Background: Total hip arthroplasty (THA), a critical surgery for hip joint pain relief and mobility restoration, involves careful consideration of various factors, including stem length. Short stems are often chosen for their potential to reduce tissue damage and thigh pain. Precise alignment is necessary to alleviate complications such as stem loosening and fractures. We aimed to compare intramedullary insertion freedom and alignment changes between short and standard stems in THA. This study is based on preoperative planning simulations, highlighting the potential clinical implications.
Methods: This retrospective study involved 102 hip joints (34 each from Dorr A, B, and C) undergoing initial THA between 2015 and 2017. A preoperative computed tomography scan was used to create three-dimensional bone models for planning virtual surgery, assessing stem insertion in flexion/extension, and measuring the anterior femoral offset. One-way repeated-measures analysis of variance was conducted to compare intramedullary insertion freedom and anterior femoral offset across the three Dorr classifications (A, B, and C). A paired t-test was used to compare intramedullary insertion freedom and anterior femoral offset between short and standard stems for each Dorr classification and between different medullary shapes.
Results: Statistically significant differences were observed between the stem types (p < 0.05). Short stems demonstrated significantly greater intramedullary insertion freedom, with averages of 7.5°, 8.2°, and 9.1° for Dorr A, B, and C, respectively, compared with 4.3°, 5.0°, and 5.8° for standard stems. Additionally, the anterior femoral offset was significantly higher in short stems, with an average increase of 2.5 mm across classifications, compared to 1.2 mm in standard stems (p < 0.05).
Conclusion: Short stems offer enhanced intramedullary insertion freedom and improved anterior femoral offset, potentially leading to better alignment outcomes in THA. However, their increased freedom necessitates precise surgical planning, particularly in patients with wider medullary morphologies. These findings emphasize the importance of simulation-based planning in understanding the impact of stem length, while clinical studies are needed to validate these results.
Background: Surgical intervention is the ultimate treatment for scoliosis, but iatrogenic spinal cord injury is one of the major concerns. Although intraoperative electrophysiological monitoring can aid in detecting and reducing postoperative neurological complications, its use is still controversial.
Methods: A retrospective chart review of 6,577 scoliotic patients who underwent surgery for curve correction with a reported complication was conducted. Our dataset was sourced from the morbidity and mortality database of the Scoliosis Research Society spanning the period from 2013 to 2023. The sensitivity of intraoperative monitoring was evaluated.
Results: Intraoperative monitoring was used in 60% of surgeries, while 26% of the reported complications in the study cohort were new postoperative neurologic deficits. The overall monitoring performance indicated a sensitivity of 45%. Neurogenic motor evoked potential showed the best outcomes among the individual monitoring methods. The highest sensitivity (60.4%) was achieved using four monitoring methods, demonstrating significantly better results than one, two, and three methods.
Conclusions: The monitoring practice benefits in distinguishing postoperative neurologic deficits within the scoliosis population. Employing four monitoring techniques yielded the most favourable outcomes.
Background: Total hip arthroplasty (THA) is one of the most effective treatments for hip arthritis. However, postoperative outcomes of THA in patients with bony ankylosed hips remain inconclusive. We aimed to examine the postoperative results of THAs for bony ankylosed hips using propensity score matching.
Methods: A propensity score was calculated using logistic regression analysis for a bony-ankylosed group (40 hips, 38 patients) and a non-ankylosed (control) group (829 hips, 729 patients). Patients were followed up for more than 10 years after primary THA. The propensity score used five covariates: age, sex, height, weight, and body mass index. Propensity matching was performed, with each bony ankylosed hip being matched to a non-ankylosed control hip. The clinical outcomes of the Japanese Orthopaedic Association (JOA) hip scores and complications were investigated.
Results: The propensity-matched population consisted of 40 bony ankylosed hips (38 patients) and 40 hips (40 patients) of matched controls. In both groups, the postoperative JOA hip scores at the last follow-up significantly improved compared to the preoperative scores. The JOA hip scores at the last follow-up for all components in the bony-ankylosed group were significantly lower than those in the control group. The number of hips with postoperative complications was significantly higher in the bony-ankylosed group than that in the control group.
Conclusions: THA for patients with bony ankylosed hips achieved positive results, including improved JOA hip scores; however, these scores were inferior to those observed in patients with non-ankylosed hips. This should be preoperatively communicated to patients with bony ankylosed hips who undergo THA.
Background: Orthogeriatric hospital care is recommended for hip fra cture patients, but differentiated hospital care has not been evaluated. The aim of this study was to describe physical performance and health-related quality of life for hip fracture patients 1-year after surgery in four treatment pathways. We also report changes in functional outcomes from baseline to 1-year follow-up together with readmission and mortality rates for each pathway.
