Acta Orthopaedica Belgica
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Prevalence of lumbar high-intensity zone: assessment using a screening tool independent of spinal symptoms.
No full text The prevalence of high-intensity zone has not been clearly established. We evaluated 216 patients studied with abdominal-pelvic magnetic resonance imaging to determine the prevalence of lumbar high-intensity zone using a screening tool independent of spinal symptoms. We looked for high-intensity zone, disc degeneration, spondylolisis, spondylolisthesis, Modic changes and scoliosis. We determined if these variables, age and sex affected the presence of high-intensity zone; through a logistic regression analysis we evaluated their independent effect. Patients’ mean age was 56.3±17.4 years; 66.8% were females. Prevalence of high-intensity zone was 11.06%; prevalence was larger in males (18.06%) than females (7.59%), p= 0.02. Patients with and without high-intensity zone did not differ in age or presence of scoliosis. High-intensity zone was more frequent in degenerated discs, but not in levels with spondylolisis, spondylolisthesis or Modic changes. Male sex (OR= 2.3, 1.04-5.38) and disc degeneration (OR= 6.76, 1.77-25.81) independently influenced the presence of high-intensity zone
Musculoskeletal injuries among elite Greek gymnasts: A ten-year study of 156 elite athletes.
No full textInjury data on elite gymnasts outside North America are sparse. This study reports the injuries recorded over a period of 10 years in 156 Greek elite male and female gymnasts. 2390 injuries were reported for a rate of 1,5 new injuries per year per athlete. Most commonly affected areas were the hip (18.5%), the ankle (16.5%), the lumbar spine (16%) and the foot (16%). The most frequent diagnosis was tendinitis (32%), followed by low back pain (20%), and sprains (12%). Fifteen athletes (9%) sustained serious injuries that required surgery. Rhythmic gymnasts had significantly more repetitive load type injuries compared to artistic gymnasts (p=0.049). Gymnastics is a sport with a high incidence of musculoskeletal pathology that needs proper documentation in order to establish preventive measures
Inclination but not anatomical reconstruction is related with higher cobalt levels in MoM hip arthroplasty
No full textBackground: Metal on Metal total hip arthroplasty is associated with elevated serum cobalt levels. In this study we investigate if there is a relation between the inclination angle of the cup and the anatomical reconstruction of the hip on the serum cobalt level.Methods: Postoperative cobalt serum levels were measured in 250 patients. On standardized radiographs inclination angle, lower limb length, lateral offset, center of rotation distance were evaluated. A difference of more than 5 millimeter compared to the preoperative situation was considered as a non-anatomical reconstruction.Results: For every 10 degrees increase in inclination the cobalt level increased 14% (p=0.036). Women with the same cup inclination angle showed 34% higher cobalt levels than men (p=0.013). No relation was found between the anatomical reconstruction and the serum cobalt levels.Conclusions: A higher inclination of the cup leads to higher serum cobalt levels, but a non-anatomical reconstruction has no influence on serum cobalt levels
Staged Bone Grafting for the Management of Segmental Long Bone Defects Caused by Trauma or Infection using Induced-Membrane Technique.
No full textAbstractSegmental bone defect is extremely difficult to treat. The current methods of treatment include bone transport and vascularized fibula transfer. An evolving new staged method is the induced membrane (Masquelet) technique. Its idea is the formation of a biological membrane around cement spacer inserted in bone gap. In a second stage surgery, this membrane is incised with care, spacer removed and the cavity filled with morcellized cancellous graft. This study included 20 patients (open fractures in 6 cases, infected non union in 11 cases and aseptic atrophic nonunion in 3 cases. The average size of bone defect was 7.2 cm. Soft tissue defect was present in 3 patients. 2nd stage was done after an average of 6 weeks. 17 cases united, 2 cases of graft resorption and 1 case of infectedgraft. The average time to union was 7.4months. The major complications of this technique include infection and graft resorption.Keywords: (Segmenta bone defect, Induced membrane, Masquelet, Cement spacer, Cancellous bone graft
Tranexamic acid in joint replacement: a randomized trial comparing intravenous oral and topical routes
No full textAbstractPurposeOur purpose is to compare intravenous, oral and topical routes of tranexamic acid in terms of reducing perioperative blood loss and blood transfusion rates in total knee and hip arthroplasty.Materials and methodsIn this prospective randomized comparative study, 57 patients undergoing primary knee or hip arthroplasty were assigned to receive intravenous, oral or topical tranexamic acid. Primary outcomes were blood loss at day 1 and day 3.ResultsThe mean blood loss at day 1 was 954 ±356 mL in the intravenous group, 880 ±506 mL in the oral group and 754 ±382 mL in topical group with no statistically significant difference (p=0.15). The mean blood loss at day 3 was 1659 ±637 mL in the intravenous group, 1530 ±686 mL in the oral group and 1296 ±588 mL in topical group. With no statistically significant difference (p=0.22).ConclusionNone of the 3 routes was found to be superior in terms of reducing perioperative blood loss in joint replacement
Surgical management of rickets-like bone deformities (knock-knee and bow- leg) in children in sub-Saharan Africa
