Hasil untuk "Orthopedic surgery"

M. Akram, Rashid Ahmed, I. Shakir et al.

Dongni Lan, Kongmei Li, Zhimao Ye et al.

Abstract Background Mogroside V (MV) is a triterpene glucoside that reportedly exhibits an array of antitumor, anti-inflammatory, hypolipidemic, and hypoglycemic properties. In prior studies, our group determined that MV was able to readily enhance osteogenic bone marrow mesenchymal stem cells (BMSCs) differentiation under high-glucose conditions through mechanisms potentially associated with miR-10b-5p and PI3K/Akt signaling activity. The precise molecular basis for these effects, however, remains to be fully elucidated. Objective This study aims to explore the potential mechanisms by which MV regulates the osteogenic differentiation of BMSCs under hyperglycemic conditions. Methods Femoral and tibial BMSCs were isolated from control and diabetic C57BL/6J mice. qRT-PCR was used to quantify miR-10b-5p levels. Putative miR-10b-5p target genes were predicted through bioinformatics assays and validated in a luciferase reporter assay system. miR-10b-5p expression was inhibited with an antagomiR-10b-5p construct, while PI3K/Akt pathway signaling was inhibited with LY294002. Western blotting was used to detect PI3K/Akt pathway and target gene protein levels, while Alizarin red staining was used to detect calcium nodule deposition by BMSCs. Results miR-10b-5p upregulation was noted in BMSCs exposed to hyperglycemic conditions. HOXD10 was identified as a cell differentiation-related miR-10b-5p target gene in bioinformatics analyses, and the targeting relationship between the two was confirmed in a luciferase reporter assay. MV treatment elicited significantly higher levels of miR-10b-5p expression, PI3K phosphorylation, and calcium deposition, while antagomiR-10b-5p or LY294002 treatment reversed these changes, and the opposite trends were observed with respect to HOXD10 protein levels. Conclusion MV favors BMSCs osteogenic differentiation under high-glucose conditions through the upregulation of miR-10b-5p and the activation of PI3K/Akt signaling.

Albert D. Mousad, MD, Ali A. Mohamed, MS, Daniel F. Schodlbauer, MD et al.

P. Carpintero, J. Caeiro, R. Carpintero et al.

Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. These fractures have several complications. Some of these are medical, and other related to the surgical treatment itself. Medical complications may affect around 20% of patients with hip fracture. Cognitive and neurological alterations, cardiopulmonary affections (alone or combined), venous thromboembolism, gastrointestinal tract bleeding, urinary tract complications, perioperative anemia, electrolytic and metabolic disorders, and pressure scars are the most important medical complications after hip surgery in terms of frequency, increase of length of stay and perioperative mortality. Complications arising from hip fracture surgery are fairly common, and vary depending on whether the fracture is intracapsular or extracapsular. The main problems in intracapsular fractures are biological: vascularization of the femoral head, and lack of periosteum -a major contributor to fracture healing- in the femoral neck. In extracapsular fractures, by contrast, the problem is mechanical, and relates to load-bearing. Early surgical fixation, the role of anti-thromboembolic and anti-infective prophylaxis, good pain control at the perioperative, detection and management of delirium, correct urinary tract management, avoidance of malnutrition, vitamin D supplementation, osteoporosis treatment and advancement of early mobilization to improve functional recovery and falls prevention are basic recommendations for an optimal maintenance of hip fractured patients.

