Acta orthopaedica Belgica最新文献

The purpose of the current study is to determine which variables influence the onset of chronic regional pain syndrome (CRPS) following Sanders type 1 calcaneal fractures, which are treated conservatively, and to discover how Vitamin C (VC) supplementation, which is often mentioned in the literature, affects the outcomes of these fractures. The study incorporated individuals who had a Sanders type 1 fracture that was both closed and non-displaced and were treated with conventional plaster. The current study retrospectively reviewed medical records to gather demographic data, duration of immobilization, smoking habits, administration of VC supplementation, and presence of diabetes mellitus (DM). The Budapest criteria were employed to make the clinical diagnosis of CRPS. The study cohort comprised 258 (75.9%) males and 82 (24.1%) females aged between 18 and 90 years who had sustained Sanders type 1 calcaneal fractures and were managed non-operatively. CRPS was detected in 42 (12.4%) of the 340 subjects. CRPS patients had a statistically higher immobilization duration than those without CRPS (p<0.05). Smoking and DM were more common among patients with CRPS (p<0.05) and CRPS patients had a much lower rate of VC consumption (4.8%) (p<0.05). The current study is the first to examine risk variables for CRPS after calcaneal fractures. Long periods of immobility, female gender, and lack of VC supplementation increase the risk of CRPS. CRPS also increases with diabetes and smoking.

Background: The Ehlers Danlos Syndromes (EDS) are inherited in an autosomal dominant pattern and patients classically present with hypermobility, skin hyper-elasticity, blood vessel fragility and atrophic scarring. Due to hypermobility, disorders such as joint pain and early arthritis are common. The aim of this study was to assess clinical and radiological outcomes of total hip arthroplasty (THA) in patients with EDS treated in a high volume orthopaedic centre.

Methods: A search was performed of the electronic patient record system at our institution from 1998 - 2019 using the search terms 'EDS' or 'Danlos' and 'arthroplasty'. Over the 22-year study period, there were approximately 32,000 primary THAs performed at our institution. We collated demographic information including age, gender, BMI, smoking history and medical comorbidities. Implant type, bearing surfaces and size was also documented, with clinical and radiological assessment at last known follow up.

Results: A total of n=5 primary THAs were identified in n=4 patients at a median follow-up of 3 years. All patients were female with a median age of 68 (SD 18.9) years and a median BMI of 30.7 (SD 4.5). The majority of patients were smokers, and had a chronic history of low back pain (n=3, 75%). Uncemented implants were used on n=3 occasions with the remainder being hybrid (n=2). Femoral head size ranged from 28mm to 44mm. One patient had a post-operative surgical wound erythema that resolved within 48 hours of onset, otherwise there were no significant wound complications. To date, there have been no documented dislocations, with all patients having satisfactory clinical and radiological outcome at last known follow up.

Conclusions: This study demonstrates that total hip arthroplasty can be safely performed in patients with a diagnosis of EDS, with no significant complications in the intermediate term.

Background and aims: Arthrofibrosis is a complication of intra-articular knee surgery which is caused by intra-articular fibrosis. To date, several preventive therapies for arthrofibrosis have been reported. This systematic review aims to summarize current knowledge about pharmacological arthrofibrosis prevention.

Methods: A systematic literature search was conducted in Medline, Web of Science, and Cochrane library using the search term 'Arthrofibrosis AND prevention'. Subsequently, articles reporting the effects of a preventive pharmacological intervention against arthrofibrosis were included in this review.

Results: 16 studies investigated the pharmacological prevention of arthrofibrosis of which 13 were conducted in animal models. Several drugs improved the range of motion (ROM) in animal models. Bevacizumab (ROM +39.4 degrees), nonsteroidal anti-inflammatory drugs (ROM +18.0-31.2 degrees), and rosiglitazone (ROM +19.5 degrees) significantly increased the ROM. Artesunate, mitomycin c, bevacizumab, hyaloglide, and botulinum toxin A significantly reduced adhesion scores. None of the drugs tested in humans improved the functional outcomes after joint arthroplasty. Methodological differences limited the ability to compare outcomes and, due to poor reporting of methodology, many studies had an unclear risk of bias.

Conclusion: This review identified several drugs as potential candidates for arthrofibrosis prevention. These drugs modulate inflammation or alter the activity of fibroblasts. Most studies are conducted in experimental animal models and none of these results are currently translated into a clinical application. Moreover, the methodology and route of administration varied between studies. Nor were dose dependency studies conducted. Future studies should adopt a standardized approach to determine the effects of preventive pharmacological interventions on arthrofibrosis.

