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Search for other papers by Pierre Hoffmeyer in
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Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
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Department of Safety & Security Science, Delft University of Technology, Delft, The Netherlands
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Background
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Loosening is a major cause for failure of total hip and total knee arthroplasties (THAs/TKAs). Preemptive diagnostics of asymptomatic loosening could open strategies to prevent gross loosening. A multitude of biomarkers may discriminate between loosened and stable implants, but it is unknown which have the best performance. The present systematic review aimed to assess which biomarkers have shown the most promising results in discriminating between stable and aseptic loosened THAs and TKAs.
Methods
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PubMed, Embase, Web of Science, Cochrane Library, and Academic Search Premier were systematically searched up to January 2020 for studies including THA/TKA and biomarkers to assess loosening. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the ICROMS tool to classify the quality of the studies.
Results
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Twenty-eight (three high-quality) studies were included, reporting on a median of 48 patients (interquartile range 28–69). Serum and urine markers were evaluated in 22 and 10 studies, respectively. Tumor necrosis factor α and osteocalcin were significantly higher in loosened compared with stable implants. Urinary N-terminal telopeptide had significantly elevated levels in loosened prostheses.
Conclusion
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Several serum and urine markers were promising in discriminating between loosened and stable implants. We recommend future studies to evaluate these biomarkers in a longitudinal fashion to assess whether progression of loosening is associated with a change in these biomarkers. In particular, high-quality studies assessing the usability of these biomarkers are needed.
Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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Search for other papers by Primitivo Gómez-Cardero in
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The complication rate of ankle arthroscopy (AA) ranges from 3.5% to 14%.
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To avoid such complications, it is essential to have a thorough understanding of the anatomy of the ankle, to perform the procedure very carefully and with appropriate instrumentation, and to use a non-invasive distraction technique.
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The most frequent complications are neurological (cutaneous nerve injuries), which are usually caused by direct injury during arthroscopic portals or by a distracting pin when using an invasive distraction technique. They usually resolve spontaneously within a few months.
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The iatrogenic formation of a pseudoaneurysm is a severe but extremely rare complication (an incidence of 0.008%).
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There are several treatments for pseudoaneurysms: external compression; direct thrombin injection, surgical intervention (resection of the damaged segment of the artery and reconstruction with a reversed long saphenous vein interposition graft), and endovascular embolisation.
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Other rare complications include wound infections (localised superficial infection), problems at the portal incisions (prolonged portal drainage, residual pain in the portal, portal scar dehiscence, cyst at the portal site), type I complex regional pain syndrome, instrument breakage, painful scars and nodules, and a number of other rarer complications.
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In conclusion, when performing AA, it is important to remember the potential complications and try to avoid them. When they do occur, it is essential to diagnose and treat them appropriately.
Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
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Department of Trauma and Orthopaedic Surgery, Hospital Nostra Senyora de Meritxell, Andorra
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Universidad de Valladolid, Valladolid, Spain
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Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
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Search for other papers by the PISCO Investigators † in
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A peri-implant femoral fracture (PIFF) is defined as a femoral fracture in the presence of a pre-existing non-prosthetic implant. Classification systems, treatment guidelines and fixation strategies exist for peri-prosthetic fractures, but there is no standard of care regarding PIFFs.
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The aim of the Peri-Implant Spanish Consensus (aka PISCO) investigators is to reach an agreement regarding current practices for management of PIFFs and to propose four main principles to assess surgical treatment and prevention of these fractures.
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This consensus review was conducted according to the Delphi method. Twenty-two expert orthopaedic trauma surgeons performed the consensus and the definitive statements were approved unanimously.
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Biological fixation principles must be utilized in the surgical treatment of peri-implant femur fractures, which include closed or minimally invasive reduction techniques. The osteosynthesis must protect the entire bone.
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Gaps between two implants should be avoided. If implant overlap is not possible to achieve, then spanning inter-implant fixation systems must be used, especially in osteoporotic bone.
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Previous implants should be retained during surgical treatment of peri-implant femur fractures. Only those implants that would interfere with current fixation goals should be removed.
