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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 -
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 -
Acta Ortopedica Mexicana 2024Progressive pseudorheumatoid dysplasia (PPD) is an autosomal recessive hereditary disease of very low prevalence. It is characterized by the affection of multiple... (Review)
Review
Progressive pseudorheumatoid dysplasia (PPD) is an autosomal recessive hereditary disease of very low prevalence. It is characterized by the affection of multiple joints, generating arthrosis and progressive deformities from a very young age, which significantly affect the quality of life of patients. Its diagnosis is only confirmed by genetic testing, and no specific pharmacological treatment is still available. In the case of hip involvement, one treatment option is arthroplasty. In this case report, we present a 15-year-old boy with bilateral coxarthrosis secondary to PPD who underwent bilateral total hip arthroplasty in two stages. We highlight the characteristics of this rare entity, the intraoperative findings, the functional outcomes, and the impact on quality of life.
Topics: Humans; Adolescent; Male; Arthroplasty, Replacement, Hip; Joint Diseases
PubMed: 38862149
DOI: 10.35366/115814 -
Acta Ortopedica Mexicana 2024intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized...
INTRODUCTION
intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonization, prophylaxis should include vancomycin. Intraosseous (IO) administration of vancomycin could enhance its effectiveness in total knee arthroplasty (TKA).
MATERIAL AND METHODS
a retrospective review was conducted, including 143 patients at risk of PJI scheduled for TKA who received IO vancomycin along with intravenous (IV) cefazolin, referred to as group I (GI), between May 2021 and December 2022. The occurrence of complications in the first three postoperative months was evaluated. Results were compared with 140 patients without risk factors who received standard IV prophylaxis, designated as group II (GII).
RESULTS
in GI, 500 mg of IO vancomycin was administered, injected into the proximal tibia, in addition to standard IV prophylaxis. In GII, patients received only IV cefazolin. The incidence of complications was 1.64% in GI and 1.4% in GII. The PJI rate at 90 postoperative days was 0.69% in GI and 0.71% in GII.
CONCLUSIONS
IO vancomycin administration, along with standard IV prophylaxis, provides a safe and effective alternative for patients at risk of MRSA colonization. This approach minimizes complications associated with IV vancomycin use and addresses logistical challenges of timely administration.
Topics: Humans; Vancomycin; Retrospective Studies; Arthroplasty, Replacement, Knee; Male; Female; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Middle Aged; Prosthesis-Related Infections; Cefazolin; Methicillin-Resistant Staphylococcus aureus; Infusions, Intraosseous; Aged, 80 and over; Staphylococcal Infections
PubMed: 38862147
DOI: 10.35366/115812 -
Acta Ortopedica Mexicana 2024revision joint replacement surgery presents a surgical challenge. The use of rotating hinge prostheses is an option in patients with femorotibial bone defects, ligament...
INTRODUCTION
revision joint replacement surgery presents a surgical challenge. The use of rotating hinge prostheses is an option in patients with femorotibial bone defects, ligament insufficiency, or significant deformities. The aim of this study was to evaluate the clinical, functional, and radiological outcomes of a series of patients who underwent surgery using the GMK Hinge (Medacta®) rotational hinge model.
MATERIAL AND METHODS
a descriptive, retrospective, and analytical study was conducted on a series of 36 patients, with a mean age of 72.5 years (47-85), operated on by the same surgical team between January 2015 and January 2022. The etiology of revision was chronic infection in 38.9% of cases, instability in 33.3%, aseptic loosening in 19.4%, and stiffness in 8.4%. The Knee Society Score (KSS) and the Forgotten Joint Score (FJS) were used to assess functional outcomes. The degree of femorotibial bone defect was evaluated using the Anderson Orthopaedic Research Institute (AORI) classification. Postoperative complications are also recorded.
RESULTS
a total of 36 patients, 17 males and 19 females, were included, with a mean follow-up of 30 months (12-66). Twelve patients had type 1 defects, ten had 2A defects, ten had 2B defects, and two had type 3 defects on the femoral side, with the use of wedges required for asymmetrical defects (21 patients). The predominant tibial defect was type 1 without the need for wedges. The majority achieved a satisfactory outcome on the KSS scale (72.2 ± 9.4), with significant differences compared to the previous KSS (54.3 ± 8.9). A score of 31 (12-67) was also obtained on the FJS scale. Postoperative complications were present in 16.7% of patients.
CONCLUSIONS
complex prosthetic revision surgery using a rotating hinge prosthesis represents a suitable therapeutic option, yielding appropriate clinical and functional outcomes, albeit not without complications.
Topics: Humans; Male; Female; Aged; Retrospective Studies; Knee Prosthesis; Arthroplasty, Replacement, Knee; Reoperation; Middle Aged; Aged, 80 and over; Prosthesis Design; Prosthesis Failure; Postoperative Complications; Follow-Up Studies; Treatment Outcome
PubMed: 38862144
DOI: 10.35366/115809