Hasil untuk "Orthopedic surgery"

R. Collins, A. Scrimgeour, S. Yusuf et al.

J. D. Whitehouse, N. Friedman, K. Kirkland et al.

N. Martelli, C. Serrano, H. van den Brink et al.

Andrew C. Yuan, Alexander Cowtan, Zhiyang He et al.

Quantum code surgery offers a flexible, low-overhead framework for executing logical measurements within quantum error-correcting codes. It encompasses several fault-tolerant logical computation schemes, including parallel surgery, universal adapters and fast surgery, and serves as the key primitive in extractor architectures. The efficiency of these schemes crucially depends on constructing low-overhead ancilla systems for measuring arbitrary logical operators in general quantum Low-Density Parity-Check (qLDPC) codes. In this work, we introduce a method to construct an ancilla system of qubit size $O(W \log W)$ to measure an arbitrary logical Pauli operator of weight $W$ in any qLDPC stabilizer code. This new construction immediately reduces the asymptotic overhead across various quantum code surgery schemes.

Marc Kegel, Paula Truöl

In this short note, we prove that every closed, oriented, connected 3-manifold arises as Dehn surgery along a braid positive link.

Marc Kegel, Lisa Piccirillo

Distinct knots K, K' can sometimes share a common p/q-framed Dehn surgery. A folk conjecture held that for a fixed pair of knots, this can occur for at most one value of p/q. We disprove this conjecture by constructing pairs of distinct knots K,K' that have common Dehn surgeries for four distinct slopes. We also construct non-isotopic Legendrian knots K,K' that have contactomorphic contact (+1)-and (-1)-surgeries, disproving an analogous conjecture in contact geometry.

Yuto Ozawa, Yusuke Osawa, Taisuke Seki et al.

Purpose The conjoined tendon‐preserving posterior (CPP) approach is a modified posterior approach for total hip arthroplasty (THA) that preserves the short external rotator muscles and most ischiofemoral ligaments. The objective of the present study was to compare the short‐term clinical outcomes, complications, and imaging evaluations of CPP and posterior approaches in THA. Methods This retrospective study included 83 patients from May 2018 to September 2021: 36 patients with 42 hips who underwent THA with the CPP approach (CPP group) and 47 patients with 60 hips who underwent THA with the standard posterior approach (PA group) with a minimum of 2 years of follow‐up. Assessment tools included operative times, blood loss, preoperative and last follow‐up Harris Hip Scores (HHS), postoperative complications, and implant placement angles between the groups. Statistical analysis was performed using chi‐square tests and T‐tests. Results The CPP approach had a significantly longer operative time and greater blood loss compared to the PA group. Preoperative and postoperative HHS were not significantly different between groups. Considering complications, the PA group had one case each of dislocation and infection, and the CPP group had two cases of sciatic nerve palsy, but the difference was not significant. Cup anteversion, inclination and stem anteversion were not significantly different between groups. Conclusion Functional outcomes, complication rates, and implant placement angles were comparable with the posterior approach, and the CPP approach has the potential to reduce postoperative dislocations. However, careful attention should be paid to sciatic nerve palsy during early initiation of the CPP approach, and this study did not demonstrate that the CPP approach was clearly superior to the posterior approach.

Alessandro Carrozzo, Régis Pailhé, Ophélie Manchec et al.

Abstract Purpose The aim of this study was to compare implant survival, clinical outcomes and radiographic alignment between navigated and non‐navigated total knee arthroplasty (TKA) performed with a single implant system. Methods A retrospective multicenter analysis of prospectively collected data from 6078 TKAs performed for primary osteoarthritis using a single implant system was performed. Procedures were divided into two groups: navigated (n = 3602) and non‐navigated (n = 2476). The primary outcome was implant survival. Secondary outcomes included re‐intervention rates, patient‐reported outcomes measures (PROMs, International Knee Society scores), and range of motion. Results Five‐year implant survival was similar between the non‐navigated (98.9%; 95% confidence interval [CI], 98.2%–99.3%) and navigated (98.3%; 95% CI, 97.6%–98.8%) groups (p = 0.505). After adjustment for potential confounders, navigated procedures showed a slightly higher risk of surgical reintervention excluding infection (hazard ratio 1.42, 95% CI: 1.02–1.96, p = 0.036). PROM analyses were restricted to patients with both baseline and 5‐year questionnaires (n = 470). The improvement of patient‐reported functional outcomes at 5 years was not significantly different between groups (p = 0.893 after adjustment for potential confounders). Conclusions Navigation was equivalent to conventional instrumentation TKA with respect to implant survival. After adjusting for confounders and excluding septic revisions, navigated procedures showed a slightly higher reoperation risk. No significant advantage in functional outcomes was observed at mid‐term follow‐up. These findings do not support a clear clinical benefit for routine use of navigation in this setting. Level of Evidence Level III, retrospective comparative study.

