Hasil untuk "Orthopedic surgery"

Mackenzie H. Morris, BS, Ikechukwu C. Amakiri, MD, Andrew J. Homere, MD et al.

Background: Traumatic arthrotomies are rare, urgent injuries that carry high presumed risks for joint contamination and septic arthritis (SA). Most of these injuries occur in the knee. Like open fractures, treatment typically involves prompt antibiotic administration followed by surgical irrigation, debridement, and closure. Unlike open fractures, there is sparse evidence guiding pediatric arthrotomy management. This study aimed to characterize the demographics, clinical management, and outcomes of pediatric traumatic arthrotomies of the knee and other joints. Methods: Children with confirmed traumatic arthrotomy diagnoses admitted to the emergency department at a level 1 pediatric trauma center between 2013 and 2023 were retrospectively reviewed. Patient demographics, clinical characteristics, and outcomes were summarized using descriptive statistics. Postoperative complications were analyzed, along with 95% confidence intervals calculated using the Clopper-Pearson method. Results: Our cohort consisted of 36 patients (75% male, 68% White, average age 10 years, 58% privately insured). Traumatic arthrotomies most frequently resulted from falls (44%) and occurred in the knee joint (89%). The median time from admission to the operating room was 9 h (r, 2-45), with antibiotics initiated after a median of 4 h (r, 0-16) and continued for a median of 6 d (r, 0-24). Most patients (92%) underwent open irrigation and debridement with a median irrigation volume of 6 L (r, 1-9 L), and drain placement was used in 8 patients (22%). Forty-four percent of patients with a knee arthrotomy had an associated deep structure injury requiring repair. Four patients (11%) required reoperation for complex soft-tissue management, and three (8%) experienced noninfectious complications. Two patients developed superficial infections (5%); no cases of deep infection/SA were observed. Median duration of joint immobilization was 14 d (r, 0-59), and median time to return to full range of motion was 45 d (r, 6-93). Median time to clearance for full activity was 40 d (r, 12-153). Conclusions: Following a traumatic arthrotomy, most children achieve complete, uncomplicated recoveries. We report an absence of deep infection and a low superficial infection rate, none of which occurred in the knee. However, surgeons should remain vigilant in assessing for associated soft-tissue injuries. Key Concepts: (1) In this investigation, we found that there is a very low risk of deep infection or septic arthritis in children with traumatic arthrotomies (0% in our series) when applying the standard of care of timely antibiotic administration and surgical irrigation and debridement of the joint. (2) There was a high rate of structural soft-tissue injury that required repair (i.e., patellar/quadriceps tendon laceration) in traumatic arthrotomies of the knee. (3) Most children experience full recovery and return to sport around 6 weeks after traumatic arthrotomy. Level of Evidence: Level IV, case series

Ali Lari, Ali Esmaeil, Matthew Marples et al.

Kevin A. Wu, Devika Shenoy, Elizabeth Sachs et al.

