Acta Orthopaedica Belgica
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Shoulder arthroplasty for glenohumeral osteoarthritis: results from a comprehensive survey in Belgium and the Netherlands
No full textIntroductionThe purpose of this survey in Belgium and the Netherlands was to assess treatment variation in glenohumeral osteoarthritis between experienced and less experienced orthopedic surgeons, and to investigate perioperative treatment after shoulder arthroplasty in a large group of orthopedic surgeons.Materials and MethodsOrthopedic surgeons specialized in shoulder surgery were invited to complete a survey between November 2013 and February 2015.ResultsSeventy percent of the approached surgeons completed the survey. Less experienced surgeons (< 6 years) and surgeons from the Netherlands find patient characteristics (e.g. smoking p=0.01) more relevant than more experienced surgeons (≥ 6 years) and surgeons from Belgium.Less experienced surgeons will less likely (p=0.001) perform resurfacing arthroplasty compare to experienced surgeons. The less and the experienced surgeons use similar indications for a reverse shoulder arthroplasty regarding age limit and cuff arthropathy without osteoarthritis.Less experienced surgeon will more likely (p=0.003) prescribe a low molecular weight heparin during the hospital stay after a shoulder arthroplasty.ConclusionIn this survey, we found a decrease in the use of resurfacing arthroplasty and a strong increase in the use of reverse shoulder arthroplasty.Besides, there is little consensus concerning pre-operative planning, patient characteristics, surgical technique, and patient reported outcome measures.
Shear force in the femoral neck affects clinical outcome of total hip arthroplasty
No full textCase-reports of broken modular femoral necks have implied increased shear loading as the main culprit. The study aim was to determine whether total hip endoprostheses with modular femoral necks produced larger magnitudes of shear force, smaller leg length discrepancy and better WOMAC score in comparison to nonmodular implants. A single-surgeon series of unilateral uncemented primary total hip arthroplasties (50 modular ProfemurZ and 52 nonmodular Zweymüller) was compared retrospectively in hip force magnitudes computed with a previously validated static biomechanical model, radiographic changes before/after total hip arthroplasty, leg lengths and WOMAC. Modular implants ProfemurZ on average had larger shear force magnitudes in the femoral neck than nonmodular Zweymüller, but there was no significant difference in leg-length discrepancy or WOMAC score. In multivariate regression (adjusted for implant type, gender, age, BMI, leg length discrepancy) increase in shear force magnitude was an independent predictor of better WOMAC score, regardless of the implant type
Thoraco Lumbar Spine Metastasis - Current concepts and an update on surgical management.
No full textSpinal metastases are causing a treatment dilemma worldwide. As current medicine evolves, treatment of primary tumours is improving, leading to increased survival and hence later presentation of metastases. Spine is one of the main locations for metastases with thoracolumbar regions being most commonly affected. Currently treatment options are mainly for palliation and include chemotherapy, radiotherapy and surgery. A review of literature was carried to look into the current practices and evidence for the management of thoracolumbar spinal metastases. As surgical techniques are becoming more minimally invasive, a similar trend is occuring in treatment of metastatic disease. This is resulting in fewer morbidities and complications, which has a knock on effect of increasing survival in certain patient groups. However, there are still concerns regarding the appropriate surgical approaches for thoracolumbar metastases and whether these newer minimally invasive techniques have the same oncological benefits as the standard open procedures. Future research should focus on comparing outcomes and survival rate of minimally invasive versus open surgery
Comparison of fine needle aspiration and core needle biopsy in the diagnosis of bone tumours
No full textMuch literature exists regarding the diagnostic yield and accuracy of core needle biopsy (CNB) and fine needle aspiration (FNA) but none compares both in the same tumour. Ninety-four patients were prospectively studied using a FNA and CNB. With FNA 70 diagnoses were possible (74,5%). Accurate diagnosis rate was 97,1%. In 92 patients (97,9%) a diagnosis was obtained with CNB and 91 (98,9%) were accurate.. The diagnostic yield was 74,5% for FNA and 97,9% for CNB (p<0.0001). The diagnostic accuracy was 97,1% for FNA and 98,9% for CNB (p=0.5787). Regarding determining malignancy FNA and CNB had 98,3% and 98,5% sensibility, 100% and 100% specificity, 100% and 100% positive predictive value and 95,2% and 96,2% negative predictive value, respectively. In conclusion FNA is as accurate as CNB on all accounts. Despite the reliability of FNA, the number of inconclusive cases makes it an inferior technique when compared with CNB
Asymmetry and pelvic movements 6 months after total hip replacement. - Secondary analyses from a randomized controlled trial.
No full textPurposeThe aim was : 1) To investigate gait asymmetry and pelvic range of motion (ROM) during walking speed and stair ascending after Total Hip Replacement (THR), and 2) to test whether change in these parameters are influenced by resistance training.MethodsA consecutive sub-sample of 32 patients within a randomized controlled trial was included. Patients were randomly assigned to a control group or training group. Walking test (speed, asymmetry and pelvic ROM), stair test (speed and pelvic ROM) and leg extension power (LEP) were measured preoperative, 10 weeks and 6 months postoperative.ResultsWalking and stair ascending speed, LEP and pelvic ROM in the frontal plane during walking increased significantly from baseline to 6 months follow up (p<0.005). There were no significant changes in gait asymmetry or the remaining pelvic ROM measurements (p>0.05) and no between-group differences.ConclusionPelvic movements in the frontal plane during maximal walking increased after surgery. No changes occurred in gait asymmetry and pelvic ROM 6 months after THR while LEP and speed during walking and stair ascending increased significantly.
