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Bone graft incorporation failure with inappropriate limb load transfer can lead to aseptic acetabular loosening of metal-on-metal prosthesis: A case report

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World Journal of Orthopedics 2024年第7期15卷 668-674页

作者： RafałStanisław Domagalski Bogdan Dugiełło Sonia Rokicka Szymon Czech RafałSkowroński Dominika Rokicka Marta Patrycja Wróbel Krzysztof Strojek Tomasz Stołtny district hospital of orthopaedics and trauma surgery in piekaryśląskie PiekaryŚląskie 41-940Poland district Railway hospital Medical University of SilesiaKatowice 40-760Poland Faculty of Medicine Medical University of GdańskGdańsk 80-210Poland “AlFA”orthopaedics and traumatology Center Białystok 15-763Poland Department of Internal Medicine Diabetology and Cardiometabolic DisordersFaculty of Medical Sciences ZabrzeMedical University of SilesiaZabrze 41-800Poland

BACKGROUND Aseptic acetabular loosening can result from various factors that can be categorized into groups:patient-related,surgeon-related and *** present a case of a 63-year-old patient who at first underwent a total hip arthro-plasty(THA)using a metal-on-metal bearing due to hip ***-up visits revealed no complications after the *** years after the THA,acetabular component loosening occurred due to subsequent trauma of the opposite hip,necessitating a revision THA using a ceramic-on-ceramic *** SUMMARY We aim to illustrate a rare case where the primary reason for undergoing THA revision was not only incomplete bone graft incorporation but also improper limb load *** the revision arthroplasty,a 9-year follow-up visit revealed improvements in all evaluation measures on questionnaire compared to the state before surgery:Harris Hip Score(before surgery:15;after surgery:95),Western Ontario and McMaster Universities Arthritis Index(before surgery:96;after surgery:0),and Visual Analogue Scale(before surgery:10;after surgery:1).CONClUSION Opposite-hip trauma caused a weight transfer to the limb after a THA *** process led to a stress shielding effect,resulting in acetabular component loosening.

关键词： Acetabular loosening limb load Stress shielding effect Revision hip arthroplasty Case report

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Stress fractures in uncommon location:Six case reports and review of the literature

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World Journal of Clinical Cases 2020年第18期8卷 4135-4150页

作者： Krzysztof Ficek Paulina Cyganik Jolanta Rajca Agnieszka Racut Aleksandra Kiełtyka Jerzy Grzywocz Grzegorz Hajduk Department of Science Innovation and DevelopmentGalen-OrthopaedicsBierun 43-150Poland Department of Physiotherapy The Jerzy Kukuczka Academy of Physical EducationKatowice 40-065Poland Industry Cooperation Department University of SilesiaKatowice 40-007Poland Diagnostic Imaging Department Helimed Diagnostic ImagingKatowice 40-760Poland Department of Spine surgery District Hospital of Orthopedics and Trauma SurgeryPiekaryŚląskie 41-940Poland

BACKGROUND Individuals’interest in sports activities has been increasing,contributing to more stress fracture occurrences in uncommon locations on the *** this study,several cases of stress fractures in atypical locations are presented,and the possibility of combining diagnostic methods to make accurate and quick diagnoses is ***,different causes of stress fractures,as well as various modalities of treatment,are *** potential factors of stress fractures were identified by a literature *** SUMMARY Six cases of stress fractures in the calcaneus,intermediate cuneiform bone,sacrum,tibia(bilateral),navicular bone and femoral neck are presented,with different types of diagnostic imaging and *** of the cases were associated with an aspect of mobility because all of the patients were physically active in various sport *** The type of therapeutic procedure selected should depend on the specific clinical case,i.e.,the patient’s condition and level of physical activity.

关键词： Stress fractures Case report Calcaneus Intermediate cuneiform bone Sacral bone Navicular bone

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trauma-induced“Macklin effect”with pneumothorax and large pneumomediastinum,disguised by allergy

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Frontiers of Medicine 2013年第3期7卷 386-388页

作者： Salomone Di Saverio Kenji Kawamukai Andrea Biscardi Silvia Villani luca Zucchini Gregorio Tugnoli Departments of Emergency and surgery Emergency Surgery and Trauma Surgery UnitTrauma CenterMaggiore Hospital-Bologna Local Health DistrictBolognaItaly Department of Thoracic surgery Trauma CenterMaggiore HospitalBolognaItaly Accident and Emergency Trauma CenterMaggiore HospitalBolognaItaly

A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs(NSAIDS).The triage nurse assigned the patient to Accident&Emergency(A&E)doctor as probable allergic reaction to *** X-ray(CXR),ordered after 24 hours,revealed a huge subcutaneous chest and neck emphysema without clearly visible *** chest CT scan showed a small left pneumothorax and a large amount of air in the *** patient was conservatively treated since he was eupnoeic and hemodynamically *** pathophysiology of pneumomediastinum was first described by Macklin in *** Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the *** this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.

