-
Medicine Jun 2024The aim was to investigate the independent risk factors for lower extremity deep vein thrombosis (DVT) after total knee arthroplasty, and to establish a nomogram... (Observational Study)
Observational Study
The aim was to investigate the independent risk factors for lower extremity deep vein thrombosis (DVT) after total knee arthroplasty, and to establish a nomogram prediction model accordingly. Data were collected from total knee replacement patients from January 2022 to December 2023 in our hospital. Unifactorial and multifactorial logistic regression analyses were used to determine the independent risk factors for lower extremity DVT after total knee arthroplasty and to establish the corresponding nomogram. The receiver operating characteristic curves were plotted and the area under the curve was calculated, and the calibration curves and decision curves were plotted to evaluate the model performance. A total of 652 patients with total knee arthroplasty were included in the study, and 142 patients after total knee arthroplasty developed deep veins in the lower extremities, with an incidence rate of 21.78%. After univariate and multivariate logistic regression analyses, a total of 5 variables were identified as independent risk factors for lower extremity DVT after total knee arthroplasty: age > 60 years (OR: 1.70; 95% CI: 1.23-3.91), obesity (OR: 1.51; 95% CI: 1.10-1.96), diabetes mellitus (OR: 1.80; 95% CI: 1.23-2.46), D-dimer > 0.5 mg/L (OR: 1.47; 95% CI: 1.07-1.78), and prolonged postoperative bed rest (OR: 1.64; 95% CI: 1.15-3.44). the nomogram constructed in this study for lower extremity DVT after total knee arthroplasty has good predictive accuracy, which helps physicians to intervene in advance in patients at high risk of lower extremity DVT after total knee arthroplasty.
Topics: Humans; Arthroplasty, Replacement, Knee; Female; Male; Venous Thrombosis; Middle Aged; Nomograms; Risk Factors; Aged; Lower Extremity; Postoperative Complications; Fibrin Fibrinogen Degradation Products; ROC Curve; Retrospective Studies; Logistic Models; Age Factors; Incidence
PubMed: 38875414
DOI: 10.1097/MD.0000000000038517 -
Medicine Jun 2024To investigate the outcomes of the direct anterior approach (DAA) in total hip arthroplasty (THA) and its impact on improving hip joint function. This retrospective...
To investigate the outcomes of the direct anterior approach (DAA) in total hip arthroplasty (THA) and its impact on improving hip joint function. This retrospective analysis included 94 patients who underwent THA between December 2017 and December 2020 at Dongguan Hospital, Guangzhou University of Chinese Medicine. The study group comprised 50 patients who received the DAA, while the control group comprised 44 patients who received the postero-lateral approach (PA). The follow-up period was 12 months. A comparison was made between the 2 groups based on perioperative indicators (operation time, intraoperative blood loss, hospitalization time, bed rest time, incision length, pain score), duration of walker use, incidence of postoperative complications, hip joint function (Harris score), quality of life (SF-36), and activities of daily living (ADL). The treatment effectiveness rate was higher in the study group (P < .05). The study group had a longer operation time, lower intraoperative blood loss, shorter hospitalization and bed rest time, smaller incision length, and lower visual analog scale (VAS) score after treatment, with statistically significant differences (P < .05). The study group also had a shorter duration of walker use after surgery (P < .05). The Harris score after treatment was higher in the study group compared to the control group (P < .05). Additionally, the study group had higher SF-36 scores and ADL scores after treatment (P < .05). There was no significant difference in the incidence of postoperative complications between the 2 groups (P > .05). The DAA in THA resulted in reduced pain and intraoperative blood loss, contributing to the promotion of postoperative recovery in patients with good short-term outcomes. This procedure warrants further promotion.
Topics: Humans; Arthroplasty, Replacement, Hip; Retrospective Studies; Female; Male; Middle Aged; Activities of Daily Living; Operative Time; Aged; Quality of Life; Treatment Outcome; Postoperative Complications; Hip Joint; Recovery of Function; Blood Loss, Surgical; Length of Stay
PubMed: 38875400
DOI: 10.1097/MD.0000000000038479 -
Journal of Orthopaedic Surgery (Hong... 2024
Letter to the editor regarding "Intraoperative intravenous versus periarticular injection of glucocorticoids in improving clinical outcomes after total knee arthroplasty: A prospective, randomized and controlled study".
Topics: Humans; Arthroplasty, Replacement, Knee; Glucocorticoids; Injections, Intra-Articular; Prospective Studies; Randomized Controlled Trials as Topic; Injections, Intravenous; Treatment Outcome; Intraoperative Care
PubMed: 38874127
DOI: 10.1177/10225536241263655 -
Frontiers in Bioengineering and... 2024During activities of daily living (ADLs), the wrist is mainly engaged in positioning and directing the hand. Researches have demonstrated that restoring wrist mobility...
