Advances in Orthopedics最新文献

Background: Lateral patellar dislocation is frequently observed among teenagers and young adults. There is no consensus on the best type of graft or fixation strategy for the femur and patella, and complications such as iatrogenic patella fracture, tunnel malposition, and grafting failure are common. The objective of our research is to find out the functional outcome of a new method of medial patellofemoral ligament (MPFL) reconstruction, which involves two key components: (1) patellar fixation is accomplished by suturing the two limbs of the looped doubled hamstring graft in a divergent fashion to the retinaculum at the medial border of the upper half of patella and (2) the placement of a suture anchor tied to the graft at the isometric point on the medial femur condyle.

Methods: This study is a retrospective assessment of patients who underwent MPFL reconstruction at our hospital between September 2018 and August 2020. Patients were monitored for at least 2 years after the initial procedure until August 2022.

Results: A total of 29 patients were recruited for the study, with 22 being females and the average age being 30.38 years. During the postoperative period, none of the participants experienced instability, redislocation, patellar/femoral fractures, or abnormal distal femur growth. The Tegner-Lysholm knee score was good to excellent for 17 (58.6%) participants, fair for 10 (34.5%) participants, and poor for 2 (6.9%) participants. The Kujala anterior knee pain score was more than 80 for 19 (65.5%) participants.

Conclusion: This research presents a significant achievement rate of the surgical procedure, accompanied by the mean Tegner-Lysholm knee score of 82.68 and the mean Kujala anterior knee pain score of 82.71. Notably, there were no complications observed in the postoperative period.

Background: The objective of this study is to evaluate the biostatistical interpretation abilities of fellowship trained orthopaedic surgeons.

Methods: A cross-sectional survey was administered to orthopaedic surgeon members of the American Shoulder and Elbow Surgeons (ASES), assessing orthopaedic surgeon attitudes towards biostatistics, confidence in understanding biostatistics, and ability to interpret biostatistical measures on a multiple-choice test.

Results: A 4.5% response rate was achieved with 55 complete survey responses. The mean percent correct was 55.2%. Higher knowledge test scores were associated with younger age and fewer years since board exam completion (p ≤ 0.001). Greater average number of publications per year correlated with superior statistical interpretation (p=0.009). Respondents with higher self-reported confidence were more likely to accurately interpret results (p ≤ 0.017). Of the respondents, 93% reported frequently using statistics to form medical opinions, 98% answered that statistical competency is important in the practice of orthopaedic surgery, and 80% were eager to continue learning biostatistics.

Conclusions: It is concerning that fellowship-trained shoulder and elbow surgeons, many of whom frequently publish or are reviewing scientific literature for publication, are scoring 55.2% correctly on average on this biostatistical knowledge examination. Surgeons that are further from formal statistical knowledge training are more likely to have lower biostatistical knowledge test scores. Respondents who published at the highest rate were associated with higher scores. Continuing medical education in biostatistics may be beneficial for maintaining statistical knowledge utilised in the current literature.

Background: Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients' quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration.

Materials and methods: Sixty cases with grade II-III knee osteoarthritis according to the Kellgren-Lawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment.

Results: At 6-month follow-up, Group C (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded.

Conclusion: The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone.

Introduction: This study aimed to compare the effect of intrathecal bupivacaine plus dextrose 5% and fentanyl with bupivacaine alone on the onset and duration of analgesia in patients undergoing lower-limb orthopedic surgery.

Materials and methods: A total of 40 patients eligible for lower-limb surgery were divided into two groups by simple randomization: the control group which received only bupivacaine and the intervention group which received bupivacaine plus dextrose 5% and fentanyl. Anesthesia was induced by the spinal method. The visual analog scale (VAS) was used to assess the patients' pain; hemodynamic status (systolic and diastolic blood pressure and the heart rate) and oxygen saturation were also monitored.

