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Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis

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World Journal of Orthopedics 2022年第4期13卷 381-387页

作者： Vasiliki Fesatidou Evangelos Petsatodis dimitrios kitridis Panagiotis Givissis Efthimios Samoladas 4^(th)Department of General Surgery Aristotle University of ThessalonikiSchool of MedicineThessaloniki 54124Greece Department of Interventional Radiology Papanikolaou General Hospital of ThessalonikiThessaloniki 57010Greece 1^(st)Orthopaedic Department Aristotle University of ThessalonikiSchool of MedicineThessaloniki 54124Greece

BACKGROUND Iliopsoas muscle abscess(IPA)and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management.They are both frequently related to underlying conditions,such as immunosuppression,and in many cases they are combined.IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process,including spondylodiscitis.Computed tomographyguided percutaneous drainage has been established in the current management of this condition.AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.METHODS Patient demographics,clinical presentation,underlying conditions,isolated microorganisms,antibiotic regimes used,abscess size,days until the withdrawal of the catheter,and final treatment outcomes were recorded and analyzed.RESULTS All patients presented with night back pain and local stiffness with no fever.The laboratory tests revealed elevated inflammatory markers.Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases.Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients.Negative cultures were found in the remaining 3 patients.The treatment protocol included percutaneous computed tomographyguided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy.All procedures were done in an outpatient setting with no need for patient hospitalization.CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.

关键词： Iliopsoas abscess Spondylodiscitis Percutaneous drainage Minimally invasive Outpatient Immunocompromised

Viral infections in orthopedics: A systematic review and classification proposal

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World Journal of Orthopedics 2022年第11期13卷 1015-1028页

作者： Konstantinos Sidiropoulos Savvas Ilias Christofilos Konstantinos Tsikopoulos dimitrios kitridis Lorenzo Drago Gabriele Meroni Carlo Luca Romanò Venu Kavarthapu General Hospital of Serres Serres 62100Greece Department of Genetics Evolution and EnvironmentUniversity College LondonLondon WC1E 6BTUnited Kingdom Department of Orthopaedics 404 Army General HospitalLarissa 41222Greece the First Department of Orthopaedics Aristotle University of ThessalonikiThessaloniki 54124Greece Department of Biomedical Sciences for Health and Microbiome University of MilanMilan 20133Italy Department of Biomedical Surgicaland Dental SciencesOne Health UnitUniversity of MilanMilan 20133Italy Gruppo di Studio SIOT Infezioni-Clinica San Gaudenzio-Novara-Gruppo Policlinico di Monza University of MilanMilan 20100Italy Trauma and OrthopaedicsKings College Hospital LondonDenmark HillLondon SE59RSUnited Kingdom

BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.METHODS We searched MEDLINE,Cochrane Central Register of Controlled Trials(CENTRAL),the Reference Citation Analysis(RCA),and Scopus for completed studies published before January 30,2021,to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries.Quality assessment was performed using SYRCLE's risk of bias tool for animal studies,Moga score for case series,Wylde score for registry studies,and Newcastle-Ottawa Scale for case-control studies.RESULTS Six human and four animal studies were eligible for inclusion in the qualitative synthesis.Hepatitis C virus was implicated in several peri-and post-operative complications in patients without cirrhosis after major orthopedic surgery.Herpes virus may affect the integrity of lumbar discs,whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.CONCLUSION Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis.Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms.Therefore,based on our literature search,the proposed clinical and pathogenetic classification scheme is as follows:(1)Viral infections of bone or joint;(2)Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues;and(3)Viral infection as a risk factor for post-surgical bacterial infection.

关键词： Viral infection Musculoskeletal system Bone and joint manifestations Chikungunya Zika Hepatitis C virus Herpesviridae Ross River virus Cross-reactivity Classification

In vitro laboratory infection research in orthopaedics:Why,when,and how

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世界骨科杂志:英文版 2023年第8期14卷 598-603页

作者： Konstantinos Tsikopoulos Lorenzo Drago Gabriele Meroni dimitrios kitridis Byron Chalidis Fotios Papageorgiou Paraskevi Papaioannidou 1^(st)Department of Pharmacology School of MedicineFaculty of Health SciencesAristotle University of ThessalonikiThessaloniki 54124Greece Department of Biomedical Sciences for Health School of MedicineUniversity of MilanMilan 20133Italy Department of Biomedical Surgical and Dental SciencesUniversity of MilanMilan 20133Italy 1^(st)Department of Orthopaedic School of MedicineFaculty of Health SciencesAristotle University of ThessalonikiThessaloniki 57010Greece Department of Orthopaedic Surgery 404 General Army HospitalLarisa 41222Greece 1^(st)Department of Pharmacology Aristotle University of ThessalonikiThessaloniki 54124Greece

