Hasil untuk "Orthopedic surgery"

Alain Charles Masquelet

Kartik Logishetty, Jeroen C. F. Verhaegen, Shannon Tse et al.

Aims: The effectiveness of total hip arthroplasty (THA) for patients with no or minimal radiological signs of osteoarthritis (OA) is unclear. In this study, we aimed to: 1) assess the outcome of such patients; 2) identify patient comorbidities and CT or MRI findings which predicted outcome; and 3) compare their outcome to the expected outcome of THA for hip OA. Methods: Adult patients undergoing THA for hip pain, with no or minimal radiological features of OA (Tönnis grading scale ≤ 1), were identified from a consecutive series of 1,925 THAs. Exclusion criteria were: inflammatory arthritis; osteonecrosis of the femoral head; prior trauma or infection; and patients without minimum one-year follow-up and patient-reported outcome measures (PROMs). The primary outcome measure was the Oxford Hip Score (OHS). Secondary outcome measures were EuroQol-visual analogue scale (EQ-VAS), University of California and Los Angeles (UCLA) scale, and patient satisfaction on a validated three-point ‘better’, ‘same’, or ‘worse’ scale. Results: A total of 107 patients with a median age of 41 years (IQR 18 to 73) were included, with mean follow-up of 6.0 years (SD 3.1). All patients underwent a diagnostic hip injection as a decision aid. Median postoperative OHS was 34 (IQR 28 to 42), with 36 patients (33%) achieving a patient-acceptable symptom state (OHS ≥ 42), lower than THA patients in international registries (40 to 43 points). Secondary outcomes were UCLA of 6 (4 to 8) and EQ-VAS of 73 (51 to 80); 91/102 patients (89%) felt ‘better’ and would ‘undergo surgery again'. Patients with chronic pain syndrome or hypermobility had lower OHS than patients without comorbidities (-6 points, p < 0.006). Overall, 84 patients had a CT and 34 patients an MRI. Patients with subchondral cysts (OHS 42 (37 to 45) vs 35 (26 to 36); p = 0.014) or joint space narrowing on CT (OHS 42 (IQR 37 to 44) vs 35 (26 to 36); p = 0.022) had higher function. Conclusion: Despite high satisfaction levels, patients undergoing THA with minimal or no radiological OA had lower postoperative function than typical THA patients. We recommend obtaining low-dose CT imaging and a diagnostic hip injection to aid decision-making. Cite this article: Bone Jt Open 2025;6(3):328–335.

Zhaosu Zheng, Haiyang Guo, Songjun Wang et al.

Abstract Background Diabetic foot is a prevalent complication of diabetes mellitus. The tibial transverse transport technique was widely use to diabetic foot management. Recently, some clinical studies have applied tibial periosteal distraction (PD) in diabetic foot patients, reporting favorable therapeutic outcomes. However, the mechanisms by which PD facilitates lower limb wound healing in diabetic foot remain poorly understood. Our study aims to create PD rat model to preliminarily explore the underlying therapeutic mechanisms. Methods We developed periosteal distraction fixation system. The periosteal distraction in diabetes rat model (male SD rat) was successfully established. The effects of PD on wound healing were researched. HE staining, immunofluorescence staining and western blot were used to investigate the mechanisms. Results PD enhanced wound healing by angiogensis and EPCs recruitment through SDF-1/CXCR4 and OPN signaling activation, and through ERK1/2 phosphorylated to accelerate M2 macrophage polarization. Enhanced neovascularization and EPCs recruitment were observed in the PD group with double immune-labelling of CD31 and α-SMA, CD34 and CD133. SDF-1/CXCR4, OPN signaling activation and ERK1/2 phosphorylation were seen in the results of immunofluorescence staining and western blot in PD group. The amount of M2 macrophages was increased and M1 was reduced in the PD group by immunofluorescence staining. Conclusion PD enhanced blood flow and regulated inflammatory response to accelerate diabetes foot ulcer healing.

ahmed elasas, Samir Ahmed Elshoura, Mahmoud El Said et al.

