Acta orthopaedica Belgica最新文献

Introduction: The health care sector is the fifth largest contributor to greenhouse emissions globally. Results of several studies have demonstrated that altering surgical practices from inpatient to outpatient service was associated with cost savings, reduction of medical waste and energy expenditure. The objective of this study was a comparison of costs and energy expenditure for hand surgeries performed in an operating theatre versus a ward procedure room. The analysis included the cost of materials, cost of sterilization of surgical instruments and energy expenditure for sterilization generated at standard hand surgery operations, including carpal tunnel release, surgery for Dupuytren's disease, benign tumor and ganglion cyst excision, de Quervain's disease, or trigger finger release. Typical hand surgery operations performed in a procedure room at the surgical ward generated lower costs (amounting to 53% of main theatre costs), 1 kg less clinical waste and were associated with significant (67%) reduction in energy expenditure compared to surgeries performed in the main operative theatre. Performing common hand surgery operations in a ward procedure room instead of the operating theatre resulted in significant economic and environmental benefits without compromising patient safety.

The aim of this study is to investigate the effect of the video of full flexion-extension movement of the operated knee on kinesiophobia level and functional results in the postoperative rehabilitation period in patients with high level of kinesiophobia who underwent total knee prosthesis surgery. For this purpose sixty patients with a preoperative Tampa Kinesiophobia Scale score above 39.5 and who underwent total knee replacement were included in this prospective study. The patients were randomly divided into two groups based on whether the video of their knee motion was captured. All patients were evaluated by using Tampa Scale for Kinesiophobia, SF-36 short form, Visual Analogue Scale, Range of Motion and 2-minute walk test before and 6 months after the surgery. As a results of the study the reduction in kinesiophobia level was not significant in either of the groups. There were significant improvements in both groups in terms of pain reduction, better range of motion and 2-minute walk test results. There was no significant difference between the two groups in the 2-minute walk test, but the improvement in pain reduction, knee flexion angle and quality of life were observed to be superior in the study group compared to the control group at the 6 month evaluation. At the end: Our results suggest that the rehabilitation performed with the help of the video as a visual stimulus is effective on increasing range of motion, reducing pain level and improving quality of life but not effective on levels of kinesiophobia.

Periprosthetic shoulder infection (PSI) management is very complicated because of its unique microbiology and due to the heterogeneity of studies published about it. Nowadays, there isn't a strict consensus on the diagnosis. Nevertheless, the criteria established by the musculoskeletal infection society (MSIS) are generally used by the scientific community. The objective of this retrospective study case and literature review is to establish that the MSIS criteria are insufficient to diagnose PSI. We did a retrospective monocentric analysis concerning PSI. Out of the 25 shoulder arthroplasty revisions conducted in our institution from January 2010 till January 2022 (including primary implants placed in other facilities), 10 had a positive periprosthetic culture from samples taken during surgery. In 60% of cases, the diagnosis of PSI has been made because of 2 positive periprosthetic cultures (major criterion). In 10% of cases, the diagnosis of prosthetic shoulder infection was recognized from the presence of a cutaneous fistula in communication with the joint implants (major criterion). In no case was the diagnosis of PSI determined by the presence of 4 out of 6 minor MSIS criteria. In 30% of cases, the MSIS criteria were insufficient to establish the PSI diagnosis. The MSIS criteria are insufficient to establish the diagnosis of PSI and should be considered as a methodological bias in published studies on this subject.

The aim is to identify any difference in patient populations and outcomes for those admitted acutely versus those who fracture their hip as an inpatient. Retrospective data was collected from the Scottish MSK audit. 18 months were analysed (01/2017-06/2018) to identify patient demographics and outcomes. It discovered 10,140 patients: 92% (9320/10,140) admitted acutely: 81% (7535/9320) own homes, 19% (1755/9320) care homes, <1% (31/9320) from other non-NHS origins. Inpatients accounted for 8% (820/10,140): 70% (578/820) were on acute wards, 20% (167/820) rehab, 9% (76/820) NHS Continuing Care. No difference in ages: 80.1 years acutes vs 80.2 years inpatients, p=0.73. Gender was significant amongst inpatients: males 11% (317/3009) vs females 7% (504/7133), p<0.001. The inpatient hip fractures had longer inpatient stays than the acutely admitted hip fractures (40 vs 17 days, p<0.001) and spent a longer time in rehabilitation (32 vs 25 days, p<0.001). They were less likely to return to their home/carehome in 30 days (23% vs 60%, p<0.001), or, at 60 days post-admission (41% vs 74%, p<0.001). Mortality rate was higher at 30 days (13% vs 6%, p<0.001) and at 60 days post-admission (21% vs 10%, p<0.001). There was no difference in readmission rates within 14 days. Inpatient hip fractures constitute a much smaller proportion compared with acute admissions, yet they've significantly worse outcomes. This may be because the acute fractures have been admitted following the recommended standards of care. Meanwhile, inpatients have already been admitted medically unwell and may have more co-morbidities.

Background: Aim of the randomised controlled trial was to compare the long-term outcomes following external fixation with wrist distractor and Kirschner wires (EF) with those after internal fixation with volar locking plates (IF) of displaced, intra-articular distal radius fractures in patients 18 to 65 years of age.

Methods: Surgery was performed after taking informed written consent following inclusion and randomisation. The primary outcomes were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and Jakim's score, and secondary outcomes included wrist range of motion, grip strength and pain. Linear mixed models were employed to assess and compare the 2 groups.