Abstract Background Orthopedic procedures often require removing bone or pathological tissue, with traditional methods involving instruments like curettes and rongeurs. However, these methods can be time-consuming and lead to increased blood loss. To mitigate these side effects, vacuum-assisted tools have been developed to aid in tissue removal. These devices enable surgeons to suction tissue without discarding it, potentially improving outcomes in conditions such as osteomyelitis or tumor removal while enabling collection of the material for downstream applications. Despite limited research, vacuum-assisted devices show promise beyond bone marrow harvesting. This study assesses infection and clearance rates, estimated blood loss, and total procedure time associated with the use of vacuum-assisted tissue removal, with a goal to understand if these devices can be used for tissue removal across a variety of pathologic conditions. Methods A retrospective cohort study was conducted on patients undergoing orthopedic procedures with the Avitus® Bone Harvester repurposed from its original design from December 1, 2021, to July 1, 2023. Procedures were categorized into oncology, and debridement for infection cases. Infection cases were further categorized into those secondary to trauma and those involving primary infections (osteomyelitis and periprosthetic joint infection). Clinical variables, including demographics, intraoperative details, complications, and follow-up, were reviewed. Statistical analysis included descriptive statistics computed with R Studio. Results The study included 44 patients, with debridement for infection cases being the most common (primary infection: 45.5%; infection secondary to trauma: 18.1%), followed by oncology cases (36.4%). In all oncology cases, a definitive diagnosis was established using the device, and no post-operative infections were reported. The infection clearance rate was 85.0% for primary infection cases and 50.0% for cases of infection following trauma. Across the entire cohort, the average blood loss was 314.52 mL (sd: 486.74), and the average total procedure time was 160.93 min (sd: 91.07). The overall reoperation rate was 47.7%, with an unplanned reoperation rate of 11.4%. Conclusion The vacuum-assisted bone harvester was effectively utilized in a wide range of debridement and curettage procedures across diverse orthopedic surgeries. In oncology cases, the device enabled effective tissue removal with comparable recurrence rates, demonstrating its potential to minimize contamination while preserving tissue for accurate diagnoses. Additionally, a high rate of osteomyelitis eradication was observed in debridement for primary infection cases (85%). Despite the relatively high reoperation rate of 47.7%, it is crucial to interpret this figure within the context of the varied reasons for reoperation. Many of these reoperations were planned as part of a staged approach to treatment or were unrelated to the device's performance. It is crucial to acknowledge that isolating the device's contribution to these results can be difficult. The utilization of the device should be guided by considerations of cost-effectiveness and patient-specific risk factors.

Krishna Mandalia, Andrew R. Ames, James C. Parzick et al.

BACKGROUND Social determinants of health (SDOH) are the collection of environmental, institutional and intrinsic conditions that may bias access to, and utilization of, healthcare across an individual's lifetime. The effects of SDOH are associated with disparities in patient-reported outcomes after hip and knee arthroplasty, but its impact on rotator cuff repair (RCR) is poorly understood. This study aimed to investigate the influences that SDOH have on accessing appropriate orthopedic treatment, as well as its effects on patient-reported outcomes following RCR. METHODS This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and guidelines outlined by the Cochrane Collaboration. A search of PubMed, the Cochrane Library, and Embase from inception until March 2022 was conducted to identify studies reporting at least one SDOH and its effect on access to healthcare, clinical outcomes, or patient-reported outcomes following RCR. The search term was created with reference to the PROGRESS-Plus framework. Methodological quality of included primary studies was appraised using the Newcastle-Ottawa Scale (NOS) for non-randomized studies, and the Cochrane Risk of Bias Tool for randomized studies. RESULTS Thirty-two studies (level I-IV evidence) from 18 journals across 7 countries, published between 1999 and 2022, met inclusion criteria, including 102,372 patients, 669 physical therapy (PT) clinics, and 71 orthopedic surgery practices. Multivariate analysis revealed female gender, labor-intensive occupation and workers' compensation claims, comorbidities, tobacco use, federally-subsidized insurance, lower education level, racial/ethnic minority status, low-income place of residence and low-volume surgery regions, unemployment, and preoperative narcotic use contribute to delays in access to healthcare and/or more severe disease state upon presentation. Black race patients were found to have significantly worse postoperative clinical and patient-reported outcomes, and experienced more pain following RCR. Furthermore, Black and Hispanic patients were more likely to present to low-volume surgeons and low-volume facilities. A lower education level was shown to be an independent predictor of poor surgical and patient-reported outcomes as well as increased pain and worse patient satisfaction. Patients with federally-subsidized insurance demonstrated significantly worse postoperative clinical and patient-reported outcomes CONCLUSIONS: The impediments created by SDOH lead to worse clinical and patient-reported outcomes following RCR including increased risk of postoperative complications, failed repair, higher rates of revision surgery, and decreased ability to return to work. Orthopedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR.

