K Seki, T Seki, T Imagama, Y Matsuki, T Kawakami, T Sakai
Intravenous acetaminophen is an integral component of multimodal postoperative pain management. This prospective study aims to assess the efficacy of the repeated administration of intravenous acetaminophen and the impact on postoperative patient satisfaction with postoperative pain management after total knee arthroplasty (TKA). We enrolled 98 patients scheduled for unilateral TKA. Patients were randomly assigned to receive either 1000 mg of intravenous acetaminophen at 6-hour intervals (AAP group) or not to receive intravenous acetaminophen (control group). All patients underwent single-shot femoral nerve block after general anesthesia, as well as intraoperative periarticular infiltration of analgesia prior to implantation. The primary outcome was the postoperative numerical rating scale (NRS) pain score at rest. The NRS score was measured just before the administration of study drugs, immediately after arrival in the ward (time 0), and at 6, 12, 18, 24, and 48 h (time 1 to time 5, respectively) postoperatively. We also evaluated the mean doses of rescue opioid use for 24 h postoperatively. At time 5, the AAP group had significantly improved mean NRS score than controls (3.0 vs. 4.0; P < 0.01). Rescue opioid use was significantly lower in the AAP group for 24 hours compared to controls (0.3 μg vs. 0.9 μg; P < 0.01). Repeated intravenous acetaminophen administration after TKA may provide better analgesia and reduce opioid use.
{"title":"Efficacy of repeated administration of intravenous acetaminophen for pain management after total knee arthroplasty.","authors":"K Seki, T Seki, T Imagama, Y Matsuki, T Kawakami, T Sakai","doi":"10.52628/89.3.10347","DOIUrl":"10.52628/89.3.10347","url":null,"abstract":"<p><p>Intravenous acetaminophen is an integral component of multimodal postoperative pain management. This prospective study aims to assess the efficacy of the repeated administration of intravenous acetaminophen and the impact on postoperative patient satisfaction with postoperative pain management after total knee arthroplasty (TKA). We enrolled 98 patients scheduled for unilateral TKA. Patients were randomly assigned to receive either 1000 mg of intravenous acetaminophen at 6-hour intervals (AAP group) or not to receive intravenous acetaminophen (control group). All patients underwent single-shot femoral nerve block after general anesthesia, as well as intraoperative periarticular infiltration of analgesia prior to implantation. The primary outcome was the postoperative numerical rating scale (NRS) pain score at rest. The NRS score was measured just before the administration of study drugs, immediately after arrival in the ward (time 0), and at 6, 12, 18, 24, and 48 h (time 1 to time 5, respectively) postoperatively. We also evaluated the mean doses of rescue opioid use for 24 h postoperatively. At time 5, the AAP group had significantly improved mean NRS score than controls (3.0 vs. 4.0; P < 0.01). Rescue opioid use was significantly lower in the AAP group for 24 hours compared to controls (0.3 μg vs. 0.9 μg; P < 0.01). Repeated intravenous acetaminophen administration after TKA may provide better analgesia and reduce opioid use.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z E Çelen, B Özkurt, Ö Aydin, T Akalan, O Gazi, A Utkan
The treatment strategy remains controversial for bilateral end-stage osteoarthritis, particularly with regard to patient safety. The aim of this study was to compare the safety and clinical results of sequential simultaneous bilateral total knee arthroplasty (ssBTKA) and staged bilateral total knee arthroplasty (staBTKA). Patients who underwent either simultaneous (n=168) or staged (n=63) bilateral total knee arthroplasty in a single center between February 2017 and April 2021 were identified retrospectively. Data related to age, gender, body mass index, ASA score, comorbidities, operative time, transfusion rate, length of stay, knee range of motion (ROM), Knee Society Score (KSS), complications, and mortality rates were evaluated. Mean follow-up duration was 39.0±14.7 months. Preoperative characteristics were similar among cohorts. Transfused units were significantly higher in the ssBTKA group (p<0.001). Operative time and length of stay were significantly higher in the staBTKA group (respectively, p<0.001 and p=0.004). Complication rates (except superficial infection rate which was significantly higher in the staBTKA group), revision rates, mortality rates and functional outcomes were statistically similar between the groups (p>0.05). Presence of preoperative coronary artery disease comorbidity was significantly associated with increased postoperative myocardial infarction risk (p=0.001). ssBTKA provided similar functional results, shorter cumulative hospital stay and shorter operative time without increasing complications and mortality rates compared to staBTKA procedure. For patients with pre-existing coronary artery disease, a more cautious approach should be preferred to decrease complications.
