scholarly journals Does the Kinematch® Prosthesis Impair Knee Flexion in Patients with Trochlear Dysplasia?

2014 ◽  
Vol 4 (1) ◽  
pp. 42-45
Author(s):  
Ronald Grelsamer, MD ◽  
Paul Cavallaro, BS
Keyword(s):  
Knee Flexion ◽  
Primary Outcome ◽  
Trochlear Dysplasia ◽  
Patient Specific ◽  
Consecutive Series ◽  
Severe Dysplasia ◽  
Clinical Difference ◽  
Axial Ct ◽  
Control Study ◽  
Patellofemoral Replacement

Background: Patellofemoral replacements are used to treat isolated patellofemoral arthritis in carefully selected patients. The Kinematch® custom-designed implant is placed directly on subchondral bone, leading critics of the device to believe that this results in overstuffing and limitation of flexion in cases of trochlear dysplasia; the current study aims to evaluate this premise.Methods: A retrospective analysis of a consecutive series of 24 patients (32 knees) was conducted.  Trochlear dysplasia was evaluated using pre-operative axial CT scans, and knees were categorized as having minimal or moderate/severe dysplasia (moderate = flat trochlea, severe = convex trochlea). The primary outcome was post-operative knee flexion.Results: There was no statistical or clinical difference in post-operative knee flexion between the minimal (120°+12) and the moderate/severe dysplasia (117°+9) groups (p=.34).  Conclusions: Use of the Kinematch® patient-specific custom trochlear component does not significantly limit flexion in cases of trochlear dysplasia, and although the surgeon has the ability to deepen the trochlea by way of the pre-operative model, this is not necessary. Keywords: Patellofemoral replacement; custom; flexion; trochlear dysplasiaLevel of Evidence: III, Case-control study

scholarly journals Is Maternal Obesity Associated With Fetal Congenital Lung Malformations?

2020 ◽  
Author(s):  
Linden Stocker ◽  
Diana Wellseley ◽  
Rajeswari Parasuraman ◽  
Michael Stanton ◽  
David Howe
Keyword(s):  
Primary Outcome ◽  
Maternal Obesity ◽  
Case Control Study ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Control Group ◽  
Retrospective Case ◽  
Clinical Difference ◽  
Congenital Lung Malformations ◽  
Control Study

Abstract BackgroundPrevious data demonstrated an increased incidence in congenital lung malformations (CLM) and hypothesised a link with maternal obesity.MethodA retrospective case-control study (1994-2017) including all cases of CLM and matched controls (N=114 pregnancies). For each diagnosis of a baby diagnosed antenatally with CLM, two controls were selected. Primary outcome measure was mean Body Mass Index of women of affected pregnancies.ResultsThe women in affected pregnancies had a greater BMI (26.7 ±5.2kg/m2 (n=38)) than the control women (24.6±4.7 kg/m2 (n=76)) (p=0.03). 60.5% (n=46) of women in the control group and 39.5% (n=15) women in the CLM group had a normal BMI (<25kg/m2). Women with a BMI > 25kg/m2 had a 1.53 relative risk (RR) of having an affected baby (p=0.02, 95% CI 1.05-2.24). ConclusionObesity is not associated with increased rates of CLM. There is a small clinical difference in the BMI of women affected by CLM.

Risk Factors Associated With Nephrotoxicity During Outpatient Intravenous Vancomycin Administration

2021 ◽  
pp. 875512252110543
Author(s):  
Karen M. Krueger ◽  
Lisa LaCloche ◽  
Amy Buros Stein ◽  
Ryan Kates ◽  
Milena Murray ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Outpatient Setting ◽  
Intravenous Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Intravenous Antibiotics ◽  
Vancomycin Trough ◽  
Control Study

Background: Many studies have described an association between intravenous vancomycin and nephrotoxicity; however, the majority have evaluated incidence and risk factors among hospitalized patients. Outpatient administration of intravenous antibiotics is a growing practice and presents its own set of unique challenges. Objective: The aim of this study was to identify risk factors for vancomycin-associated nephrotoxicity in the outpatient setting. Methods: A case-control study of patients who received intravenous vancomycin through an Outpatient Parenteral Antimicrobial Therapy (OPAT) program was conducted. Patients were identified who developed an acute kidney injury (AKI) during treatment. The primary outcome was the incidence of AKI during treatment. Results: A total of 37 out of 130 patients (28.5%) met the criteria for AKI. AKI was more likely to occur in patients with a longer duration of therapy, higher maximum trough concentration, co-administration of a fluoroquinolone or metronidazole, and those who received another potentially nephrotoxic medication. Co-administration of a fluoroquinolone (OR = 5.96, P = 0.009, [CI: 1.59, 24.38]), any nephrotoxic medication (OR = 11.17, P < 0.001, [CI 3.14, 51.23]), and a higher maximum vancomycin trough (OR = 1.29, P < 0.001, [CI 1.17, 1.44]) were all indicative of a higher odds of an AKI. Conclusion: In this cohort, vancomycin-associated nephrotoxicity was common during outpatient intravenous antibiotic therapy. Co-administration of a fluoroquinolone, any nephrotoxic medication, and a higher maximum vancomycin trough were associated with AKI development. Further study is needed to determine how this impacts long-term clinical outcomes and what measures can be taken to reduce nephrotoxicity risk.