Results: There was a significant difference between groups in the type of lower-limb movement at the L1 anesthesia level, the sensory block level at time zero after surgery, the type of backward movement at time zero after surgery, and the analgesic dose received (p < 0.05). Fifteen and 30 minutes after the start of surgery, mean systolic blood pressure, and 45 and 60 minutes after the start of surgery, systolic and diastolic blood pressure and the heart rate were significantly lower in the control group than in the intervention group (p < 0.05). The VAS score was significantly lower in the intervention group than in the control group at 6 and 24 hours after surgery (p < 0.05). Systolic and diastolic blood pressure at time zero, systolic blood pressure at hour 6, and diastolic blood pressure at hour 24 after surgery were significantly lower in the control group than in the intervention group (p < 0.05).

Conclusion: The mean duration of anesthesia and analgesia was significantly longer in patients receiving bupivacaine plus fentanyl than in those receiving bupivacaine alone. However, concerning hemodynamic parameters, it cannot be concluded that the bupivacaine plus fentanyl receiving group was generally superior to the bupivacaine receiving group.

Background: The increasing number of canceled operations in patients undergoing total knee arthroplasty (TKA) due to high blood pressure readings has put a considerable burden on surgeons. In this study, we aim to assess the effect of giving antianxiety drugs preoperatively on maintaining blood pressure (BP) and blood loss for patients undergoing TKA surgery.

Methods: This retrospective case-control study included patients who underwent total knee arthroplasty and divided them into two main groups: those who had taken a 3 mg bromazepam oral tablet at the night preoperatively and the control group. The blood pressure of patients was then measured preoperatively (baseline), in the morning of surgery, in the operating room before anesthesia, and during the surgery. The percentage of measured BP was calculated by dividing the measured BP by the baseline, then multiplying by 100.

Results: 301 patients were included in our study: 137 received bromazepam and 164 as a control group. The ratio of systolic BP (SBP) in the morning of surgery to the baseline (percentage of morning SBP) decreased significantly in the bromazepam group compared with the controls. The ratio of SBP, in the operating room before anesthesia (percentage of preanesthesia SBP) also decreased significantly in the bromazepam group. However, the percentage of SBP in the middle of surgery did not change significantly. In addition, there was a significant difference change from the baseline in diastolic BP and mean arterial BP between the two groups in the morning of surgery, inside the theatre, and in the middle of the operation. The bromazepam group also showed a significant decrease in blood loss.

Conclusion: Preoperative oral antianxiety drugs (bromazepam) helps in controlling hemodynamic changes associated with anxiety, including maintaining BP in well-controlled hypertensive and healthy patients undergoing TKA, and it plays a role in decreasing the total blood loss.

Background: Percutaneous rupture of lumbar facet cysts (LFC) is the only nonsurgical treatment which is effective in directly reducing cysts. However, this is not yet a common procedure, and its effectiveness, including the associated complications, remains unclear. Therefore, this study aimed to evaluate the clinical outcomes of percutaneous rupture for LFC and elucidate whether this minimally invasive procedure could become an alternative to surgeries for cases resistant to conservative treatments.

Methods: This study investigated 57 symptomatic patients with LFC for whom conservative treatments were ineffective and underwent percutaneous rupture of the LFC. All patients were followed up for >2 years posttreatment. Clinical evaluations (visual analogue scale (VAS) and recovery rate calculated using the Japanese Orthopedic Association (JOA) scores) and radiographic evaluations (size of LFC based on magnetic resonance imaging (MRI)) were performed from pretreatment to the final follow-up examination.

Results: Successful LFC rupture, without hospitalization and general anesthesia, was achieved in 48 patients. No severe complications occurred during treatment through the last observation. Satisfactory clinical results with significant improvements in the VAS and JOA scores were obtained (VAS: pre/posttreatment: 80.7 mm/11.2 mm, JOA: pre/posttreatment: 15.6 points/26.7 points, and recovery rate: 82.3%). A significant reduction in the LFC was also observed in all cases based on the posttreatment MRI findings. No successful rupture cases required subsequent surgical treatments, although four cases of LFC recurrence required additional percutaneous rupture treatment.

Conclusions: Percutaneous rupture for LFC is not only a safe and minimally invasive procedure without any severe complications or requirements for hospitalization and general anesthesia but also a beneficial procedure that can eliminate the need for surgery in cases resistant to conservative treatments.