Background: Bone defects remains a frequent complication of total knee arthroplasty [TKA]. The management of these defect in the revision TKA is a surgical challenge.The aim of the work: This study aimed to evaluate the clinical and radiological outcome of the bone defects management in revision TKA [rTKA].Patients and Methods: Thirty patients with bone defects after TKA were included. All were classically evaluated by history taking, clinical examination, laboratory and radiological workup. Then submitted to rTKA with management of bone defects by different methods.  They were followed up at 6 weeks, 3 months, 6 months then yearly. The clinical outcome was measured by Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] score, range of motion [ROM], leg raising test and clinical assessment of limb alignment. The radiological outcome by limb & component alignment. In addition, any complications were recorded.Results: The side of surgery was mainly the right side [66.7%]. The bone defect was mainly femoral [50.0%], then tibial [40.0%] The majority of cases were Anderson class IIA [53.3%] and aseptic loosening was the major cause [56.7%]. Metal augments was the commonest treatment method [50% of cases] followed by bone graft in 16.7%. There was significant increase of postoperative ROM [100] and WOMAC score [85.9] after surgery than corresponding values before surgery [45 and 19 respectively].  Deep infection was confined to cases with cone and metal block, while deep vein thrombosis [DVT] was confined to metal block and metal augments. The postoperative WOMAC score was significantly different between management methods [the highest score was recorded with metal augments and metal blocks [90 and 90.5 respectively], while the lowest was registered with the cone [70.7].Conclusion: The management method of bone defect had significant impact on complication type and operative time, but not on functional outcome following revision TKA.

Sydney Boike, MD, Mikayla J. Baker, MD, Lucas Ray, MD et al.

Purpose: This study aims to investigate normative measurements of the thumb relative to the index finger; this may help guide hand surgery reconstruction and define a thumb as hyperplastic or hypertrophic. Methods: In total, 162 Minnesota State Fair participants were measured for thumb and index finger length, width, girth; joint range of motion (ROM) of the interphalangeal and metacarpophalangeal joints; and pinch and grip strength. Results: Participants’ age averaged 42.5 (range 14–88) years with 57% female, 86% White, and 86% right-handed. The right and left demonstrated similarity of thumb and index finger size for each participant. Men demonstrated larger length and girth of the thumb and index finger and stronger pinch and grip strengths but have minimal differences in ROM compared to women. The ratio of the index fingernail is 75% of the thumbnail. The length of the thumb is 73% of the index finger, and the thumb interphalangeal girth is 80% of the index finger proximal interphalangeal (PIP) joint. On average, the thumb tip sits 1.9 cm proximal to the index PIP joint. Conclusions: Anthropometric measurements of the thumb and index fingers demonstrate similarities of right and left hands for length, girth, ROM, and strength. Differences exist with size and strength greater for men compared with women, without differences in ROM. The thumb tip, on average, sits 19 mm proximal to the PIP joint, which is contrary to the conventional teaching for index pollicization to set the thumb tip length to the level of the adjacent finger PIP joint. Type of study/level of evidence: Therapeutic IV.

Enneng Yang, Li Shen, Zhenyi Wang et al.

Multi-task learning (MTL) compresses the information from multiple tasks into a unified backbone to improve computational efficiency and generalization. Recent work directly merges multiple independently trained models to perform MTL instead of collecting their raw data for joint training, greatly expanding the application scenarios of MTL. However, by visualizing the representation distribution of existing model merging schemes, we find that the merged model often suffers from the dilemma of representation bias. That is, there is a significant discrepancy in the representation distribution between the merged and individual models, resulting in poor performance of merged MTL. In this paper, we propose a representation surgery solution called "Surgery" to reduce representation bias in the merged model. Specifically, Surgery is a lightweight task-specific module that takes the representation of the merged model as input and attempts to output the biases contained in the representation from the merged model. We then designed an unsupervised optimization objective that updates the Surgery module by minimizing the distance between the merged model's representation and the individual model's representation. Extensive experiments demonstrate significant MTL performance improvements when our Surgery module is applied to state-of-the-art (SOTA) model merging schemes.