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If the previous implant is in the femoral neck region, then femoral neck protection must be maintained when treating the peri-implant fracture, even if the neck fracture has already healed.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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The cavovarus deformity is a pathological condition characterised by an anomalous elevation of the longitudinal arch. This condition results from a significant hindfoot varus and forefoot equinus deformity. This phenomenon comprises diverse anomalies and therapies and exhibits a prevalence of 25% within the populace.
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A thorough clinical evaluation is required to identify deformities in the cavovarus foot. Weight-bearing radiographs play a crucial role in identifying the apex of deformity and quantifying the required extent of correction.
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Cavus feet are frequently linked with neurological conditions affecting sensory and motor nerves. Identifying the optimal treatment for individual patients necessitates the performance of clinical and radiographic evaluations. Inaccurate diagnosis of a neurological disorder can lead to inappropriate surgical intervention, relapse, and inadequate reconstruction. When faced with progressive anomalies, it is crucial to implement a phased surgical protocol promptly to avoid exacerbating malalignment. Various surgical procedures have been recorded, including soft tissue releases, tendon transfers, osteotomies, and arthrodesis, which are selected based on the nature and extent of the deformity assessment findings, with the ultimate goal of reaching a foot that is both plantigrade and balanced.
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Due to a lack of research on this topic, the present review aims to furnish the most recent literature update on the manifestation, imaging evaluation, and optimal therapeutic interventions currently accessible for individuals afflicted with cavovarus deformities and to assist healthcare providers in selecting the most suitable therapy for paediatric patients with this condition in their routine clinical practice.
Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Objective
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This study aimed to provide the evidence of the role of addition hyaluronic acid immediate after arthroscopy in pain relief and functional recovery.
Methods
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A multiple databases search of the PubMed, the Cochrane Library, and Embase was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to identify randomized controlled trials that evaluate the effect the hyaluronic acid compared with placebo addition immediately after arthroscopy for degenerative arthropathy. Data related to postoperative pain using the visual analog scale, and functional scores, were extracted and analyzed using the RevMan software.
Results
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A total of five randomized controlled trials were included in this study. All patients showed significant pain relief after surgery at 2 weeks and 2 months, but no statistically significant differences between the hyaluronic group and control group were observed at 2 weeks and 2 months, respectively. This meta-analysis did not find a difference of WOMAC score between the two groups at 2 weeks (MD: 3.07; 95% CI: −0.66 to 6.81; I2 =39%; P = 0.11) and 2 months (MD: 5.47; 95% CI: −0.69 to 11.62; I2 =57%; P = 0.08), respectively.
Conclusion
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For patients with symptomatic degenerative arthropathy, adding hyaluronic acid immediately after arthroscopic surgery did not appear to provide patients with more pain relief and better functional recovery.
Search for other papers by Erdem Sahin in
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Surgical intervention is the treatment of choice for recurrent lateral patellar instability.
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Surgery should be considered for first time lateral patella dislocations with osteochondral fractures or underlying anatomical risk factors.
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Primary repair and nonanatomical imbrications/reconstructions have fallen out of favor due to abnormal biomechanics and high rates of recurrence. Anatomical reconstruction of the MPFL using a variety of auto and allograft tissues have yielded good outcomes and low redislocation rates.
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Physeal sparing MPFL reconstruction techniques under radiological control are safe and do not cause growth disturbance. Allografts may be indicated for hyperlax patients.
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Although no clear cutoff points exist, correction of valgus and excessive femoral anteversion should be considered when indicated.
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Osteochondral and chondral injuries are common and should be addressed during surgery for instability.
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Objective
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To this day, diagnostic standards and uniform definition for acute, isolated syndesmotic injuries are missing. The aim of the current study was to conduct a systematic review of the classification systems and diagnostics currently applied and to propose a best evidence diagnostic approach.