{"title":"Comparison of safety and efficiency between sequential simultaneous bilateral and staged bilateral total knee arthroplasty at a high-volume center: a retrospective cohort study.","authors":"Z E Çelen, B Özkurt, Ö Aydin, T Akalan, O Gazi, A Utkan","doi":"10.52628/89.3.11954","DOIUrl":"10.52628/89.3.11954","url":null,"abstract":"<p><p>The treatment strategy remains controversial for bilateral end-stage osteoarthritis, particularly with regard to patient safety. The aim of this study was to compare the safety and clinical results of sequential simultaneous bilateral total knee arthroplasty (ssBTKA) and staged bilateral total knee arthroplasty (staBTKA). Patients who underwent either simultaneous (n=168) or staged (n=63) bilateral total knee arthroplasty in a single center between February 2017 and April 2021 were identified retrospectively. Data related to age, gender, body mass index, ASA score, comorbidities, operative time, transfusion rate, length of stay, knee range of motion (ROM), Knee Society Score (KSS), complications, and mortality rates were evaluated. Mean follow-up duration was 39.0±14.7 months. Preoperative characteristics were similar among cohorts. Transfused units were significantly higher in the ssBTKA group (p<0.001). Operative time and length of stay were significantly higher in the staBTKA group (respectively, p<0.001 and p=0.004). Complication rates (except superficial infection rate which was significantly higher in the staBTKA group), revision rates, mortality rates and functional outcomes were statistically similar between the groups (p>0.05). Presence of preoperative coronary artery disease comorbidity was significantly associated with increased postoperative myocardial infarction risk (p=0.001). ssBTKA provided similar functional results, shorter cumulative hospital stay and shorter operative time without increasing complications and mortality rates compared to staBTKA procedure. For patients with pre-existing coronary artery disease, a more cautious approach should be preferred to decrease complications.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included "trapeziometacarpal osteoarthrosis", "trapeziometacarpal arthrodesis" and "trapeziectomy with ligament reconstruction". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.
斜方腕骨关节炎的最佳治疗方法仍然存在争议。该荟萃分析评估了斜方腕关节融合术(TMA)与斜方骨切开韧带重建术(LRTI)的主观和客观结果。从成立到2022年6月30日,检索了PubMed、Cochrane图书馆、Embase、Web of science数据库。关键词包括“斜方腕骨关节病”、“斜方腕关节融合术”和“斜方截骨韧带重建术”。随机对照试验(RCTs)和对照临床试验(CCTs)包括接受TMC骨关节炎治疗的患者。提取主观结果视觉模拟量表(VAS)、患者评定的手腕和手部评估(PRWHE)、手臂、肩膀和手部残疾(DASH)评分、Kapanji评分、客观结果指间和掌指关节总运动、手掌外展、握力、尖端、按键握力和并发症。对每种方法的方法学质量进行了独立评估。对比较试验进行荟萃分析。在纳入的5项研究中(2项随机对照试验,3项CCTs),208例患者被分为TMA组(n=107)和LRTI组(n=101)。与TMA组相比,LRTI组的PRWHE、尖端握力和手掌外展能力更好。DASH评分、VAS评分、kapandji评分、握力、按键握力、总IP关节运动、总MCP关节运动及并发症无统计学差异。LRTI组在PRWHE、尖端握力和掌侧外展方面具有更明显的优势。此外,DASH评分、VAS评分、kapandji评分、握力、按键握力、总IP关节和总MCP关节运动及并发症无统计学差异。因此,我们得出结论,LRTI更适合用于TMC骨关节炎的更多治疗。当然,长期随访需要高质量的研究。
{"title":"Differences between trapeziometacarpal arthrodesis and trapeziectomy with ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis.","authors":"K Chen, Y Shun, W Xiang","doi":"10.52628/89.3.11618","DOIUrl":"10.52628/89.3.11618","url":null,"abstract":"<p><p>The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included \"trapeziometacarpal osteoarthrosis\", \"trapeziometacarpal arthrodesis\" and \"trapeziectomy with ligament reconstruction\". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K Anjiki, S Hayashi, T Fujishiro, T Hiranaka, R Kuroda, T Matsumoto
Fitmore stem is a rectangular, tapered, short, cementless stem. A characteristic feature of this stem is that it provides rotational stability due to the high medullary occupancy achieved by its rectangular cross-section and thick antero- posterior width. We aimed to investigate the differences in periprosthetic bone remodelling between a rectangular- tapered short stem and a short tapered-wedge stem. Eighty patients who underwent primary total hip arthroplasty using a rectangular-tapered short stem (Fitmore) or a short tapered-wedge stem (Tri-Lock BPS) were enrolled in this study. Bone mineral densities (BMDs) in the seven Gruen zones were evaluated using dual-energy X-ray absorptiometry at baseline, and at 6 and 24 months postoperatively. Peri-prosthetic BMD and clinical factors were assessed and compared. In addition, correlations between