scholarly journals Reconstructive Challenges of Distal Tibia Bone Tumors: Extracorporeally Irradiated Autograft Combined with a Nonvascularized Autograft Fibula for Superior Reconstruction and Functional Outcomes When Compared to Ipsilateral Pedicled Fibula Transfer Alone

Sarcoma ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Manit K. Gundavda ◽  
Manish G. Agarwal ◽  
Rajeev Reddy ◽  
Ashik Bary
Keyword(s):  
Functional Outcomes ◽  
Patient Reported Outcomes ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Anatomical Reconstruction ◽  
Control Group ◽  
Study Group ◽  
Tibiotalar Joint ◽  
Patient Reported ◽  
Vascularized Fibula

Introduction. Traditionally, centralization of the fibula with fusion across the tibiotalar joint has been used to reconstruct distal tibial defects. Although effective, it requires long periods of protected weight-bearing. The fibula or the fixation often fails before fibular hypertrophy necessitating multiple additional surgeries. A method of using ECRT with the available ipsilateral fibula (nonvascularized) to reconstruct the distal tibia defect with the aim of early return to weight-bearing was evolved. This paper documents our early experience. Patients and Methods. Four patients; with the diagnosis of osteosarcoma in 3 patients and recurrent giant cell tumor of the bone in 1 patient, underwent resection of the distal tibia for tumors between 2017 and 2019. Extracorporeally irradiated (50 Gy) distal tibia along with ipsilateral nonvascularized fibula was used to bridge the defect and fuse the tibiotalar joint. A plate was used to rigidly hold the construct. The final outcome was compared to the historical control group that underwent only pedicled ipsilateral fibula transposition and ankle arthrodesis without recycled autograft or allograft between 2009 and 2017. Oncological reconstruction and functional outcomes were compared for each group. Patient reported outcomes on the acceptability of ankle fusion; cosmesis and function were analyzed and compared between the two groups. Results. The mean resection length in the study group (4 patients) was 7.75 cm (7 to 8.5 cm). As compared to the historical cohort of 7 patients, the study population showed statistically superior results in all reconstruction, functional, and patient-reported outcomes except time to proximal junction union ( p = 0.068 ). There were no reconstruction failures, infection, or nonunions in the study group, whereas the control comparative group had 2 proximal junction nonunions and a mean time to fibular hypertrophy of 143 weeks (82 to 430 weeks) with fibula centralization. Earlier weight-bearing was allowed (mean 26.75 weeks; median 27 weeks) compared to (mean 80.75 weeks; median 80 weeks) in the control group. Conclusion. We think that ECRT with ipsilateral vascularized fibula is a promising method of reconstructing the distal tibia. The recycled autograft tibia added strength to the distal tibia construct in our study and aided the anatomical reconstruction of the distal tibia. The patient-reported outcomes for cosmesis and acceptability add to the benefits of performing this procedure. Consistent early union across the proximal junction and earlier weight-bearing were clear advantages of this method.

scholarly journals Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Junren Zhang ◽  
Wofhatwa Solomon Ndou ◽  
Nathan Ng ◽  
Paul Gaston ◽  
Philip M. Simpson ◽  
...  
Keyword(s):  
Learning Curve ◽  
Functional Outcomes ◽  
Patient Reported Outcomes ◽  
Meta Analysis ◽  
Robotic Arm ◽  
Component Position ◽  
Positioning Accuracy ◽  
Patient Reported ◽  
Total Knee ◽  
Improved Accuracy

AbstractThis systematic review and meta-analysis were conducted to compare the accuracy of component positioning, alignment and balancing techniques employed, patient-reported outcomes, and complications of robotic-arm assisted total knee arthroplasty (RATKA) with manual TKA (mTKA) and the associated learning curve. Searches of PubMed, Medline and Google Scholar were performed in October 2020 using PRISMA guidelines. Search terms included “robotic”, “knee” and “arthroplasty”. The criteria for inclusion were published clinical research articles reporting the learning curve for RATKA and those comparing the component position accuracy, alignment and balancing techniques, functional outcomes, or complications with mTKA. There were 198 articles identified, following full text screening, 16 studies satisfied the inclusion criteria and reported the learning curve of rTKA (n=5), component positioning accuracy (n=6), alignment and balancing techniques (n=7), functional outcomes (n=7), or complications (n=5). Two studies reported the learning curve using CUSUM analysis to establish an inflexion point for proficiency which ranged from 7 to 11 cases and there was no learning curve for component positioning accuracy. The meta-analysis showed a significantly lower difference between planned component position and implanted component position, and the spread was narrower for RATKA compared with the mTKA group (Femur coronal: mean 1.31, 95% confidence interval (CI) 1.08–1.55, p<0.00001; Tibia coronal: mean 1.56, 95% CI 1.32–1.81, p<0.00001). Three studies reported using different alignment and balancing techniques between mTKA and RATKA, two studies used the same for both group and two studies did not state the methods used in their RATKA groups. RATKA resulted in better Knee Society Score compared to mTKA in the short-to-mid-term follow up (95%CI [− 1.23,  − 0.51], p=0.004). There was no difference in arthrofibrosis, superficial and deep infection, wound dehiscence, or overall complication rates. RATKA demonstrated improved accuracy of component positioning and patient-reported outcomes. The learning curve of RATKA for operating time was between 7 and 11 cases. Future well-powered studies on RATKAs should report on the knee alignment and balancing techniques utilised to enable better comparisons on which techniques maximise patient outcomes.Level of evidence III.