Chanchal Kumar Singh, Ghanshyam Narayan Khare, Prabhanjan Agrawal

Background: This study compares open reduction and internal fixation (ORIF) versus hemiarthroplasty (HA) in the management of complex proximal humerus fractures. MATERIALS AND METHODS: Neer three- and four-part fracture-dislocations, surgical neck fracture-dislocations with severe articular impaction, and any head-split fracture treated surgically at our institution were studied retrospectively. Constant–Murley scores, Disability of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES) Shoulder, and 36-item Short-Form Health Survey (SF-36) scores were obtained and compared between ORIF versus HA treatment. Results: Thirty patients were included in the analysis: 15 treated with ORIF were compared to 15 treated with HA with an average follow-up of 60 months. The mean Constant score (72 ± 15 vs. 54 ± 19; P = 0.005), DASH score (13 ± 17 vs. 29 ± 18; P = 0.006), ASES score (87 ± 13 vs. 66 ± 22; P = 0.003), and SF-36 physical composite score (PCS) (50 ± 11 vs. 40 ± 11; P = 0.02) all favored the ORIF group. Because of the potential confounding variable posed by including younger patients, we performed a subgroup analysis of patients older than 50 years. In this group, the Constant, DASH, ASES, and PCS scores remained significantly better in the ORIF group. Conclusion: Results of this retrospective study show improved patient-reported outcomes and quality of life scores in patients undergoing ORIF for complex proximal humerus fractures as compared to patients undergoing HA, despite a higher revision rate in the ORIF cohort. When considering patients older than 50 years, outcomes after ORIF were better than HA.

Alex K Miller, MD, Matthew R Cederman, BS, Daniel K Park, MD

ABSTRACT: Background: There is growing interest in transitioning various surgical procedures to the outpatient care setting. However, for Medicare patients, the site of service for surgical procedures is influenced by regulations within the Inpatient and Outpatient Prospective Payment Systems. The purpose of this study is to quantify changes in utilization of outpatient spine surgery within the Medicare population, as well as to determine changes in outpatient volume after removal of a procedure from the “inpatient-only” list. Methods: This is a cross-sectional study of Medicare billing database information for selected spine procedures included in the Medicare Physician/Supplier Procedure Summary (PSPS) public use files from 2010–2021. These files include aggregated data from Medicare Part B fee-for-service claims, published yearly. Procedures from Healthcare Common Procedural Coding System (HCPCS) code ranges 22010–22899 and 62380–63103 were selected for analysis, limited to surgical services delivered in the inpatient, hospital outpatient department (HOPD), and ambulatory surgical center (ASC) settings. For each HCPCS code included, estimates of the total number of services and corresponding changes in volume were calculated. Results: Within the range of codes included in the study, the total number of outpatient spine procedures rose approximately 193% from 2010 to 2021, with compound annual growth rate (CAGR) for outpatient procedures per year of 9.9% for HOPDs and 15.7% for ASCs (-2.2% for inpatient procedures). Within this period, the ASC list grew from 12 procedures to 58 procedures. In 2021, the highest volume ASC procedure was HCPCS 63047, at approximately 4970 procedures. Conclusions: This study demonstrates a trend of increasing utilization of HOPDs and ASCs for spine procedures among Medicare beneficiaries from 2010 to 2021. Though HOPDs are currently more widely utilized, the ongoing additions of spine procedures to the ASC covered procedures list may shift this balance.

Xuefeng Luo, Dehua Wang, Wei Xu et al.