periprosthetic BMD changes and stem anteversion error were analyzed using Pearson's correlation coefficient in the two groups. A significantly better postoperative periprosthetic BMD change was found in zones 1 and 7 in the rectangular-tapered group. Additionally, no significant correlation was observed between stem anteversion error and periprosthetic BMD changes in the rectangular-tapered groups. However, in the tapered-wedge group, there were significant negative correlations between the stem anteversion error and BMD changes at 6 months and 24 months in zones 1 and 7. In the rectangular-tapered group, a significantly better postoperative periprosthetic BMD change was found particularly in the region proximal to the stem. Rectangular-tapered short stem can be more resistant to rotation due to higher medullary occupancy and may lead to better periprosthetic BMD than the tapered-wedge short stem, especially in the proximal region of the stem.
{"title":"Rectangular tapered short stem excellently preserves proximal bone mineral density preservation than tapered wedge short stem.","authors":"K Anjiki, S Hayashi, T Fujishiro, T Hiranaka, R Kuroda, T Matsumoto","doi":"10.52628/89.3.11833","DOIUrl":"10.52628/89.3.11833","url":null,"abstract":"<p><p>Fitmore stem is a rectangular, tapered, short, cementless stem. A characteristic feature of this stem is that it provides rotational stability due to the high medullary occupancy achieved by its rectangular cross-section and thick antero- posterior width. We aimed to investigate the differences in periprosthetic bone remodelling between a rectangular- tapered short stem and a short tapered-wedge stem. Eighty patients who underwent primary total hip arthroplasty using a rectangular-tapered short stem (Fitmore) or a short tapered-wedge stem (Tri-Lock BPS) were enrolled in this study. Bone mineral densities (BMDs) in the seven Gruen zones were evaluated using dual-energy X-ray absorptiometry at baseline, and at 6 and 24 months postoperatively. Peri-prosthetic BMD and clinical factors were assessed and compared. In addition, correlations between periprosthetic BMD changes and stem anteversion error were analyzed using Pearson's correlation coefficient in the two groups. A significantly better postoperative periprosthetic BMD change was found in zones 1 and 7 in the rectangular-tapered group. Additionally, no significant correlation was observed between stem anteversion error and periprosthetic BMD changes in the rectangular-tapered groups. However, in the tapered-wedge group, there were significant negative correlations between the stem anteversion error and BMD changes at 6 months and 24 months in zones 1 and 7. In the rectangular-tapered group, a significantly better postoperative periprosthetic BMD change was found particularly in the region proximal to the stem. Rectangular-tapered short stem can be more resistant to rotation due to higher medullary occupancy and may lead to better periprosthetic BMD than the tapered-wedge short stem, especially in the proximal region of the stem.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K Kempenaers, N VAN Beek, R Lauwers, M Tengrootenhuysen
The aim of this study was to compare whether the newest TKA prosthesis (Persona) gives improved clinical outcomes due its more anatomical design in comparison to older prostheses (balanSys). This study included a total of 89 patients planned for TKA from June 2018 to September 2019. Outcomes such as Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion (ROM), numeric pain rating scale (NRS), analgesics and alignment were recorded next to patient characteristics and complications. Our results showed a significant improvement in NRS, ROM and functional scores postoperatively compared to preoperatively for both the Persona and the balanSys implants. Although the flexion ROM for the Persona group was higher at 6 and 12 months postoperative compared to the balanSys, this was mainly a regaining of the preoperative ROM. Throughout all timepoints, there were no statistically significant differences observed in NSAID and opioid usage between the balanSys and Persona groups. Both implants are safe and efficient to use in the treatment of knee osteoarthritis. Although Persona had an improved postoperative flexion, this did not have an impact on any of the patient-reported outcomes.