X. Qu, Hongtao Yang, Bo Jia et al.

Bone and joint-related infections remain the primary and most critical complications of orthopedic surgery. We have innovatively prepared Zn-Cu alloys to achieve outstanding material and antibacterial properties. In this study, we systematically assessed the material properties and antibacterial activity of these Zn-Cu alloys. Our results showed that the Zn-2Cu alloy had the best mechanical properties, biocompatibility, and osteogenic properties. Findings of microbial cultures, CLSM, SEM, and TEM indicated that Zn-2Cu alloy can inhibit both coagulase-positive and coagulase-negative staphylococci, as well as antibiotic-resistant strains (MRSA and MRSE), by preventing the bacteria adhesion and the biofilm formation. Zn-2Cu alloy could broadly affect the expression of MRSA genes associated with adhesion, autolysis, biofilm formation, virulence, and drug resistance. A rat femur intramedullary nail infection-prevention model was established and the Zn-2Cu alloy-treated group showed significant antibacterial activity against MRSA and reduced the inflammatory toxic side-effects and infection-related bone loss. Collectively, our results indicate the potential utility of Zn-Cu alloy implants with 2 wt% Cu in treating orthopedic infections. Statement of Significance Osteomyelitis is a serious complication of orthopedic surgeries. Wide use of antibiotics contributes to the appearance of multi-drug resistant strains like methicillin-resistant staphylococcus aureus (MRSA). Alternatively, anti-osteomyelitis implants with broad-spectrum antibacterial properties can be favorable. Here, the antibacterial performance of biodegradable Zn-Cu alloys was evaluated with four different bacteria strains including antibiotic-resistant strains (MRSA and MRSE). Zn-Cu alloys exert excellent bacterial killing capability in all strains. In a rat femur infection model, the alloy showed significant antibacterial activity against MRSA and reduced inflammatory toxic side-effects as well as infection-related bone loss. The antibacterial property of Zn-2Cu alloy was associated with inhibition of gene expression related to wall synthesis, adhesion, colonization, biofilm formation, autolysis, and secretion of virulence factors in MRSA.

Simon N van Laarhoven, Malou E M te Molder, Gijs G Van Hellemondt et al.

Background and purpose: Rotating hinged knee implants are highly constrained prostheses used in cases in which adequate stability is mandatory. Due to their constraint nature, multidirectional stresses are directed through the bone–cement–implant interface, which might affect fixation and survival. The goal of this study was to assess micromotion of a fully cemented rotating hinged implant using radiostereometric analysis (RSA). Patients and methods: 20 patients requiring a fully cemented rotating hinge-type implant were included. RSA images were taken at baseline, 6 weeks, and 3, 6, 12, and 24 months postoperatively. Micromotion of femoral and tibial components referenced to markers in the bone was assessed with model-based RSA software, using implant CAD models. Total translation (TT), total rotation (TR), and maximal total point motion (MTPM) were calculated (median and range). Results: At 2 years, TTfemur was 0.38 mm (0.15–1.5), TRfemur was 0.71° (0.37–2.2), TTtibia was 0.40 mm (0.08–0.66), TRtibia was 0.53° (0.30–2.4), MTPMfemur was 0.87 mm (0.54–2.8), and MTPMtibia was 0.66 mm (0.29–1.6). Femoral components showed more outliers (> 1 mm, > 1°) compared with tibial components. Conclusion: Fixation of this fully cemented rotating hinge-type revision implant seems adequate in the first 2 years after surgery. Femoral components showed more outliers, in contrast to previous RSA studies on condylar revision total knee implants.

Nicola Francesco Lopomo

Yuval Kesary, Vivek Singh, Tal Frenkel-Rutenberg et al.

Seyed Alireza Mirghasemi MBBS, Helen Huetteman, Stephanie Mrowczynski et al.