关键词： thoracic trauma differential diagnosis critical care pneumothorax pneumomediastinum CT scan pitfalls lung and airways physiology

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Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review

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World Journal of Clinical Cases 2019年第14期7卷 1825-1836页

作者： Christoph Kolja Boese Philipp lechler Michael Frink Michael Hackl Peer Eysel Christian Ries Department of Orthopaedic and trauma surgery University Hospital of CologneCologne 50931Germany Clinic for trauma and Hand surgery KreisklinikenAltotting 84503Germany Center for orthopaedics and trauma surgery University Hospital Giessen and MarburgMarburg 35043Germany

BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESUlTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONClUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.

关键词： Antibiotic therapy Outpatient parenteral antibiotic therapy Inpatient parenteral antibiotic therapy Cost analysis Periprosthetic joint infection Parenteral

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Return to sport after lower limb arthroplasty-why not for all?

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World Journal of Orthopedics 2019年第2期10卷 90-100页

作者： Shivan S Jassim Jenni Tahmassebi Fares S Haddad Angus Robertson trauma and orthopaedics Royal London Hospital trauma and orthopaedics University College London Hospital trauma and orthopaedics Cardiff and Vale NHS Trust

BACKGROUND Total hip and knee replacements are being performed in increasing numbers in progressively younger patients with higher activity demands. Many such patients have expectations of returning to athletic activity post-operatively yet are not always able to do so and the reasons behind this have not been extensively examined. We hypothesise that any reasons for a failure to return to athletic activity post-operatively are *** To quantify the return to athletic activity following lower limb joint arthroplasty and understand qualitative reasons for altered activity *** A single centre, single surgeon retrospective questionnaire for hip and knee arthroplasty patients under age 60 years, minimum two years post-surgery with exclusion criteria of multiple degenerative joint involvement and multiple medical co-morbidities. Outcomes were validated joint-specific(Oxford hip and knee) and lifestyle questionnaires [short form 12(SF-12) and University of California, los Angeles(UClA)] and an activity questionnaire assessing ability participation in athletic activity post-operatively. Statistical analysis was performed on the validated outcome data, including comparison between hip and knee replacements. Frequency tables were produced to quantify the different athletic activities participated in by *** Responses were received from 64 patients(80% response rate). There was a statistically significant improvement in Oxford hip and knee scores following surgery. SF-12 scores also improved for all patients, but no statistically significant difference was seen between joints(P = 0.88). Mean UClA scores pre-operatively were 7.67 and at two years post-operatively were 7.69, with no statistically significant change(P = 0.91). All patients reported high satisfaction and improved ability to perform athletic activity at a higher frequency compared to pre-operatively. The most common reasons for changing activity participation were not wa

关键词： Joint replacement Athletic activity Sport Outcomes

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lower limb intracast pressures generated by different types of immobilisation casts

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World Journal of Orthopedics 2017年第2期8卷 170-177页

作者： Salma Chaudhury Alexandra Hazlerigg Anuhya Vusirikala Joseph Nguyen Stuart Matthews trauma Unit John Radcliffe HospitalUniversity of Oxford trauma and orthopaedics Department Royal Berkshire Hospital hospital for Special surgery

AIM To determine if complete, split casts and backslabs [plaster of Paris(POP) and fiberglass] generate different intracast pressures and pain. METHODS Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. RESUlTS A significant difference between the various types of casts was noted when the saline volume was greater than 100 ml(P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs(P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 ml and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 ml(P = 0.009). Intracast pressures were significantly lower in split casts(P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs(P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mm Hg and greater(P = 0.001). Split fiberglass casts had significantly reduced pain levels(P =

关键词： Fracture Pressure lower limb Plaster of Paris Cast Fiberglass Backslab Compartment syndrome

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Diabetic foot attack:Managing severe sepsis in the diabetic patient

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World Journal of Critical Care Medicine 2025年第1期14卷 1-13页

作者： Kisshan Raj Balakrishnan Dharshanan Raj Selva Raj Sabyasachi Ghosh Gregory AJ Robertson Department of trauma and orthopaedics Wrexham Maelor HospitalWrexham LL137TDUnited Kingdom Department of trauma and orthopaedics The Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY107AGUnited Kingdom

Diabetic foot attack(DFA)is the most severe presentation of diabetic foot disease,with the patient commonly displaying severe sepsis,which can be limb or life *** can be classified into two main categories:Typical and atypical.A typical DFA is secondary to a severe infection in the foot,often initiated by minor breaches in skin integrity that allow pathogens to enter and *** form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy,microvascular disease,and hyperglycemia,which facilitate infection spread and tissue *** form of DFA can present as one of a number of severe infective pathologies including pyomyositis,necrotizing fasciitis,and myonecrosis,all of which can lead to systemic sepsis and multiorgan *** atypical DFA,however,is not primarily *** can occur secondary to either ischemia or Charcot *** of the typical DFA involves prompt diagnosis,aggressive infection control,and a multidisciplinary *** can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections,and the combined British Orthopaedic Foot and Ankle Society-Vascular Society *** article highlights the importance of early recognition,comprehensive management strategies,and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.

