Hasil untuk "Orthopedic surgery"

Meng Meng, Jinzuo Wang, Huagui Huang et al.

Background Currently, metal implants are widely used in orthopedic surgeries, including fracture fixation, spinal fusion, joint replacement, and bone tumor defect repair. However, conventional implants are difficult to be customized according to the recipient's skeletal anatomy and defect characteristics, leading to difficulties in meeting the individual needs of patients. Additive manufacturing (AM) or three-dimensional (3D) printing technology, an advanced digital fabrication technique capable of producing components with complex and precise structures, offers opportunities for personalization. Methods We systematically reviewed the literature on 3D printing orthopedic metal implants over the past 10 years. Relevant animal, cellular, and clinical studies were searched in PubMed and Web of Science. In this paper, we introduce the 3D printing method and the characteristics of biometals and summarize the properties of 3D printing metal implants and their clinical applications in orthopedic surgery. On this basis, we discuss potential possibilities for further generalization and improvement. Results 3D printing technology has facilitated the use of metal implants in different orthopedic procedures. By combining medical images from techniques such as CT and MRI, 3D printing technology allows the precise fabrication of complex metal implants based on the anatomy of the injured tissue. Such patient-specific implants not only reduce excessive mechanical strength and eliminate stress-shielding effects, but also improve biocompatibility and functionality, increase cell and nutrient permeability, and promote angiogenesis and bone growth. In addition, 3D printing technology has the advantages of low cost, fast manufacturing cycles, and high reproducibility, which can shorten patients' surgery and hospitalization time. Many clinical trials have been conducted using customized implants. However, the use of modeling software, the operation of printing equipment, the high demand for metal implant materials, and the lack of guidance from relevant laws and regulations have limited its further application. Conclusions There are advantages of 3D printing metal implants in orthopedic applications such as personalization, promotion of osseointegration, short production cycle, and high material utilization. With the continuous learning of modeling software by surgeons, the improvement of 3D printing technology, the development of metal materials that better meet clinical needs, and the improvement of laws and regulations, 3D printing metal implants can be applied to more orthopedic surgeries. The translational potential of this paper Precision, intelligence, and personalization are the future direction of orthopedics. It is reasonable to believe that 3D printing technology will be more deeply integrated with artificial intelligence, 4D printing, and big data to play a greater role in orthopedic metal implants and eventually become an important part of the digital economy. We aim to summarize the latest developments in 3D printing metal implants for engineers and surgeons to design implants that more closely mimic the morphology and function of native bone.

A. Punnoose, L. Claydon-Mueller, O. Weiss et al.

Key Points Question Is prehabilitation associated with improved outcomes in patients undergoing orthopedic surgery? Findings In this systematic review and meta-analysis of 48 unique trials involving 3570 unique patients, the prehabilitation intervention significantly improved function, health-related quality of life, muscle strength, and back pain prior to surgery in patients undergoing orthopedic procedures compared with usual care (without prehabilitation). Postoperatively, prehabilitation improved function in the short to medium term in comparison with usual care. Meaning These findings suggest that prehabilitation is associated with improving some outcomes for patients undergoing orthopedic surgery both preoperatively and postoperatively.

Fei Han, Xiao Huang, Xin Wang et al.

Artificial intelligence (AI) drives transformative changes in orthopedic surgery, steering it toward precision and personalization through intelligent applications in preoperative planning, intraoperative assistance, and postoperative rehabilitation/monitoring. Breakthroughs in deep learning, robotics, and multimodal data fusion have enabled AI to demonstrate significant advantages. Nonetheless, current applications face challenges such as limited real‐time decision autonomy, fragmented medical data silos, standardization gaps restricting model generalization, and ethical/regulatory frameworks lagging behind technological advancements. Therefore, a critical analysis of the current status of AI and the acceleration of its clinical translation is urgently required. This study systematically reviews the core advancements, challenges, and future directions of AI in orthopedic surgery from technical, clinical, and ethical perspectives. It elaborates on the “perceptual‐decisional‐executional” intelligent closed loop formed by algorithmic innovation and hardware upgrades, summarizes AI applications across surgical continuum, analyzes ethical and regulatory challenges, and explores emerging trajectories. This review integrates the end‐to‐end applications of AI in orthopedics, illustrating its evolution. It introduces an “algorithm‐hardware‐ethics trinity” framework for technical translation, providing methodological guidance for interdisciplinary collaboration. Additionally, it evaluates the combined efficacy of diverse algorithms and devices through practical cases and details of future research frontiers, aiming to inform researchers of current landscapes and guide subsequent investigations.

