SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Results of meniscal injuries repair using different arthroscopic techniques
No full textAim: Evaluation of clinical and radiological outcomes following meniscal repair using different arthroscopic techniques for all meniscal tears amenable for repair. Methods: Sixty-one patients were involved in a prospective study; all cases presented with meniscal tears underwent arthroscopic meniscal repair from December 2016 to December 2017. Outcomes involved the site of tear, the repair technique, and associated injuries. The International Knee Documentation Committee Score (IKDC) and Tegner Lysholm Knee Score were used to analyze the clinical and functional outcomes postoperatively. Results: Of the 61 patients, 50 patients (81.9%) had meniscal tear associated with isolated ligamentous ACL injury, 6 cases had corrective osteotomy with ACL reconstruction to correct concomitant genu varus, 2 cases (3.3%) had meniscal tear associated with isolated ligamentous PCL injury, and 9 patients (14.8%) presented with isolated meniscal tear; IKDC was preoperatively (44.52 ± 8.79), postoperatively at 6 months (90.97 ± 6.75) and at 12 months (92.27 ± 2.68) with P-value (0.001). Tegner Lysholm score was preoperatively (52.16 ± 12.22), postoperatively at 6 months (88.03 ± 6.84) and at 12 months (93.26 ± 2.95) with P-value (0.001). Fifty eight patients (95.1%) had no postoperative symptoms at 6 and 12 months’ follow-up. The remaining 3 cases (4.9%) underwent partial meniscectomy due to persistent postoperative clinical symptoms with no signs of healing in MRI. Conclusions: Our study concluded that arthroscopic meniscal repair is an effective way in the management of meniscal tears regarding clinical and functional outcomes
Medical innovations to maintain the function in patients with chronic PJI for whom explantation is not desirable: a pathophysiology-, multidisciplinary-, and experience-based approach
No full textIntroduction: PJI is the most dramatic complication after joint arthroplasty. In patients with chronic infection, prosthesis exchange is in theory the rule. However, this surgical approach is sometimes not desirable especially in elderly patients with multiple comorbidities, as it could be associated with a dramatic loss of function, reduction of the bone stock, fracture, or peroperative death. We propose here to report different approaches that can help to maintain the function in such patients based on a pathophysiology-, multidisciplinary-, and an experience-based approach. Methods: We describe the different points that are needed to treat such patients: (i) the multidisciplinary care management; (ii) understanding the mechanism of bacterial persistence; (iii) optimization of the conservative surgical approach; (iv) use of suppressive antimicrobial therapy (SAT); (v) implementation of innovative agents that could be used locally to target the biofilm. Results: In France, a nation-wide network called CRIOAc has been created and funded by the French Health ministry to manage complex bone and joint infection. Based on the understanding of the complex pathophysiology of PJI, it seems to be feasible to propose conservative surgical treatment such as “debridement antibiotics and implant retention” (with or without soft-tissue coverage) followed by SAT to control the disease progression. Finally, there is a rational for the use of particular agents that have the ability to target the bacteria embedded in biofilm such as bacteriophages and phage lysins. Discussion: This multistep approach is probably a key determinant to propose innovative management in patients with complex PJI, to improve the outcome. Conclusion: Conservative treatment has a high potential in patients with chronic PJI for whom explantation is not desirable. The next step will be to evaluate such practices in nation-wide clinical trials
Factors lead to return to sports and recreational activity after total knee replacement
No full textIntroduction: The number of total knee replacements performed (TKR) is increasing and so are patient expectations and functional demands. The mean age at which orthopedic surgeons may indicate TKR is decreasing, and therefore return to sport (RTS) after TKR is often an important expectation for patients. The aim of this study was to analyze the mid-term RTS, recreational activities, satisfaction level, and forgotten joint level after TKR. Methods: Between January 2015 and December 2016, 536 TKR (same implant design, same technique) were performed in our center. The mean age at survey was 69 years with a mean follow-up of 43 months. All patients who did not have a follow-up in the last 6 months were called. Finally, 443 TKR were analyzed. RTS was assessed using the University of California Los Angeles Scale (UCLA), forgotten joint score (FJS), and Satisfaction Score. Results: In this study, 85% of patients had RTS after TKR with a mean UCLA score increasing from 4.48 to 5.92 and a high satisfaction rate. Satisfaction with activity level was 93% (satisfied and very satisfied patients). The RTS is more important for people with a higher preoperative UCLA score and a lower American Society of Anesthesiologist score (ASA). Each point increase in ASA score is associated with reduced probability to RTS by 52%. Discussion: RTS and recreational activity were likely after TKR with a high satisfaction score. Preoperative condition and activity are the two most significant predictive factors for RTS. Level of evidence: Retrospective case series, level IV
Current effect of COVID-19 global pandemic on the professional and life profiles of the Egyptian spine surgeons
