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Reducing costly falls after total knee arthroplasty

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World Journal of Orthopedics 2018年第10期9卷 198-202页

作者： Surajudeen Adebola Bolarinwa Wendy Novicoff Quanjun Cui department of orthopaedic surgery University of Virginia Health System

AIM To investigate whether adductor canal nerve block(ACB) reduces patient falls when compared to femoral nerve block(FNB) after total knee arthroplasty(TKA). METHODS We conducted an institutional review of all-cause falls after TKA from January 2013 to August 2016 using a quality improvement database. Our inclusion criteria were patients with diagnosis of primary knee osteoarthritis who underwent primary unilateral TKA with either a FNB or an ACB and sustained a fall during their hospitalization. We excluded patients who had revision TKA and extensor mechanism reconstruction. We also excluded patients with a history of post-traumatic arthritis, prior history of lower extremity fracture, history of neurological disease, or cerebrovascular disease. RESULTS A total of 834 patients had TKA with femoral nerve block and knee immobilizer(FNB + KI). Of those patients, 11(1.3%) experienced a fall during their hospital stay. In contrast, 791 patients had TKA with ACB. Of those patients, only one(0.13%) patient fall was recorded within this group. We used the Fisher's exact test to compare the differences between the two groups. The difference between the two groups achieves statistical significance(P = 0.006). We also found that 11 out of the 12 patients that fell had a right TKA procedure while one patient had a left TKA procedure. Nine out of twelve patients that fell were female, while only three patients were *** Given the reduction in the number of falls with ACB, it is recommended that ACB be considered the preferred analgesia for patients undergoing a TKA procedure.

关键词： Reducing falls Adductor canal nerve block Total knee arthroplasty Femoral nerve block Costly falls

Using a Patient-Specific 3D-Printed Surgical Guide for High Tibial Osteotomy:A Technical Note

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Journal of Shanghai Jiaotong university(Science) 2021年第3期26卷 339-345页

作者： JIANG Xu XIE Kai LI Bo HU Xumin WU Haishan GAO Liangbin WANG Liao YAN Mengning Shanghai Key Laboratory of orthopaedic Implants Department of Orthopaedic SurgeryShanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai200011China department of orthopaedic surgery Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhou510120China

Patient-specific instrumentation(PSI)enables a more accurate alignment of the lower limbs in a high tibial osteotomy(HTO)than in traditional surgery;however,the current design of commercial PSIs is not ***,we designed a new patient-specific surgical guide to improve the accuracy of the osteotomy and verified its reliability through a clinical ***,we describe a patient with isolated medial-compartment bilateral knee osteoarthritis,accompanied by a varus deformity of the proximal *** patient was treated with HTO using a patient-specific 3D-printed surgical *** concluded that the patient-specific 3D-printed surgical guide improved the accuracy of the osteotomy and the alignment of the lower limb.

关键词： high tibial osteotomy(HTO) 3D printing patient-specific instrumentation(PSI) wedge augment

Knee locking caused by osteochondroma of the proximal tibia adjacent to the pes anserinus:A case report

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World Journal of Clinical Cases 2023年第23期11卷 5595-5601页

作者： Tatsuru Sonobe Michiyuki Hakozaki Yohei Matsuo Yojiro Takahashi Katsuhiro Yoshida Shinichi Konno department of orthopaedic surgery Fukushima Medical University School of MedicineFukushima 960-1295Japan department of orthopaedic surgery Fukushima General Health and Welfare CentreFukushima 963-8041Japan Higashi-Shirakawa orthopaedic Academy Fukushima Medical University School of MedicineFukushima 960-1295Japan department of orthopaedic surgery Fujita General HospitalFukushima 969-1793Japan

BACKGROUND Osteochondroma is one of the most common benign bone tumors,and it may cause bone and joint deformities and limited range of motion of an adjacent *** pes anserinus region is one of the most frequent sites of osteochondroma,but knee locking caused by osteochondromas in the pes anserinus region is extremely *** SUMMARY We describe a 13-year-old Japanese girl’s extra-articular knee locking that occurred when the semitendinosus tendon got caught in osteochondroma that had developed in the pes anserinus *** osteochondroma was surgically *** postoperative outcome has been excellent,with no recurrence of knee locking or tumor one-year *** When a young person develops knee locking,the possibility of extra-articular as well as intra-articular locking should be ***,one of the causes of extra-articular locking,can be treated with surgery with good postoperative results.