I. Antoniac, M. Miculescu, V. Manescu (Paltanea) et al.

Magnesium (Mg)-based alloys have become an important category of materials that is attracting more and more attention due to their high potential use as orthopedic temporary implants. These alloys are a viable alternative to nondegradable metals implants in orthopedics. In this paper, a detailed overview covering alloy development and manufacturing techniques is described. Further, important attributes for Mg-based alloys involved in orthopedic implants fabrication, physiological and toxicological effects of each alloying element, mechanical properties, osteogenesis, and angiogenesis of Mg are presented. A section detailing the main biocompatible Mg-based alloys, with examples of mechanical properties, degradation behavior, and cytotoxicity tests related to in vitro experiments, is also provided. Special attention is given to animal testing, and the clinical translation is also reviewed, focusing on the main clinical cases that were conducted under human use approval.

Wenqing Liang, Chao Zhou, Juqin Bai et al.

Recent advancements in orthopedic surgery have greatly improved the management of musculoskeletal disorders and injuries. This review discusses the latest therapeutic approaches that have emerged in orthopedics. We examine the use of regenerative medicine, including stem cell therapy and platelet-rich plasma (PRP) injections, to accelerate healing and promote tissue regeneration. Additionally, we explore the application of robotic-assisted surgery, which provides greater precision and accuracy during surgical procedures. We also delve into the emergence of personalized medicine, which tailors treatments to individual patients based on their unique genetic and environmental factors. Furthermore, we discuss telemedicine and remote patient monitoring as methods for improving patient outcomes and reducing healthcare costs. Finally, we examine the growing interest in using artificial intelligence and machine learning in orthopedics, particularly in diagnosis and treatment planning. Overall, these advancements in therapeutic approaches have significantly improved patient outcomes, reduced recovery times, and enhanced the overall quality of care in orthopedic surgery.

Levent Kostem, Fikret Oztop, Ahmet Sebik et al.

Abstract In eight of a total of 53 diagnostic arthroscopy cases, cartilage lesions and additional meniscus lesions resulting frorm intaraticular corticosteroid injections were identified between September 1987 and July 1988.Three of the cases were active sportsmen and all three had necrosis of the meniscus due to local corticosteroid administration following trauma. Mean time span for the onset of symptoms were determined to be eight months after local corticosteroid administration. ÖzetKortizonun uzun süreli sistemik kullanımından sonra veya diz içine lokal uygulanmasından sonra diz ekleminde, özellikle femur kondillerinde kıkırdak nekrozu oluşması çok görülmektedir. Özellikle lokal uygulamada kortizonun meniskus içine yapılması sonucunda meniskuslardaki lezyonlar ortaya çıkmaktadır. Eylül 1987-Temmuz 1988 ayları arasında uyguladığımız toplam 53 tanısal artroskopi olgusunun 8inde intraartiküler kortizon enjeksiyonlarına bağlı kıkırdak lezyonu ve ilave meniskus lezyonları saptadık. 3 olgumuz aktif sporcu olup, her ikisinde de travmayı takiben lokal kortizon uygulaması sonucu meniskusta nekroz ve her iki eklem yüzeylerinde de kıkırdak lezyonları mevcuttu. Olgularda, lokal kortizon uygulamalarından sonra yakınmaların ortaya çıkması ortalama 8 ay olarak saptandı.

Duy Nguyen Anh Tran, Bao Tu Thai Nguyen, Hoan Le Nguyen et al.