Michael DeFrance, DO, Jonathan Lang, MPH, Caroline Aprigliano, BS et al.

Background: Advances in smart technology have expanded into the field of orthopedic surgery to deliver enhanced patient care. Smart technology has also raised important issues regarding protected patient information. The purpose of this study is to determine patient preferences regarding smart technology in their postarthroplasty care. Methods: Patient surveys were administered in the office setting of 2 adult reconstructive orthopedic surgeons during a 4-week period. Surveys queried patient demographics, twelve yes/no questions, five continuous agree/disagree statements, and a single free-text question. Logistic regression and statistical significance testing were performed. Results: Of the study patients, 83.6% were willing to wear a device. Women were more likely to consent to a monitoring device and have activity data collected than men (P < .05). Younger patients were more likely to consent to a device and have data collected than octogenarians. Nearly 90% of respondents indicated peace of mind with data being constantly tracked. However, 64% of respondents had hesitations about a surgically implanted device that was independent of a previous arthroplasty surgery (P < .05). Conclusions: Patients are comfortable with smart technology being involved in their postoperative care, especially younger patients and women. Older individuals, possibly with less experience using smart technology in their lives, were not as willing to wear smart devices or have their data collected. Nearly two-thirds of patients had hesitations about surgically implanted smart devices. Further investigation is needed to understand hesitations concerning smart implants as the orthopedic community enters an era of commercially available smart implants in total joint arthroplasty.

Drew Sanders, MD, David O’Neill, MD, Adam Starr, MD

Purpose: Our unique case reports injuries and radiographic findings of a patient with major chest wall trauma: the pectoralis myogram. Results: The patient was a 49 year old male involved in a motor vehicle collision with right sided pneumothorax with loss of lung markings, numerous rib fractures, a comminuted left clavicle fracture, and notable air outlines of what appeared to be the pectoralis major muscles on both sides of the chest wall. His injuries were successfully managed non-surgically in the ICU and then ward with a chest tube, sling, pain control, and physiotherapy despite the major trauma to his forequarter and chest wall. Conclusion: Understanding that this radiographic finding represents injury to lung parenchyma, chest wall musculature and soft tissues, and the bony supporting structures of the chest wall and shoulder girdle can help the clinician judge the severity of injury and anticipate treatment needs.

Sindhu Doppalapudi, Anjali Jain, Wahid Khan et al.

Anthony L. Karzon, Rishin J. Kadakia MD, Michelle M. Coleman MD, PhD et al.

Category: Bunion Introduction/Purpose: Arthrodesis of the first metacarpophalangeal joint (MTPJ) is frequently performed for the most common conditions affecting the great toe, hallux rigidus and hallux valgus. However, there is no detailed depiction of the procedural incidence in recent years. We hypothesize that stratified incidences of patients undergoing this procedure in the last decade has risen. Methods: The Truven MarketScan database was queried to identify patients who underwent 1st MTPJ arthrodesis from January 2009 to December 2019 based on CPT coding. Population estimates from the US Census Bureau were used to calculate the annual incidence of 1st MTPJ arthrodesis. Volume and incidence were estimated for annual sums, gender, age subgroups, and four statistical geographical regions of the U.S. Results: In total, 184,016 1st MTPJ arthrodesis procedures were identified in the database from 2009 to 2019. Annual volumes have increased significantly by 70.8%, from 12,125 to 20,710 total procedures nationwide. Procedural incidence reported per 1,000,000 people significantly increased by 58.7%, at 63.8 in 2019. Growth in incidence was demonstrated in males and females of all defined age subgroups. Incidence stratified by region rose in all regions except for the Northeast, where a -0.5% change between 2010 and 2019 was noted, albeit insignificant. Conclusion: The epidemiology of 1st MTPJ arthrodesis has yet to be clarified in recent years. We have found that the annual volumes and incidence of 1st MTP arthrodesis has increased in the past decade. Growth in incidence was demonstrated in both sexes of all age cohorts as well as regionally in the United States. Identifying current trends in procedural incidences can help provide orthopedic surgeons with insight into temporal and quantitative changes in the field.

