. Constant- Murley Score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score showed a sustained improvement compared to pre-operative scores across all studies. MRI showed increased tendon thickness starting from 6 months, with MRI signals suggesting that the implant was integrating with the native tendon and becoming indistinguishable. While using Regeneten for rotator cuff tears of various sizes and chronicity is associated with reduced retear rates in some studies, the clinical outcomes remain within the same range as those seen with traditional rotator cuff repair. Additional randomized controlled trials are required to validate these results and clarify the appropriate indications for using this implant.

Metastasis stands as one of the most prominent prognostic factors in osteosarcoma. Over 70% of metastatic osteosarcoma occurrences affect the lung. Nonetheless, to date, there has been a scarcity of research addressing predictive factors for lung metastasis risk in osteosarcoma. The objective of this study is to identify the predictive factors that have a role in the risk of lung metastasis in osteosarcoma. This is a retrospective study conducted between January 2018 until January 2023. From the obtained research subjects, an assessment selection was carried out using inclusion and exclusion criteria. Subsequently, preoperative data related to predictive factors will be collected from the research subjects, followed by a clinicopathological conference, chemotherapy, and surgery. Afterward, an evaluation of pulmonary metastasis will be conducted six months after the diagnosis. A total of 47 osteosarcoma patients who met the inclusion and exclusion criteria were analyzed. Bivariate and multivariate logistic regression analyses revealed statistically significant predictive factors for the risk of pulmonary metastasis in osteosarcoma: ALP levels (p=0.014), LDH levels (p=0.038), presence of pathological fractures (p=0.025), and tumor size (p=0.027).

Percutaneous intra-meniscal platelet-rich plasma (PRP) is a promising tool for managing low-grade meniscal injuries in non-athletic patients. The study evaluates the clinical and radiological outcomes of PRP intra-meniscal injection in meniscal tears. Forty-eight patients were injected with 3 injections of PRP at an interval of one week with a standardised technique under sonographic guidance. All the patients had MRI evidence of meniscal injury with failed conservative management for at least 3 months. The IKDC score and VAS score were recorded initially and during follow-ups. MRI was performed on at least 12 months post-injection. Medial meniscus tear (n=33) was most commonly present. The mean follow-up of the patient was 14.4 months (Range: 12-16 months) except for 1 patient. Horizontal or oblique tears were the most common injury suffered by the patients (n=35). According to MRI classification, 6 patients had grade 1 lesions, 28 patients had grade 2 lesions, and 14 patients had grade 3 lesions. The mean IKDC and VAS scores improved significantly at the last follow-up. Pain at the site of the injection for 1-2 days was the most common adverse effect. Two patients were surgically intervened at 4 and 6 months respectively. Intra-meniscal PRP injection can be a promising modality to manage low-grade meniscal injuries. It is easy, and minimally invasive to manage meniscal tears. Although there was no radiological evidence of healing, clinical improvement was seen in all the patients. Further, long-term randomized studies are required to ascertain the benefits.

COVID-19 has extensively affected the health-care organization with varying impact on different medical specialties. Long term ICU admission is associated with a less familiar complication: the formation of heterotopic ossifications (HO). In this case report we would like to emphasize the unrecognized burden of the coronavirus pandemic in patient care from the perspective of the orthopedic surgeon. We describe two patients with major HOs around their hip joints after COVID-19. Current literature underlines the increased prevalence of HO formation in COVID-19 patients requiring long-lasting mechanical ventilation and ICU admission including prone positioning. Preventing HO formation remains a difficult undertaking without obvious evidence supporting a golden standard treatment. We advice early passive mobilization during ICU stay, also during prone positioning, serum ALP follow-up during admission, NSAID administration if possible and a low threshold in the use of radiotherapy of joints with a limited range of motion.

To our knowledge, no Dutch questionnaires exist to administer patient satisfaction after total shoulder arthroplasty. The goal of this study is to develop a Dutch translation of the satisfaction questionnaire used by Swarup et al. (2017)1, into Dutch. This ensures the suitability for clinical application an application in research in all Dutch-speaking regions worldwide. A forward-backward translation approach was used. The clarity of the pre-final version was tested on 8-35 post-operative total shoulder arthroplasty patients. The responses of the patients were studied at one single time point. The Dutch translation of the satisfaction questionnaire proposed by Swarup et al. (2017)1 was considered clear to more than 80% of patients, which was set as norm value where the questionnaire can be assumed clear and understable. The Dutch translation of the postoperative satisfaction questionnaire by Swarup et al. (2017)1 met the 80% clarity criterion and can be considered clear. This study provides a base for future research assessing the psychometric properties of this questionnaire.

The concept of Debridement, Antibiotics and Implant Retention (DAIR) is well known in periprosthetic joint infections. Extrapolating this concept to fracture related infections is mired in controversies. Characteristics of the metal implant, duration of infection, state of fracture healing, microbiological profile etc. appear to play a role in the decision making process whether or not to keep, adjust , exchange or remove (infected) metalwork. More than likely it is the quality of source control by meticulous debridement having a major impact whether a DAIR approach to FRI could result in a successful outcome.