{"title":"Total knee arthroplasty: do newer CR implants yield better results? A single center prospective study.","authors":"K Kempenaers, N VAN Beek, R Lauwers, M Tengrootenhuysen","doi":"10.52628/89.3.11325","DOIUrl":"10.52628/89.3.11325","url":null,"abstract":"<p><p>The aim of this study was to compare whether the newest TKA prosthesis (Persona) gives improved clinical outcomes due its more anatomical design in comparison to older prostheses (balanSys). This study included a total of 89 patients planned for TKA from June 2018 to September 2019. Outcomes such as Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion (ROM), numeric pain rating scale (NRS), analgesics and alignment were recorded next to patient characteristics and complications. Our results showed a significant improvement in NRS, ROM and functional scores postoperatively compared to preoperatively for both the Persona and the balanSys implants. Although the flexion ROM for the Persona group was higher at 6 and 12 months postoperative compared to the balanSys, this was mainly a regaining of the preoperative ROM. Throughout all timepoints, there were no statistically significant differences observed in NSAID and opioid usage between the balanSys and Persona groups. Both implants are safe and efficient to use in the treatment of knee osteoarthritis. Although Persona had an improved postoperative flexion, this did not have an impact on any of the patient-reported outcomes.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wide-awake local anesthesia and no tourniquet (WALANT), first used for hand surgery, has been sparingly described for use in fracture fixation of the upper limb. We present our experience using this technique. 26 patients with upper limb fractures (3 distal radius, 6 radial shaft, 11 ulnar shaft, and 6 olecranon fractures) were operated on using WALANT by three orthopedic surgeons. We used 35-40ml of 2% Lignocaine with 1:80000 Adrenaline(7mg/kg) diluted with normal saline. Numeric Pain Rating (NPR) scoring was done during injection and per-operatively, and the Likert scale was used for the surgeon's satisfaction. The average NPR score was reported as 0.65 (1-3) during injection and 0.15 (0-2) preoperatively. All three surgeons reported excellent satisfaction in all the cases operated on. No complication occurred due to anesthesia. WALANT is a much simpler option and can be safely used in place of general anesthesia or regional blocks for fixation of fractures of the upper limb, with added advantages of no need for a tourniquet and better intraoperative assessment of fracture fixation.
{"title":"Wide-awake local anesthesia and no tourniquet (WALANT) in upper limb fractures.","authors":"N Bansal, P Tiwari, P Dev","doi":"10.52628/89.3.11357","DOIUrl":"10.52628/89.3.11357","url":null,"abstract":"<p><p>Wide-awake local anesthesia and no tourniquet (WALANT), first used for hand surgery, has been sparingly described for use in fracture fixation of the upper limb. We present our experience using this technique. 26 patients with upper limb fractures (3 distal radius, 6 radial shaft, 11 ulnar shaft, and 6 olecranon fractures) were operated on using WALANT by three orthopedic surgeons. We used 35-40ml of 2% Lignocaine with 1:80000 Adrenaline(7mg/kg) diluted with normal saline. Numeric Pain Rating (NPR) scoring was done during injection and per-operatively, and the Likert scale was used for the surgeon's satisfaction. The average NPR score was reported as 0.65 (1-3) during injection and 0.15 (0-2) preoperatively. All three surgeons reported excellent satisfaction in all the cases operated on. No complication occurred due to anesthesia. WALANT is a much simpler option and can be safely used in place of general anesthesia or regional blocks for fixation of fractures of the upper limb, with added advantages of no need for a tourniquet and better intraoperative assessment of fracture fixation.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miguel Tovar-Bazaga, David Sáez-Martínez, Álvaro Auñón, Felipe López-Oliva, Emilio Calvo
Cement removal during hip or knee arthroplasty revision is challenging and not exempt of complications. Cement-on-cement procedure is among techniques developed to safe removal of cement from bone, and it could be a realistic solution. This cement-on-cement devices can provide advantages in removing bone cement during hip and knee arthroplasty septic and non-septic revision surgeries, and can be regarded as an effective and safe alternative. We present our experience using the cement-on-cement technique in 34 cases between 2010 and 2021, including revision surgeries for 20 knee and 14 hip arthroplasties. In 3 out of 34 cases the technique failed, with a success of 91%. Mean surgical time was 2.77 (SD 0.93) hours and blood transfusion was required in 23 cases. Success was achieved in every aseptic case. Of all patients, 60% were septic cases. Infection was considered to be eradicated in 70% (14/20) of patients with a septic revision. Cement-on-cement is a safe and effective alternative for cement removal during hip and knee arthroplasty revision. Level of evidence: III, retrospective case series.