Cesar D Lopez MD, Jessica Ding BA, Joel R Peterson MD et al.

With current emphasis on preoperative templating of anatomical and reverse shoulder arthroplasty (aTSA and rTSA, respectively), patients often receive thin slice (<1.0 mm) computerized tomography (CT) scans of the operative shoulder, which includes about two-thirds of the ipsilateral lung. The purpose of this study is to evaluate the prevalence and management of incidentally detected pulmonary nodules on preoperative CT scans for shoulder arthroplasty. In this single-center retrospective study, we queried records of aTSA and rTSA patients from 2015 to 2020 who received preoperative CT imaging of the shoulder. Compared to patients with negative CT findings, there were significantly more females (63.8% vs. 46.4%; P  = .011), COPD (13.0% vs. 4.7%; P  = .015), and asthma (18.8% vs. 6.9%; P  = .003) among the patients with incidental nodules on CT. Binary logistic regression confirmed that female sex (odds ratio = 2.00; 95% CI = 1.04 to 3.88; P  = .037), COPD history (OR = 3.02; 95% CI = 1.05 to 8.65; P  = .040), and asthma history (OR = 3.17; 95% CI = 1.30 to 7.77; P  = .011) were significantly associated with an incidental nodule finding. Incidental pulmonary nodules found on shoulder arthroplasty preoperative CT scans are often low risk in size with low risk of malignancy, and do not require further workup. This study may provide guidance to orthopedic surgeons on how to manage patients with incidental pulmonary nodules to increase chances of early cancer detection, avoid unnecessary referrals, reduce potentially harmful radiation exposure of serial CT scans, and improve cost efficiency.

Ayhan Bilir, Taskin Ceyhan, Meric A. Altinoz et al.

Abstract Objectives: The primary cell culture, as a model system, is the multiplication of a replica of the resource tissue under in vitro conditions. This study was designed to standardize the culture technique of two groups of osteoblast cells extracted from the calvaria of mature and fetal BALB/c mice, to examine the cultured cells histomorphologically, to define cellular elements through histochemical techniques, and to determine the rate of culturability.\nMethods: Calvaria from 10 young mature mice and 6 to 9 fetal calvaria from each of the eight pregnant mice were obtained. A mechanical separation was conducted in sterile environment with a laminar air flow. The cells from four mature calvaria and all fetal calvaria were cultured in DME-F12 medium, while those of the remaining six mature calvaria were planted in RPMI-1640 medium. Cell confluence was monitored at every 24 hours. Successful specimens were stained with picro-thionin and photographed with invert photo-microscope.\nResults: Of the young mature calvaria cultivated in RPMI-1640, four were unsuccessful, whereas, of the six mature calvaria in DME-F12, two were partially successful and four were successful. In DME-F12, successful, partially successful, and unsuccessful results were obtained in six, one, and one fetal calvaria, respectively.\nConclusion: Our results suggest that embryonic tissues can be cultivated at a higher rate than mature tissues and that the quality of the cultivation medium has a significant role in the cultivation process. Özet Amaç: Primer hücre kültürü bir model sistem olarak, kaynak doku benzerinin in vitro şartlarda çoğaltılmasıdır. Bu çalışmada, kaynak olarak kullanılan BALB/c soyu ergin fare ve fetal fare kalvaryumundan sağlanan iki grup osteoblast hücrelerinin kültür tekniğini standart hale getirmek, çoğaltılan kemik hücrelerini histomorfolojik olarak incelemek, histokimyasal tekniklerle hücresel elemanları tanımlamak ve kültüre edilebilirlik oranlarını belirlemek amaçlandı.\nÇalışma planı: On adet genç erişkin, sekiz adet gebe farenin 6-9 arası değişen fetal kalvaryumu kullanıldı. Hava akımlı steril ortam içinde mekanik ayırma yapılarak fetal ve dört ergin kalvaryum için DME-F12 , diğer 6 ergin kalvaryum için de RPMI-1640 medyum kullanılarak flasklara ekildi. Yirmi dört saatte bir, mikroskop altında hücrelerin yapışma özellikleri gözlemlendi. Başarılı kültürler picro-thionin boyama tekniği ile tespit edilip boyanarak fotoğraf ataçmanlı mikroskop ile incelendi ve fotoğraflandırıldı.\nSonuçlar: Genç ergin kalvaryumların RPMI-1640 medyumunda kültüre edilen 4’ü başarısız olarak değerlendirildi. Buna karşılık DME-F12 medyumunda kültür edilen altı ergin kalvaryumdan ikisi kısmen, dördü başarılı olarak değerlendirildi. Fetal kalvaryumların ise aynı medyumda bir tanesi başarısız, biri kısmen, altısı ise tam başarılı bulundu.\nÇıkarımlar: Sonuçlarımız, embriyonik dokuların daha yüksek oranlarda kültüre edilebildiğini ve kültür ortamlarının kemik hücre kültürlerinin başarısında önemli rol oynadığını göstermektedir.