Category: Midfoot/Forefoot Introduction/Purpose: An adult flatfoot deformity is a complex pathology that has been attempted to be addressed surgically with a variety of different procedures. Transfer of the flexor tendon has been a cornerstone of the treatment of flatfoot deformity for years. After the procedure, the appearance of the bony correction of the foot is noticeable on radiography, but after surgery when the patient begins to bear the weight the soft tissue laxity affects the achieved bony correction when compared to non- weight bearing images. This study aims to identify the effects of tendon transfer on bony and soft tissue after weight-bearing to better predict what the outcomes of surgery will be. Methods: 29 patients were included. there were 18 patients that underwent tendon transfer as part of their flat foot correction and 11 patients that underwent non-tendon transfer procedure for correction of flat foot deformity. Imaging was performed on patient's weight bearing (WB) and non-weight bearing (NWB) before and after surgery. X-ray measurements included Angles: calcaneal pitch (ML-CP), talo-1st metatarsal (ML-T1MT),talocalcaneal (ML-TC), talar declination (ML-Tdec), calcaneal 1st metatarsal (ML-C1MT) and Distances: talar height (ML-Tal-h), navicular height (ML-Nav-h), 1st cuneiform height (ML-1CN-h), cuboid height (ML-Cub-h), and 1st to 5th metatarsal distance (ML-1CN/5MT) in lateral X-ray and Angles: talonavicular coverage (AP-TN), talar 1st metatarsal (AP-T1MT), talar 2nd metatarsal (AP-T2MT) and Distances: talonavicular uncoverage distance in AP. The differences in measurement between the pre op post op non weight bearing considered as bony correction effect The differences in measurement between the pre op post op weight bearing considered as soft tissue effect. Results: the results from non-weight bearing imaging, tendon transfer had a statistically significant impact on calcaneal pitch (, p=0.026), Talo-1st metatarsal (p=0.048), talar declination ( p=0.038), talar height (p=0.016), navicular height ( p=0.014), 1st cuneiform height (p=0.001), talonavicular coverage (p=0.019), talar-1st metatarsal angle (p=0.015), and talar to 2nd metatarsal angle ( p=0.001). the results from WBimaging, tendon transfer had a statistically significant impact on calcaneal pitch ( p=0.000), calcaneal 1st metatarsal (p=0.02), talar height (35 to 39, p=0.003), navicular height ( p=0.002), 1st cuneiform height (p=0.016), cuboid height ( p=0.016), 1st to 5th The post-op effect calcaneal pitch was 12 degrees of difference in NWB compared to 6 degrees of difference in WB The effect on talar height, navicular height, and 1st cuneiform height was 10mm, 9mm, and 8mm, respectively, in NWBimages. This compares to an effect of 4mm, 6mm, and 4mm, respectively, WB imaging. Conclusion: When comparing NWB to WBimages, the effect of surgery on flat foot correction is consistently less pronounced inWB. there will be a difference between the bony correction and soft tissue correction. there is still a significant soft tissue effect seen in WBimaging. The comparison between NWB, WB changes shows that the soft tissue effect is around 50% of the bony correction on several key measurements. These include calcaneal pitch and talar, navicular, and 1st cuneiform height. These results provide a framework for establishing the soft tissue effect that tendon transfer surgery provides for flat foot correction surgery.

E. Marcantonio, L. Goldman, C. Mangione et al.

Taavy Miller, Shane Wurdeman

The goal of health economics and outcomes research is to improve healthcare decision making. In the absence of high-value clinical data, the availability and quality of administrative healthcare data could be vital in the generation of evidence for orthotics and prosthetics services. The purpose of this article is to provide a stronger understanding of administrative healthcare data analysis, an area that has been scarcely examined within prosthetics and orthotics despite the wealth of information available within such data. Examples of common datasets in this arena currently available are provided, as well as an overview of the limitations and advantages of studies utilizing such datasets. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35958/28315 How To Cite: Miller TA, Wurdeman S. Value and applicability of large administrative healthcare databases in prosthetics and orthotics outcomes research. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.4. https://doi.org/10.33137/cpoj.v4i2.35958 Corresponding Author: Taavy A Miller, PhD, CPO Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA. E-Mail: tamiller@hanger.com ORCID ID: https://orcid.org/0000-0001-7117-6124

Adriano Machado Filho, Jefferson Soares Martins, Paulo Victor de Souza Pereira et al.

We report the case of a 60-year-old woman with a schwannoma of the medial plantar nerve. She presented with the complaint of pain for about 2 years and a painful lesion in the medial plantar region of the left forefoot and on the second toe. Physical examination showed well-defined, firm tumor masses painful to palpation on the medial and plantar surface of the left forefoot and second toe. We surgically explored the area and excised 3 lesions, resulting in complete pain relief and no aesthetic complaints. Schwannomas of the medial plantar nerve are rare tumors, with only a few reports of cases extending to the forefoot. The finding of multiple schwannomas may be a red flag for the possible existence of local, painful, nerve lesions despite a negative Tinel sign. Appropriate surgical planning contributed to our successful intervention, without aesthetic, painful, or functional sequelae for the patient. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Topi Laaksonen, Jani Puhakka, Jussi Kosola et al.