scholarly journals Clinical and Immunological Efficacy of Mangosteen and Propolis Extracted Complex in Patients with Gingivitis: A Multi-Centered Randomized Controlled Clinical Trial

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2604
Author(s):  
Jin-Young Park ◽  
Kyung-A Ko ◽  
Ji-Yeong Lee ◽  
Jae-Woon Oh ◽  
Hyun-Chang Lim ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Daily Intake ◽  
Test Group ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Control Groups ◽  
Immunological Parameters ◽  
Significant Difference ◽  
Patient Reported ◽  
And Control

Background: Mangosteen and propolis extracts (MAEC) have been potential therapeutic agents known to exhibit powerful antioxidant and anti-inflammatory properties. The aim of the current study was to evaluate the clinical and immunological efficacy of MAEC as well as safety and patient-reported outcomes (PROMs) on gingivitis and incipient periodontitis. Methods: This study was performed on 104 patients diagnosed with gingivitis or incipient periodontitis. At baseline, the participants were randomly allocated to either the test group, with daily intake of a single capsule containing 194 mg of MAEC for eight weeks, or control group, with placebo. Clinical periodontal evaluation and immunological parameters from saliva and gingival sulcular fluid were assessed at baseline, four, and eight weeks. Individual PROMs were assessed by OHIP-14 questionnaires. Results: There was a significant difference of modified gingival index at four and eight weeks between the test and control groups. In the test group, crevicular interleukin (IL)-6 was reduced, and the salivary matrix metalloproteinase (MMP)-9 was increased after eight weeks. PROMs were improved up to four weeks compared to placebo. Conclusion: Oral administration of MAEC would have a potential to reduce gingival inflammation clinically and immunologically in the patients with gingivitis and incipient periodontitis.

Does the sequential addition of accelerometer-based navigation and sensor-guided ligament balancing improve outcomes in TKA?

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 24-30
Author(s):  
Andrew T. Livermore ◽  
Jill A. Erickson ◽  
Brenna Blackburn ◽  
Christopher L. Peters
Keyword(s):  
Patient Reported Outcomes ◽  
Control Group ◽  
Complication Rates ◽  
Ligament Balancing ◽  
Patient Reported ◽  
Distal Femoral Resection ◽  
Sequential Addition ◽  
Group 2 ◽  
Femoral Resection ◽  
Group 1

Aims A significant percentage of patients remain dissatisfied after total knee arthroplasty (TKA). The aim of this study was to determine whether the sequential addition of accelerometer-based navigation for femoral component preparation and sensor-guided ligament balancing improved complication rates, radiological alignment, or patient-reported outcomes (PROMs) compared with a historical control group using conventional instrumentation. Methods This retrospective cohort study included 371 TKAs performed by a single surgeon sequentially. A historical control group, with the use of intramedullary guides for distal femoral resection and surgeon-guided ligament balancing, was compared with a group using accelerometer-based navigation for distal femoral resection and surgeon-guided balancing (group 1), and one using navigated femoral resection and sensor-guided balancing (group 2). Primary outcome measures were Patient-Reported Outcomes Measurement Information System (PROMIS) and Knee injury and Osteoarthritis Outcome (KOOS) scores measured preoperatively and at six weeks and 12 months postoperatively. The position of the components and the mechanical axis of the limb were measured postoperatively. The postoperative range of motion (ROM), haematocrit change, and complications were also recorded. Results There were 194 patients in the control group, 103 in group 1, and 74 in group 2. There were no significant differences in baseline demographics between the groups. Patients in group 2 had significantly higher baseline mental health subscores than control and group 1 patients (53.2 vs 50.2 vs 50.2, p = 0.041). There were no significant differences in any PROMs at six weeks or 12 months postoperatively (p > 0.05). There was no difference in the rate of manipulation under anaesthesia (MUA), complication rates, postoperative ROM, or blood loss. There were fewer mechanical axis outliers in groups 1 and 2 (25.2%, 14.9% respectively) versus control (28.4%), but this was not statistically significant (p = 0.10). Conclusion The sequential addition of navigation of the distal femoral cut and sensor-guided ligament balancing did not improve short-term PROMs, radiological outcomes, or complication rates compared with conventional techniques. The costs of these added technologies may not be justified. Cite this article: Bone Joint J 2020;102-B(6 Supple A):24–30.

Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as Compared With Matched Controls

2020 ◽  
Vol 48 (10) ◽  
pp. 2471-2480 ◽  
Author(s):  
Claudia R. Brick ◽  
Catherine J. Bacon ◽  
Matthew J. Brick
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoroacetabular Impingement ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Control Group ◽  
Total Hip ◽  
Patient Reported ◽  
Acetabular Overcoverage

Background: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis. Purpose: To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA >40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty. Results: A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups ( P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points ( P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty. Conclusion: Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.

Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control Group

2020 ◽  
Vol 49 (1) ◽  
pp. 66-75 ◽  
Author(s):  
David R. Maldonado ◽  
Cynthia Kyin ◽  
Jacob Shapira ◽  
Philip J. Rosinsky ◽  
Mitchell B. Meghpara ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Hip Arthroscopy ◽  
Matched Control ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Control Group ◽  
Study Group ◽  
Matched Control Group ◽  
Patient Reported

Background: Hip arthroscopy in patients with borderline dysplasia continues to be surrounded by controversy. Even more controversial is the management of the failed hip arthroscopy in this population. There is a paucity of studies in contemporary literature regarding outcomes after arthroscopic revision surgery. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores in patients with borderline dysplasia who underwent revision hip arthroscopy and (2) to compare these PRO scores with those of a propensity-matched control group without dysplasia who underwent revision hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected between August 2009 and November 2017. Inclusion criteria were revision arthroscopic surgery, capsular plication, and baseline and minimum 2-year follow-up for the following PROs: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with Tönnis grade >1 or previous hip conditions were excluded. Two groups were created: a study group with borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and a control group without dysplasia (LCEA, 25°-40°). Groups were propensity-matched in a 1:3 ratio for sex, age, body mass index, and follow-up time. Results: A total of 22 revision borderline dysplastic hips (21 patients) had a minimum 2-year follow-up during the study period. Patients in this group reported significant improvements for all PROs from baseline and achieved the minimal clinically important difference (MCID) for the mHHS at a rate of 70%. Moreover, 21 borderline dysplastic hips (21 patients) were matched to 63 control hips (63 patients). Mean LCEA for the study and control groups was 22.6 ± 1.7 and 32.0 ± 5.0, respectively. Both groups reported similar improvement in all PROs. The rate for achieving the MCID for the mHHS and VAS was similar between groups; however, the control group had higher rates of meeting the MCID for the HOS-SSS and NAHS ( P = .042 and P = .025, respectively). The rates of conversion to hip arthroplasty were 7.9% (n = 5) in the control group and 23.8% (n = 5) in the borderline dysplasia propensity-matched group ( P = .052). The rate of re-revision arthroscopy was 11.1% (n = 7) in the control group and 19.0% (n = 4) on the borderline dysplasia group ( P = .350). Conclusion: After revision hip arthroscopy, significant improvement was obtained for all PROs in patients with borderline dysplasia at a minimum 2-year follow-up. Moreover, outcomes, patient satisfaction, the rate for achieving the MCID for the mHHS and VAS, and the rate for secondary surgery were similar to those of a propensity-matched control group without dysplasia. Nevertheless, there was a nonsignificant trend toward higher secondary procedures in the study group; therefore, arthroscopic revision surgery in the borderline patients should be approached with measured prognosis.

scholarly journals Does additional weekend and holiday physiotherapy benefit geriatric patients with hip fracture? — A case-historical control study

2021 ◽  
pp. 1-10
Author(s):  
Dennis Kim Chung Mo ◽  
Ken Kin Ming Lau ◽  
Donna Mei Yee Fung ◽  
Bosco Hon Ming Ma ◽  
Titanic Fuk On Lau ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Functional Outcomes ◽  
Geriatric Patients ◽  
Historical Control ◽  
Hospital Length Of Stay ◽  
Lower Percentage ◽  
Control Group ◽  
Study Group ◽  
Rehabilitation Hospital