Background: Preoperative cognitive function (PCF) is gaining attention as a predictor of surgical outcomes due to its association with muscle function and recovery. Its role in postoperative recovery following transforaminal lumbar interbody fusion (TLIF), however, remains unclear. Objectives: This study aimed to evaluate the impact of PCF on functional and quality-of-life outcomes after TLIF surgery. Materials and Methods: A prospective study of 89 patients undergoing TLIF assessed PCF preoperatively using the Short Portable Mental Status Questionnaire. Outcomes, including Japanese Orthopaedic Association (JOA) and EuroQol 5-Dimensions 3-Level (EQ-5D-3L) scores, were measured at baseline, 3, 6, and 12 months postsurgery. Generalized estimating equations analyzed the associations between PCF and recovery. Results: JOA and EQ-5D-3L scores improved significantly at all postoperative time points, reflecting enhanced functional and quality-of-life outcomes after TLIF. PCF showed a weak-to-moderate negative correlation with JOA and EQ-5D-3L scores across all time points. Greater PCF impairment was associated with lower postoperative JOA (β = −1.432, P = 0.036) and EQ-5D-3L (β = −0.065, P = 0.016) scores. Conclusions: PCF significantly affects postoperative outcomes following TLIF, particularly in early recovery. Assessing and addressing PCF preoperatively could enhance recovery trajectories.

Daniel Suter, Aidana Massalimova, Christoph Johannes Laux et al.

Abstract One of the most established approaches to navigate pedicle screws is the planning and alignment (PA) method. Thereby a trajectory and associated entry point (EP) is planned and navigated after referencing to patient anatomy. However, deviations from the planned EP potentially lead to an altered screw position. The aim of this study was to investigate the influence of these EP deviations and to examine possible alternative methods. The merits of two new points of reference (screw tip point STP and midpoint MP) were therefore analyzed. STP represents the point on the optimal screw tip, MP the point at the center/midportion of the pedicle at its narrowest portion. The adapted screw trajectory was defined as the directional vector from any chosen EP to the STP or MP. First, computer simulations were used to evaluate the performance of these new approaches. Subsequently, the navigation technique yielding more acceptable screws in case of an EP deviation was analyzed on phantom-sawbone models. Both new methods showed a significantly larger number of possible screw trajectories in the simulations (p < 0.01). Even with a deliberate deviation of 4.5 mm (IQR 3.3) from the optimal EP, a perforation-free screw diameter of 4.9 mm (IQR 5.7 mm) could be achieved using the new navigation techniques. The simulated perforations were mainly located laterally with a median of 8.45 mm (IQR 3.95) distance to the medial pedicle wall. The PA method seems to be susceptible to EP deviations. The STP and MP methods are possible improvement mechanisms to overcome this disadvantage.

Jinjin Yang, Lei Lei, Di Qiu et al.

Background Postoperative delirium is common in older adult patients and associated with a poor prognosis. The use of benzodiazepine was identified as an independent risk factor for delirium, but there is no randomized controlled trial regarding the relationship between remimazolam, a new ultra-short acting benzodiazepine, and postoperative delirium. We designed a randomized controlled trial to evaluate if remimazolam increases the incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery with general anesthesia. Patients and Methods We enrolled 320 patients aged more than 60 with American Society of Anesthesiologists physical status I–III who underwent orthopedic surgery. Patients were randomized to two groups to receive intraoperative remimazolam or propofol, respectively. Our primary outcome was the incidence of delirium within 3 days after surgery. Secondary outcome was emergence quality including the incidence of emergence agitation, extubation time, and length of post-anesthesia care unit (PACU) stay. Adverse events were also recorded. Results The incidence of postoperative delirium was 15.6% in the remimazolam group and 12.4% in the propofol group (Risk ratio, 1.26; 95% CI, 0.72 to 2.21; Risk difference, 3.2%; 95% CI, −4.7% to 11.2%; P = 0.42). No significant differences were observed for time of delirium onset, duration of delirium, and delirium subtype between the two groups. Patients in remimazolam group had a lower incidence of hypotension after induction and consumed less vasoactive drugs intraoperatively, but had a longer postoperative extubation time and PACU stay. Conclusion General anesthesia with remimazolam was not associated with an increased incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery.

