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Subsequent total joint arthroplasty: Are we learning from the first stage?

World Journal of Orthopedics 2024年第3期15卷 230-237页

作者： Christine Jiang Wu Colin Penrose Sean Patrick Ryan Michael Paul Bolognesi Thorsten Markus Seyler Samuel Secord Wellman department of Orthopaedic surgery Duke University HospitalDurhamNC 27710United States department of Orthopaedic surgery Midwest Center for Joint ReplacementIndianapolisIN 46241United States

BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(Psurgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decrea

关键词： Staged total joint arthroplasty Asynchronous total joint arthroplasty Subsequent total joint arthroplasty Contralateral total joint arthroplasty Perioperative outcomes

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Hemiarthroplasty for irreparable distal radius fractures in the elderly:A comprehensive review

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World Journal of Orthopedics 2024年第6期15卷 578-584页

作者： Adriano Cannella Ludovico Caruso Giulia Maria Sassara Giuseppe Taccardo Marco Passiatore Marina Marescalchi Rocco De Vitis department of orthopaedics Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Bone and joint surgery ASST-Spedali CiviliBrescia 25123Italy

BACKGROUND Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures(DRFs).However,further investigation with long-term follow-up is required to validate these initial findings.AIM To review the literature on the outcomes of distal radius hemiarthroplasty with available implants to assess its viability as a treatment option.METHODS A comprehensive review of the literature was conducted using electronic databases,including PubMed,Medline,and Scopus.The search terms employed were"distal radius fracture","hemiarthroplasty","wrist arthroplasty",and related terminology.The search was restricted to articles published in English from 1980 until June 2023.Inclusion criteria encompassed cases or case series of DRF treated with hemiarthroplasty,providing clinical or radiographic outcomes,and published in peer-reviewed journals.RESULTS A total of 2508 articles from PubMed and 883 from Scopus were identified initially.Following screening and removal of duplicates,13 articles met the inclusion criteria.These articles,predominantly clinical retrospective studies,provided insights into hemiarthroplasty outcomes,including functional improvements and complications.Hemiarthroplasty was a treatment option for complex DRF,particularly those cases with severe comminution,intraarticular involvement,or severe osteoporosis.Functional outcomes demonstrated improvements in pain relief,wrist mobility,and grip strength,with variability across studies.Complications included implant loosening,infection,nerve injury,and stiffness,with varying incidence rates influenced by surgical techniques and implant choice.Long-term outcomes were inadequately documented,warranting further research.CONCLUSION Hemiarthroplasty is a promising treatment for irreparable DRF in the elderly.Long-term outcomes and complications require further study.

关键词： Irreparable distal radius fracture Hemiarthroplasty Osteoporosis Wrist prosthesis Elderly

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Outcome of percutaneous reconstruction of chronic lateral collateral ligament rupture

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Chinese Journal of Traumatology 2024年第1期27卷 58-62页

作者： Soliudeen Adebayo Arojuraye Ibrahim Abolaji Alabi Ibrahim Usman Mustapha department of orthopaedics National Orthopaedic Hospital Dala-KanoNigeria department of surgery Bayero University KanoNigeria