Adrian Kelly, Aftab Younus, Patrick Lekgwara

Osteopetrosis is a metabolic bone disease resulting in skeletal hyper-sclerosis. Three major genetic subtypes of the disease are phenotypically expressed into three distinguishable forms of the disease, each dictating specific management. Autosomal recessive “severe” osteopetrosis occurs secondary to defective osteoclastic resorption of immature bone. Regarding the neurosurgical considerations in this group cranial concerns rather than spinal symptoms often predominate. Visual deterioration is the most frequent presenting complaint often beginning within the first few months of life. A secondary complication is hearing loss which is estimated to affect op to 78% of children within their first year of life. Here neurosurgical interventions for foraminal bony encroachment is of little long-term benefit with a more favourable outcome is seen with medical therapies. The autosomal recessive “intermediate form” of osteopetrosis is frequently not evident at birth and has a milder more protracted clinical course with individuals often surviving into adulthood. Labelled marble brain disease several case reports note the association between this form of the disease and intracranial calcifications and subsequent neuronal degeneration. Neurosurgical interventions have a beneficial role here but must be exercised in a patient specific manner. Autosomal dominant “benign” osteopetrosis has a relatively late onset typically occurring in early adolescence. In these individuals cranial nerve compression neuropathies are far less common with an approximate incidence of only 5%. These patients largely come to the attention of the attending neurosurgeon for the management of spinal complications which include spinal fractures, kyphoscoliosis, accelerated spinal degeneration and spinal osteomyelitis. Regarding the treatment of spinal fractures in patients with osteopetrosis no clear evidence-based guidelines currently exist. Several case reports note a high complication rate with surgical intervention however acceptable long term outcomes do occur with augmented, relatively protracted, post-operative bracing.