scholarly journals The Evaluation of Trochlear Osseous Morphology: An Epidemiologic Study

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0044
Author(s):  
Sercan Yalçin ◽  
Gabriel Onor ◽  
Scott Kaar ◽  
lee Pace ◽  
Paolo Ferrua ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Normal Population ◽  
Trochlear Dysplasia ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Epidemiologic Study ◽  
Intraobserver Reliability ◽  
Severe Dysplasia ◽  
Mild Dysplasia ◽  
Study Population

Objectives: The purpose of this study is to investigate the prevalence of the trochlear dysplasia in our study population. Methods: We obtained 692 skeletally mature femoral specimens from the [Blinded Institution], [Blinded Collection]. Five observers were asked to evaluate each specimen for trochlear dysplasia on a scale between 0 and 3 (0 – normal/no dysplasia; 1 – mild dysplasia; 2 – moderate dysplasia; 3 – severe dysplasia). Each observer made initial evaluations for interobserver reliability. Each observer then re-evaluated each specimen one month later to determine intraobserver reliability. We evaluated inter and intraobserver reliability utilizing intraclass correlation coefficient (ICC). All statistics were performed with SPSS v.25 (IBM, USA). Results: The interobserver ICC of first and second evaluation of all observers were found to be 0.906 [0.894-0,916] and 0.904 [0.892-0.915], respectively. The intraobserver ICC of observers were as follows: Reviewer1: 0.799 [0.771-0.825]; Reviewer2: 0.686 [0.645-0.724]; Reviewer3: 0.808 [0.781-0.832]; Reviewer4: 0.787 [0.757-0.814]; Reviewer5: 0.778 [0.747-0.806]. These results show intra and interobserver correlation was good to excellent. The percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia for first evaluation, by reviewer, are as follows: Reviewer 1: 82.7%, 12.1%, 4.0%, 1.2%; Reviewer 2: 37.3%, 26.2%, 27.5%, 9.1%; Reviewer 3: 57.9%, 28.0%, 12.1%, 1.9%; Reviewer 4: 64.2%, 25.6%, 7.7%, 2.6%; Reviewer 5: 65.6%, 14.9%, 12.3%, 7.2%. The percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia for second evaluation, by reviewer, are as follows: Reviewer 1: 78.8%, 16.6%, 3.6%, 1.0%; Reviewer 2: 40.3%, 26.4%, 23.3%, 10.0%; Reviewer 3: 42.2%,35.1%, 18.8%, 3.9%; Reviewer 4: 57.4%, 31.9%, 8.2%, 2.5%; Reviewer 5: 73.7%, 8.2%, 9.7%, 8.4%. In total, the percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia were 60.00%, 22.51%, 12.72%, 4.77%; respectively. Conclusions: This study shows that although there was no absolute criteria to grade trochlear dysplasia, observers had similar opinions on the degree of dysplasia. Also, our cohort shows that moderate to severe dysplasia is not uncommon as it is present in around 17% of knees in our cohort. This is the first epidemiologic study evaluating the prevalence of trochlear dysplasia in the normal population.

scholarly journals Patient-specific metal implants for focal chondral and osteochondral lesions in the knee; excellent clinical results at 2 years

2020 ◽  
Author(s):  
Johannes Holz ◽  
Tim Spalding ◽  
Tarek Boutefnouchet ◽  
Pieter Emans ◽  
Karl Eriksson ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Treatment Options ◽  
Clinical Results ◽  
Patient Specific ◽  
Osteochondral Lesions ◽  
Consecutive Series ◽  
Open Label ◽  
Full Data ◽  
Level Of Evidence ◽  
Metal Implants