Purpose:Many techniques have been described for the reconstruction of chronic lateral collateral ligament(LCL)rupture with different autograft options.The advantages of percutaneous LCL reconstruction include small incisions,minimal soft tissue disruption,less postoperative pain,and speedy rehabilitation and recovery.The aim of this study was to report the functional outcome of percutaneous LCL reconstruction and overall patient satisfaction in Africans.Methods:This prospective and interventional study involving 51 patients with chronic LCL rupture who had percutaneous LCL reconstruction using peroneus longus autograft was conducted between January 2021 and December 2022 in National Orthopaedic Hospital,Dala-Kano,Nigeria.The inclusion criteria were patients between the ages of 18 and 45 years with chronic isolated LCL and not more than 1 injury of knee ligament.Exclusion criteria were active infection,and multi-ligament knee injury requiring 2-staged surgery.The knee functions were assessed preoperatively,3 months,6 months,and 12 months postoperatively using the Lysholm scoring system.Patient satisfaction with the outcome of the treatment was assessed using a 5-point Likert scale.Relevant information was recorded into Microsoft Excel sheet and data was analyzed using SPSS version 23.0 for windows.The paired samples t-test was used to compare the clinical outcomes as continuous variables.Statistical significance was considered at psurgery was 7 months(ranging from 3 to 28 months).The mean follow-up period was(14.07±3.13)months.The mean preoperative and 1-year postoperative Lysholm scores were 44.33±12.97 and 97.96±1.23,respectively.Conclusion:Percutaneous LCL reconstruction using peroneus longus autograft significantly improves patient knee function and results in excellent patient satisfaction。

关键词： rupture ligament percutaneous

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In Situ Sustained Macrophage-Targeted Nanomicelle-Hydrogel Microspheres for Inhibiting Osteoarthritis

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Research 2024年第1期2023卷 1-16页

作者： XiaoXiao Li Xingchen Li Jielai Yang Yawei Du Liang Chen Gang Zhao Tingjun Ye Yuan Zhu Xiangyang Xu Lianfu Deng Wenguo Cui department of orthopaedics Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025P.R.China

There are stillchallenges in applying drug nanocarriers for in situ sustained macrophage targeting and regulation,due to the rapid clearance of nanocarriers and burst drug release invivo.Herein,a nanomicellehydrogel microsphere,characterized by its macrophage-targeted nanosized secondary structure that allows it to accurately bind to M1 macrophages through active endocytosis,is employed for in situ sustained macrophage targeting and regulation,and addresses the insufficient osteoarthritis therapeutic efficacy caused by rapid clearance of drug nanocarriers.The 3-dimensional structure of a microsphere can prevent the rapid escape and clearance of a nanomicelle,thus keeping it in joints,while the ligand-guided secondary structure can carry drugs to accurately target and enter M1 macrophages,and release drugs via the transition from hydrophobicity to hydrophilicity of nanomicelles under inflammatory stimulation inside the macrophages.

关键词： micelle release spheres

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Health economics for intra-capsular hip fractures undertaking fixation

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World Journal of Orthopedics 2024年第1期15卷 30-38页

作者： Anatole Wiik Thomas Ashdown Ian Holloway department of surgery Trauma and OrthopaedicsLondon North West University HealthcareLondon HA13UJUnited Kingdom department of surgery Trauma and OrthopaedicsLondon North West University HospitalLondon HA13UJUnited Kingdom

BACKGROUND Hip fracture is a common musculoskeletal injury in the elderly requiring surgery worldwide.The operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for fixation.AIM To determine the most beneficial method of fixation for patients with intracapsular hip fractures.METHODS A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation methods.Patient notes,electronic records and clinical codes for cost benefit were evaluated.A validated quality of life measure was collected at least 1 year after surgery.RESULTS A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective period.There were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age,gender,co-morbidities and fracture configuration.There was no significant difference in blood loss,tip apex distance,radiation exposure,length of stay,radiological union time,collapse,avascular necrosis or re-operation between fixation methods.Logistic regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of 7.25.There were 9(19%)and 4(11%)patients respectively,who required re-operation.There was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual CONCLUSION No significant advantage was identified with differing fixation type,but irrespective there were a high number of patients requiring re-operation.This was predicted by initial fracture displacement and patient age.Arthroplasty may need to be carefully considered for health economics and patient benefit.

