Advances in Orthopedics最新文献

Objective: The aim of this study was to look for preoperative patients' related factors correlating with worse clinical outcomes in a cohort of elderly patients undergoing simultaneous bilateral total knee arthroplasty (SiBTKA) to search for risk factors, which may influence clinical outcomes and safety. Subjects and Methods. The hospital database was mined searching for patients older than 70 years that underwent SiBTKA for severe bilateral knee osteoarthritis (OA) between 2012 and 2016. Preoperative clinical information, Oxford Knee Score (OKS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) prior to surgery were recorded. The OKS and the KOOS were submitted again after a minimum of 5 years of follow-up (FU).

Results: An improvement was observed in all clinical scores at last FU. The major complication rate was 5.4%. No patients' clinical data showed correlation with perioperative complications or need for transfusions. Functional scores at the last FU were negatively affected by age at surgery and positively affected by preoperative clinical scores. Discussion. In the setting of severe symptomatic bilateral knee OA, SiBTKA seems to be effective in improving symptoms at midterm follow-up, with acceptable rates of perioperative complications in patients older than 70. Higher age at surgery and lower preoperative functional scores are associated with worse clinical outcomes at FU. This could assist surgeons in advising patients that delay of surgical treatment could worsen outcomes.

Background: This study aimed to investigate factors, such as differences in femoral shape, that could affect the femoral valgus correction angle (VCA) for the intramedullary alignment rod (IM rod) by using a three-dimensional (3D) measurement system in patients with varus knee osteoarthritis undergoing total knee arthroplasty (TKA).

Methods: A total of 305 knees in 233 Japanese patients with varus knee osteoarthritis who underwent primary TKA by using Jig Engaged 3D Pre-Operative Planning Software for the TKA operation support system was examined. We retrospectively analysed factors, such as the shape of the proximal, middle, and distal femur in the coronal plane, all of which could affect the VCA for the IM rod, by multiple linear regression analyses.

Results: The VCA for the IM rod was 5.9° ± 1.6° (range: 1.7° to 10.7°), and the femoral lateral bowing angle (FBA) was 3.5° ± 3.2°. Major factors independently associated with the VCA for the IM rod were the FBA (β: 0.75), femoral offset (β: 0.38), and the medial angle between the mechanical femoral axis and the line that connects the distal margins of the medial and lateral femoral condyles (β: -0.16). The model was created by stepwise multiple linear regression (F = 266.6, p < 0.001, and estimated effect size = 4.4) explained 85% of the variance in the VCA for the IM rod (R ² = 0.85).

Conclusions: The VCA for the IM rod was most strongly associated with femoral lateral bowing in patients with varus knee osteoarthritis undergoing TKA. Our findings suggest that preoperatively measuring the VCA for the IM rod in patients with femoral lateral bowing by using a 3D measurement system could be useful for accurate coronal alignment of the femoral component in TKA.

Combinations of various nonopioid analgesics have been used to decrease pain and opioid consumption postoperatively allowing for faster recovery, improved patient satisfaction, and decreased morbidity. These opioid alternatives include acetaminophen, NSAIDs, COX-2 specific inhibitors, gabapentinoids, local anesthetics, dexamethasone, and ketamine. Each of these drugs presents its own advantages and disadvantages which can make it difficult to implement universally. In addition, ambiguous administration guidelines for these nonopioid analgesics lead to a difficult implementation of standardization protocols in spine surgery. A focus on the efficacy of different pain modalities specifically within spine surgery was implemented to assist with this standardized protocol endeavor and to educate surgeons on limiting opioid prescribing in the postoperative period. The purpose of this review article is to investigate the various opioid sparing medications that have been used to decrease morbidity in spine surgery and better assist surgeons in managing postoperative pain. Methods. A narrative review of published literature was conducted using the search function in Google scholar and PubMed was used to narrow down search criteria. The keywords "analgesics," "spine," and "pain" were used.

Introduction: Developmental dysplasia of the hip (DDH) is one of the commonest hip joint pathologies in children; to treat it properly, hip surgeons should know the normal femoral head (FH) coverage by the acetabulum. This paper aims to assess the femoral head coverage in healthy children younger than 6 years.

Methods: 270 hip joint CT scans were selected, and digital pelvic models were created according to these scans. FH coverage by the five acetabular regions was assessed according to patient's age and sex.