Background and purpose — Traditionally, overriding distal radius fractures in children have been reduced and immobilized with a cast or treated with percutaneous pin fixation. There is recent evidence that these fractures heal well if immobilized in the bayonet position without reduction. We evaluated the present treatment of these fractures. Methods — A questionnaire including AP and lateral radiographs of overriding distal radius fractures in 3 pre-pubertal children was answered by 213 surgeons from 28 countries. The surgeons were asked to choose their preferred method of treatment (no reduction, reduction, reduction and osteosynthesis), type and length of cast immobilization, and the number of clinical and radiographic follow-ups. Results — Of the 213 participating surgeons, 176 (83%) would have reduced all 3 presented fractures, whereas 4 (2%) would have treated all 3 children with cast immobilization without reduction. Most reductions (77%) would have been done under general anesthesia. Over half (54%) of the surgeons who preferred anesthesia would have fixed (pins 99%, plate 1%) the fractures. An above-elbow splint or circular cast was chosen in 84% of responses, and the most popular (44%) length of immobilization was 4 weeks. Surgeons from the Nordic countries were more eager to fix the fractures (54% vs. 31%, p < 0.001) and preferred shorter immobilization and follow-up times and less frequent clinical and radiological follow-ups compared with their colleagues from the USA. Interpretation — Most of the participating surgeons prefer to reduce overriding distal radius fractures in children under anesthesia. There is substantial lack of agreement on the indications for osteosynthesis, type of cast, length of immobilization, and follow-up protocol.

A. B. Kaiser

Jonathan Day MS, Matthew S. Conti MD, Nicholas Williams MPH et al.

Background: Severe adult-acquired flatfoot deformity (AAFD) is often associated with painful medial column collapse at the naviculocuneiform (NC) joint. However, many surgeons surgically correct the deformity without directly addressing this joint. The purpose of this study was to examine the role of first-tarsometatarsal (TMT) fusion combined with subtalar fusion in correcting deformity at the NC joint. Methods: We retrospectively analyzed 40 patients (41 feet) who underwent first-TMT and subtalar (ST) fusion as part of a flatfoot reconstructive procedure. We assessed 6 radiographic parameters both preoperatively and at a minimum of 6 months postoperatively, including talonavicular (TN) coverage angle, lateral talo–first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, hindfoot moment arm, and a newly defined navicular-cuneiform incongruency angle (NCIA). Patient-Reported Outcomes Measurement Information System (PROMIS) clinical outcomes were assessed preoperatively and at a minimum 1-year follow-up. Results: The NCIA demonstrated excellent interobserver reliability, with no significant change between pre- and postoperative measurements. All other radiographic parameters, except calcaneal pitch, demonstrated statistically significant improvement postoperatively ( P < .01). Overall, patients had statistically significant improvement in all PROMIS domains ( P < .01), except for depression. Worsening NC deformity was not associated with worse patient-reported outcomes. Conclusions: Our data suggest that when addressing painful collapse of the medial arch in patients with AAFD, fusion of the first-TMT joint in combination with other procedures leads to acceptable radiographic and clinical outcomes. There was no change in deformity at the NC joint in our patient cohort at short-term follow-up, and patients achieved significant improvement in multiple PROMIS domains. Although TMT fusion had no effect on NC deformity, residual or worsening NC deformity did not significantly affect clinical outcomes. In addition, the NCIA was found to be a reliable radiographic parameter to assess NC deformity in the presence of talonavicular and/or first-TMT fusion. Level of Evidence: Level III, retrospective comparative study.

Jorge Rojas, MD, MSc, Alexander Bitzer, MD, Jacob Joseph, BA et al.

Background: This study aimed to determine the toileting ability (TA) of patients undergoing primary reverse total shoulder arthroplasty (RTSA) and identify factors associated with TA postoperatively. Methods: A questionnaire regarding toileting was administered to 119 patients who underwent primary RTSA with a minimum 1-year follow-up. Patients were separated into 2 groups based on whether the arm that underwent RTSA was the one used for toileting (study group, n = 74) or not (control group, n = 45). Patient-reported TA was calculated both before and after RTSA. Multivariate analysis was performed to identify factors associated with TA postoperatively. Results: Impairment in TA before RTSA was higher in the study group and affected almost three-quarters of the patients (72%). In the study group, primary RTSA resulted in a statistically significant improvement in TA (P < .001), and no difference in TA was found between groups after RTSA (P = .076). Postoperatively, 92% of the patients in the study group were able to manage toileting with the involved extremity (54% without difficulty and 38% with some degree of difficulty). Only 1 patient (1.3%) was totally unable to manage toileting with either arm postoperatively. The patients at risk of toileting difficulties postoperatively were those who had preoperative toileting difficulties and lower postoperative internal rotation range of motion. Conclusions: Over 90% of patients can manage toileting after primary RTSA, and total toileting inability is rare after the procedure (1.3%). Patients should be counseled that after primary RTSA, they have a high probability of being able to manage toileting with independence even if it is with some difficulty.