Hakan Omeroglu, Derya Hakan Ucar, Yucel Tumer

Abstract Objectives: We developed a new method -measuring the perpendicular distance between the center of the femur head and the tip of the trochanter- for radiographic assessment of the proximal femur.\nMethods: The “center-trochanter distance” (CTD) refers to the perpendicular line drawn to the femoral shaft axis between two parallel lines that pass through the center of the femoral head (C) and the tip of the greater trochanter (T). The measured distance in millimeters is expressed as a positive or negative value depending on the location of the point C, that is, above or below the point T, respectively. Measurements were made on anteroposterior plain radiographs of 200 skeletally immature and 600 skeletally mature hips, all of which had been assessed as normal. Values that were found to be below or above the standard deviation of 1 and 2 of the mathematical means were regarded as “normal” and “pathological”, respectively. The reliability of the method was tested in 43 hips that had been surgically treated for developmental dysplasia of the hip and had a long-term follow-up.\nResults: The center-trochanter distance measured below -5 mm and above 15 mm in the skeletally immature proximal femora, and below -17 mm and above 7 mm in the skeletally mature proximal femora were regarded as “pathologic”. The intraobserver (kappa coefficient, 0.92 and 0.81) and interobserver (kappa coefficient 0.88) reliability of the method was found to be excellent.\nConclusion: The center-trochanter distance may prove to be useful in radiographic assessment of the proximal femur in several hip disorders such as developmental dysplasia of the hip and Legg-Calvé-Perthes disease. Özet Amaç: Proksimal femurun radyografik değerlendirmesi için geliştirdiğimiz yeni bir yöntem -femur başı merkezi ile trokanter uç noktası arasındaki dik uzaklığın ölçülmesi- tanımlanarak sunuldu.\nÇalışma planı: “Merkez-trokanter uzaklığı” (MTU), femur diyafiz aksına dik çizilen ve femur başı merkezi (M) ve büyük trokanterin üst ucundan (T) geçen iki paralel çizgi arasında milimetre olarak ölçülür. Eğer M noktası T noktasına göre üstte ya da altta ise ölçülen uzaklık sırasıyla pozitif ya da negatif değer olarak ifade edilir. Bu yöntemi uygulamak amacıyla, kemiksel olgunlaşmasını tamamlamamış 200 kalçanın ve tamamlamış 600 kalçanın normal olarak değerlendirilen ön-arka direkt pelvis radyografileri üzerinde ölçümler yapıldı. Elde edilen aritmetik ortalamanın bir standart sapma (SS) altı ya da üstünde kalan değerler “normal”, aritmetik ortalamanın iki SS altı ya da üstünde kalan değerler “patolojik” olarak kabul edildi. Yöntemin güvenirliği gelişimsel kalça displazisi nedeniyle ameliyat edilen ve uzun dönem izlemi olan 43 kalçada sınandı.\nSonuçlar: Kemiksel olgunlaşmasını tamamlamamış proksimal femurda -5 mm altı ve 15 mm üzeri, kemiksel olgunlaşmasını tamamlamış proksimal femurda -17 mm altı ve 7 mm üzerindeki MTU değerleri patolojik olarak değerlendirildi. Yöntemin gözlemci (kappa katsayısı 0.92 ve 0.81) ve gözlemciler (kappa katsayısı 0.88) arası güvenirliği mükemmel düzeyde bulundu.\nÇıkarımlar: Merkez-trokanter uzaklığı, gelişimsel kalça displazisi ve Legg-Calvé-Perthes hastalığı gibi kalça patolojilerinde proksimal femurun radyografik değerlendirmesinde kullanılabilir.

Sameh A. Labib MD, Rahul Goel MD, Wesley J. Manz et al.

Category: Other Introduction/Purpose: The current COVID-19 pandemic has created a unique problem for orthopaedic surgeons by mandating ‘social distancing’ and limiting patient-provider interactions. Centers have reacted to this by implementing Telemedicine as a way to still provide care for patients. We have developed a Telemedicine protocol we believe allows for enough information to be gathered to provide an accurate diagnosis and with high patient satisfaction. Methods: A 12-step standardized protocol was created to be used during foot and ankle Telemedicine visits. This was coupled with pre-visit preparation by the office staff with the patient as well as recommending appropriate follow-up either in person or again via Telemedicine. After implementation of this system in April 2020, we retrospectively reviewed Press-Ganey data collected for provider rating (scale 0-10) with Telemedicine visits and traditional office visits through June 2020. Scores of 9 and 10 out of 10 were grouped together to represent an excellent experience, and all other responses were grouped together as a less than excellent experience. Fischer’s exact test was used to compare samples. Results: A total of 183 patients were surveyed during this time period, 127 from telemedicine visits and 56 from in-office visits. 106/127 (83.4%) patients surveyed after Telehealth visits and 50/56 (89.2%) after in-person visits rated their visit as a 9 or 10 (p=0.37). Conclusion: The COVID-19 pandemic has changed the way that orthopaedic surgeons have needed to deliver care to their patients. Though the transition has had its difficulties, it would be a failure in progress to not recognize and adopt the advances that have been made during this time. Though the adaption of Telemedicine was made out of necessity at our institution, the lessons learned during this trying time has enabled us to provide excellent orthopaedic care through telemedicine that can continue once restrictions have been lifted.