Background: Simple bone cysts are benign bony lesions. Treatment strategies are varied for this particular pathology. It remains controversial as to what the ideal treatment strategy is. Recently, bony substitute injections have emerged as a potential option for treatment. This paper aimed to describe our institution's experience in using bony substitute injections to treat unicameral bone cysts.

Methods: A retrospective review of consecutive patients over an 84-month period at a tertiary paediatric hospital was performed. Information regarding patients' presentation, diagnosis, and management was recorded and summarised.

Results: A total of 15 patients were included in our study, with a mean follow-up of 118 weeks. 86.7% of patients demonstrated clinical resolution (absence of pain at the latest follow-up) and 80% of patients demonstrated radiographic resolution. Only one patient sustained a subtrochanteric fracture post-index operation, whilst two others demonstrated redevelopment of cystic architecture on follow-up.

Conclusion: This study demonstrates that bone substitute injection is potentially a minimally invasive and seemingly successful technique in the treatment of unicameral bone cysts and other simple bone lesions. Further randomised and comparative studies are required to confirm and validate our findings.

Introduction: As surgical site infections (SSIs) after joint arthroplasty contribute to increased morbidity and mortality, they require further surgical intervention, prolonged hospitalisation, and antimicrobial treatment. The aim of our study is to examine the association between preoperative quality of life (QoL) and other predictive factors on the development of SSIs after primary arthroplasty.

Methods: This is a prospective study that enrolled 56 patients with hip and knee primary osteoarthritis who underwent joint replacement. Data were collected from January to March 2017, including patient demographic characteristics, comorbidities, laboratory results, and perioperative clinical data. The patients' QoL was evaluated preoperatively by applying the knee injury and osteoarthritis outcome score (KOOS) and the hip disability and osteoarthritis outcome score (HOOS) for total knee replacement (TKR) and total hip replacement (THR), respectively. A 5-year follow-up was conducted to assess the clinical status of the patients.

Results: 66.1% of patients underwent TKR, with 4.9 ± 1.2 days of hospitalisation, 16% of them required autologous blood transfusion, while 33.9% of patients were treated with THR, with 5.7 ± 1 days hospitalisation and 36.8 of them required this type of transfusion. 16 patients were diagnosed with SSIs, with the older of them (>65 years old) presenting lower probability (odds ratio: 0.13, 95% CI: 0.03-0.62) requiring treatment with additional antibiotics, while revision surgery was performed in 3 of these cases, following periprosthetic joint infection (PJI). Overall preoperative QoL was not statistically associated with SSIs, but low QoL scores were associated with higher rates of SSIs and increased levels of postoperative pain (p = 0.009 < 0.05).

Conclusions: The duration of each operation (>90 min), the length of hospitalisation (>4 days), and the presence of comorbidities including hypothyroidism and recurrent urinary tract infections were associated with a high risk for SSIs following arthroplasties. On the contrary, this study revealed no association between other comorbidities, including heart coronary disease, hypertension, and diabetes mellitus, with close monitoring of plasma glucose and SSIs. Moreover, the younger the patients, the more likely they were to require treatment with antibiotics. Overall, high QoL index scores were mainly accompanied by low rates of postoperative SSIs and pain.

Background: Comminuted tibial pilon fractures are induced by high-energy mechanisms and are often associated with soft tissue injuries. Their surgical approach is problematic due to postoperative complications. Minimally invasive management of these fractures has a considerable advantage in preserving the soft tissue and the fracture hematoma.

Materials and methods: We conducted a retrospective study of a series of 28 cases treated at the Orthopedic and Traumatological Surgery Department of the CHU Ibn Sina in Rabat over a period of 3 years and 9 months, from January 2018 to September 2022.

Results: After a mean follow-up of 16 months, 26 cases had good clinical results according to the Biga SOFCOT criteria and 24 cases had good radiological results according to the Ovadia and Beals criteria. No cases of osteoarthritis were observed. No skin complications were reported.

Conclusion: This study highlights a new approach that deserves to be considered for this type of fracture as long as no consensus has been given.