{"title":"Effectiveness and safety of a cement-on-cement removal system for hip and knee arthroplasty revision surgery.","authors":"Miguel Tovar-Bazaga, David Sáez-Martínez, Álvaro Auñón, Felipe López-Oliva, Emilio Calvo","doi":"10.52628/89.2.11562","DOIUrl":"https://doi.org/10.52628/89.2.11562","url":null,"abstract":"<p><p>Cement removal during hip or knee arthroplasty revision is challenging and not exempt of complications. Cement-on-cement procedure is among techniques developed to safe removal of cement from bone, and it could be a realistic solution. This cement-on-cement devices can provide advantages in removing bone cement during hip and knee arthroplasty septic and non-septic revision surgeries, and can be regarded as an effective and safe alternative. We present our experience using the cement-on-cement technique in 34 cases between 2010 and 2021, including revision surgeries for 20 knee and 14 hip arthroplasties. In 3 out of 34 cases the technique failed, with a success of 91%. Mean surgical time was 2.77 (SD 0.93) hours and blood transfusion was required in 23 cases. Success was achieved in every aseptic case. Of all patients, 60% were septic cases. Infection was considered to be eradicated in 70% (14/20) of patients with a septic revision. Cement-on-cement is a safe and effective alternative for cement removal during hip and knee arthroplasty revision. Level of evidence: III, retrospective case series.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tibial plateau fractures with posterior comminution are difficult to reduce and stabilise. Standard lateral approach doesn't offer adequate visualisation. Posterior approach is suitable for isolated posterior fractures. The addition of a specifically contoured rim plate can enable fixation of posterior fragments through a modified lateral approach.The purpose of this study was to evaluate the advantages and limitations of this novel technique. We present a prospective series of 16 tibial plateau fractures with posterolateral depression, operated over a period of 7 years (04.2014-09.2021). The mean age of the patients was 52 years .They were followed for an average period of one year.Clinical and functional assessment was performed according to the criteria of Knee Society Clinical Rating Score. The lateral and posterior component of the fracture was stabilised by a horizontal rim plate, through a posterolateral approach, with or without fibular osteotomy. 9 patients had excellent, 5 had good, 2 had average ratings. The average objective rating was 87,5 (70- 97), and the average functional rating was - 74,4 (40-100). The average ROM was 110° (100°-120°). Two of the fractures healed in 5° varus and 8° valgus respectively. One knee joint ended up with 10° flexion deficit. Three knees had medio- lateral instability, with no functional impairment. In 4 cases the K wires of the weber fibular osteotomy fixation migrated. The absence of late articular collapse of the treated fractures may be attributed to the initial stability of fixation.The addition of a rim plate addresses the posterior comminution and makes early rehabilitation safe.