Junqing Jia

Abstract Purpose The present study was designed to evaluate the efficacy and safety of combined use of intravenous (IV) TXA administration and topical intraarticular tranexamic acid (TXA) strategy in patients aged over 70 undergoing total hip arthroplasty (THA). Methods One hundred eighty patients were randomized into three groups, including an IV group, a local group, and a combined group. Patients were administrated with 15 mg/kg of IV-TXA in the IV group, 2 g TXA in the topical group, or 15 mg/kg IV-TXA combined with 2 g TXA in the combined group. Total blood loss (TBL), maximum hemoglobin drop, the transfusion rate and the number of allogeneic blood units, and the incidence of deep venous thrombosis (DVT), and pulmonary embolism (PE) were recorded and analyzed. Results TBL was 757.75 ± 188.95 mL in the combined group, which was significantly lower than in the IV group (892.75 ± 218.47) or the topical group (1015.75 ± 288.71) (p = 0.015, p = 0.001 respectively). The mean values of maximum hemoglobin drop in the combined, IV, and topical groups were 2.67 ± 0.42, 3.28 ± 0.52, and 3.75 ± 0.62 g/dL, respectively, with a significant intergroup difference (p < 0.001 for all). PE was not detected within 1 month after the surgery. Asymptomatic DVT was reported in 1 patient of the IV group, and in 2 patients from the combined group, while the difference was not statistically significant. Conclusions Compared to intravenous or topical use of TXA, the combined therapy effectively decreased total blood loss and reduced the transfusion rate, simultaneously possessed the same degree of safety in primary THA patients aged over 70.

Kenichi Yoshikawa, Hirotaka Mutsuzaki, Ayumu Sano et al.

Abstract Background The Hybrid Assistive Limb (HAL, CYBERDYNE) is a wearable robot that provides assistance to patients while walking, standing, and performing leg movements based on the intended movement of the wearer. We aimed to assess the effect of HAL training on the walking ability, range of motion (ROM), and muscle strength of patients after total knee arthroplasty (TKA) for osteoarthritis and rheumatoid arthritis, and to compare the functional status after HAL training to the conventional training methods after surgery. Methods Nine patients (10 knees) underwent HAL training (mean age 74.1 ± 5.7 years; height 150.4 ± 6.5 cm; weight 61.2 ± 8.9 kg), whereas 10 patients (11 knees) underwent conventional rehabilitation (mean age 78.4 ± 8.0 years; height 150.5 ± 10.0 cm; weight 59.1 ± 9.8 kg). Patients underwent HAL training during 10 to 12 (average 14.4 min a session) sessions over a 4-week period, 1 week after TKA. There was no significant difference in the total physical therapy time including HAL training between the HAL and control groups. Gait speed, step length, ROM, and muscle strength were evaluated. Results The nine patients completed the HAL training sessions without adverse events. The walking speed and step length in the self-selected walking speed condition, and the walking speed in the maximum walking speed condition were greater in the HAL group than in the control group at 4 and 8 weeks (P < 0.05). The step length in the maximum walking speed condition was greater in the HAL group than in the control group at 2, 4, and 8 weeks (P < 0.05). The extension lag and knee pain were lower in the HAL group than in the control group at 2 weeks (P < 0.05). The muscle strength of knee extension in the HAL group was greater than that in the control group at 8 weeks (P < 0.05). Conclusion HAL training after TKA can improve the walking ability, ROM, and muscle strength compared to conventional physical therapy for up to 8 weeks after TKA. Since the recovery of walking ability was earlier in the HAL group than in the control group and adverse events were not observed in this pilot study, HAL training after TKA can be considered a safe and effective rehabilitation intervention. Trial registration UMIN, UMIN000017623. Registered 19 May 2015