关键词： Extra-articular knee locking Impingement Osteochondroma Pes anserinus Tibia surgery Case report

Multi-factorial sustainability approach is necessary to preserve knee function following osteoarthritis diagnosis

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World Journal of Orthopedics 2013年第4期4卷 175-177页

作者： John Nyland Roland Jakob Division of Sports Medicine Department of Orthopaedic Surgery University of Louisville orthopaedic surgery Hopital Cantonal CH-1701 Fribourg Switzerland

Knee function preservation following a diagnosis of osteoarthritis may benefit from healthy patient lifestyles, exercise or activity habits, and daily living routines. Underlying societal issues and social roles may contribute further to both ecological and knee function preservation concerns. Based on sustainability theory and social ecology concepts we propose that factors such as health history, genetic predisposition, socioenvironmental factors and local-regional-global physiological system viability contribute to knee function preservation. Addressing only some of these factors or any one factor in isolation can lead the treating physician, surgeon and rehabilitation clinician to less than optimal treatment effectiveness. An example is presented of a 57-year-old man with medial tibiofemoral osteoarthritic. In the intervention decision-making process several factors are important. Patients who would benefit from early knee arthroplasty tend to place osteoarthritis knee pain elimination at the top of their list of treatment expectations. They also have minimal or no desire to continue impact sport, recreational or vocational activities. In contrast, patients who are good candidates for a knee function preservation treatment approach tend to have greater expectations to be able to continue impact sport, recreational or vocational activities, are willing and better able to implement significant behavioral changes and develop the support systems needed for their maintenance, are willing to tolerate and live with minor-to-moderate intermittent knee pain, and learn to become more pain tolerant.

关键词： Knee surgery Treatment planning Comprehensive care

Stability of unicortical locked fixation versus bicortical non-locked fixation for forearm fractures

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Bone Research 2014年第2期2卷 131-135页

作者： Timothy J Pater Steve I Grindel Gregory J Schmeling Mei Wang department of orthopaedic surgery Medical College of Wisconsin Milwaukee WI USA orthopaedic & Rehabilitation Engineering Center Marquette University Milwaukee WI USA

Locking plate fixation is being widely applied for fixation of forearm fractures and has many potential advantages, such as fixed angle fixation and improved construct stability, especially in osteoporotic bone. Biomechanical data comparing locking devices to commonly used Low Contact Dynamic Compression （LCDCP） plates for the fixation of forearm fractures has been lacking. The purpose of this study was to compare the fixation stability of a 3.5-mm unicortical locked plate with bicortical non-locked LCDCP plates. Six matched pairs of fresh frozen cadaveric forearms were randomly assigned to unicortical locked and bicortical unlocked groups. Non-destructive four-point bending and torsional test was performed on the ulna and radius separately, using a servohydraulic testing system to obtain construct stiffness of the intact specimens and specimens after osteotomy and plating. The specimens were then loaded to failure to test the fixation strength. The locked unicortical fixation showed significantly higher bending stiffness than the unlocked bicortical fixation, but with significantly lower stiffness and strength in torsion. Fixation strength was comparable between the two groups under bending, but significantly greater in the bicortical non-locked group under torsion. Findings from this study suggest that postoperative rehabilitation protocols may need modification to limit torsional loading in the early stage when using locked unicortical fixation. The study also points out the potential advantage of a hybrid fixation that combines locked unicortical and unlocked bicortical screws.

关键词： Stability of unicortical locked fixation versus bicortical non-locked fixation for forearm fractures

Complications associated with posterior lumbar interbody fusion using Bagby and Kuslich method for treatment of spondylolisthesis

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Chinese Medical Journal 2003年第1期116卷 99-103页

作者：陈亮唐天驷杨惠林 department of orthopaedic surgery

Objective To analyze complications associated with posterior lumbar interbody fusion (PLIF) in which two Bagby and Kuslich (BAK) interbody fusion cages were *** A total of 118 patients with spondylolytic spondylolisthesis underwent single-level PLIF using two BAK cages filled with morselized autogenous bone. The major clinical and radiographic complications were analyzed after a follow-up with an average time of 2 years and 9 *** Complications were divided into intraoperative and postoperative complications. Intraoperative complications mainly included dural tear (4 patients, 3.4%), nerve root injury (3 patients, 2.5%) and suboptimal cage position (9 patients, 7.5%). No death was caused by the operation. Postoperative complications chiefly consisted of cage retropulsion (3 patients, 2.5%), cage subsidence (4 patients, 3.4%), and postlaminectomy arachnoiditis (2 patients, 1.7%). Pseudarthrosis was noted radiographically with evidence of motion between adjacent vertebra on lateral flexion-extension films and luciencies around the cages (2 patient, 1.7%), continuous posterior cage migration (2 patients, 1.7%) or continuous cage subsidence (2 patients, 1.7%). Two patients died, one from a traffic accident and the other from metastatic cancer 1 year *** The results of this study indicate that PLIF with BAK cages is an effective but also technically difficult procedure. The relatively high incidence of complications reminds us of the importance of surgical indications and proper manipulations.