Objective: To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training. Methods: A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals. Results: With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II ([Formula: see text]) and significant higher MBI scores ([Formula: see text] deviation, median; Study group: [Formula: see text] points, 51 points; Control group: [Formula: see text] points, 43 points; [Formula: see text]) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: [Formula: see text] points, 7 points; Control group: [Formula: see text] points, 6 points; [Formula: see text]) and MBI scores (Study group: [Formula: see text] points, 68 points; Control group: [Formula: see text] points, 64 points; [Formula: see text]) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: [Formula: see text] days, 7 days; Control group: [Formula: see text] days, 6 days; [Formula: see text]). The average LOS in rehabilitation hospital (Study group: [Formula: see text] days, 20 days; Control group: [Formula: see text] days, 23 days; [Formula: see text]) and total in-patient LOS (Study group: [Formula: see text] days, 26 days; Control group: [Formula: see text] days, 28 days; [Formula: see text]) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, [Formula: see text]). Conclusion: Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.

scholarly journals Exercise reduces systemic immune inflammation index (SII) in childhood cancer patients

2021 ◽  
Author(s):  
Matteo Winker ◽  
Sandra Stössel ◽  
Marie Astrid Neu ◽  
Nadine Lehmann ◽  
Khalifa El Malki ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Patient Reported Outcomes ◽  
Controlled Trial ◽  
Control Group ◽  
Inflammation Markers ◽  
Clinical Trial Registration ◽  
Lymphocyte Ratio ◽  
Patient Reported ◽  
Immune Inflammation ◽  
Anti Inflammatory

AbstractWhile exercise and physical activity have been suggested to reduce mortality and symptoms in cancer, knowledge on these associations in patients with childhood cancer (CCPs) is sparse. Anti-inflammatory properties of exercise might mediate these beneficial effects. We investigated the influence of exercise on the inflammation markers neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic-immune-inflammation index (SII) and associations to patient-reported-outcomes in CCPs in a randomized-controlled trial. Results show associations between inflammation markers and patient-reported outcomes. Compared to the control group, SII was significantly reduced following exercise (p=0.036). Anti-inflammatory effects of exercise are also present in CCPs and may underlie exercise-induced benefits on symptoms. Clinical Trial Registration Number: NCT02612025

scholarly journals Remote Management of Patients after Total Joint Arthroplasty via a Web-Based Registry during the COVID-19 Pandemic

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1296
Author(s):  
Michele Ulivi ◽  
Luca Orlandini ◽  
Valentina Meroni ◽  
Mario D’Errico ◽  
Arianna Fontana ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Short Form ◽  
Joint Arthroplasty ◽  
Physical Activities ◽  
Functional Score ◽  
Control Group ◽  
Study Group ◽  
Web Based ◽  
Patient Reported

Background: In 2020, due to the outbreak of the COVID-19 (Coronavirus Disease 2019) pandemic, patients who underwent total joint arthroplasty were not able to undergo the proper postoperative surgical and rehabilitative care. This study aims to evaluate the potential of a web-cloud-based database on patients’ follow-up in extraordinary situations, when a traditional in-person follow-up cannot be warranted. Methods: Patients who underwent joint arthroplasty at our Institute between 21 February and 16 March 2020 were included in the study group and were matched to a similar population undergoing joint arthroplasty in February/March 2019. All patients routinely complete questionnaires before and after treatment, including patient-reported outcome measures such as the Visual Analogues Scale (VAS), Knee/Hip Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS/HOOS-PS) and Short-Form Health Survey (SF-12) for the monitoring of clinical improvements. Results: 56 (study group) and 144 (control group) patients were included in the study. Both groups demonstrated significant improvements at 3 months. HOOS-PS improvement was significantly reduced in the 2020 group compared to 2019 (21.7 vs. 33.9, p < 0.001). This reduction was related to intense physical activities. Similarly, the functional score improvement related to these activities was reduced for patients undergoing knee replacement (8 vs. 10, p < 0.05). Conclusions: The web-based Institute Registry emerged as a meaningful and sensitive tool during an extraordinary situation such as the COVID-19 pandemic to monitor patients’ progression after total joint arthroplasties. Thanks to this tool, it was possible to observe that the prevention of usual postoperative care due to pandemic-related restrictions did not alter the benefits observed after joint replacement surgeries, even if this condition reduced the postoperative improvements in the most burdensome physical activities. A broader use of this kind of tool would improve and potentially reduce the burden and costs of postoperative patients’ monitoring in standard and extraordinary conditions. In addition, the systematic remote collection of data would allow for the identification of relevant differences in clinical outcomes in specific conditions or following the modification of treatment and rehabilitation protocols.

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