During activities of daily living (ADLs), the wrist is mainly engaged in positioning and directing the hand. Researches have demonstrated that restoring wrist mobility can significantly enhance the manipulation ability, reduce body distortion caused by motion compensation, and improve the quality of life for amputees. However, most daily activities, particularly the delicate ones, place high demands on the ability of wrist to maintain a certain rotation angle, also known as non-back-drivable ability, which poses a challenge to the design of prosthetic wrists. To address this issue, various solutions have been proposed, including motor holding brakes, high reduction ratio reducers, and worm gears. However, the motor holding brake only functions after a power outage and cannot continuously prevent torque from the load end. The latter two solutions may alter the transmission ratio, resulting in reduced movement speed and transmission efficiency. Therefore, how to design a miniaturized non-back-drivable mechanism without changing the transmission ratio so that the forearm rotational freedom can be locked at any position for any duration is a problem to be solved in the research of prosthetic wrist designs. This paper presents a line-contact based non-back-drivable clutch (NBDC) that does not cause changes in the transmission ratio, ensuring the motion performance of the prosthetic limb. At the same time, it does not introduce additional friction in the forward transmission process, guaranteeing the overall efficiency. Most importantly, it only allows the torque transmitting from the motor to the load, prevents the load reversely from driving back even in a power failure condition, significantly improving the stability, safety, and comfort. Detailed kinematic and static analyses of the working process has been conducted, and transient dynamics simulation has been performed to verify its effectiveness. Through experiments, it is demonstrated that the self-locking torque of the output end could reach approximately 600 Nmm, and the unlocking torque of the input end is about 80 Nmm, which can be effectively integrated in prosthetic wrist rotation joints, contributing to the performance, safety and energy saving of prosthetic joint systems.
PubMed: 38872901
DOI: 10.3389/fbioe.2024.1385076 -
Antimicrobial Resistance and Infection... Jun 2024To promote the nation-wide implementation of semi-automated surveillance (AS) of surgical site infection after hip and knee arthroplasty, the Dutch National Institute...
Evaluation of a multifaceted implementation strategy for semi-automated surveillance of surgical site infections after total hip or knee arthroplasty: a multicentre pilot study in the Netherlands.
INTRODUCTION
To promote the nation-wide implementation of semi-automated surveillance (AS) of surgical site infection after hip and knee arthroplasty, the Dutch National Institute for Public Health and the Environment (RIVM) deployed a decentralised multifaceted implementation strategy. This strategy consisted of a protocol specifying minimum requirements for an AS system, supported by a user manual, education module, individual guidance for hospitals and user-group meetings. This study describes an effect evaluation and process evaluation of the implementation strategy for AS in five frontrunner hospitals.
METHODS
To evaluate the effect of the implementation strategy, the achieved phase of implementation was determined in each frontrunner hospital at the end of the study period. The process evaluation consisted of (1) an evaluation of the feasibility of strategy elements, (2) an evaluation of barriers and facilitators for implementation and (3) an evaluation of the workload for implementation. Interviews were performed as a basis for a subsequent survey quantifying the results regarding the feasibility as well as barriers and facilitators. Workload was self-monitored per profession. Qualitative data were analysed using a framework analysis, whereas quantitative data were analysed descriptively.
RESULTS
One hospital finished the complete implementation process in 240 person-hours. Overall, the elements of the implementation strategy were often used, positively received and overall, the strategy was rated effective and feasible. During the implementation process, participants perceived the relative advantage of AS and had sufficient knowledge about AS. However, barriers regarding complexity of AS data extraction, data-infrastructure, and validation, lack of capacity and motivation at the IT department, and difficulties with assigning roles and responsibilities were experienced.
CONCLUSION
A decentralised multifaceted implementation strategy is suitable for the implementation of AS in hospitals. Effective local project management, including clear project leadership and ownership, obtaining commitment of higher management levels, active involvement of stakeholders, and appropriate allocation of roles and responsibilities is important for successful implementation and should be facilitated by the implementation strategy. Sufficient knowledge about AS, its requirements and the implementation process should be available among stakeholders by e.g. an education module. Furthermore, exchange of knowledge and experiences between hospitals should be encouraged in user-group meetings.