关键词： complication spondylolisthesis posterior lumbar interbody fusion BAK interbody fusion cage

Multi-length scale bioprinting towards simulating microenvironmental cues

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Bio-Design and Manufacturing 2018年第2期1卷 77-88页

作者： Elisabeth L Gill Xia Li Mark A. Birch Yan Yan Shery Huang department of Engineering University of CambridgeTrumpington Street Cambridge CB2 1PZ UK Division of Trauma and orthopaedic surgery Department of Surgery University of Cambridge Cambridge UK

It is envisaged that the creation of cellular environments at multiple length scales, that recapitulate in vivo bioactive and structural roles, may hold the key to creating functional, complex tissues in the laboratory. This review considers recent advances in biofabrication and bioprinting techniques across different length scales. Particular focus is placed on 3D printing of hydrogels and fabrication of biomaterial fibres that could extend the feature resolution and material functionality of soft tissue constructs. The outlook from this review discusses how one might create and simulate microenvironmental cues in vitro. A fabrication platform that integrates the competencies of different biofabrication technologies is proposed. Such a multi-process, multiscale fabrication strategy may ultimately translate engineering capability into an accessible life sciences toolkit, fulfilling its potential to deliver in vitro disease models and engineered tissue implants.

关键词： 3D bioprinting Electrospinning Additive manufacturing Microenvironment Disease modelling Tissueengineering

RANKL-induced M1 macrophages are involved in bone formation

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Bone Research 2017年第4期5卷 317-329页

作者： Rong Huang Xin Wang Yinghong Zhou Yin Xiao The Institute of Health and Biomedical Innovation Queensland University of Technology department of orthopaedic surgery Affiliated Hospital of Zunyi Medical University

The activation of M1 macrophages can be achieved by stimulating them with lipopolysaccharide （LPS） and interferon-γ （IFN-γ）. However, M1 can be found under physiological conditions without any pathological stimuli. This study aimed to understand the involvement of RANKL-induced M1 macrophages in bone formation compared with pathologically induced macrophages. Fischer rats were used to investigate macrophage distribution in normal and injured femoral condyles in vivo. Bone marrow-derived macrophages （BMDMs） were activated with LPS＋IFN-γ and RANKL to achieve M1 activation in vitro. Gene expression related to inflammation, osteoclastogenesis, angiogenesis, and migration was determined by reverse transcription-quantitative polymerase chain reaction （RT-qPCR） and fluorescence-activated cell sorting （FACS）. Tissue macrophages showed distinct expression patterns at different bone regions. RANKL was found in close proximity to inducible nitric oxide synthase-positive （iNOS＋） cells in vivo, suggesting an association between RANKL expression and iNOS＋ cells, especially in trabecular bone. RANKL-induced macrophages showed a different cytokine secretion profile compared with pathologically induced macrophages. Both osteoclasts and M1 macrophages peaked on day 7 during bone healing. RANKL could trigger Ml-like macrophages with properties that were different from those of LPS＋IFN-γ-induced macrophages. These RANKL-activated M1 macrophages were actively involved in bone formation.

关键词： RANKL-induced M1 macrophages are involved in bone formation

Low-intensity pulsed ultrasound therapy: a potential strategy to stimulate tendon-bone junction healing

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2012年第12期13卷 955-963页

作者： Zhi-min YING Tiao LIN Shi-gui YAN department of orthopaedic surgery the Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310009China department of orthopaedic Research Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusetts 02115USA

Incorporation of a tendon graft within the bone tunnel represents a challenging clinical problem. Successfulanterior cruciate ligament (ACL) reconstruction requires solid healing of the tendon graft in the bone tunnel. En-hancement of graft healing to bone is important to facilitate early aggressive rehabilitation and a rapid return topre-injury activity levels. No convenient, effective or inexpensive procedures exist to enhance tendon-bone (T-B)healing after surgery. Low-intensity pulsed ultrasound (LIPUS) improves local blood perfusion and angiogenesis,stimulates cartilage maturation, enhances differentiation and proliferation of osteoblasts, and motivates osteogenic differentiation of mesenchymal stem cells (MSCs), and therefore, appears to be a potential non-invasive tool for T-Bhealing in early stage of rehabilitation of ACL reconstruction. It is conceivable that LIPUS could be used to stimulateT-B tunnel healing in the home, with the aim of accelerating rehabilitation and an earlier return to normal activities inthe near future. The purpose of this review is to demonstrate how LIPUS stimulates T-B healing at the cellular andmolecular levels, describe studies in animal models, and provide a future direction for research.

关键词： Low-intensity pulsed ultrasound ACL reconstruction Ultrasound Anterior cruciate ligament reconstruction LIPUS Tendon-bone interface healing Fracture healing