{"title":"Lateral tibial plateau fractures with posterior comminution. Can a rim plate offer sufficient support?","authors":"Yordan Andonov","doi":"10.52628/89.2.10533","DOIUrl":"https://doi.org/10.52628/89.2.10533","url":null,"abstract":"<p><p>Tibial plateau fractures with posterior comminution are difficult to reduce and stabilise. Standard lateral approach doesn't offer adequate visualisation. Posterior approach is suitable for isolated posterior fractures. The addition of a specifically contoured rim plate can enable fixation of posterior fragments through a modified lateral approach.The purpose of this study was to evaluate the advantages and limitations of this novel technique. We present a prospective series of 16 tibial plateau fractures with posterolateral depression, operated over a period of 7 years (04.2014-09.2021). The mean age of the patients was 52 years .They were followed for an average period of one year.Clinical and functional assessment was performed according to the criteria of Knee Society Clinical Rating Score. The lateral and posterior component of the fracture was stabilised by a horizontal rim plate, through a posterolateral approach, with or without fibular osteotomy. 9 patients had excellent, 5 had good, 2 had average ratings. The average objective rating was 87,5 (70- 97), and the average functional rating was - 74,4 (40-100). The average ROM was 110° (100°-120°). Two of the fractures healed in 5° varus and 8° valgus respectively. One knee joint ended up with 10° flexion deficit. Three knees had medio- lateral instability, with no functional impairment. In 4 cases the K wires of the weber fibular osteotomy fixation migrated. The absence of late articular collapse of the treated fractures may be attributed to the initial stability of fixation.The addition of a rim plate addresses the posterior comminution and makes early rehabilitation safe.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Svetlana Bogaert, Nicolas Cuylits, Konstantinos Drossos, Anne Lejeune, Monika Tooulou, Nader Chahidi
The aim of this retrospective study was to evaluate the potential bony erosion and the clinical and radiological results of primary trapeziectomy with RegjointTM interposition, in patients with peritrapezial arthritis. Data were recorded on twenty patients over a period of two years (January 2015-December 2016). On average 24 months, patients were reconvened for a post-operative evaluation (subjective evaluation of pain, function and patient satisfaction; clinical evaluation with strength and mobility measures; post-operative X-rays). On X-rays, 2 criteria were evaluated: the bony erosion and the shortening of the thumb column (trapezium+metacarpal height measure, ratio between first and second metacarpal bones, a new radiological assessment tool based on a trapezoid relationship gradation). In most patients, surgery relieved pain and offered good functional results, according to the Quick Disabilities of the Arm, Shoulder and Hand scale. Following surgery, our patients showed a subjective improvement, both in terms of pain and functional results. For plain X-ray, only 3 patients showed an osteolytic lesion (maximum of 2.8 millimeters) on the first metacarpal base. A statistically significant reduction in the thumb column height was generally observed on follow-up X-rays. However, all of these radiologic changes were present without any clinical impact. We show that the RegjointTM spacer is an available alternative in the surgical treatment of peritrapezial arthritis. We did not highlight any significant associated complications, no important adverse tissue reaction or bone erosion, no pain or functional disorder. Type of study/level of evidence Therapeutic IV.
{"title":"Primary trapeziectomy with Regjoint(TM), a poly-L/D-lactide spacer, a two-year follow-up study with new radiological assessment tool.","authors":"Svetlana Bogaert, Nicolas Cuylits, Konstantinos Drossos, Anne Lejeune, Monika Tooulou, Nader Chahidi","doi":"10.52628/89.2.9448","DOIUrl":"https://doi.org/10.52628/89.2.9448","url":null,"abstract":"<p><p>The aim of this retrospective study was to evaluate the potential bony erosion and the clinical and radiological results of primary trapeziectomy with RegjointTM interposition, in patients with peritrapezial arthritis. Data were recorded on twenty patients over a period of two years (January 2015-December 2016). On average 24 months, patients were reconvened for a post-operative evaluation (subjective evaluation of pain, function and patient satisfaction; clinical evaluation with strength and mobility measures; post-operative X-rays). On X-rays, 2 criteria were evaluated: the bony erosion and the shortening of the thumb column (trapezium+metacarpal height