Abstract Purpose Surgical treatment options for the management of focal chondral and osteochondral lesions in the knee include biological solutions and focal metal implants. A treatment gap exists for patients with lesions not suitable for arthroplasty or biologic repair or who have failed prior cartilage repair surgery. This study reports on the early clinical and functional outcomes in patients undergoing treatment with an individualised mini-metal implant for an isolated focal chondral defect in the knee. Methods Open-label, multicentre, non-randomised, non-comparative retrospective observational analysis of prospectively collected clinical data in a consecutive series of 80 patients undergoing knee reconstruction with the Episealer® implant. Knee injury and Osteoarthritis Outcome Score (KOOS) and VAS scores, were recorded preoperatively and at 3 months, 1 year, and 2 years postoperatively. Results Seventy-five patients were evaluated at a minimum 24 months following implantation. Two patients had undergone revision (2.5%), 1 declined participation, and 2 had not completed the full data requirements, leaving 75 of the 80 with complete data for analysis. All 5 KOOS domain mean scores were significantly improved at 1 and 2 years (p < 0.001–0.002). Mean preoperative aggregated KOOS4 of 35 (95% CI 33.5–37.5) improved to 57 (95% CI 54.5–60.2) and 59 (95% CI 55.7–61.6) at 12 and 24 months respectively (p < 0.05). Mean VAS score improved from 63 (95% CI 56.0–68.1) preoperatively to 32 (95% CI 24.4–38.3) at 24 months. The improvement exceeded the minimal clinically important difference (MCID) and this improvement was maintained over time. Location of defect and history of previous cartilage repair did not significantly affect the outcome (p > 0.05). Conclusion The study suggests that at 2 years, Episealer® implants are safe with a low failure rate of 2.5% and result in clinically significant improvement. Individualised mini-metal implants with appropriate accurate guides for implantation appear to have a place in the management of focal femoral chondral and osteochondral defects in the knee. Level of evidence IV.

scholarly journals Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures

2018 ◽  
Vol 07 (04) ◽  
pp. 350-354
Author(s):  
Reinier Beks ◽  
Tessa Drijkoningen ◽  
Femke Claessen ◽  
Thierry Guitton ◽  
David Ring ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Consecutive Series ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Improve Reliability ◽  
Control Study

Purpose Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable. Methods A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures. Fifty-seven members of the Science of Variation Group (SOVG) were randomized to diagnose fracture location and displacement by using radiographs alone or radiographs and a computed tomography (CT) scan. Results Observers reviewing radiographs alone and observers reviewing radiographs and CT scans both had substantial agreement on fracture location (κ = 0.82 and κ = 0.80, respectively; p = 0.54). Both groups had only fair agreement on fracture displacement (κ = 0.28 and κ = 0.35, respectively; p = 0.029). Conclusion Proximal pole fractures are sufficiently distinct from proximal waist fractures that CT does not improve reliability of diagnosis. Level of Evidence Level IV interobserver reliability case-control study.

scholarly journals Anti-thrombotics and their impact on inpatient epistaxis management: a tertiary centre experience

2021 ◽  
Author(s):  
Gavin Donaldson ◽  
Kwee Yen Goh ◽  
Puneet Tiwari ◽  
Sangeeta Maini ◽  
Bhaskar Ram ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Surgical Intervention ◽  
Evidence Base ◽  
Patient Specific ◽  
Admission Rates ◽  
Tertiary Centre ◽  
Co Morbidity ◽  
Spss Software

Abstract Introduction Epistaxis represents a massive burden upon NHS resources. Despite being an extremely common reason for emergency ENT admissions, there remains significant variation in its management. Although the evidence base is continually growing, there appears to be a lack of guidance towards managing anti-coagulants and anti-platelet medications and identifying patient-specific outcomes in this setting. Epistaxis has long been associated with a multitude of risk factors but none have shown consistent, direct correlation. Materials and methods We aimed to identify if the use of anti-thrombotic medication was associated with a longer length of hospital admission or conferred a higher requirement for nasal packing, re-packing, surgery or re-admission. We conducted a retrospective analysis of 100 consecutive adult patients admitted over a 6-month period. Statistical analysis was conducted using SPSS software. Results Sixty-five percent of patients were taking anti-thrombotic medication. The variability of admission INR values in those taking warfarin did not relate with any outcome measure. There was no statistical difference between patients taking anti-thrombotic medication and those who do not, with regards to our primary outcome measures. Re-admission rates within 28 days were found to be 13%, with anti-thrombotic medication use and pre-existing cardiovascular disease recognised as commonly encountered risk factors. Three percent of patients required surgical intervention. Eight percent of patients required re-packing, with a Rapid Rhino chosen in all instances. Conclusion The use of anti-thrombotic medication is not associated with increased morbidity or increased rate of complications. Anti-thrombotic usage and more than one medical co-morbidity increase the risk of re-admission within 28 days.