Results: Normal reference values of FH coverage by different acetabular regions were obtained. It was found that the growth process of different acetabular regions occurs nonlinearly with the periods of acceleration. Anterior and superior-anterior acetabular regions grow more intensively in boys up to 3 years old and between 4 and 5 years old both in boys and girls; superior-posterior, posterior-superior, and posterior-inferior acetabular regions grow more intensively in boys and girls up to 3 years old and between 4 and 5 years old (p ≤ 0.005). The following sex differences in FH coverage by the acetabulum were found: more superior-anterior FH coverage was found in boys and posterior FH coverage in girls (p ≤ 0.005).

Purpose: Femoral neck fractures (FNFs) are a significant cause of mortality and disability among the elderly. Total hip arthroplasty (THA) is the preferred treatment method in active, cognitively intact patients. In less active or cognitively impaired patients, bipolar hemiarthroplasty (BHA) is the practical option in Japan. Even with the direct anterior approach (DAA), clinical concerns about conducting THA in elderly patients include possible dislocations, critical complications, and medical cost-effectiveness. This study is aimed at rethinking the practical surgical indications for FNFs.

Methods: Between April 2019 and March 2021, BHA patients with displaced FNF (n = 21) performed through the DAA were compared with THA patients with displaced FNF (n = 19). The perioperative complications, clinical and radiologic outcomes, and mortality were compared between groups retrospectively at six months.

Results: THA patients had an increased average operation time (103.3 min vs. 89.1 min, P < 0.05) and similar amounts of bleeding (183.16 ml. vs. 121.1 ml.). The percentages of patients who received biological transfusion showed no difference, with low rates of perioperative complications (4% vs. 0%) and similar mortality rates compared to BHA patients. One THA patient experienced posterior dislocation during a state of postoperative delirium.

Conclusion: THA through the DAA might be a credible and safe option for FNF patients, with excellent functional outcomes and fewer surgery-related complications. Early posterior dislocation might be related to optimized offset distance and not related to leg discrepancy or other radiographic items. Hence, orthopedic surgeons should reconsider their options before conducting BPH for elderly and cognitively intact FNF patients.

Background: Total knee arthroplasty (TKA) is often indicated for end-stage knee osteoarthritis management. The posterior-stabilized (PS) implant is one of the TKA implants with various component designs, including femoral component cutting jigs. However, little is known about how the differences in cutting jig designs affect the outcomes. This study aims to compare the radiographic and functional outcomes of the patients who underwent cemented TKA using all-in-one and four-in-one femoral component PS implants.

Methods: A retrospective comparative study assessed patients who underwent cemented TKA using PS implants from 2018 to 2019. The patients were divided into all-in-one and four-in-one groups. Demographic data, surgery duration, postoperative radiological findings after one week, and functional outcomes after two years were collected and compared.

Results: A total of 96 patients were included in the study, 55 patients were in all-in-one sample, and 41 patients were in four-in-one sample. The majority of the patients in both groups were female, aged >60 years old, overweight (BMI ≥ 25), and presented with an ASA score of II. We found significantly shorter surgery duration in the all-in-one group compared to the four-in-one group (128.00 ± 36.24 vs. 210.61 ± 57.54, p=0.000). The four-in-one group and the all-in-one group showed the insignificant difference in α, β, δ, and γ angles (p=0.476, 0.273, 0.594, and 0.818). The functional outcomes (SF-12, KSS, and KOOS) showed insignificant differences.

Conclusion: There is no differentiation for the postsurgery functional and radiological outcomes between all-in-one and four-in-one implants.

Background: The distribution of postoperative orthopedic infection and their susceptibility pattern to antibiotics vary regionally and change over time. The incidence of methicillin-resistant Staphylococcus aureus infection is rising worldwide. Therefore, knowledge of the frequency of the causative microorganisms and their susceptibility to antibiotics are necessary for an improved therapeutic outcome. This study aims to study the frequency and distribution of postoperative orthopedic infection and their resistance pattern to antibiotics.

Methods: The study utilized a retrospective design that took place over a period of 5 years from 2016 and 2020 at a tertiary care hospital. The bacterial culture testing was performed by a recommended method. Descriptive statistics were used to analyze the data.

Results: A total of 158 patients (100 males and 58 females) with positive cultures of postoperative orthopedic infection were included. The most common infective organism was Staphylococcus aureus, 64 patients (38.1%); coagulase-negative staphylococci, 40 patients (23.8%); Klebsiella species, 14 patients (8.3%); and Enterococcus species, Escherichia coli, and Pseudomonas aeruginosa in 10 patients (6%). Data also showed that gram-positive bacteria were detected in 118 patients (70.8%), while gram-negative microorganisms were found in 50 patients (29.8%). Among Staphylococcus aureus, 79.7% were MRSA, and vancomycin was the most effective antibiotic in staphylococcus infections. The antibiotics with the greatest sensitivity to gram-positive bacteria were vancomycin, linezolid, tigecycline, moxifloxacin, and nitrofurantoin, while the antibiotics for gram-negative bacteria with greater sensitivity were tigecycline, amikacin, ertapenem, imipenem, and cefotaxime.