Methods: We included 177 hip fracture patients aged 65 years or older from a single center in Norway. Participants were discharged home, to specialised rehabilitation, regular rehabilitation or nursing home based on orthogeriatric assessment of pre- and postfracture function, mobility level and Ac tivities of Daily Living. Outcome variables included Short Physical Performance Battery, EuroQol-5-dimension-5-level, Barthel-index, Lawton & Brody Instrumental Activities of Daily Living, Lawton & Brody Self-Maintenance Scale, readmission and mortality rates during follow-up.
Results: Participants discharged home and to specialised rehabilitation were younger and healthier than participants discharged to regular rehabilitation and nursing home. All groups had a clinically important improvement in Short Physical Performance Battery score (mean 4.8 points, 95% confidence interval (CI) 4.2, 5.5) from post-surgery to 1-year follow-up and a clinically important decline in EuroQol-5-dimension-5-level (mean -0.12 points, CI -0.16, -0.07) from baseline to 1-year follow-up. The decline in Barthel-index from baseline to 1-year follow-up was greater in the regular rehabilitation group (mean -2.3 points, CI -4.2, -0.2) than in the home group (mean -0.6 points, CI -1.4, 0.2) and specialised rehabilitation group (mean -0.4 points, CI -2.4, 1.6). Participants in the regular rehabilitation group were more frequently readmitted (standardised Pearson residual 4.1) and mortality rates were higher in the nursing home group (standardised Pearson residual 7.8) during the first year.
Conclusions: Orthogeriatric treatment pathways for hip fracture patients entailed differentiation based on factors such as age, mobility, comorbidity and physical function. Participants in all pathways improved in physical performance-scores, yet experienced decline in quality of life-scores during follow-up. Overall readmission and mortality rates were not influenced, but varied between pathways. Further research is needed to investigate the need for differentiated hospital treatment and its potential effects on rehabilitation after discharge.
Background: The porous structure in bone tissue is essential for maintaining the physiological functions and overall health of intraosseous cells. The lacunar-canalicular net (LCN), a microscopic porous structure within osteons, facilitates the transport of nutrients and signaling molecules through interstitial fluid flow. However, the transient behavior of fluid flow within these micro-pores under dynamic loading conditions remains insufficiently studied.
Methods: The study constructs a fluid-solid coupling model including the Haversian canal, canaliculi, lacunae, and interstitial fluid, to examine interstitial fluid flow behavior within the LCN under dynamic loading with varying frequencies and amplitudes. The relationship between changes of LCN pore volume and fluid velocity, and pressure is researched.
Results: The results demonstrate that increasing strain amplitude leads to significant changes of LCN pore volume within osteons. In a complete loading cycle, with the increase of compressive strain, the pore volume in the osteon gradually shrinks, and the pressure gradient in the LCN increases, which promotes the increase of interstitial fluid velocity. When the compressive strain reaches the peak value, the flow velocity also reaches the maximum. In the subsequent unloading process, the pore volume began to recover, the pressure gradient gradually decreased, the flow rate decreased accordingly, and finally returned to the steady state level. At a loading amplitude of 1000 µε, the pore volume within LCN decreases by 1.1‰. At load amplitudes of 1500 µε, 2000 µε, and 2500 µε, the pore volume decreases by 1.6‰, 2.2‰ and 2.7‰ respectively, and the average flow velocity at the center of the superficial lacuna is 1.36 times, 1.77 times, and 2.14 times that at 1000 µε, respectively. Additionally, at a loading amplitude of 1000 µε under three different loading frequencies, the average flow velocities at the center of the superficial bone lacuna are 0.60 μm/s, 1.04 μm/s, and 1.54 μm/s, respectively. This indicates that high-frequency and high-amplitude dynamic loading can promote more vigorous fluid flow and pressure fluctuations with changes in LCN pore volume.
Conclusions: Dynamic mechanical loading can significantly enhance the interstitial fluid flow in LCN by the changes of LCN pore volume. and dynamic loading promoted fluid flow in shallow lacunae significantly higher than that in deep lacunae. The relationship between changes of LCN pore volume and interstitial fluid flow behavior has implications for drug delivery and bone tissue engineering research.
Background: Resistance exercise is recommended as the first line of treatment for rotator cuff related shoulder pain (RCRSP), but with conflicting evidence supporting the superiority of specific prescription parameters. Particularly, the role of pain-related prescription parameters remains poorly understood, despite their wide clinical application and potential impact on treatment outcomes. This review aims to investigate how pain-related prescription parameters, such as pain allowance and intensity limits, are reported, described, and applied in clinical trials assessing resistance exercise interventions for RCRSP.
Methods: Guided by PRISMA-ScR, this scoping review followed a comprehensive and systematic search in MEDLINE (Ovid), MEDLINE (EMBASE), Central (Cochrane), PEDro and CINAHL (EBSCO). Two authors independently performed title and abstract screening, and full text screening on eligible records. Randomized clinical trials (RCTs) published in English between 2018 and 2023, applying resistance exercise for RCRSP were included. Both quantitative and qualitative approaches to data analysis were conducted.