Functional Outcomes and Accuracy of Patient-Specific Instruments for Total Knee Arthroplasty

2018 ◽  
Vol 25 (5) ◽  
pp. 470-475 ◽  
Author(s):  
Andrea H. Stone ◽  
Udai S. Sibia ◽  
James H. MacDonald
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Patient Specific ◽  
Consecutive Series ◽  
Coronal Alignment ◽  
Patient Specific Instrumentation ◽  
Estimated Blood Loss ◽  
Patient Specific Instruments ◽  
Total Knee

Background. Patient-specific instruments (PSIs) were developed to improve mechanical axis alignment for patients undergoing total knee arthroplasty (TKA) as neutral alignment (180°) is a predictor of long-term success. This study examines alignment accuracy and functional outcomes of PSI as compared with standard instruments (SIs). Methods. We retrospectively reviewed a consecutive series of TKA procedures using PSI. A total of 85 PSI procedures were identified, and these were compared with a matched cohort of 85 TKAs using SI. Intraoperative decision-making, estimated blood loss, efficiency, Knee Society Scores, and postoperative radiographs were evaluated. Results. One hundred and seventy patients with comparable patient demographics were reviewed. Eighty-one percent of the PSI procedures were within target (180 ± 3°) mechanical alignment, while the SI group had 70% of cases within the target plane ( P = .132). Mean target alignment (2.0° PSI vs 2.2° SI, P = .477) was similar between groups. Twenty-seven percent of patients in the PSI group had surgeon-directed intraoperative recuts to improve the perceived coronal alignment. The change in hematocrit was reduced in the PSI group (8.89 vs 7.21, P = .000). Procedure time and total operating room time were equivalent. Knee Society Scores did not differ between groups at 6 months or at 1 year. Conclusion. Patient-specific instrumentation decreased change in hematocrit, though coronal alignment and efficiency were equivalent between groups. Surgeons must evaluate cuts intraoperatively to confirm alignment. Functional outcomes are equivalent for PSI and SI groups.

scholarly journals Anatomic Factors Affecting Size of Suboccipital Decompression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Courtney Pendleton ◽  
Lohit Velagapudi ◽  
Jack Jallo
Keyword(s):  
Spinous Process ◽  
Perioperative Period ◽  
Mass Effect ◽  
Transverse Sinus ◽  
Foramen Magnum ◽  
Patient Specific ◽  
Bivariate Analysis ◽  
Posterior Arch ◽  
Consecutive Series ◽  
Suboccipital Decompression

Abstract INTRODUCTION Emergent suboccipital decompressions are not uncommon procedures for the management of cerebellar infarcts and hemorrhages with mass effect. While anatomic landmarks, such as the transverse sinus and foramen magnum, provide clear boundaries to the decompression, there are a multitude of patient-specific anatomic factors that complicate positioning, and make obtaining an adequate decompression challenging. METHODS We reviewed a consecutive series of patients undergoing emergent suboccipital decompressions. Patients in whom a unilateral decompression was performed were excluded from the study. A total of 43 patients met the inclusion criteria, and were further reviewed. The primary outcome was to determine what anatomic factors predicted maximal width and cranial-caudal extent of SOC bone flap. Head CTs, including scout film radiographs, and chest XRs in the pre- and perioperative period were reviewed to measure specific anatomic features. RESULTS The average patient age was 55 (19-85). 34% of patients were female. A bivariate analysis showed that AP diameter correlated to inion-to-foramen magnum distance (P = .001, r2 = 0.501), shoulder width (P = .001, r2 = 0.509), and soft tissue at C1 measured from posterior arch on CT (P = .004, r2 = 0.444). The angle measured from a plumb line through the CT scout radiograph and a line connecting the inion to the spinous process of C2 also correlated to AP diameter (P = .046, r2 = 0.309). The width of decompression also correlated to the cranial-caudal height (P < .001, r2 = 0.522). A linear regression model demonstrated that cranial-caudal height was predicted (F (16,22) = 2.654, P = .017, r2 = 0.659) by age, maximum SOC width, and BMI (ß = -0.421, P = .031, 95% CI = (-1.067, -0.058)). CONCLUSION We demonstrate that a number of anatomic factors affect the ability to achieve optimal SOC size. While these factors are not modifiable, awareness of these factors may help guide positioning and operative planning to achieve maximum cerebellar decompression and help improve patient functional outcomes after emergent suboccipital decompression.

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