Morten Kjaer Ravn, MD, Trine Ivarsen Ostergaard, MD, Henrik Daa Schroeder, DMSc et al.

Background: Rotator cuff (RC) tears are associated with RC muscle atrophy and changes in composition that are crucial to the prognosis of RC repair. The aim of this study was to characterize muscle fiber composition in the supraspinatus (SS) muscle under tear conditions. Methods: Muscle biopsies were obtained from 21 patients undergoing surgery for an RC tendon tear. Biopsies were obtained from the musculotendinous junction of the SS muscle, and control biopsies were harvested from the deltoid muscle (DT). Biopsies were immunohistochemically processed for detection of type 1 (slow type) and type 2 (fast type) fibers and analyzed using unbiased, stereological principles. We counted the total numbers of type 1 and 2 muscle fibers/mm2, and fiber diameter was used to estimate muscle fiber atrophy and hypertrophy. Results: We found significantly more type 2 cells/mm2 in the SS compared with the DT (P < .01). In addition, we found a significantly higher fraction of type 1 fibers than type 2 fibers in the DT (P < .01), whereas both fiber types were equally present in the SS. The diameters of SS cells were generally smaller than those of DT cells. Atrophy of especially SS type 2 fibers was also demonstrated. Fiber atrophy was more pronounced in men than women. Conclusion: The changes in the composition of SS muscle cell types suggest a shift from type 1 to type 2 muscle fibers and atrophy of both type 1 and 2 fibers. This composition indicates loss of endurance and rapid fatigue of the SS muscle under RC tear conditions.

Albert T. Anastasio, Kevin X. Farley, John M. Rhee

Background Context: The diagnosis of generalized anxiety disorder (GAD) and major depressive disorder (MDD) amongst adolescents is rising worldwide. Rates of these disorders are higher in those with adolescent idiopathic scoliosis. Purpose: To elucidate whether or not depression and anxiety are associated with increased length of stay and total cost after posterior spinal fusion for adolescent idiopathic scoliosis. Study Design/Setting, Patient Sample: This study utilized the Nationwide Inpatient Sample (NIS) to obtain a sample of n = 564 in the depression and anxiety cohort and n = 5,185 in the cohort without concomitant diagnosis of depression and anxiety. Outcome Measures: Length of stay and total cost after posterior spinal fusion for adolescent idiopathic scoliosis. Methods: The Nationwide Inpatient Sample (NIS) was queried for patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis with either the concomitant diagnosis of major depressive disorder or generalized anxiety disorder. Comorbidities and other confounders were controlled for using multivariate regression analysis to determine the effect of having either mood disorder on cost and length of stay (LOS) after PSF. Results: We determined that after controlling for confounding variables and comorbidities through multivariate regression analysis, patients with either depression or anxiety had increased odds ratios for increased LOS but not for cost. Conclusions: The emergence of adolescent MDD and GAD may have significant implications on the inpatient stay for patients undergoing major surgery, including PSF for adolescent idiopathic scoliosis.

E. Marcantonio, L. Goldman, C. Mangione et al.

Felipe Galvão Abreu, M.D., João Luís Moura, M.D., Carlos Mesquita Queirós, M.D. et al.

Lateral meniscus lesions result in loss of meniscus hoop stresses and can lead to lateral compartment overload and early degenerative changes. Arthroscopic suture repair provides good long-term results. However, posterior vertical tears in the peripheral area of the meniscus can be technically challenging to resolve. This Technical Note describes the suture hook technique using an accessory posterolateral portal. We believe it is a safe, effective method for repairing full vertical tears of the lateral meniscus.