No full textPurpose: rickets-like deformities of the lower limb (knock-knee or bow-leg) are very frequent in sub-Saharan Africa.Methods: A prospective study was carried out over a period of 5 years. Forty children were treated surgically for rickets-like deformities. The surgical technique was guided growth using a tension-band plate (eight plate).Results: The deformity was bilateral in 33 cases and unilateral in 7 cases (73 knees). The deformities were knock-knees in 20 cases, bowlegs in 18 cases and there were 2 windswept deformities Good correction was obtained after a mean time of 11.4 months for genu varum and after a mean time of 12.4 months. The two windswept deformities were corrected after 8 and 9 months respectively.Conclusions: the guided growth technique using eight plate is effective as well in Africa. The needed material is not expensive if a two-hole tubular plate is used with two screws
Trapeziectomy with ligament reconstruction and tendon interposition arthroplasty in a male cohort: a retrospective study
No full textOsteoarthritis of the carpometacarpal joint of the thumb is a common disease, mostly affecting middle aged women. This article presents the results of a trapeziectomy with a ligament recontruction/tendon interposition (LRTI) procedure. We evaluated 60 male patients with 76 operated thumbs. The mean follow-up was 62 months (ranging from 8 to 133 months, with SD of 33 months). The outcome was measured with the disabilities of the arm, shoulder and hand score (DASH), a Nelson Hospital score (NHS), a Visual analogue scale (VAS) score and range of motion (ROM). The preoperative height of the trapezium was measured and compared with the height of the trapezial space postoperativaly. The DASH score improved from 25,6 to 16,1. The VAS score for pain, satisfaction, dexterity and function were correlated. On x-ray, there was an average loss of 67% of trapezial height compared preoperativaly with postoperativaly, but no correlation was found with clinical outcome of subjective parameters
Coronal alignment in osteoarthritic knees, does it change in flexion?
No full textChanges in coronal alignment in osteoarthritic knees evolving from extension to flexion remain poorly studied. Using an imageless computer-navigation system (Stryker©) we prospectively collected measurements of dynamic coronal pre-implant alignment during primary total knee arthroplasty. Coronal alignment of the osteoarthritic knee was determined at maximal extension and 90° flexion. Measurements were subgrouped as varus (≤-3°), neutral (>-3°, <+3°) or valgus (≥+3°). Of 545 osteoarthritic knees (347 females), coronal alignment in extension was 261 (48%) varus, 197 (36%) neutral and 87 (16%) valgus. Varus extension alignment was more common in male versus female knees (p< .0001). Valgus extension alignment was more common in female versus male knees (p= .002). In flexion, 174 (66%) of varus knees remained varus. Coronal alignment remained unchanged (within +3°; -3°) in flexion versus extension in approximately half of the OA knees observed. This insight into a changing coronal deformity might contribute to a better understanding of osteoarthritic knee behaviour
Do double-row suture-locking anchors impact the biomechanical outcomes of rotator cuff surgery? A biomechanical study.
No full textIntroduction: Several surgical techniques for arthroscopic repair of the rotator cuff have been described in the literature. The aim of this study was to determine whether the suture thread locking method in double-row anchors influences their biomechanical properties. We compared the pullout strength of two anchors with different locking mechanisms.Methods: We performed 30 pullout tests at 135° using two different double-row anchors, an interference fit lock (5.5 mm SwiveLock) and a combination lock (5.5 mm MultiFix S). One anchor of each type was implanted on the tuberosity of a bovine humeral bone.Results: Mean pullout strength was 239.29 ± 83.73 N for the SwiveLock anchors and 253.82 ± 87.65 N for the MultiFIX S anchors, mean displacement (in millimeters) was 28 ± 9 and 30 ± 12, respectively which were not statistically significantly different.Conclusion: The addition of an internal lock in the double-row suture-locking anchor did not improve the biomechanical properties in a pullout test of 135°
Hip abduction pillow use following total hip arthoplasty does not decrease acute hip dislocation rates
No full textBackgroundDislocation following total hip arthroplasty (THA) is a complication with reported incidence rates varying from 0.5% to 10.6%. Placement of an abduction pillow is a precautionary measure undertaken to help prevent acute hip dislocation. Our primary aim is to compare the rates of acute hip dislocation between THA patients who received a post-operative hip abduction pillow and those who did not. Methods This is a retrospective single-center, multi-surgeon case-series of patients who underwent primary THA between June 1, 2014, and June 01, 2018 at our National Orthopaedic Hospital. Exclusion criteria included revision surgery, conversion surgeries. Dislocation rates were compared between the 2 groups: reported as relative risk (RR) estimates.Results 1154 patients received hip abduction pillows following THA compared to 1296 patients who did not. 2 patients suffered an acute hip dislocation in the former group compared to one patient in the latter.The relative risk of suffering an acute hip dislocation was 2.25 times higher if the hip abduction pillow was utilized. Conclusion Removal of the hip abduction pillow following primary total hip arthroplasty does not increase the risk of in-hospital acute hip dislocation, regardless of approach used.