Abstract Purpose Ecchymosis is one of the most common complications following total knee arthroplasty (TKA), which is closely related to postoperative bleeding. However, it is still controversial whether anticoagulation treatment should be continued for postoperative ecchymosis patients. We suppose that personalized delayed anticoagulation therapy could be beneficial for decreasing postoperative bleeding. Methods A total of 201 TKA patients were retrospectively included in this study, among whom ecchymosis patients received drug anticoagulation treatment 1–2 days later than usual, while nonecchymosis patients received regular drug anticoagulation treatment. The perioperative blood loss, coagulation state, fibrinolytic state and complications were collected and analyzed. Results Eighty‐nine patients (44.3%) developed ecchymosis within 3 days after TKA. There were no differences in baseline characteristics between the two groups. In the ecchymosis group, higher K values and lower calculated coagulation index values were observed in thromboelastography, along with greater total blood loss and a more significant decrease in haemoglobin levels on postoperative Day 1 (POD1) compared to the nonecchymosis group. Additionally, the ecchymosis patients exhibited higher levels of fibrinogen degradation products and D‐dimer (D‐D) on POD1, with no differences noted on POD3, indicating that patients with ecchymosis are in a relatively hypocoagulable and hyperfibrinolytic state compared to those without ecchymosis. Therefore, the delayed anticoagulation treatment proved beneficial for correcting these postoperative conditions. No statistically significant differences were found between the two groups in postoperative complications, demonstrating that delayed anticoagulation treatment is safe. Conclusion Patients with ecchymosis exhibited a relatively hypocoagulable and hyperfibrinolytic state with a stronger tendency for postoperative bleeding. Delayed anticoagulation in ecchymosis patients could effectively prevent further exacerbation of postoperative bleeding by avoiding sustained hypocoagulable and hyperfibrinolysis states. Personalized delayed anticoagulation therapy could be beneficial for managing postoperative ecchymosis for TKA patients. Level of Evidence Level IV.

Hyung-Been Yhim, MD, Seokha Yoo, MD, Sun-Kyung Park, MD et al.

Background: Single-injection adductor canal block (SACB) is one of the multimodal pain managements in total knee arthroplasty. The effect of an intrathecal local anesthetic is prolonged with an intraoperative dexmedetomidine infusion. Currently, SACB’s effect along with the prolonged spinal anesthesia effect by dexmedetomidine has not been studied elsewhere. Methods: Seventy-eight patients were randomized to either the SACB group (n = 39) or the control group (n = 39). Spinal anesthesia and continuous infusion of dexmedetomidine were performed intraoperatively. The SACB was performed using 15 mL of either 0.5% ropivacaine or normal saline in postanesthesia care unit postoperatively. Primary endpoint examined the average numerical rating scale (NRS) pain scores at 2, 6, 12, and 24 hours after SACB while resting or moving. The secondary outcomes were the morphine equivalent, postoperative nausea and vomiting score, quadriceps strength, and overall satisfaction score. Results: The SACB group showed a lower average NRS pain score until 24 hours than the control group (2.4 vs 3.3 resting, 3.4 vs 4.1 moving). Resting and moving NRS scores at 6 and 12 hours were significantly lower in the SACB group, whereas no difference was found at 2, 24, and 48 hours, regardless of movement. The satisfaction score was higher in the SACB group than in the control group (9 [7.3-10.0] vs 7 [5.3-8.8]), and morphine equivalent at 2 hours was lower in the SACB group (2 [1-3]) than in the control group (2.9 [1.6-4]). Conclusions: SACB provided an additional analgesic effect in patients undergoing total knee arthroplasty under spinal anesthesia with continuous dexmedetomidine intravenous infusion.

Kelly Pohland

Let $p$ be an odd prime, and let $C_p$ denote the cyclic group of order $p$. We use equivariant surgery methods to classify all closed, connected $2$-manifolds with an action of $C_p$. We additionally provide a way to construct representatives of each isomorphism class using a series of equivariant surgery operations. The results in this paper serve as an odd prime analogue to a similar classification proved by Dan Dugger.

Jacob Caudell

Building on Greene's changemaker lattices, we develop a lattice embedding obstruction to realizing an L-space bounding a definite 4-manifold as integer surgery on a knot in the Poincaré homology sphere. As the motivating application, we determine which lens spaces are realized by $p/q$-surgery on a knot $K$ when $p/q > 2g(K) -1$. Specifically, we use the lattice embedding obstruction to show that if $K(p)$ is a lens space and $p \geq 2g(K)$, then there exists an equivalent surgery on a Tange knot with the same knot Floer homology groups; additionally, using input from Baker, Hedden, and Ni, we identify the only two knots in the Poincaré homology sphere that admit half-integer lens space surgeries. Thus, together with the Finite/Cyclic Surgery Theorem of Boyer and Zhang, we obtain the corollary that lens space surgeries on hyperbolic knots in the Poincaré homology sphere are integral.