Methods
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Medline (PubMed), Scopus, Cochrane Central Register of Controlled Trials, and Embase were searched from inception to June 5, 2022, for studies reporting the outcome of surgically treated acute, isolated syndesmotic injuries. First, all classifications used in the eligible studies were identified and illustrated according to the individual syndesmotic structures injured. Second, the indication for surgery and stabilization, based on the diagnostics applied and the time point assessed (pre- or intra-operatively), was analyzed, including the applied cutoff criteria.
Results
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Ten out of 4190 studies, comprising 317 acute ligamentous syndesmotic injuries, met the inclusion criteria. Seven studies facilitated one of the three different classification systems (Calder, West Point, or Sikka classification). Eight studies based their indication for surgery on a combination of clinical and radiographic examinations and two on radiographs only. The most applied clinical tests were the external rotation stress test and squeeze test. The most common radiologic diagnostics were plain radiographs and MRI. Intraoperatively, instability was verified most commonly using arthroscopy.
Conclusion
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Current classifications and diagnostics for syndesmotic injuries are heterogeneous, often cannot be attributed to the ligaments injured. An evidence-based diagnostic algorithm based on noninvasive diagnostics and an anatomy-based classification for acute syndesmotic instability is presented.
Search for other papers by Valeria Pintar in
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St George’s University of London, UK
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St George’s University of London, UK
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St George’s University of London, UK
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Purpose
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Tourniquets are commonly used intraoperatively in orthopaedic surgery to control bleeding and improve visibility in the surgical field. Recent evidence has thrown into question the routine use of tourniquets in the adult population resulting in a British Orthopaedic Association standard for intraoperative use. This systematic review evaluates the evidence on the practice, benefits, and risks of the intraoperative use of tourniquets for trauma and elective orthopaedic surgery in the paediatric population.
Methods
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A prospectively registered systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO: CRD42022359048). A search of MEDLINE, Embase, the Cochrane Library and a Grey literature search was performed from their earliest record to 23 March 2023. Studies reporting tourniquet data in paediatric patients undergoing orthopaedic surgery were included. Data extracted included demographics, involved limb, trauma versus elective use, tourniquet use as primary or secondary measure, and tourniquet parameters and complications.
Results
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Thirty-nine studies were included. Tourniquet practices and information reporting varied considerably. Tourniquets were used uneventfully in the majority of patients with no specific benefits reported. Several physiological and biochemical changes as well as complications including nerve injury, compartment syndrome, skin burns, thrombosis, post-operative limb swelling, and pain were reported.
Conclusions
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Tourniquets are routinely used in both trauma and elective paediatric orthopaedic surgery with no high-quality research affirming benefits. Severe complications associated with their use are rare but do occur. High-quality studies addressing their benefits, the exact indication in children, and the safest way to use them in this population are necessary.
Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Purpose
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Transforaminal lumbar interbody fusion (TLIF) is a classic surgical procedure for posterior lumbar fusion. This study aims to analyze the TLIF field by bibliometric method and comprehensively summarize the research status and trends.
Methods
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All TLIF-related articles were retrieved from the Web of Science. The data were analyzed using R software and SPSS to calculate corresponding indicators. Visualizations were drawn using VOSviewer and Scimago Graphica, including country, institution, journal, author, and keywords.
Results
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A total of 919 articles were included. The annual publication volume of TLIF-related articles presented an exponential growth. North America, Europe, and Asia were the main sources of articles, with the USA and China being the main contributors and the USA being the global research center for TLIF. The level of the national economy was an important factor affecting TLIF-related research. The highest number of contributions in this field was made by Kern Singh among authors and by Rush University among institutions. The European Spine Journal was the most influential journal. The research focus has gradually shifted from perfecting the TLIF technique toward emphasizing the patient level. The improvement of minimally invasive techniques and how to improve clinical outcomes as well as accelerate postoperative rehabilitation of patients may be the hot spot of future research.
Conclusions
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With the advancement of medical technology and the popularization of minimally invasive concepts in recent years, TLIF and its derivative technologies have attracted increasing attention. Patient-centered minimally invasive surgery is a hot research topic in the field of TLIF currently and will continue to be so into the future