Conclusion: Staphylococcus aureus is the most common postoperative orthopedic infection, which was predominantly MRSA with vancomycin being the most effective antibiotic. In addition, the results showed a high resistance pattern to the commonly used antibiotics, leaving few choices. Antibiotic agents should be carefully selected according to specific drug sensitivity through routine monitoring of drug resistance patterns and to help formulate hospital antibiotic policy.

Introduction: The direct anterior approach (DAA) has garnered a lot of attention and surgical popularity for total hip arthroplasty in recent years. Some of the postulated advantages for the increase in popularity of this approach include better pain control and earlier recovery in the immediate postoperative period. The amount of literature available on this topic has rapidly increased over the last 10 years requiring the need for an updated guide to best navigate the topic.

Methods: The ISI Web of Knowledge database was used to search for research articles regarding the DAA surgical technique. The Boolean operative that yielded the largest search results was ([direct anterior approach hip] OR [anterior hip] OR [anterior hip arthroplasty] NOT [spine]).

Results: 92% of the highest cited articles on the DAA were published within the past two decades. One author, Keggi K, published 4 or more articles, with the highest citation average (110.5 citations). Recent articles were more strongly correlated with higher citation counts (R ² = 0.21 v. 0.19).

Conclusion: This review clearly outlines the increasing trend in the most influential publications regarding DAA being published in the past two decades. This review allows interested surgeons to understand the historic literature pertaining to this topic. This review can assist future researchers in identifying trends in UKA as well as help clinicians navigate this body of literature.

Background: The purpose of this study was to evaluate the feasibility of the virtual clinic for outpatient follow-up care after TKR surgery.

Methods: A total of 546 TKR surgeries were performed from January 2017 to December 2019. 30 patients were not able to go the hospital for routine follow-up. The data collections were taken for age, gender, year of surgery, functional score (Oxford Knee Score (OKS)), and active range of motion (ROM). The virtual clinic was conducted with the physician assistant and the operating surgeon via WhatsApp video call (WhatsApp Inc., Mountain View, California, USA) or Zoom (Zoom Video Communications, Inc., San Jose, California, USA).

Result: The average follow-up period was 39.1 months. The earliest follow-up was 20 months, while the longest follow-up was 97 months. The average OKS score was 45. The average consultation time for the virtual clinic is 9 minutes 21 seconds. Most of the patients were satisfied with the online consultation, with only two patients having a satisfaction score below 80%.

Conclusion: The virtual clinic for TKR surgery showed a high satisfaction rate during the COVID-19 pandemic, which has the potential to extend to the postpandemic era.

The purpose of this study was to determine caregivers' knowledge, attitude, and practice (KAP) on the prevention and care of pressure injuries (PIs) in individuals with spinal cord injury. A quantitative cross-sectional study with descriptive correlation design was used to implement a modified semistructured questionnaire using a convenient sampling method. McDonald's standard of learning outcome measurement criteria was used to categorize caregivers' KAP. A Pearson product-moment correlation coefficient (r) was utilized to assess the relationships between caregivers' KAP, with a p value of 0.05 or less considered statistically significant. The study findings indicate that caregivers had a moderate level of knowledge (M = 73.68%, SD = 6.43), a neutral attitude (M = 70.32%, SD = 6.89), and a moderate level of practice (M = 74.77%, SD = 9.08). A positive correlation existed between caregivers' knowledge and attitude (r = 0.30, p < 0.01), as well as between knowledge and practice (r = 0.37, p < 0.01). Nevertheless, there was no correlation between attitude and practice (r = 0.12, p > 0.05). The study findings suggest that caregivers need to develop a positive attitude and expand their knowledge in order to improve their practice. The KAP factors that require higher priority were positioning and turning the patient, preventing skin breakdown, assessing weight changes over time, interest in patient care, additional care for PIs, frequently changing the individual's position, priority to PI care, interest in other types of care other than PIs, using special cushions, consulting doctors on a regular basis, being aware of clothing and fabrics, proper transfer technique, pressure relief, and skin inspection, among others.