P. Wahl, P. Wahl, K. Rönn et al.

<p class="p p-first" id="__p2">Introduction: Local application of antibiotics provides high concentrations at the site of interest, with minimal systemic toxicity. Carrier materials might help manage dead space. Calcium sulphate (CaSO₄) has a dissolution time that only slightly exceeds the usually recommended duration of systemic antibiotic treatments. This <em>in vitro</em> study evaluates compatibility, release kinetics and antibacterial activity of new combinations of antibiotics with CaSO₄ as carrier material.</p><p id="__p3">Methods: CaSO₄ pellets added with 8% w/w antibiotic powder were exposed once in phosphate-buffered saline (PBS) solution and once in bovine plasma, in an elution experiment run over 6 weeks at 37 °C. Antibiotic elution was examined at various time points. Concentration was measured by liquid chromatography with tandem mass spectrometry. Antimicrobial activity was checked with an agar diffusion test.</p><p id="__p4">Results: Piperacillin-tazobactam, ceftazidime, cefepime, and meropenem showed fast reduction of concentration and activity. Flucloxacillin and cefuroxime remained present in relevant concentrations for 4 weeks. Ciprofloxacin, levofloxacin and clindamycin lasted for 6 weeks, but also at cell toxic concentrations. Ceftriaxone showed a near-constant release with only a small reduction of concentration from 130 to 75 mg/l. Elution profiles from PBS and plasma were comparable.</p><p class="p p-last" id="__p5">Conclusion: CaSO₄ provides new possibilities in the local treatment of bone and joint infections. Ceftriaxone appears to be of particular interest in combination with CaSO₄. Release persists at clinically promising concentrations, and appears to have a depot-like slow release from CaSO₄, with only a small reduction in activity and concentration over 6 weeks. To the best of our knowledge, such a particular persistent release never was described before, for any antibiotic in combination with a carrier material for local application.</p>

Bikas Sahoo, Alok C Agrawal, Bikram K Kar et al.

There are numerous classification systems for fracture neck of femur in adults. A fracture classification is proposed either for taxonomical purpose, characterization, guiding intervention, or predicting outcomes of intervention. The classifications described in this chapter are needed to decide on choice of implant, stability, acceptability of reduction, vascularity and long term prognosis.

Clare M. McNally, MPhil(Dent), Renuka Visvanathan, MBBS, PhD, Sharon Liberali, DClinDent(SND) et al.

Background: Antibiotic prophylaxis before dental treatment is routinely recommended by orthopaedic surgeons to prevent prosthetic joint infection (PJI). This recommendation is at odds with current guidelines. Methods: A postal survey of 9 checkbox or short-answer questions was completed by 633 orthopaedic surgeons. Results: The majority of respondents (n = 186 of 260, 72%) believe that antibiotic prophylaxis is required indefinitely for dental treatment. A small number (n = 43, 15%) seek a dentist's opinion before elective joint replacement. The surgeons reported low numbers of PJIs, although 24% (n = 68 of 280) believed that they were associated with dental treatment. Conclusions: Australian orthopaedic surgeons continue to recommend antibiotic prophylaxis for dental treatment. The recording of PJI in relation to dental procedures into clinical registries would enable the development of consistent guidelines between professional groups responsible for the care of this patient group.

T. Laine, D. Schlenzka, K. Mäkitalo et al.

M. Briggs, J. Closs