No full textIntroduction: During the recent decade, many outbreaks of infectious diseases have been reported at increasing scales and frequency. The novel COVID-19 is the most recent lethal virus and has been declared to be a pandemic disease on March 11th, 2020. It has spread from China to most of the countries around the world causing a great burden on individuals and communities. The socioeconomic and professional profiles have been affected seriously by this pandemic. The aim of this study was to assess the short-term effects of COVID-19 on the socioeconomic profile of spinal surgeons in Egypt. Methods: We conducted a cross-sectional online survey study to address the effect of COVID-19 global pandemic on spine surgeons in Egypt, discussing the short-term socioeconomic effect of COVID-19 global pandemic on the professional and social profiles of the Egyptian spine surgeons. A SurveyMonkey® questionnaire was sent to 190 spine surgeons registered in the Egyptian spine association database. Results: Ninety male surgeons responded to our four-day survey. The responders included the following: 4 residents, 16 fellows, and 70 consultants working in different Egyptian hospitals. The partial country lockdown was associated with drop in monthly income and in number of both elective and emergency operations. Most surgeons either stopped surgery or limited the number of either elective or emergency surgeries as well as outpatient clinics. Most of them were not in the COVID-19 team or did not receive any training, working under immense physical and psychological stress of being exposed to transmission of infection. Discussion: COVID-19 global pandemic negatively affected spine surgeons in Egypt socioeconomically. The Health Authority and the community have to work jointly to help the health care professionals in overcoming this crisis
Cell salvage within adult and pediatric idiopathic scoliosis surgery: A random cross-sectional study
No full textIntroduction: This study aimed to evaluate the use of a cell savage and its impact on the amount of allogenic blood transfused to the patients during idiopathic scoliosis surgery. Methods: A total of 142 randomly selected patients with scoliosis had been included in this study. The adult group consisted of 78 patients, and the pediatric group, 64 patients. Both groups were divided into subgroups (pre-cell saver era and cell saver era). Data on the following parameters were collected: amount of blood transfused intraoperatively, within 24 h postoperatively, and overall. The number of patients who received transfusion was counted as the number of patients who avoided any transfusion. For statistical purposes, we performed unpaired student t-test, chi-square test, and Mann–Whitney test. Results: There was no significant difference in adult groups perioperatively. In the pediatric group, there was a statistically significant difference intraoperatively. Economic analysis of blood management showed positive numbers for both groups, where more than 1 unit of blood was transfused. Conclusions: Statistical analysis showed the cost-effectiveness of the perioperative use of cell salvage during pediatric scoliosis surgery. Overall, the use of cell salvage during scoliosis surgery had a positive impact on both blood management and patient recovery
COVID-19. An update for orthopedic surgeons
No full textThe COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon
Is obesity a contraindication for simultaneous bilateral total knee arthroplasty? A prospective case–control study
No full textAim: Total Knee Arthroplasty (TKA) for decades has been an effective treatment modality for chronic arthritis of the knee. However, there is scarcity of literature comparing the functional outcomes of simultaneous bilateral TKA in obese patients with non-obese Indian population. We conducted this study to evaluate the functional outcomes and complication rates of simultaneous bilateral TKA in obese patients matched control with non-obese patients. Materials and methods: We divided the patients into two study groups based on their body mass index (BMI). Patients with a BMI of less than 30 were classified as non-obese and those with a BMI of more than 30 were classified as obese. All the patients underwent simultaneous bilateral TKA by a single surgeon using the same implant and technique. Patients were followed up regularly and functional outcomes in terms of Oxford knee score were noted at 6 weeks, 3 months, and 1 year. Post-operative complications and time to recovery was also compared. Results: Mean follow-up in obese group was 18 months (12–25 months) and in non-obese group was 17 months (12–24 months). Both the groups were matched with control in terms of pre-operative parameters. Post-operative hemoglobin drop, ICU requirement, length of hospital stay, mean walking time, and mean time to climbing stairs were similar in both the groups. Oxford knee score was significantly better in non-obese group at 6 weeks, but was similar in both the groups at 3 months, 6 months, 1 year, and last follow-up. There was no statistically significant difference seen in the complication rate in both the groups. There was no implant loosening or radiolucency seen. Conclusion: We conclude in our study that simultaneous bilateral TKA gives comparable mid-term results in obese patients in comparison to the non-obese patients
Plate coverage predicts failure for volarly unstable distal radius fractures with volar lunate facet fragments
No full textIntroduction: Loss of reduction after operative fixation of volarly unstable distal radius fractures with a volar lunate facet fragment (VLF) is considered problematic because it results in carpal subluxation or dislocation and subsequent impaired function. We hypothesized that the indicator of loss of reduction of the VLF after fixation is plate coverage of the bony fragment. We investigated the relationship between the plate coverage of the VLF and loss of reduction after fixation, and calculated the plate coverage that was associated with failure of fixation of the VLF.