关键词： Hip fracture Fixation Patient reported outcome measure Cost

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Correction method for moderate and severe degrees of hallux valgus associated with transfer metatarsalgia

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World Journal of Orthopedics 2024年第3期15卷 238-246页

作者： Amangasy Zhanaspayev Nurlan Bokembayev Marat Zhanaspayev Aidos Tlemissov Sabina Aubakirova Alexander Prokazyuk department of Traumatology and orthopaedics The National Scientific Center of Traumatology and Orthopaedics Named after Academician Batpenov NDAstana 010000Kazakhstan department of Traumatology and Paediatric surgery Non-Commercial Joint-Stock Company“Semey Medical University”Semey 071400Kazakhstan department of Habilitation and Rehabilitation Center of Habilitation and Rehabilitation of Persons with Disabilities of the Abai RegionSemey 071400Kazakhstan department of Anaesthesiology and Resuscitation Center of Nuclear Medicine and OncologySemey 071400Kazakhstan

BACKGROUND Hallux valgus(HV)is a common foot deformity that manifests with increasing age,especially in women.The associated foot pain causes impaired gait and decreases quality of life.Moderate and severe HV is a deformity that is charac-terized by the involvement of lesser rays and requires complex surgical treatment.In this study,we attempted to develop a procedure for this condition.AIM To analyse the treatment results of patients who underwent simultaneous surgical correction of all parts of a static forefoot deformity.METHODS We conducted a prospective clinical trial between 2016 and 2021 in which 30 feet with moderate or severe HV associated with Tailor’s bunion and metatarsalgia were surgically treated via a new method involving surgical correction of all associated problems.This method included a modified Lapidus procedure,M2M3 tarsometatarsal arthrodesis,intermetatarsal fusion of the M4 and M5 bases,and the use of an original external fixation apparatus to enhance correction power.Preoperative,postoperative,and final follow-up radiographic data and American Orthopaedic Foot and Ankle Society(AOFAS)scores were compared,and P values<0.05 were considered to indicate statistical significance.RESULTS The study included 28 females(93.3%)and 2 males feet(6.7%),20(66.7%)of whom had a moderate degree of HV and 10(33.3%)of whom had severe deformity.M2 and M3 metatarsalgia was observed in 21 feet,and 9 feet experienced pain only at M2.The mean follow-up duration was 11 months.All patients had good correction of the HV angle[preoperative median,36.5 degrees,interquartile range(IQR):30-45;postoperative median,10 degrees,IQR:8.8-10;follow-up median,11.5 degrees,IQR:10-14;P<0.01].At follow-up,metatarsalgia was resolved in most patients(30 vs 5).There was a clinically negligible decrease in the corrected angles at the final follow-up,and the overall AOFAS score was significantly better(median,65 points,IQR:53.8-70;vs 80 points,IQR:75-85;P<0.01).CONCLUSION The developed method showed good sustainability of correction po

关键词： Hallux valgus Metatarsalgia Tailor’s bunion Lapidus procedure Proximal metatarsal osteotomy Splayfoot

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Review and update on the management of triangular fibrocartilage complex injuries in professional athletes

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World Journal of Orthopedics 2024年第2期15卷 110-117页

作者： Valerio Pace Francesco Bronzini Giovanni Novello Giuseppe Mosillo Luca Braghiroli department of Trauma and orthopaedics AOSP TerniTerni 05100Italy department of Trauma and orthopaedics University of PerugiaPerugia 06100Italy department of Trauma and orthopaedics Hand UnitAOSP TerniTerni 05100Italy

Triangular fibrocartilage complex injuries are common in amateur and professional sports.These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist,particularly on the ulnar side and in association with rotations or radial/ulnar deviations.In order to treat professional athletes,a detailed specific knowledge of the pathology is needed.Moreover,the clinician should fully understand the specific and unique environment and needs of the athletes,their priorities and goals,the type of sport,the time of the season,and the position played.An early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon.A compromise between conservative vs surgical indications,athletes’needs and expectations,and financial implications should be achieved.Arthroscopic procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same time.Conservative measures are often used as first line treatment when possible.Peripheral lesions are treated by arthroscopic repair,whilst central lesions are treated by arthroscopic debridement.Further procedures(such as the Wafer procedure,ulnar osteotomies,etc.)have specific indications and great implications with regard to rehabilitation.