Julia S. Retzky, William ElNemer, Nathan H. Varady et al.

Abstract Purpose The aims of the present study are to describe the (1) incidence, (2) indications, and (3) risk factors for revision tibial tubercle osteotomy (rTTO) in a national sample of patients in the United States. Methods A retrospective review of the Mariner PearlDiver database was performed. Patients who underwent unilateral primary tibial tubercle osteotomy (TTO) from 2015 to 2021 with a minimum 2‐year follow‐up were included, and patients who required revision TTO were identified. Patients with insufficient information, history of total knee arthroplasty (TKA), or lower extremity fracture as indication for primary TTO excluded. Demographic variables including age, sex, Elixhauser comorbidity index (ECI), diagnosis and comorbidities were compared between the no revision (NR) and revision TTO groups. Continuous variables were compared via Student's t‐test, and dichotomous variables were compared via chi‐squared test. Multivariate Cox‐proportional hazard modelling was utilized to identify predictors of revision TTO. Results 4919 patients who underwent TTO were included, 105 of whom required revision TTO. The average age was 26.5 ± 11.5 years, and 3782 (77%) patients were female. The median follow‐up time was 4.3 years (interquartile range [IQR]: 3.1–5.6 years). The most common indications for primary TTO included instability (62%) and chondromalacia/pain (33%). The most common indications for rTTO were instability (38%), chondromalacia/pain (28%) and fracture (24%). The median time to rTTO was 91 days [IQR: 20–219 days]. The following variables were associated with an increased risk for revision TTO: hypothyroidism (hazard ratio [HR] 1.8 [range: 1.1–3.0], p = 0.028), renal disease (HR = 3.3 [1.3–8.7], p = 0.014) and stroke (HR = 2.8 [1.3–5.8], p = 0.007). Conclusion Instability is the most common indication for rTTO, and most rTTO occur within 91 days of the primary procedure. History of hypothyroidism, renal disease and stroke are all independent risk factors for rTTO. These results highlight the importance close management of higher risk patients in the perioperative period following primary TTO. Preoperative medical optimisation of conditions such as hypothyroidism may mitigate postoperative complications following primary TTO. Level of Evidence Level III.

R. Lohre, Aaron J Bois, J. Pollock et al.

Key Points Question What is the quantifiable skill and knowledge transfer for surgical trainees using immersive virtual reality to learn both pathology recognition and complex procedural skills? Findings In this randomized clinical trial of 18 senior orthopedic surgery residents, those trained using immersive virtual reality demonstrated significant improvements in knowledge and procedural metrics compared with a control group receiving technical video instruction. A transfer effectiveness ratio of 0.79 was demonstrated, indicating that immersive virtual reality substituted for 47.4 minutes of equivalent real operating room training. Meaning These findings suggest that immersive virtual reality may play a significant role in the future of procedural training, supplementing and perhaps augmenting traditional teaching and effectively reducing early surgical learning curves.

J. Stambough, B. Curtin, J. Gililland et al.

The COVID-19 global pandemic has upended nearly every medical discipline, dramatically impacted patient care and has had far-reaching effects on surgeon education. In many areas of the country, elective orthopedic surgery has completely stopped to ensure that resources are available for the critically ill and to minimize the spread of disease. COVID-19 is forcing many around the world to re-evaluate existing processes and organizations and adapt to carry out business, of which medicine and education are not immune. Most national and international orthopedic conferences, training programs, and workshops have been postponed or canceled, and we are now critically evaluating the delivery of education to our colleagues as well as residents and fellows. This article describes the evolution of orthopedic education and significant paradigm shifts necessary to continue to teach ourselves and the future leaders of our noble profession.

Enrico Panichi, Sara Sassaroli, Giorgio Maria Ciccarese et al.