The musculoskeletal system involves multiple tissues which are constantly exposed to being exposed to various biological and mechanical stimuli.As such,isolating and studying a particular system from a complex human clinical environment is not always a realistic expectation.On top of that,recruitment limitations,in addition to the nature of orthopaedic interventions and their associated cost,sometimes preclude consideration of human trials to answer a clinical question.Therefore,in this mini review,we sought to rationalize the rapid evolution of biomedical research at a basic scientific level and explain why the perception of orthopaedic conditions has fundamentally changed over the last decades.In more detail,we highlight that the number of orthopaedic in vitro publications has soared since 1990.Last but not least,we elaborated on the minimum requirements for conducting a scientifically sound infection-related laboratory experiment to offer valuable information to clinical practitioners.We also explained the rationale behind implementing molecular biology techniques,ex vivo experiments,and artificial intelligence in this type of laboratory research.

关键词： Biofilm In vitro Laboratory research Methodology

Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty

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World Journal of Orthopedics 2021年第12期12卷 1008-1015页

作者： Byron Chalidis dimitrios kitridis Panagiotis Givissis The First Orthopaedic Department Aristotle University of ThessalonikiSchool of MedicineThessaloniki 57010Greece

BACKGROUND Development of infrapatellar saphenous neuroma(ISN)is a well-recognized reason for knee pain following total knee arthroplasty(TKA).So far,very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient satisfaction.AIM To present the results of surgical treatment for ISN after primary TKA,the level of pain relief,and the improvement of knee motion and function.METHODS Fifteen patients(13 women,2 men)with persistent medial pain for more than six months after primary TKA,due to osteoarthritis,underwent surgical excision of ISN.ISN diagnosis was confirmed with the presence of Tinel’s sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local anesthetic.Component loosening,malalignment,instability and infection were excluded systematically in all patients as a source of pain.Pain relief in terms of visual analog scale(VAS),active knee range of motion(ROM),and the Knee Society Score(KSS)for pain and function were evaluated preoperatively and at least six months postoperatively.RESULTS The mean patients’age was 71.3±5.4 years old.The mean interval between TKA and neuroma excision was 10 mo(range,6 to 14 mo),while the mean follow-up was 8 mo(range:6 to 11 mo).All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after surgery.Pain on the VAS scale improved from 8.6±1.3 preoperatively to 0.8±0.9 at the final follow-up(P=0.001).KSS pain and function scores were improved from 49.3±5.9 and 62.7±12.8 before surgery to 91.8±4.2 and 75.3±11.3 after surgery,respectively(P=0.001 and P=0.015).Active knee ROM was also increased postoperatively from 96±4 to 105±6 degrees(P=0.001).There were no complications and no further operations required.CONCLUSION ISN should be considered a potential cause of persistent pain following TKA.Neuroma excision not only provides immediate pain relief and resolution of symptoms but may also improve th

关键词： Total knee arthroplasty Infrapatellar branch of saphenous nerve Neuroma Neurogenic pain Knee osteoarthritis

Network meta-analyses: Methodological prerequisites and clinical usefulness

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World Journal of Methodology 2022年第3期12卷 92-98页

作者： Savvas Ilias Christofilos Konstantinos Tsikopoulos Alexios Tsikopoulos dimitrios kitridis Konstantinos Sidiropoulos Panagiotis Nikolaos Stoikos Venu Kavarthapu Department of Genetics Evolutionand EnvironmentUniversity College LondonLondon WC1E 6BTUnited Kingdom Department of Pharmacology School of MedicineFaculty of Health Sciences Aristotle University of ThessalonikiThessaloniki 54124Greece Department of Otolaryngology-Head and Neck Surgery AHEPA University General HospitalAristotle University of ThessalonikiThessaloniki 57010Greece Department of Orthopaedics Aristotle University of ThessalonikiSchool of MedicineGeorge Papanikolaou Hospital ThessalonikiThessaloniki 57010Greece Department of Orthopedics General Hospital of SerresSerres 62100Greece Department of Medicine University of ThessalyLarissa 41500Greece Department of Trauma and Orthopaedics King’s College Hospital NHS Foundation TrustLondon SE59RSUnited Kingdom

It is an undeniable fact that systematic reviews play a crucial role in informing clinical practice;however,conventional head-to-head meta-analyses do have limitations.In particular,studies can only be compared in a pair-wise fashion,and conclusions can only be drawn in the light of direct evidence.In contrast,network meta-analyses can not only compare multiple interventions but also utilize indirect evidence which increases their precision.On top of that,they can also rank competing interventions.In this mini-review,we have aimed to elaborate on the principles and techniques governing network meta-analyses to achieve a methodologically sound synthesis,thus enabling safe conclusions to be drawn in clinical practice.We have emphasized the prerequisites of a well-conducted Network Meta-Analysis(NMA),the value of selecting appropriate outcomes according to guidelines for transparent reporting,and the clarity achieved via sophisticated graphical tools.What is more,we have addressed the importance of incorporating the level of evidence into the results and interpreting the findings according to validated appraisal systems(i.e.,the Grade of Recommendations,Assessment,Development,and Evaluation system-GRADE).Lastly,we have addressed the possibility of planning future research via NMAs.Thus,we can conclude that NMAs could be of great value to clinical practice.