Matrix-Induced Adipose-Derived Mesenchymal Stem Cells Implantation for Knee Articular Cartilage Repair. Two Years Follow-up.
No full textObjective. The aim of this study was to evaluate the efficacy of cartilage repair using matrix-induced adipose-derived mesenchymal stem cells (MSCs) for focal chondral knee lesions.Materials and Methods. Twenty consecutive patients treated for symptomatic full-thickness chondral defects were prospectively followed for two years. All patients underwent a single-stage procedure consisting in filling each defect with autologous culture-expanded mesenchymal stem cells embedded in a trimmed-to-fit commercially available biodegradable matrix. Knee-related function was evaluated based on subjective scores given by two self-reported questionnaires (KOOS and IKDC). Results. The data analysis recorded significant improvements (p<0.001) in all the values. The mean preoperative scores in the subscales of KOOS, as well as in the IKDC subjective score were constantly increased during the follow-up period with statistical significant differences at 6, 12 and 24 months review.Conclusions. Matrix-induced adipose-derived mesenchymal stem cells implantation is an efficient and safe single-staged cell-based procedure to manage full-thickness focal chondral lesions of the knee.
Results of the treatement of intracapsular femoral neck fractures with a new dynamic locking plate.
No full textThe purpose of this study was to evaluate the outcomes in patients with intracapsular femoral neck fractures treated with the novel Targon FN implant. Sixty two patients (mean age: 57 years) were included. The clinical and radiological results were investigated. Radiological and clinical follow-up (mean time: 21,2 months) was available for 51 patients; in 36 patients, Harris Hip Score (HHS) outcome data were additionally assessed. The overall complication rate was 8%. The median Harris Hip Score was 92 (range 30-100). The results of the Harris Hip Score were rated excellent or good in 26 (72%) patients and fair or poor in 10 (28%). The HHS was correlated significantly with age at trauma, time from admission to operation, preexisting cardiovascular risk factors and disease of the ipsilateral leg. The positive experience with Targon FN suggests that this implant is an advance in treatment of intracapsular femoral neck fractures with head-preserving surgery
Greater tuberosity sclerosis: a radio-graphic sign of rotator cuff Tear?
No full textAbstract:Objective: The study had been carried out to investigate the relation of sclerosis of the greater tuberosity to cuff tear, or whether this may signify partial or complete tear.Patients and methods: This retrospective study conducted on 425 patients, 250 Females (58.8%) and 175 males (41.2%). Dominant side was affected in 342 Patients (80%). The average age in males was 46 years (24-68 years) and 54.5 years in Females (44-65 years).Results: Greater tuberosity sclerosis had 93.5% sensitivity for rotator cuff tear,67.5% specificity, 90.4% positive predictive value (PPV), 51.9% negativePredictive value (NPV) and 85.2% accuracyConclusion: Greater tuberosity sclerosis had both high sensitivity and positive Predictive value for rotator cuff tears; however, more in-depth evaluation was required to better understand the relation between greater tuberosity sclerosis and rotator cuff tear.Level of evidence II
Outcomes of Surgical Repair of Zone 2 Digital Nerve Injury
No full text ABSTRACTIn this study, we aimed to present the demographic, etiological, and clinical characteristics and mid-term results of surgery in patients with a zone 2 digital nerve injury. Between January 2012 and November 2014, a total of 48 patients with 138 digital nerve injuries were included. Sensorial evaluation was performed through static two-point discrimination test. The results were classified according to the guidelines of the American Surgical Association. Sensorial recovery level was carried out based on the Seddon classification. Functional evaluation was carried out by the Sollerman Hand Function Test (SHFT) and by Quick-Disabilities of Arm, Shoulder, Hand (Q-DASH) questionnaire. A total of 33 digital nerves were S0, 18 were S1, 15 were S2, three were S3, and 69 were S3+. The mean postoperative SHFT score was 73.6 and the mean postoperative Q-DASH score was 38.9. Our study results suggest that acute primary surgical repair of zone 2 digital nerve injuries offers improved and earlier recovery
The role of the carpometacarpal ligaments of the thumb in stability and the development of osteoarthritis lesions: an anatomical study
No full textThis study aims to assess ligament lesions and subluxations of the carpometacarpal (CMC) joint of the thumbs and the role that these ligament ruptures play in the pathophysiology of osteoarthritis (OA). Twenty-five fresh-frozen cadaver hands were dissected. There were 14 female and 11 male with mean age 65 years (51-92 years old). The ligament ruptures and the metacarpal translation associated with these ruptures were measured (mm). Cartilage thickness in the trapezium and metacarpal of specimens was assessed. We investigated the relationship between the ligament ruptures and the area of chondromalacia and OA. There was a relationship between the presence of a tear in the DRL and OA in the radial quadrants (P = 0.032). These observations suggest a translation of metacarpal on trapezium in the production of arthritic lesions and support a hypothesis that pathologic joint instability could be a cause of CMC osteoarthritis. This study suggests that repairing the DRL during ligament reconstruction of the CMC joint should be considered