Topics: Humans; Netherlands; Arthroplasty, Replacement, Knee; Pilot Projects; Arthroplasty, Replacement, Hip; Surgical Wound Infection
PubMed: 38872201
DOI: 10.1186/s13756-024-01418-0 -
PloS One 2024Pain at the tip of the stem of a knee prosthesis (End-of-Stem Pain) is a common problem in revision total knee arthroplasty (TKA). It may be caused by a problematic...
Pain at the tip of the stem of a knee prosthesis (End-of-Stem Pain) is a common problem in revision total knee arthroplasty (TKA). It may be caused by a problematic interaction between stem and bone, but the exact biomechanical correlate is still unknown. On top of this, there is no biomechanical study investigating End-of-Stem Pain at the distal femur using human specimens. Aim of this study was to find out whether the implantation of a revision total knee implant leads to high femoral surface strains at the tip of the stem, which the authors expect to be the biomechanical correlate of End-of-Stem Pain. We implanted 16 rotating hinge knee implants into 16 fresh-frozen human femora using the hybrid fixation technique and comparing two reaming protocols. Afterwards, surface strains on these femora were measured under dynamic load in two different load scenarios (climbing stairs and chair rising) using digital image correlation (DIC) and fracture patterns after overcritical load were analysed. Peak surface strains were found at the tip of the stem in several measurements in both load scenarios. There were no significant differences between the two compared groups (different trial sizes) regarding surface strains and fracture patterns. We conclude that implantation of a long intramedullary stem in revision TKA can lead to high surface strains at the tip of the stem that may be the correlate of femoral End-of-Stem Pain. This finding might allow for a targeted development of future stem designs that can lead to lower surface strains and therefore might reduce End-of-Stem Pain. Digital Image Correlation proved valid for the measurement of surface strains and can be used in the future to test new stem designs in vitro.
Topics: Humans; Arthroplasty, Replacement, Knee; Femur; Knee Prosthesis; Aged; Female; Reoperation; Male; Stress, Mechanical; Biomechanical Phenomena; Middle Aged; Aged, 80 and over
PubMed: 38870168
DOI: 10.1371/journal.pone.0305387 -
Cureus May 2024In the evolving field of orthopedic surgery, the integration of three-dimensional printing (3D printing) has emerged as a transformative technology, particularly in... (Review)
Review
In the evolving field of orthopedic surgery, the integration of three-dimensional printing (3D printing) has emerged as a transformative technology, particularly in addressing the rising incidence of degenerative joint diseases. The integration of 3D printing technology in hip arthroplasty offers substantial advantages throughout the surgical process. In preoperative planning, 3D models enable meticulous assessments, aiding in accurate implant selection and precise surgical strategies. Intraoperatively, the technology contributes to precise prosthesis design, reducing operation duration, X-ray exposures, and blood loss. Beyond surgery, 3D printing revolutionizes medical equipment production, imaging, and implant design, showcasing benefits such as enhanced osseointegration and reduced stress shielding with titanium cups. Challenges include a higher risk of postoperative infection due to the porous surfaces of 3D-printed implants, technical complexities in the printing process, and the need for skilled manpower. Despite these challenges, the evolving nature of 3D printing technologies underscores the importance of relying on existing orthopedic surgical practices while emphasizing the need for standardized guidelines to fully harness its potential in improving patient care.
PubMed: 38868274
DOI: 10.7759/cureus.60201 -
Journal of the American Academy of... Jun 2024The utilization of ambulatory surgery centers (ASCs) and same-day discharge (SDD) from hospital-based centers (HBCs) after total hip arthroplasty (THA) continues to... (Comparative Study)
Comparative Study
INTRODUCTION
The utilization of ambulatory surgery centers (ASCs) and same-day discharge (SDD) from hospital-based centers (HBCs) after total hip arthroplasty (THA) continues to increase. There remains a paucity of literature directly comparing patient-reported outcomes by surgery site. We sought to compare outcomes between patients undergoing THA at an ASC versus HBC while controlling for medical comorbidities.
METHODS
Patients undergoing primary THA with SDD (postoperative day 0) from a single HBC (1,015 patients) or stand-alone ASC (170 patients) from December 2020 to 2021 were identified. Patient demographics, comorbidities, and 90-day complications were collected. Hip Osteoarthritis Outcome Score (HOOS JR), VR-12, and procedural satisfaction scores were collected preoperatively and at 3, 6, and 12 months. Patients were matched by age and American Society of Anesthesiologists (ASA). Chi-squared analysis was conducted to compare categorical variables, and a Wilcoxon rank-sum test was used for continuous variables. Linear regression models were conducted considering age, sex, and presence of comorbidities.