Background and research aims: Scapholunate interosseous ligament rupture can cause wrist issues like pain, strength loss, and cartilage degeneration. While various surgical treatments exist, it's unclear which method is optimal. This study aims to determine the superior treatment approach for scapholunate dissociation.

Methods: In Pubmed, Embase, Scopus and Web of Science was searched for articles reporting results of surgical repair of scapholunate dissociation. Additional inclusion criteria were English- and Dutch-language articles published between January 2000 and December 2022 with at least 8 patients and at least 1 year of follow-up.

Results: Seventeen articles were included, 9 covered tenodesis repair, 2 focused on capsulodesis, 3 on direct scapholunate ligament repair using bone anchors, and 3 on a combination of tenodesis and capsulodesis. No difference could be found between the types of surgical techniques in wrist mobility and grip strength. The Disability of Arm, Shoulder, and Hand score, Visual Analogue Scale for pain and Mayo wrist scores showed no clinically relevant difference. With all methods, normal radiological values were obtained after surgery. The mean scapholunate angle was less than 60° and the scapholunate gap less than 3 mm. However, at longer follow-up an increase in this angle and gap was seen again.

Discussion: This review did not allow to conclude that one technique was better than another to treat scapholunate dissociation because of poor quality of the included studies. Pre- and postoperative values were not always reported, there were insufficient comparative studies, and randomized prospective studies were missing.

Main reasons for prolonged hospital stay after total knee arthroplasty (TKA) are postoperative nausea and vomiting (PONV) and pain. Having a positive effect on both PONV and pain, perioperative administration of corticosteroids might improve rehabilitation and reduce length of hospital stay (LOS) after TKA. Aim of this review is to determine the effect of different corticosteroid dosages on PONV, pain, and LOS in TKA. A systematic search for articles comparing dosage effects of corticosteroids regarding PONV, pain, and LOS after primary unilateral TKA was conducted using EMBASE, PubMed publisher, MEDLINE, Cochrane, Google scholar, and Web-of-Science for articles published from inception to March 17, 2022. 16 studies were included involving 2352 TKA procedures. Most studies showed reduced pain scores in corticosteroid groups and some described better pain reduction in high-dose groups. All studies showed reduced PONV in the corticosteroid groups. LOS was similar in most studies comparing placebo and perioperative corticosteroids. Only one study reported increased infection rates and intramuscular venous thrombosis in the corticosteroid group. Concluding, current literature on corticosteroids use in TKA is highly variable in type, dosage, and timing of administering medication. Overall, corticosteroids mostly reduce pain and PONV with limited effects on LOS after TKA. Only minimal statistically significant and clinically relevant benefits were found in perioperative high-dose corticosteroids compared to low-dose. Given the short follow-up in most studies, it is not possible to evaluate safety of high-dose corticosteroids.

Background and study aims: Digital technology is a transformative product of the information age. z-osteotomy is a surgical procedure that corrects limb angulation and lengthens shortening deformities within a 40 mm difference in limb length.The purpose of this study is to Introduce the surgical technique of digitally assisted "Z" osteotomy for correction of angular and length deformities of the lower limbs and investigating its clinical efficacy.

Patients and methods: A retrospective study was conducted on five patients with multiplanar angular deformities of the lower extremity combined with limb shortening(n=5). The objective of the study was to assess the effectiveness of computer-assisted preoperative design planning and 3D-printed surgical guide fabrication in guiding precise orthopedic procedures. The study compared various parameters, including femoral or tibial cross-sections, coronal and sagittal deformities, limb length, modified Barthel Index, and post-operative complications.

Results: Five patients were granted 17.20±6.83 months of follow-up after surgery, with adequate correction of lower limb deformity, significant improvement in postoperative self-care ability improved Barthel index 90±3.08 points (P<0.05). One patient experienced postoperative wound pain at 3 months, which subsequently diminished significantly by the 4-month follow-up assessment., four cases had no complications.

Conclusions: The new surgical method of digital technology-assisted "Z" osteotomy for correction of complex deformities of the lower limbs has remarkable clinical results, can accurately correct multi-planar angular deformities and realize limb lengthening at the same time, being safe and reliable.