Gwenael Massuyeau

By classical results of Rochlin, Thom, Wallace and Lickorish, it is well-known that any two 3-manifolds (with diffeomorphic boundaries) are related one to the other by surgery operations. Yet, by restricting the type of the surgeries, one can define several families of non-trivial equivalence relations on the sets of (diffeomorphism classes of) 3-manifolds. In this expository paper, which is based on lectures given at the school ``Winter Braids XI'' (Dijon, December 2021), we explain how certain filtrations of mapping class groups of surfaces enter into the definitions and the mutual comparison of these surgery equivalence relations. We also survey the ways in which concrete invariants of 3-manifolds (such as finite-type invariants) can be used to characterize such relations.

Bing Xia, Hongqian Wang, Yingmei Dong et al.

ObjectiveTo retrospectively analyze the feasibility and efficacy of posterior hemivertebra resection without internal fixation in the treatment of congenital scoliosis in very young children.MethodsSixteen cases of very young children with congenital scoliosis treated at our hospital from April 2000 to July 2019 were collected, including 8 cases of each sex, all of whom had type I/III congenital scoliosis and were operated on at a median (interquartile range) of 9.00 (7.75) months (range, 0.5–48 months) of age. All cases underwent posterior hemivertebra resection without internal fixation and wore orthopedic braces or plaster undershirts for more than six months after surgery, with a mean follow-up of 94.31 ± 65.63 months (range, 36–222 months).ResultsCoronal plane: the preoperative Cobb angle for the segmental curve was 39.50 ± 9.70° compared to postoperative (19.19 ± 8.56°) and last follow-up (14.94 ± 12.11°) (both P &lt; 0.01); the preoperative Cobb angle for the main curve was 34.19 ± 14.34° compared to postoperative (17.00 ± 11.70°) and last follow-up (17.56 ± 16.31°) (both P &lt; 0.01); the preoperative Cobb angle of the proximal compensated curve was 14.88 ± 9.62° compared to postoperative (7.88 ± 4.66°) and last follow-up (8.38 ± 8.36°) (both P &lt; 0.05); and the preoperative Cobb angle of the distal compensated curve was 13.50° (10.50°) (range, 4°–30°) compared with postoperative 4.50° (9.25°) (range, −3° to 25°) and final follow-up 5.50° (9.50°) (range, −3° to 33°) (both P &lt; 0.01). Sagittal plane: the difference in the preoperative Cobb angle was 10.00° (14.00°) (range, −31° to 41°) for segmental kyphosis compared to postoperative 14.00° (24.50°) (range, −6° to 46°) and last follow-up 17.00° (22.55°) (range, −40° to 56°), and these were not statistically significant (both P &gt; 0.05). There was a tendency for the thoracolumbar kyphosis to worsen and the lumbosacral kyphosis to improve during the follow-up period.ConclusionPosterior hemivertebra resection without internal fixation is a feasible treatment for type I/III congenital scoliosis in very young children, but the correction of the sagittal deformity of the thoracolumbar spine is not satisfactory, and postoperative external fixation may require further improvement.

Marc Kegel, Sinem Onaran

We define a graph encoding the structure of contact surgery on contact 3-manifolds and analyze its basic properties and some of its interesting subgraphs.

Ben‐long Shi, Yang Li, Ze‐zhang Zhu et al.