A. Kurmis, J. Ianunzio

Technological advances continue to evolve at a breath-taking pace. Computer-navigation, robot-assistance and three-dimensional digital planning have become commonplace in many parts of the world. With near exponential advances in computer processing capacity, and the advent, progressive understanding and refinement of software algorithms, medicine and orthopaedic surgery have begun to delve into artificial intelligence (AI) systems. While for some, such applications still seem in the realm of science fiction, these technologies are already in selective clinical use and are likely to soon see wider uptake. The purpose of this structured review was to provide an understandable summary to non-academic orthopaedic surgeons, exploring key definitions and basic development principles of AI technology as it currently stands. To ensure content validity and representativeness, a structured, systematic review was performed following the accepted PRISMA principles. The paper concludes with a forward-look into heralded and potential applications of AI technology in orthopedic surgery. While not intended to be a detailed technical description of the complex processing that underpins AI applications, this work will take a small step forward in demystifying some of the commonly-held misconceptions regarding AI and its potential benefits to patients and surgeons. With evidence-supported broader awareness, we aim to foster an open-mindedness among clinicians toward such technologies in the future.

Wen Duan, Cheng-Mao Zhou, Jinjin Yang et al.

BACKGROUND Postoperative delirium (POD) is a common surgical complication associated with increased morbidity and mortality in elderly. Although the underlying mechanisms remain elusive, perioperative risk factors were reported to be closely related to its development. This study was designed to investigate the association between the duration of intraoperative hypotension and POD incidence following thoracic and orthopedic surgery in elderly. METHOD The perioperative data from 605 elderly undergoing thoracic and orthopedic surgery from January 2021 to July 2022 were analyzed. The primary exposure was a cumulative duration of mean arterial pressure (MAP) ≤ 65 mmHg. The primary end-point was the POD incidence assessed with confusion assessment method (CAM) or CAM-ICU for three days after surgery. Restricted cubic spline (RCS) was conducted to examine the continuous relationship between the duration of intraoperative hypotension and POD incidence adjusted with patients' demographics and surgery related factors. Then the duration of intraoperative hypotension was categorized into three groups: no hypotension, short (< 5 mins) or long duration (≥ 5 mins) of hypotension for further analysis. RESULT The incidence of POD was 14.7% (89 cases out of 605) within three days after surgery. The duration of hypotension presented a non-linear and "inverted L-shaped" effect on POD development. Compared to no hypotension, long duration (adjusted OR 3.93; 95% CI: 2.07-7.45; P < 0.001) rather than short duration of MAP ≤65 mmHg (adjusted OR 1.18; 95% CI: 0.56-2.50; P = 0.671) was closely related to the POD incidence. CONCLUSION Intraoperative hypotension (MAP ≤65 mmHg) for ≥5 mins was associated with an increased incidence of POD after thoracic and orthopedic surgery in elderly.

Mark Ehioghae, Alexis Montoya, Ritwik Keshav et al.

Purpose of Review The surge in orthopedic surgeries strains the US healthcare system, necessitating innovative rehabilitation solutions. This review examines the potential of virtual reality (VR)-based interventions for orthopedic rehabilitation. Recent Findings The effectiveness of VR-based interventions in orthopedic surgery patients is scrutinized. While some studies suggest better patient-reported outcomes and satisfaction, mixed results emerge from others, demonstrating comparable or varied results compared to traditional rehabilitation. The underlying mechanisms of VR-based rehabilitation are elucidated, showing its positive impact on proprioception, pain management, agency, and balance. Challenges of unfamiliarity, patient engagement, and drop-out rates are identified, emphasizing the need for tailored approaches. Summary VR technology’s immersive environments and multisensory experiences offer a novel approach to addressing functional deficits and pain post-surgery. The conclusion drawn is that VR-based rehabilitation complements rather than replaces conventional methods, potentially aiding in pain reduction and functional improvement. VR-based rehabilitation holds promise for enhancing orthopedic surgery outcomes, presenting a dynamic approach to recovery. Its potential to reshape healthcare delivery and reimbursement structures underscores its significance in modern healthcare. Overall, VR-based rehabilitation offers a promising avenue for optimizing postoperative recovery in orthopedic surgery patients.