Materials and methods: We conducted a retrospective review. We included patients with surgically treated volarly unstable distal radius fractures with VLF with a volar locking plate who had a minimum follow-up of 6 months. A total of 33 patients (35 wrists) met criteria for inclusion into the study. The patients were divided into a displacement group and a non-displacement group. We calculated and compared longitudinal dimension and plate coverage of the VLF between the two groups to reveal the risk factors for loss of reduction.
Results: At final follow-up, 25 fractures maintained radiographic alignment and 10 (28.6%) lost reduction. Univariate analysis between the two groups showed that plate coverage against the transverse and longitudinal dimension of the VLF was correlated with loss of reduction after operative fixation. In multivariate logistic regression analysis, only plate coverage against the longitudinal dimension of the VLF remained a significant predictor of failure. With 64.7% as the cut-off point for plate coverage against the longitudinal dimension of the VLF, the sensitivity and specificity of the prediction were 96% and 80%, respectively.
Conclusion: The predictor of loss of reduction after fixation of volarly unstable distal radius fractures with a VLF was plate coverage against the longitudinal dimension of the VLF
Large chondral fragment of the lateral femoral condyle treated with arthroscopic internal fixation in an elite young athlete
No full textFocal chondral lesions in the adolescent population create a particular challenge for orthopedic surgeons, and currently there exists no consensus on proper treatment. Numerous techniques for addressing focal chondral defects are employed in both pediatrics and adults, including fragment excision, debridement and fixation, bone marrow stimulation and microfracture techniques, cell-based options, as well as chondral and osteochondral grafts. Although historical evidence is mixed, recent reports of primary fixation of displaced cartilage fragments have shown favorable results. We present a case of reduction and fixation of a large displaced cartilage lesion in an elite young tennis player. Our results, in addition to other reports mentioned in this manuscript, highlight the importance of considering primary fixation of large chondral lesions when amenable to repair
Cross-cultural adaptation and translation of the Constant Murley Score into Arabic
No full textIntroduction: Shoulder pain is a major disorder of the musculoskeletal system. To the best of our knowledge, there is no documentation of an Arabic version of the shoulder disability and pain measurements. Constant Murley Score (CMS) is one of the standard questionnaires for clinical practice and research. The aim of this research centred around the evaluation of the Arabic Constant Murley Score and subsequently assessing the reliability and validity in comparison to disabilities of the arm, shoulder, and hand (DASH). Methods: Hundred and twenty five patients took part in this research. We did the internal consistency tests with Cronbach’s alpha. Intra-correlation coefficient, convergent validity, convergent construct validity, responsiveness, and floor and ceiling effects were also calculated. Results: Principal component analysis showed that the variance was 63.31% with a factor range of 0.42–0.85, which fulfils the uni-dimensionality criterion. Also, the Arabic CMS correlated negatively with the DASH score (−0.82, p < 0.001). The Arabic version of CMS was consistent with Cronbach’s alpha of 0.74. With Inter Class Correlation Coefficient (ICC) = 0.83 it also showed a very good test-retest reliability. Conclusion: Ours is the first translation and cross-cultural adaptation of the CMS into Arabic. Important evidences of validity were tested such as uni-dimensionality, convergent validity, and internal consistency. Results demonstrate an acceptable Cronbach’s alpha of 0.74, ICC = 0.830 indicating excellent reliability and a strong correlation of the Arabic CMS with the DASH score (r = −0.820). Overall, the Arabic version of CMS is a good and reliable diagnostic tool for patients experiencing shoulder pain