RESULTS
Patients undergoing THA at an ASC had markedly higher VR-12 Physical Component Scores at all time points and improved VR-12 Mental Component Scores at preoperative visit and 6 months. These patients had increased procedural satisfaction at 3 months, although there was no difference at 1 year. No notable difference was observed in 90-day complication rates between groups. After matching by age and ASA, each group had 170 patients. In the matched analysis, preoperative HOOS JR scores were markedly lower in the HBC group. However, there was no notable difference in HOOS JR scores, change in HOOS JR scores, and procedural satisfaction, at any postoperative time point.
CONCLUSIONS
No notable difference was observed in patient-reported outcomes at any time point for SDD after THA performed at an ASC or an HBC when controlling for age and comorbidities. This study suggests noninferiority of stand-alone ASCs for outpatient THA, regarding patient satisfaction and patient-reported outcomes.
Topics: Humans; Arthroplasty, Replacement, Hip; Patient Reported Outcome Measures; Female; Male; Middle Aged; Aged; Ambulatory Surgical Procedures; Patient Satisfaction; Osteoarthritis, Hip; Retrospective Studies
PubMed: 38866724
DOI: 10.5435/JAAOSGlobal-D-24-00124 -
Journal of the American Academy of... Jun 2024As the opioid epidemic enters its third decade, we reflect on how it has affected clinical practice within the orthopaedic community. Recent studies show prolonged...
INTRODUCTION
As the opioid epidemic enters its third decade, we reflect on how it has affected clinical practice within the orthopaedic community. Recent studies show prolonged opioid use after total knee arthroplasty (TKA) is associated with worse overall health outcomes. This study aims to elucidate trends in pain management after TKA over the past decade.
METHODS
A retrospective analysis was performed using the PearlDiver database from 2010 to 2019. Patients who underwent primary TKA without a history of mental illness, complex pain syndromes, or opioids used 6 months before surgery were selected. Postoperative prescription filling rates of opioid and nonopioid at 30, 90 days, and 1 year from surgery were analyzed. Linear regression analysis and compound annual growth rates (CAGRs) were analyzed from 2010 to 2019, a P value <0.05 being considered significant.
RESULTS
Between 2010 and 2019, 579,269 patients underwent primary TKA. At 30 days, filling of prescriptions for opioids (CAGR = 3.54%) and nonopioids (CAGR = 15.50%) markedly increased from 2010 to 2019. At 90 days, opioids decreased (CAGR = -4.42%). At 1 year, opioid (CAGR = -10.92%) and nonopioid (CAGR = -2.12%) prescriptions markedly decreased from 2010 to 2019.
DISCUSSION
This study highlights patterns of decreased opioid prescription rates at 90 days and 1 year postoperatively from 2010 to 2019. Decreasing opioid rates may indicate effectiveness in targeted public health campaigns to curb opioid overuse.
Topics: Humans; Arthroplasty, Replacement, Knee; Pain, Postoperative; Analgesics, Opioid; Retrospective Studies; Male; Female; Pain Management; Aged; Middle Aged; Analgesics, Non-Narcotic; Practice Patterns, Physicians'; Drug Prescriptions
PubMed: 38866713
DOI: 10.5435/JAAOSGlobal-D-23-00062 -
Nan Fang Yi Ke Da Xue Xue Bao = Journal... May 2024To develop the'E-Bone', a comprehensive one-stop preoperative planning system for reverse total shoulder arthroplasty with improved accuracy and efficiency.
OBJECTIVE
To develop the'E-Bone', a comprehensive one-stop preoperative planning system for reverse total shoulder arthroplasty with improved accuracy and efficiency.
METHODS
The nnU-net deep neural network was utilized for scapula segmentation to obtain precise scapula segmentation results. Based on the 3 key factors, namely bone density, upward and downward angle and nail length, the base was automatically positioned. The quantitative parameters required for surgical planning were calculated. A personalized guide plate was generated by combining glenoid morphology and base positioning information. The system interface was developed to modularize various functions for easy use, providing interactive operation and real-time display.
RESULTS
Compared with the Mimics system, the'E-bone'preoperative planning system reduced complex manual adjustments during the planning process. The average planned nail length was longer than that of the Mimics system, and the planning time was reduced by 86%. The scapula segmentation accuracy of this system reached 99.93%, better than that of Mimics to achieve a higher precision.
CONCLUSION
The"E-bone"system provides a one-stop, efficient, and accurate preoperative planning system for reverse shoulder replacement and potentially broader clinical applications.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Neural Networks, Computer; Scapula; Surgery, Computer-Assisted
PubMed: 38862455
DOI: 10.12122/j.issn.1673-4254.2024.05.19