Jari Dahmen MD, Julian Hollander Bsc, Kishan Ramsodit et al.

Category: Ankle Introduction/Purpose: The aim of this study is to assess the return to sports rate and times after treatment of osteochondral lesions of the ankle in elite level athletes. Methods: All elite level athletes treated for an OLT(P) were selected from a cross-sectional database consisting of consecutive patients with cartilage injuries of the ankle and subsequently underwent prospective follow-up. Outcomes included return to sports outcomes, patient reported outcomes and a qualitative assessment regarding mental health Results: 26 patients with a median age of 22 years (IQR: 19.0 – 24.5) were included with a median follow-up time of 48 months (IQR: 34.5 – 71.0). Seven patients (27%) underwent conservative treatment and 19 patient (73%) operative treatment. Conservative treatment yielded a return to sport rate at any level of 86%, return to pre-injury and return to performance level of both 57%. For operative treatment these rates were 100%, 74% and 63% respectively. Mean time to return to pre-injury level overall was 8.3 months. At latest follow-up only 11 patients (44%) were still active at an elite level of sport. Conclusion: Both conservative and surgical treatment for osteochondral lesions of the ankle yielded return to sport rates above 86% in elite level athletes. The results of this study can be used in the decision-making process between the physician and the elite athlete to inform them about the expected return to sport rates and times for the different treatment options for OLT(P)s. As most athletes at the time of injury and treatment are still highly motivated and disciplined to return to their sport at the same level and be able to compete at the highest level available in their sport.

F. Ghasemi, Afsaneh Jahani, Ali Moradi et al.

Aftab Tariq, A. Gill, Hafiz Khawar Hussain

The potential of artificial intelligence (AI) to transform value-based healthcare in the area of orthopedic surgery is examined in this research. Orthopedic surgeons and healthcare systems may improve patient outcomes, increase efficiency, and alter care delivery by combining AI algorithms, cutting-edge data analytics, and novel technology. Through case studies and success stories, the article provides a thorough study of the advantages and prospects provided by AI in orthopedic surgery. These instances demonstrate how AI has been successfully applied to several facets of orthopedic surgery, including as diagnosis, planning of the surgical course, surgical navigation, postoperative care, and resource allocation. The ethical and legal ramifications of using AI are also discussed in the study, with a focus on patient autonomy, privacy, accountability, and any potential effects on the healthcare workforce. The potential applications of AI in orthopedic surgery are examined, together with developments in preoperative planning, surgical robotics, remote monitoring, predictive analytics, personalised medicine, research, and innovation. The promise of AI in orthopedic surgery is obvious, despite issues with data quality, privacy, algorithm biases, and legal constraints. The ethical and appropriate application of AI technology in orthopedic surgery has the potential to significantly enhance patient outcomes, lower complications, boost efficiency, and change the way healthcare is provided. This study lays the groundwork for future study and application in the field of orthopedic surgery by offering insightful information on the role of AI in delivering value-based healthcare.

Yun Seong Choi, T. Kim, M. Chang et al.

Background With increasing interest in enhanced recovery after surgery (ERAS), the literature on ERAS in orthopedic surgery is also rapidly accumulating. This review article aims to (1) summarize the components of the ERAS protocol applied to orthopedic surgery, (2) evaluate the outcomes of ERAS in orthopedic surgery, and (3) suggest practical strategies to implement the ERAS protocol successfully. Main body Overall, 17 components constituting the highly recommended ERAS protocol in orthopedic surgery were identified. In the preadmission period, preadmission counseling and the optimization of medical conditions were identified. In the preoperative period, avoidance of prolonged fasting, multimodal analgesia, and prevention of postoperative nausea and vomiting were identified. During the intraoperative period, anesthetic protocols, prevention of hypothermia, and fluid management, urinary catheterization, antimicrobial prophylaxis, blood conservation, local infiltration analgesia and local nerve block, and surgical factors were identified. In the postoperative period, early oral nutrition, thromboembolism prophylaxis, early mobilization, and discharge planning were identified. ERAS in orthopedic surgery reduced postoperative complications, hospital stay, and cost, and improved the patient outcomes and satisfaction with accelerated recovery. For successful implementation of the ERAS protocol, various strategies including the standardization of care system, multidisciplinary communication and collaboration, ERAS education, and continuous audit system are necessary. Conclusion The ERAS pathway enhanced patient recovery with a shortened length of stay, reduced postoperative complications, and improved patient outcomes and satisfaction. However, despite the significant progress in ERAS implementation in recent years, it has mainly focused on major surgeries such as arthroplasty. Therefore, further efforts to apply, audit, and optimize ERAS in various orthopedic surgeries are necessary.