关键词： Network meta-analysis Quality of evidence Evidence-based medicine Systematic reviews

Assessing the accuracy of arthroscopic and open measurements of the size of rotator cuff tears: A simulation-based study

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World Journal of Orthopedics 2021年第12期12卷 983-990页

作者： dimitrios kitridis Dimosthenis Alaseirlis Nikolaos Malliaropoulos Byron Chalidis Patrick McMahon Richard Debski Panagiotis Givissis Orthopaedic Department Aristotle University of ThessalonikiSchool of MedicineThessaloniki 54124Greece William Harvey Research Institute Centre for Sports and ExerciseBarts and The London School of Medicine and DentistryQueen MaryUniversity of LondonLondon EC1M 6BQUnited Kingdom McMahon Orthopedics and Rehabilitation University of PittsburghPittsburghPA 15203United States Department of Bioengineering Swanson School of EngineeringUniversity of PittsburghPittsburghPA 15219United States

BACKGROUND Arthroscopic procedures are commonly performed for rotator cuff pathology.Repair of rotator cuff tears is a commonly performed procedure.The intraoperative evaluation of the tear size and pattern contributes to the choice and completion of the technique and the prognosis of the repair.AIM To compare the arthroscopic and open measurements with the real dimensions of three different patterns of simulated rotator cuff tears of known size using a plastic shoulder model.METHODS We created three sizes and patterns of simulated supraspinatus tears on a plastic shoulder model(small and large U-shaped,oval-shaped).Six orthopaedic surgeons with three levels of experience measured the dimensions of the tears arthroscopically,using a 5 mm probe,repeating the procedure three times,and then using a ruler(open technique).Arthroscopic,open and computerized measurements were compared.RESULTS A constant underestimation of specific dimensions of the tears was found when measured with an arthroscope,compared to both the open and computerized measurements(mean differences up to-7.5±5.8 mm,P<0.001).No differences were observed between the open and computerized measurements(mean difference-0.4±1.6 mm).The accuracy of arthroscopic and open measurements was 90.5%and 98.5%,respectively.When comparing between levels of experience,senior residents reported smaller tear dimensions when compared both to staff surgeons and fellows.CONCLUSION This study suggests that arthroscopic measurements of full-thickness rotator cuff tears constantly underestimate the dimensions of the tears.Development of more precise arthroscopic techniques or tools for the evaluation of the size and type of rotator cuff tears are necessary.

关键词： Shoulder Arthroscopy Simulation model Rotator cuff tear Supraspinatus tear Cuff tear size

Tibial tubercle osteotomy in revision total knee arthroplasty: A systematic review

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World Journal of Orthopedics 2020年第6期11卷 294-303页

作者： Byron Chalidis dimitrios kitridis Panagiotis Givissis 1^st Orthopaedic Department Aristotle University of ThessalonikiGeorge Papanikolaou HospitalThessaloniki 55210Greece

BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-related complications such as nonunion, tibial tubercle migration and fragmentation, and metalware related pain.AIM To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.METHODS MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.RESULTS Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases,respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.CONCLUSION The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.

关键词： Tibial tubercle osteotomy Knee flexion Extension lag Union Revision total knee arthroplasty Stiff knee

Rationalising animal research synthesis in orthopaedic literature

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World Journal of Methodology 2021年第3期11卷 75-80页

作者： Konstantinos Tsikopoulos Konstantinos Sidiropoulos dimitrios kitridis Lorenzo Drago Rakesh Ebnezar David Lavalette Orthopaedic Department Harrogate and District Foundation TrustHarrogate HG27SXNorth YorkshireUnited Kingdom Orthopaedic Department General Hospital of SerresSerres 62120Greece First Orthopedic Department of Aristotle University G.Papanikolaou General HospitalThessaloniki 55210Greece Laboratory of Clinical Microbiology Department of Biochemical Sciences for HealthUniversity of MilanMilan 20164Italy

Systematic reviews in orthopaedic literature are frequently criticised for offering inconsistent conclusions.On top of that,high-quality randomized human evidence on crucial orthopaedic topics is more often than not lacking.In this situation,pooling animal literature could offer an excellent insight into unanswered critical clinical questions,thus potentially improving healthcare.In this paper,we sought to present the rationale and basic principles governing meta-analysis of animal research.More specifically,we elaborated on the available evidence-based methods to achieve a scientifically sound animal data synthesis.In addition,we discussed result interpretation,strength of recommendations and clinical implications based on the results of these meta-analytic modalities.

关键词： Meta-analysis Animal research Evidence synthesis in vivo Orthopaedics