Results: The literature search identified 7500 records, of which 4588 titles and abstracts were screened after duplicate removal. Altogether, 304 full texts were screened leaving a total of 86 records in the final analysis. Fifty-eight (67%) studies did not mention the use of any pain-related prescription parameters, resulting in data extraction from the 28 remaining studies. Applied parameters were widely heterogenic, but three categories of pain allowance styles were identified and categorized into "yes", "no" or "ambiguous". These categories were commonly guided by specific Numerical Rating Scale (NRS)/Visual Analog Scale (VAS) limits or individual pain tolerance, used for pain monitoring and exercise progression. Citations and/or justifications for the chosen pain-related prescription parameters were reported by 10 (36%) studies, in which 5 main themes for justifications, and 3 key papers for the citations were identified.
Conclusion: This review reveals substantial reporting deficiencies regarding pain-related prescription parameters in RCTs addressing RCRSP with resistance exercise. The identified parameters varied widely, reflecting a lack of consensus and evidence-based guidance in the literature and in a clinical setting. To advance our understanding on the role of pain-related prescription parameters, more consistent reporting of these parameters in future research is warranted.
Trial registration: Published on the Open Science Framework 28.02.24: osf.io/a52kn.
Background: Familial hypercholesterolemia (FH) is a genetic condition that affects cholesterol metabolism, resulting in life-long elevated serum levels of low-density lipoprotein cholesterol. Systemically elevated cholesterol levels are associated with the onset of tendon injury and potentially lead to impaired mechanical properties. Applying a cross-sectional design, we examined whether FH patients present with altered Achilles biomechanics compared to healthy controls and conducted correlational analyses to determine the relationship between Achilles tendon biomechanics and tendon lipid or water content.
Methods: Patients with FH (n = 33) and healthy controls (n = 31) were recruited from the Greater Vancouver area. Achilles cross sectional area, thickness, lipid and water content was determined using Dixon method magnetic resonance imaging (3.0T). Achilles mechanical properties were determined using synchronized dynamometry, motion capture, ultrasound and electromyography during ramped maximal voluntary isometric contractions, and stiffness and Young's modulus calculated. Between group differences were assessed with independent t-tests or Mann-Whitney U tests and Pearson's r or Spearman's ρ were employed for correlational analyses. Sensitivity analysis was conducted on FH patients diagnosed with Achilles xanthoma and the remaining FH patients.
Results: FH patients had significantly elevated Achilles total water content (p = 0.006), cross-sectional area (p = 0.006), and thickness (p = 0.019). No between-group differences were observed in any of the biomechanical parameters. In patients with FH there were significant positive relationships between tendon lipid or water content and tendon strain (ρ = 0.35, p = 0.046; r = 0.42, p = 0.02, respectively). No significant relationships were observed in control participants. In patients with FH, increased tendon cross-sectional area was associated with reduced stiffness (r=-0.371, p = 0.033) and increased strain (r = 0.48, p = 0.005). The presence of xanthoma was associated with increased Achilles dimensions (p < 0.05), total water content (p = 0.03), strain (p = 0.029), and decreased Young's modulus (p = 0.001).
Conclusion: Increased Achilles lipid and water content is associated with increased tendon strain in people with FH and the presence of xanthoma might indicate altered tendon mechanics. This study holds relevance for individuals with hypercholesteremia, as best management practices advocate for physical activity as part of a healthy lifestyle.
Background: Hip fractures are among the most common and serious injuries in older adults. There has been a perception that extracapsular hip fractures have worse outcome than intracapsular hip fractures. We aimed to examine postoperative outcomes in patients operated for extra- and intracapsular hip fractures.
Methods: This is a secondary analysis of data from two randomized controlled trials evaluating the effect of orthogeriatric care. Bivariate analyses were conducted, comparing patients with extracapsular fracture to patients with intracapsular fracture. Mortality, length of hospital stay (LOS), new nursing home admissions, operative data and measures of functional and cognitive performance were assessed as endpoints.
Results: The primary analysis included 711 patients; 283 patients had an extracapsular fracture and 428 an intracapsular fracture. At four months follow-up, the intracapsular fracture group had significantly better Short Physical Performance Battery (SPPB) (5.0 vs. 4.0, p = 0.007), personal Activities of Daily Living (p-ADL) (17.0 vs. 16.0, p = 0.007) and instrumental ADL (i-ADL) (32.5 vs. 28.0, p = 0.049). There were no statistically significant differences between the groups at 12 months.
Conclusions: Patients with an extracapsular fracture had worse mobility and ADL levels four months postoperatively, but there were no clinically relevant differences at 12 months postoperatively.
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