measure, ratio between first and second metacarpal bones, a new radiological assessment tool based on a trapezoid relationship gradation). In most patients, surgery relieved pain and offered good functional results, according to the Quick Disabilities of the Arm, Shoulder and Hand scale. Following surgery, our patients showed a subjective improvement, both in terms of pain and functional results. For plain X-ray, only 3 patients showed an osteolytic lesion (maximum of 2.8 millimeters) on the first metacarpal base. A statistically significant reduction in the thumb column height was generally observed on follow-up X-rays. However, all of these radiologic changes were present without any clinical impact. We show that the RegjointTM spacer is an available alternative in the surgical treatment of peritrapezial arthritis. We did not highlight any significant associated complications, no important adverse tissue reaction or bone erosion, no pain or functional disorder. Type of study/level of evidence Therapeutic IV.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The posterolateral tibial plateau fracture is an uncommon intra-articular injury and mostly needed surgery. However, its surgical approach remains controversial. This manuscript describes an anterolateral approach to treat posterolateral tibial plateau fractures and evaluates the patient's functional outcomes. From June 2018 to July 2021 seventeen patients with posterolateral tibial plateau fractures were surgically treated through an anterolateral approach. The intraoperative and postoperative follow-up indicators were recorded. The reduction quality of fractures was assessed using Rasmussen radiological score, and postsurgical functional recovery was estimated using Rasmussen clinical score and Lysholm score. The mean follow-up interval was 28.71 ± 9.61 months (range 18-44). The surgery time and blood loss were 111.06 ± 15.62 min (range 85-140) and 118.12 ± 38.45 mL (range 80-250) separately. Postoperatively, the Rasmussen radiological score was 16.24 ± 2.33 (range 12-18). The average time of bone union was 14.29 ± 1.53 weeks (range 12-18). At the final follow-up, the average PTS and MPTA were 9.71 ± 2.76° (range 5-14°) and 86.82 ± 2.04° (range 84-90°) separately. A satisfactory articular reduction was achieved in 16 patients (94.1%). The final ROM was 123.29 ± 19.70° (range 60-142°). The Rasmussen clinical score and Lysholm score were 25.71 ± 5.74 (range 10-30) and 91.47 ± 6.50 (range 75-98) separately. Anterolateral approach has minimal risk of intraoperative neurovascular injuries in the popliteal fossa with satisfactory results. The hardware removal was also facilitated. This approach is feasible, safe and efficient.
{"title":"Anterolateral approach for posterolateral tibial plateau fractures.","authors":"Jianwen Li, Khan Akhtar Ali, Chengyan Xia, Meipeng Zhu, Weikai Zhang, Hui Huang","doi":"10.52628/89.2.11211","DOIUrl":"https://doi.org/10.52628/89.2.11211","url":null,"abstract":"<p><p>The posterolateral tibial plateau fracture is an uncommon intra-articular injury and mostly needed surgery. However, its surgical approach remains controversial. This manuscript describes an anterolateral approach to treat posterolateral tibial plateau fractures and evaluates the patient's functional outcomes. From June 2018 to July 2021 seventeen patients with posterolateral tibial plateau fractures were surgically treated through an anterolateral approach. The intraoperative and postoperative follow-up indicators were recorded. The reduction quality of fractures was assessed using Rasmussen radiological score, and postsurgical functional recovery was estimated using Rasmussen clinical score and Lysholm score. The mean follow-up interval was 28.71 ± 9.61 months (range 18-44). The surgery time and blood loss were 111.06 ± 15.62 min (range 85-140) and 118.12 ± 38.45 mL (range 80-250) separately. Postoperatively, the Rasmussen radiological score was 16.24 ± 2.33 (range 12-18). The average time of bone union was 14.29 ± 1.53 weeks (range 12-18). At the final follow-up, the average PTS and MPTA were 9.71 ± 2.76° (range 5-14°) and 86.82 ± 2.04° (range 84-90°) separately. A satisfactory articular reduction was achieved in 16 patients (94.1%). The final ROM was 123.29 ± 19.70° (range 60-142°). The Rasmussen clinical score and Lysholm score were 25.71 ± 5.74 (range 10-30) and 91.47 ± 6.50 (range 75-98) separately. Anterolateral approach has minimal risk of intraoperative neurovascular injuries in the popliteal fossa with satisfactory results. The hardware removal was also facilitated. This approach is feasible, safe and efficient.</p>","PeriodicalId":7018,"journal":{"name":"Acta orthopaedica Belgica","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}