Aparna Chunduri, A. Aggarwal

Background: Orthopedic surgery typically results in moderate to severe pain in a majority of patients. Opioids were traditionally the primary medication to target mechanisms of pain transmission. Multimodal analgesia has become a preferred method of pain management in orthopedic practice. Utilizing more than one mode to address post-surgical pain by recruiting multiple receptors through different medications accelerates the recovery process and decreases the need for opioids. By implementing effective analgesic techniques and interventions, this practice, in turn, decreases the usage of perioperative opioids, and in the long term, prevents addiction to pain medications and risk of opioid overdose. In orthopedic surgeries, previous studies have found that multimodal analgesia has reduced early opioid usage in the postoperative course. Pain is the result of direct injury to the nervous system, with a wide variety of chemicals directly stimulating or sensitizing the peripheral nociceptors. The pathophysiology behind the mechanism of post-surgical pain, along with the importance of preoperative, perioperative, and postoperative pain regimens are emphasized. A brief overview of pain medications and their properties is provided. These medications are further categorized, with information on special considerations and typical dosage requirements. Pain management should address both neuropathic and subjective types of pain. Effective pain control requires constant reassessment with individualized strategies. Conclusion: By focusing on multimodal analgesia, anesthesiologists can now utilize newer techniques for postoperative pain relief from orthopedic surgery, with better short-term and long-term outcomes for the patient.

P. Tan, Miao Huo, Xiaohua Zhou et al.

F. Salamanna, D. Contartese, S. Brogini et al.

Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized in all orthopedic fields, and there is still no consensus on the best implementation process. Here, we evaluated pre-, peri-, and post-operative key elements and clinical evidence of ERAS protocols, measurements, and associated outcomes in patients undergoing different orthopedic surgical procedures. A systematic literature search on PubMed, Scopus, and Web of Science Core Collection databases was conducted to identify clinical studies, from 2012 to 2022. Out of the 1154 studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on elbow surgery and 143 on hip and/or knee surgery) were considered eligible for this review. Results showed that ERAS protocols improve the recovery from orthopedic surgery, decreasing the length of hospital stays (LOS) and the readmission rates. Comparative studies between ERAS and non-ERAS protocols also showed improvement in patient pain scores, satisfaction, and range of motion. Although ERAS protocols in orthopedic surgery are safe and effective, future studies focusing on specific ERAS elements, in particular for elbow, thorax and spine, are mandatory to optimize the protocols.

F. Casari, N. Navab, L. Hruby et al.

Purpose of Review Augmented reality (AR) is becoming increasingly popular in modern-day medicine. Computer-driven tools are progressively integrated into clinical and surgical procedures. The purpose of this review was to provide a comprehensive overview of the current technology and its challenges based on recent literature mainly focusing on clinical, cadaver, and innovative sawbone studies in the field of orthopedic surgery. The most relevant literature was selected according to clinical and innovational relevance and is summarized. Recent Findings Augmented reality applications in orthopedic surgery are increasingly reported. In this review, we summarize basic principles of AR including data preparation, visualization, and registration/tracking and present recently published clinical applications in the area of spine, osteotomies, arthroplasty, trauma, and orthopedic oncology. Higher accuracy in surgical execution, reduction of radiation exposure, and decreased surgery time are major findings presented in the literature. Summary In light of the tremendous progress of technological developments in modern-day medicine and emerging numbers of research groups working on the implementation of AR in routine clinical procedures, we expect the AR technology soon to be implemented as standard devices in orthopedic surgery.