The introduction of fast-track protocols decreased length of hospital stay and improved rehabilitation and outcomes in total joint arthroplasty. Despite improved clinical results published in many papers, the patient perspective of these protocols is less investigated. Purpose of this study was to explore the patient perspective of fast-track protocols in arthroplasty. A systematic search for articles of patient experiences in total hip, knee, and shoulder arthroplasty was conducted using EMBASE, MEDLINE, Cochrane, and Web-of-Science for articles published from inception to February 14, 2023. In total 12 studies were included involving 672 patients. Most patients were satisfied with short length of hospital stay and preferred rehabilitation at home with relatives for support. Various experiences were reported regarding pain and postoperative out of hospital physical therapy. Frequently, feelings of insecurity were reported because of lack of personalized information. Based on current qualitative literature, patients are satisfied with short length of hospital stay in fast-track total joint arthroplasty. Improvements in personalized information and physical therapy protocols is needed.

The number of hospital admissions for a hip prosthesis increased by more than 91% between 2002 and 2019 in Belgium (1), making it one of the most common interventions in hospitals. The objective of this study is to evaluate patient-report- ed outcomes and hospital costs of hip replacement six months after surgery. Both generic (EQ-5D) and specific (HOOS) PROMs of general hospital patients undergoing hip replacement surgery in 2021 were conducted. The results of these PROMs were then combined with financial and health management data. The mean difference (SD) in QALYs between the preoperative and postoperative phases is 0.20 QALYs (0.32 QALYs). The average cost (SD) of all stays is €4,792 (€1,640). Amongst the five dimensions evaluated in the EQ-5D health questionnaire, the 'pain' dimension seems to be associated with the greatest improvement in quality of life. As regards Belgium, the 26,066 arthroplasties performed in 2020 might constitute a gain of 123,000 years of life in good health. The relationship between QALYs and costs described in this study posits a ratio of €23,960 per year of life gained in good health. Given that in Belgium more than 3% of the hospital healthcare budget is devoted to hip prostheses, it would seem relevant to us to apply PROM tools to the entire patient population to assess treatment effectiveness more broadly, identify patient needs and, also, monitor the quality of care provided.

Ulnar nerve release is often performed under general anaesthesia. Wide Awake Local Anaesthesia No Tourniquet (WALANT) is a new anaesthetic method increasingly used by hand surgeons in an outpatient setting. It has advantages such as the possibility to shift surgical interventions out of the regular surgical theatre settings into an outpatient clinical setting, no risk of complications or side effects resulting from regional and general anesthesia and decreased costs. The use of WALANT has not been investigated extensively in elbow surgery. This study aims to evaluate clinical outcomes after ulnar nerve release under WALANT 27 patients with ulnar nerve release for cubital tunnel syndrome were included. The primary outcome was the presence of (remaining) symptoms after ulnar nerve release. Data was extracted from medical records. 13 out of 27 patients had (mild) remaining symptoms after ulnar nerve release, and 1 complication (superficial wound infection) was seen. Ulnar nerve release under WALANT is safe and effective in patients with primary ulnar nerve entrapment that have failed conservative therapy.

The standard dorsal portals are the most commonly used in wrist arthroscopy. This cadaveric study aims to determine safe zones, by quantitatively describing the neurovascular relationships of the dorsal wrist arthroscopy portals: 1-2, 3-4, midcarpal radial, midcarpal ulnar, 4-5, 6-radial and 6-ulnar. The neurovascular structures of twenty-one fresh frozen human cadaveric upper limbs were exposed, while the aforementioned portals were established with needles through portal sites. The minimum distance between portals and: dorsal carpal branch of radial artery, superficial branch of radial nerve, posterior interosseous nerve and dorsal branch of ulnar nerve, were measured accordingly with a digital caliper, followed by statistical analysis of the data. The median and interquartile range for each portal to structures at risk were determined and a safe zone around each portal was established. Free of any neurovascular structure safe zones surrounding 1-2, 3-4, midcarpal radial, midcarpal ulnar, 4-5, 6-radial and 6-ulnar portals were found at 0.46mm, 2.33mm, 10.73mm, 11.01mm, 10.38mm, 5.95mm and 0.64mm respectively. Results of statistical analysis from comparisons between 1-2, 3-4 and midcarpal radial portals, indicated that 1-2 was the least safe. The same analysis among 3-4, midcarpal radial, midcarpal ulnar and 4-5 portals indicated that midcarpal portals were safer, while 3-4 was the least safe. Results among midcarpal ulnar, 4-5, 6-radial and 6-ulnar portals indicated that 6-radial and specifically 6-ulnar were the least safe. This study provides a safe approach to the dorsal aspect of the wrist, enhancing established measurements and further examining safety of the posterior interosseous nerve.