Results: The patients in both groups had comparable mean Quick DASH and Jakim's score, range of motion, and grip strength with no significant differences between the groups at all follow-ups. The overall complication rate was equivalent between the 2 groups, although, the rate of reoperations was higher in the IF group (p=0.03). Implant prominence or impingement was responsible for the IF group result values falling short of normal limb values even on long-term follow-up. While, results of EF group homogenously and successfully achieved normal limb functionality. At 3 years the rate of follow-up was 97%.

Conclusions: Biological healing through EF offers more natural anatomical restoration of the distal radius as evident by better long-term scores and statistically significant low reoperations rate. Absence of long-term bone-implant contact in EF group is identified as the sole factor promoting complete functional and clinical recovery.

Level of evidence: Therapeutic Level I.

The infrapatellar branch of the saphenous nerve (IPBSN) is susceptible to injury during common knee procedures, occasionally leading to the development of painful neuromas which are refractory to conservative management strategies. As a result, surgical resection has emerged as a viable treatment option for patients with persistent symptoms, and this study aims to assess the efficacy of IPBSN neuroma resection in terms of pain alleviation, functional improvement, and patient satisfaction. A retrospective study was conducted on 40 patients who underwent IPBSN neuroma resection between 2017 and 2023. Pre- and postoperative VAS scores were collected and patients were surveyed on pain relief, functional outcomes, and satisfaction of the surgery. The average VAS score for medial pain decreased from 6.5 ± 2.2 to 3.8 ± 2.8, and for anteromedial pain from 6.1 ± 2.6 to 3.1 ± 2.8. Overall, the majority of patients rated the outcome of the surgery positively with 73% reporting significant pain relief and 58% experiencing functional improvement postoperatively. Surgical resection of IPBSN neuromas is a viable treatment option for patients with chronic anteromedial knee pain after previous surgeries, resulting in significant pain relief and functional improvements in a majority of challenging cases.

The aim of the study was to determine the efficacy of wrapping nerve suture over recovery. In this prospective study, 72 patients with injured digital collateral nerves were studied during six months after microsurgical repair. 28 patients had nerve epiperineural suture with vein conduit wrapping and 44 patients had simple epiperineural nerve suture. We compare these two groups in terms of spontaneous pain, pain caused by impact and cold intolerance. We also investigated sensitive recovery with Weber test, Dellon test and the five monofilaments test. We also performed ultrasound at six months after surgery. The result of this study is in favor of using wrapping with vein to decrease presence of neuroma, pain and discomfort caused by contact without negative effect on sensitive recovery.

Despite increased sizing possibilities for implants in total knee arthroplasty (TKA) complications such as mechanical loosening and unexplained pain still exist. Similarly, approximately 20% of patients remain dissatisfied postoperatively. This study aims to evaluate the effectiveness and precision of the custom ORIGIN® TKA and assess the learning curve for its implementation. This retrospective, single-institution cohort study was conducted from March 2023 to June 2024. Forty-one patients with end-stage primary osteoarthritis, treated with custom TKA, were included. Primary outcomes measured alignment precision comparing the preoperative plan and the postoperative result on weightbearing full leg radiographs; secondary outcomes assessed the learning curve for operation time and alignment using cumulative summation (CUSUM) analysis. No significant differences between the planned and postoperative coronal alignment parameters were found, with a difference in means of -0.30° [95% CI: -1.40; 0.70] for HKA (P > 0.41), 0.30° [95% CI: -0.40; 1.60] for mLDFA (P > 0.43) and 0,10° [95% CI: -0.80; 1.00] for mMPTA (P > 0.75) . However, significant deviations were observed in sagittal alignment, with a difference of -2.5° [95% CI: -5.10; -0.50] and -2.7° [95% CI: -4.00; -1.70] for PDFA (P < 0.01) and PPTA (P < 0.000) respectively. This indicates a loss of tibial slope and femoral flexion compared to the preoperative plan. CUSUM analysis indicated an inflexion point in operative time after twenty- six procedures. Linear regression did not show a significant correlation between the number of cases and operative time. No learning curve for alignment could be demonstrated. Custom TKA with patient-specific instruments provides high precision in coronal alignment but shows variability in sagittal alignment. The learning curve for operative time is short, indicating the practicality of integrating this technology into surgical practice.

Osteochondral Defects of the knee joint are a common diagnosis. We report a case in which such a lesion was treated by using a polyvinylalcohol cylinder (SaluCartilage™, SaluMedica, Atlanta, USA) presented with increasing complaints 22 years after implantation. During workup the cylinder was shown to be completely dislodged from its implant site. Despite these findings, the patient remained mobile and active. Arthroscopic extraction of the cylinder and inspection of the joint was performed, which revealed fibrous repair of the lesion. During follow up, the patient reported minor discomfort on activity, but is satisfied with the outcome.

Chryseobacterium indologenes is a rare human pathogen which is nowadays considered an emerging fearsome organism because of its upcoming antibiotic resistance. We present a quite unique case of a multi drug resistant C. indologenes surgical wound infection in a patient submitted to cannulated screw fixation of a displaced medial malleolus fracture. The microorganism was identified only after three months of attempts to treat pharmacologically the unhealed wound, by removing the ostheosynthesis device and sonicating it, and the surgical wound progressively restored by second intention.