Objective To analyze the factors causing failure of primary surgery in congenital scoliosis (CS) patients with single hemivertebra (SHV) undergoing posterior spinal fusion, and to elucidate the revision strategies. Methods In this retrospective study, a total of 32 CS patients secondary to SHV undergoing revision surgery from April 2010 to December 2017 due to failed primary surgery with more than 2 years follow‐up were reviewed. The reasons for failure of primary surgery and revision strategies were analyzed for each patient. The radiographic parameters including coronal Cobb angle, segmental kyphosis (SK), coronal balance (CB), and sagittal vertical axis (SVA) were compared between pre‐ and post‐revision. The complications during revision and follow‐up were recorded. Results The mean age at revision surgery of the 32 CS patients was 15.8 ± 9.7 years and the average duration between primary and revision surgery was 31.0 ± 35.4 months. The reasons for failed primary surgery were severe post‐operative curve progression of focal scoliosis in 14 cases (43.8%), implant failure in 17 (53.1%) and trunk imbalance in 12 (37.5%). The candidate revision strategies included thorough resection of residual hemivertebra and adjacent discs, extending fusion levels, complete pseudarthrosis resection, massive bone graft, replacement of broken rods, satellite rod fixation, horizontalization of upper/lower instrumented vertebrae and rigid fusion of structural compensatory curves were performed individually. After revision surgery, the coronal Cobb angle, SK, CB and SVA showed significant improvement (P < 0.05) with no significant correction loss during follow‐up (P > 0.05). The intra‐operative complications included alarming changes of neurologic monitoring in three (9.4%) patients and dual tear in two, while rod fracture re‐occurred was detected in one patient at 18 months after revision. Conclusions The common reasons for failed primary surgery in CS patients with SHV undergoing posterior spinal fusion were severe post‐operative curve progression of focal scoliosis, implant failure and trunk imbalance. The revision strategies including thorough resection of residual hemivertebra and adjacent discs, extended fusion levels to structural curvature, complete pseudarthrosis resection, massive bone graft, replacement of broken internal fixation and horizontalization of upper/lower instrumented vertebrae should be individualized based on the causes of failed primary surgery.

Mijin Jung, Xiaobei Pan, Emma L. Cunningham et al.

The mechanisms underlying the occurrence of postoperative delirium development are unclear and measurement of plasma metabolites may improve understanding of its causes. Participants (<i>n</i> = 54) matched for age and gender were sampled from an observational cohort study investigating postoperative delirium. Participants were ≥65 years without a diagnosis of dementia and presented for primary elective hip or knee arthroplasty. Plasma samples collected pre- and postoperatively were grouped as either control (<i>n</i> = 26, aged: 75.8 ± 5.2) or delirium (<i>n</i> = 28, aged: 76.2 ± 5.7). Widespread changes in plasma metabolite levels occurred following surgery. The only metabolites significantly differing between corresponding control and delirium samples were ornithine and spermine. In delirium cases, ornithine was 17.6% higher preoperatively, and spermine was 12.0% higher postoperatively. Changes were not associated with various perioperative factors. In binary logistic regression modeling, these two metabolites did not confer a significantly increased risk of delirium. These findings support the hypothesis that disturbed polyamine metabolism is an underlying factor in delirium that warrants further investigation.

Tetsuya Ito

By estimating the Turaev genus or the dealternation number, which leads to an estimate of knot floer thickness, in terms of the genus and the braid index, we show that a knot $K$ in $S^{3}$ does not admit purely cosmetic surgery whenever $g(K)\geq \frac{3}{2}b(K)$, where $g(K)$ and $b(K)$ denotes the genus and the braid index, respectively. In particular, this establishes a finiteness of purely cosmetic surgeries; for fixed $b$, all but finitely many knots with braid index $b$ satisfies the cosmetic surgery conjecture.

Andrés Marafioti, Michel Hayoz, Mathias Gallardo et al.

Cataract surgery is a sight saving surgery that is performed over 10 million times each year around the world. With such a large demand, the ability to organize surgical wards and operating rooms efficiently is critical to delivery this therapy in routine clinical care. In this context, estimating the remaining surgical duration (RSD) during procedures is one way to help streamline patient throughput and workflows. To this end, we propose CataNet, a method for cataract surgeries that predicts in real time the RSD jointly with two influential elements: the surgeon's experience, and the current phase of the surgery. We compare CataNet to state-of-the-art RSD estimation methods, showing that it outperforms them even when phase and experience are not considered. We investigate this improvement and show that a significant contributor is the way we integrate the elapsed time into CataNet's feature extractor.

Tehasi Wang, Chengguang Zhang, Shuren Wang

Highlights 1. Circ_0003074 expression was upregulated in OS tissues and cells. 2. Rg3 treatment significantly decreased circ_0003074 expression in OS cells. 3. Circ_0003074 overexpression rescued Rg3-induced inhibition in OS progression. 4. Circ_0003074 induced KPNA4 production through miR-516b-5p under Rg3 treatment.