An 8-month-old male American Staffordshire terrier was referred for a no-weightbearing lameness of the right pelvic limb, hyperthermia, lethargy and inappetence. Two months before, endocarditis was diagnosed and treated in another veterinary hospital. Orthopedic, radiographic and tomographic examinations revealed a bone sequestrum of 4 × 1.4 cm and active periosteal reaction of the caudo-lateral cortical in the metaphysis and the distal third of the right femoral diaphysis, medullary osteolysis and interruption of the cranio-medial cortical profile, with involvement of the femoral trochlea leading to a secondary medial patella luxation. Hematogenous osteomyelitis was the suspected diagnosis. Once skeletally mature, after 4 months from surgical debridement and aggressive antibiotic therapy against Klebsiella oxytoca revealed by a bacteriological exam, the patient underwent prosthetic surgery for the application of a custom-made patellar groove replacement (PGR) to fill the bone defect and restore the femoral trochlea surface. Despite the serious injury that afflicted the right pelvic limb, the surgery had satisfactory outcomes until the last 18-month postoperative follow up.

Wanyuji Wang, Xueling Zheng, Hehe Wang et al.

Aging, space flight, and prolonged bed rest have all been linked to bone loss, and no effective treatments are clinically available at present. Here, with the rodent hindlimb unloading (HU) model, we report that the bone marrow (BM) microenvironment was significantly altered, with an increased number of myeloid cells and elevated inflammatory cytokines. In such inflammatory BM, the osteoclast-mediated bone resorption was greatly enhanced, leading to a shifted bone remodeling balance that ultimately ends up with disuse-induced osteoporosis. Using Piezo1 conditional knockout (KO) mice (Piezo1 fl/fl ;LepRCre), we proved that lack of mechanical stimuli on LepR + mesenchymal stem cells (MSCs) is the main reason for the pathological BM inflammation. Mechanically, the secretome of MSCs was regulated by mechanical stimuli. Inadequate mechanical load leads to increased production of inflammatory cytokines, such as interleukin (IL)-1α, IL-6, macrophage colony-stimulating factor 1 (M-CSF-1), and so on, which promotes monocyte proliferation and osteoclastic differentiation. Interestingly, transplantation of 10% cyclic mechanical stretch (CMS)-treated MSCs into HU animals significantly alleviated the BM microenvironment and rebalanced bone remodeling. In summary, our research revealed a new mechanism underlying mechanical unloading-induced bone loss and suggested a novel stem cell-based therapy to potentially prevent disuse-induced osteoporosis.

P. Everts, A. van Erp, A. Desimone et al.

Abstract There is a global interest in optimizing post-surgical tissue repair strategies, leading to better patient outcomes and fewer complications, most ideally with reduced overall cost. In this regard, in recent years, the interest in autologous biological treatments in orthopedic surgery and sports medicine has increased greatly, and the addition of platelet-rich plasma (PRP) to the surgical armamentarium is of particular note. Unfortunately, the number of PRP preparation devices has also grown immensely over the recent decades, raising meaningful concern for the considerable variation in the qualities of currently available PRP preparations. The lack of consensus on the standardization of PRP preparation and of agreement on condition specific PRP formulations is largely responsible for the sometimes contradictory outcomes in the literature. Furthermore, the full potential of PRP technology, the concept of individualized treatment protocols based on bioformulation options, and platelet dosing, angiogenesis, and antimicrobial and painkilling effects of PRP relevant to orthopedic surgery have rarely been addressed. In this review, we will discuss recent developments regarding PRP preparations and potential therapeutic effects. Additionally, we present a synopsis of several published data regarding PRP applications in orthopedic surgery for treating tendon injuries, inducing bone repair, strengthening spinal fusion outcomes, and supporting major joint replacements.

Ning Wang, Yutong Ma, Hui Shi et al.

Implant-associated infection (IAI) is one of the major challenges in orthopedic surgery. The development of implants with inherent antibacterial properties is an effective strategy to resolve this issue. In recent years, biodegradable alloy materials have received considerable attention because of their superior comprehensive performance in the field of orthopedic implants. Studies on biodegradable alloy orthopedic implants with antibacterial properties have gradually increased. This review summarizes the recent advances in biodegradable magnesium- (Mg-), iron- (Fe-), and zinc- (Zn-) based alloys with antibacterial properties as orthopedic implant materials. The antibacterial mechanisms of these alloy materials are also outlined, thus providing more basis and insights on the design and application of biodegradable alloys with antibacterial properties as orthopedic implants.

Qianhe Qin

We generalize the RBG construction of Manolescu and Piccirillo to produce pairs of knots with the same $n$-surgery, and investigate the possibility of constructing exotic definite four-manifolds using $n$-surgery homeomorphisms.