关键词： Diabetic foot attack Diabetic foot infection Diabetes mellitus Sepsis Systemic sepsis

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Compartment syndrome following total knee replacement:A case report and literature review

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World Journal of Orthopedics 2016年第9期7卷 618-622页

作者： Mohammed Shaath Mohamed Sukeik Saadallah Mortada Sean Masterson Department of trauma and orthopaedics North Manchester General Hospital Department of trauma and orthopaedics Queens Hospital

Compartment syndrome is a rare complication of total knee replacement(TKR) surgery that needs prompt diagnosis and treatment as it may be associated with high morbidity and mortality. We have found very few reports in the literature describing compartment syndrome after TKRs and therefore, present a relevant case which occurred in the immediate postoperative phase and was treated with fasciotomy and subsequent operations to close the soft tissue defects.

关键词： Compartment syndrome Complications Knee replacement Treatment

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Analysis of Cartilage Creep Recovery Using a Highly Dynamic Closed-loop Test System

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Journal of Bionic Engineering 2018年第6期15卷 1057-1066页

作者： Josef Stolberg-Stolberg Peter Foehr Iris Pflieger lara Kuntz Constantin von Deimling Andreas Obermeier Peter M. Prodinger Christian U. Grosse Rainer Burgkart Department of orthopaedics and Sports orthopaedics Klinikum rechts der Isar Technical University of Munich Munich 81675 Germany Department of trauma Hand and Reconstructive Surgery University Hospital Muenster Albert-Schweitzer-Campus 1 Muenster 48149 Germany Chair of Non-destructive Testing Technical University of Munieh Munich 81245 Germany Department of trauma surgery Trauma Center Murnau Murnau 82418 Germany

The aim of this study was to analyze cartilage creep and creep recovery after static and cyclic loading. Up to now technical limitations have hindered the measurement of creep recovery. For this reason, we developed a closed loop micro creep and creep-recovery indentation test system with active force control. Bovine osteochondral explants were tested under static （110 kPa） and cyclic （100 cycles, 350 kPa/35 kPa, 1 Hz） loading conditions and subsequently creep recovery was measured. The cartilage thickness was determined using needle indentation. For static loading, the creep and creep-recovery rates were significantly different during the first 60 seconds （p 〈 0.05）. Cyclic loading was assessed for the medial and lateral patella and resulted in a physiological patellar cartilage strain of 7.7% ± 2.6% and 8.2% ± 2.7%, respectively. We recorded a creep recovery of 97.8% ±2.1% for the medial and 98.3% ± 2.4% for the lateral patella. The advantage of this study over earlier in vitro studies is that we recorded creep-recovery profiles with an actively controlled setup. This allowed us to analyze creep recovery immediately after removing the creep load, in contrast to MRI-based in vivo studies. In future, the presented method will enable us to quantify spatial variations within articular joints.

关键词： articular cartilage indentation creep recovery arthritis regenerative tissue

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Femoro Patella Vialla patellofemoral arthroplasty: An independent assessment of outcomes at minimum 2-year follow-up

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World Journal of Orthopedics 2016年第8期7卷 487-493页

作者： Mansur Halai Andrew Ker Iain Anthony Graeme Holt Bryn Jones Mark Blyth Department of trauma and orthopaedics Glasgow Royal Infirmary Department of trauma and orthopaedics University Hospital Crosshouse

AIM: To determine outcomes using the Femoro-Patella Vialla(FPV) arthroplasty and if there is an ideal patient for this implant. METHODS: A total of 41 FPV patellofemoral joint replacements were performed in 31 patients(22 females, 9 males, mean age 65 years). Mean followup was 3.2 years(minimum 2 years). Radiographs were reviewed preoperatively and postoperatively. We assessed whether gender, age, previous surgery, patella atla or trochlear dysplasia influenced patient satisfaction or patient functional ***: The median Oxford Knee Score was 40 and the median Melbourne Patellofemoral Score was 21 postoperatively. Seventy-six percent of patients were satisfied, 10% unsure and 14% dissatisfied postoperatively. There was no radiological progression of tibiofemoral joint arthritis, using the Ahlback grading,in any patient. One patient, who was diagnosed with rheumatoid arthritis postoperatively, underwent revision to total knee replacement. There were no intraoperative lateral releases and no implant failures. Gender, age, the presence of trochlear dysplasia, patella alta or bilateral surgery did not influence patient outcome. Previous surgery did not correlate with outcome. CONClUSION: In contrast to the current literature, the FPV shows promising early results. However, we cannot identify a subgroup of patients with superior outcomes.

关键词： Patellofemoral Arthritis Femoro-Patella Vialla Outcomes Arthroplasty

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