关键词： Triangular fibrocartilage complex injuries Professional athletes Ulnar sided wrist pain Wrist arthroscopy Wrist debridement

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An analysis of the transcriptional landscape in hypoxia-treated primary nucleus pulposus cells

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Genes & Diseases 2024年第2期11卷 558-560页

作者： Zhicai Peng Zhuo Wang Shuaichi Guo Bing Tan Ruichao Cao Shengqiang Cheng Jun Chen Chunwang Xie Dehong Mao Zhenming Hu department of orthopaedics Yongchuan Traditional Chinese Medicine Hospital of ChongqingChongqing 402160China department of Orthopaedic surgery The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400010China department of Spine surgery The Third Hospital of MianyangSichuan Mental Health CenterMianyangSichuan 621000China

Intervertebral disc degeneration(IDD)is the main cause of lower back pain.Lower back pain places a huge burden on society,and all current treatments for IDD cannot restore the original function of the intervertebral disc.Proposing new treatments for IDD requires clarifying the mechanisms of IDD.Physiological hypoxia is an important feature of the nucleus pulposus because of its special anatomical structure.Using RNA sequencing(RNA-seq),we obtained the whole transcriptome of nucleus pulposus cells(NPCs)under hypoxia and hypoxia-inducible factor(HIF1A)deletion.Results demonstrated possible effects of oxygen concentration and HIF1A on NPCs.In addition,our results showed that hypoxia can affect lipid metabolism in NPCs.

关键词： structure metabolism degeneration

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Which approach of total hip arthroplasty is the best efficacy and least complication?

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World Journal of Orthopedics 2024年第1期15卷 73-93页

作者： Lertkong Nitiwarangkul Natthapong Hongku Oraluck Pattanaprateep Sasivimol Rattanasiri Patarawan Woratanarat Ammarin Thakkinstian Clinical Epidemiology and Biostatistics Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkok 10400Thailand orthopaedics surgery Police General HospitalBangkok 10330Thailand department of orthopaedics Faculty of Medicine Vajira HospitalNavamindrahiraj UniversityBangkok 10300Thailand department of orthopaedics Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkok 10400Thailand

BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,

关键词： Total hip arthroplasty Total hip replacement Approach Supercapsular percutaneously-assisted total hip Harris Hip Score Intra-operative fracture

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Deep learning automation of radiographic patterns for hallux valgus diagnosis

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World Journal of Orthopedics 2024年第2期15卷 105-109页

作者： Angela Hussain Cadence Lee Eric Hu Farid Amirouche department of Orthopaedic surgery University of Illinois College of MedicineChicagoIL 60612United States department of orthopaedics surgery University of Illinois at ChicagoChicagoIL 60612United States department of Orthopaedic surgery Northshore University Health SystemSkokieIL 6007United States

Artificial intelligence(AI)and deep learning are becoming increasingly powerful tools in diagnostic and radiographic medicine.Deep learning has already been utilized for automated detection of pneumonia from chest radiographs,diabetic retinopathy,breast cancer,skin carcinoma classification,and metastatic lymphadenopathy detection,with diagnostic reliability akin to medical experts.In the World Journal of Orthopedics article,the authors apply an automated and AIassisted technique to determine the hallux valgus angle(HVA)for assessing HV foot deformity.With the U-net neural network,the authors constructed an algorithm for pattern recognition of HV foot deformity from anteroposterior highresolution radiographs.The performance of the deep learning algorithm was compared to expert clinician manual performance and assessed alongside clinician-clinician variability.The authors found that the AI tool was sufficient in assessing HVA and proposed the system as an instrument to augment clinical efficiency.Though further sophistication is needed to establish automated algorithms for more complicated foot pathologies,this work adds to the growing evidence supporting AI as a powerful diagnostic tool.

关键词： Artificial intelligence Hallux valgus Deep learning Automated radiography

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