Hiroaki Hasegawa, Nobuhito Nango, Masafumi Machida

Quarter-detector computed tomography (QDCT) is an ultra-high-spatial-resolution imaging technique. This study aimed to verify the validity of trabecular structure evaluation using a QDCT scanner in the diagnosis of osteoporosis. We used a cancellous bone specimen image of the second lumbar vertebrae of an adult male with moderate osteoporosis. To obtain QDCT images, we created a three-dimensional model from micro-CT images of the specimen. Statistical analysis was performed on the relationship between micro-CT and QDCT imaging modalities. The differences between micro-CT and QDCT were assessed based on their significance with respect to the calculated mean measurements using the Mann–Whitney test. Single regression analysis was performed using linear regression, with micro-CT and QDCT as the explanatory and objective variables, respectively, to determine the relationship of the measured values between the two modalities. By applying the necessary correction to the micro-CT measured values, it is possible to perform an analysis equivalent to micro-CT, which offers higher spatial resolution than QDCT. We found evidence that if QDCT can be used, trabecular structure evaluation may contribute to image diagnosis to evaluate practical bone fragility.

Tetsuya Tachibana, Hiroki Katagiri, Hideyuki Koga et al.

Purpose: The advantage of total hip arthroplasty (THA) in an anterior approach compared with a posterior approach in terms of early postoperative pain and function and lowering dislocation risks is controversial. This study aimed to identify whether THA using the anterior approach lowers costs compared with the posterior approach. Methods: We identified 294 patients who underwent primary THA and compared the cost of total inpatient stay, inpatient length of stay (LOS), cost of operating room, and the rates of discharged patients, complications, and reoperation between the anterior and posterior approaches using propensity score matching analysis. Results: One-to-one matching resulted in 135 pairs of patients who underwent THA using both approaches. The cost of total inpatient stay was significantly lower in the anterior approach (anterior vs. posterior [1,322,800 vs. 1,445,219 yen]; p ​= ​0.04). Furthermore, in the anterior approach, the inpatient LOS was shorter (anterior vs. posterior [19.9 vs. 25.0 days]; p ​< ​0.001). However, there was no significant difference in the cost of the operating room and the rates of patients discharged home, total complications (anterior vs. posterior [5.2 vs. 11.1 ​%]; p ​= ​0.08), or revisions between the two approaches. Conclusions: Using propensity score matching, the current study demonstrated that THA in the anterior approach shortened inpatient LOS and rendered an 8 ​% reduction in the total inpatient cost compared with the posterior approach.

Darius Luke Lameire MD, Hassaan Abdel Khalik MMI, MD, Christopher Del Balso MBBS, MSc, FRCSC et al.

Background: There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and therefore this review aims to summarize the available techniques and to evaluate the outcomes after this procedure. Methods: A systematic electronic search of MEDLINE, EMBASE, and Web of Science was performed for all English-language studies published from their inception to April 4, 2022. All articles addressing arthroscopy in TTC nailing were eligible for inclusion. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented. Result: A total of 5 studies with 65 patients were included for analysis. All studies used arthroscopic portals for tibiotalar and subtalar joint preparation (in 4 studies) prior to TTC nailing, with 4 studies using an arthroscope and 1 study using fluoroscopy. The overall major complication rate was 13.8%; however, there was only 1 instance of deep wound infection (1.5%) and 4 instances of surgical site infections (6.2%). Full fusion was achieved in 86% of patients with an average time to fusion of 12.9 weeks. The mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score preoperatively was 34.0 and postoperatively was 70.5. Conclusion: Although limited by the number of studies, transportal joint preparation during TTC nail ankle fusion is associated with good rates of complications and successful fusion. Level of Evidence: Level III, systematic review of Level III-IV studies.

Christopher Chamberland, Earl T. Campbell

Lattice surgery is a measurement-based technique for performing fault-tolerant quantum computation in two dimensions. When using the surface code, the most general lattice surgery operations require lattice irregularities called twist defects. However, implementing twist-based lattice surgery may require additional resources, such as extra device connectivity, and could lower the threshold and overall performance for the surface code. Here we provide an explicit twist-based lattice surgery protocol and its requisite connectivity layout. We also provide new stabilizer measurement circuits for measuring twist defects which are compatible with our chosen gate scheduling. We undertake the first circuit-level error correction simulations during twist-based lattice surgery using a biased depolarizing noise model. Our results indicate a slight decrease in the threshold for timelike logical failures compared to lattice surgery protocols with no twist defects in the bulk. However, comfortably below threshold (i.e. with CNOT infidelities below $5 \times 10^{-3}$), the performance degradation is mild and in fact preferable over proposed alternative twist-free schemes. Lastly, we provide an efficient scheme for measuring $Y$ operators along boundaries of surface codes which bypasses certain steps that were required in previous schemes.