1,720,999 research outputs found
Modular augmentation in revision total knee arthroplasty
No full textPurpose: Controversy exists about the real effectiveness of modular augmentation to manage bone defects in revision total knee arthroplasty. The purpose of this study was to determine whether use of modular augmentation to reconstruct severe defects (1) significantly increased overall outcomes, (2) caused radiolucency or osteolysis and (3) affected mid-term survivorship of knee revisions. The hypothesis was that modular augmentation provides a good survivorship of knee revisions. Methods: Thirty-eight consecutive revision knee arthroplasties were followed for a median follow-up period of 7 (4.5-9) years. Type 2 and 3 defects were treated with metal augments, tantalum cones and modular cementless stems. Patients were assessed using the IKS knee and function scores and the HSS score. Results: The median IKS knee and function scores and HSS score were 34 (15-58), 19.5 (13-39) and 30 (24-60) points before the operation, respectively, and 78 (49-97), 76 (58-90) and 80.5 (64-98) points (p < 0.001) at the latest follow-up. The median knee flexion increased from 82° (31°-110°) to 116° (100°-129°) (p < 0.01). Tibial radiolucencies were observed in 2 (5.2 %) cases. Re-revision was necessary in three (7.9 %) patients. Conclusions: Modular augmentation may reduce the need for allografting to treat severe bone defects, providing a well-functioning and durable knee joint reconstruction. Level of evidence: Case-series study, Level IV. © 2012 Springer-Verlag Berlin Heidelberg
Acute patellar dislocation. What to do?
No full textAcute patellar dislocation is a common knee injury that occurs most often in adolescents, frequently associated with sporting and physical activities. Patellar re-dislocation after the first episode appears to depend primarily on the medial patellofemoral ligament injury which represents the primary ligamentous restraint, providing about 50-60 % of the restraining force against lateral patellar displacement. Clinically, up to 94-100 % of patients suffer from medial patellofemoral ligament rupture after first-time patellar dislocation. Controversy regarding how patients with first patellar dislocation should be managed still exists. Though most authors have reported good results with the conservative treatment after a first-time dislocation, several circumstances may warrant surgical intervention. A surgical approach would be necessary in the presence of severe cartilage damage or a relevant disruption of the medial stabilizers with subluxation of the patella. In these cases, the repair/reconstruction of medial stabilizers should follow the treatment of the chondral injury. Medial patellofemoral ligament reconstruction may be a more reliable method of stabilizing the patella than its repair, which has limitations related to the medial patellofemoral ligament injury location. Nowadays, there is no evidence available where osseous abnormalities should be addressed in addition to restoring the medial patellofemoral ligament. © 2012 Springer-Verlag Berlin Heidelberg
Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series
No full textPurpose: The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears. Methods: Sixty-one patients who underwent arthroscopic repair of anterosuperior cuff tears were retrospectively reviewed. At a minimum 6 months of follow-up, shoulder functional outcome scores including the Constant score (CS), simple shoulder test (SST) and visual analogic scale (VAS) were collected. Strength recovery for supraspinatus and subscapularis was investigated. Results: All patients (mean age 59 ± 7) were available at a mean follow-up of 18 ± 7 months. The average CS improved from 30.8 ± 10.2 preoperatively to 76.5 ± 12.0 postoperatively, average SST from 2.6 ± 2.0 to 8.8 ± 2.9 and average VAS pain scale from 3.8 ± 1 to 0.5 ± 0.5 (p < 0.0001). Strength at belly-press and Jobe tests significantly improved (p < 0.0001). All patients with the exception of one were satisfied with the intervention. Conclusions: Arthroscopic repair of anterosuperior rotator cuff tears provides a significant improvement in pain relief and shoulder function. Strength recovery is demonstrated in medium correlation with tendon healing. Level of evidence: Level IV, therapeutic case series
Scapulothoracic arthroscopy for symptomatic snapping scapula: A prospective cohort study with two-year mean follow-up
No full textBackground: Snapping scapula is characterized by crepitus between the scapula and the chest wall due to abnormal tissue at this site. Surgical treatment, when needed, may be either open or arthroscopic. The aim of this study was to evaluate prospectively the clinical outcomes of arthroscopic decompression in ten subjects with symptomatic snapping scapula. Patients and methods: Ten subjects, five men and five women, mean age 24 years, were treated by arthroscopy after unsuccessful conservative management for 6 months. Clinical outcomes were evaluated with the Western Ontario Rotator Cuff (WORC) index, Constant-Murley score (CS), and simple shoulder test (SST). Follow-up was at 3 and 6 months; the final evaluation was conducted at a mean interval of 24 months. The final and preoperative X-rays were compared. Results: The WORC index increased significantly at 3 (p < 0.05), 6 (p < 0.01), and 24 months (p < 0.01). Similar outcomes were found for the CS at all 3 follow-up points (3 months, p < 0.05; 6 months, p < 0.01; 24 months, p < 0.01). Mean "yes" responses on the SST were 9.8 ± 1.4 at 3 months (p < 0.05), 10.2 ± 1.2 at 6 months (p < 0.01), and 10.6 ± 1.2 at 24 months (p < 0.01). X-ray examination depicted flattening of the anterior surface of the superior-medial angle of the scapula in the five patients who had had bone resection, whereas no significant difference with preoperative imaging was detected in the five patients who were managed by bursectomy and debridement alone. Conclusions: Arthroscopy is a feasible and minimally invasive treatment for painful snapping scapula syndrome. Comparative clinical trials are needed to collect conclusive data to state that it is the most suitable treatment for this condition. © 2014 Istituto Ortopedico Rizzoli
Bone loss following knee arthroplasty: Potential treatment options
No full textIntroduction: The management of bone loss is a crucial aspect of the revision knee arthroplasty. Bone loss can hinder the correct positioning and alignment of the prosthetic components, and can prevent the achievement of a stable bone-implant interface. There is still controversy regarding the optimal management of knee periprosthetic bone loss, especially in large defects for which structural grafts, metal or tantalum augments, tantalum cones, porous metaphyseal sleeves, and special prostheses have been advocated. The aim of this review was to analyze all possible causes of bone loss and the most advanced strategies for managing bony deficiency within the knee joint reconstruction. Materials and methods: Most significant and recent papers about the management of bone defects during revision knee arthroplasty were carefully analyzed and reviewed to report the most common causes of bone loss and the most effective strategies to manage them. Results: Modular metal and tantalum augmentation showed to provide more stable and durable knee revisions compared to allografts, limited by complications such as graft failure, fracture and resorption. Moreover, modular augmentation may considerably shorten operative times with a potential decrease of complications, above all infection which has been frequently associated to the use of allografts. Conclusions: Modular augmentation may significantly reduce the need for allografting, whose complications appear to limit the long-term success of knee revisions. © 2014 Springer-Verlag
Clinical applications of vibration therapy in orthopaedic practice
No full textAbstract
BACKGROUND:
Vibration therapy (VT) has been proposed as an option to improve physical performance and reduce the negative effects of ageing on bone, muscles and tendons. Several discrepancies exist on the type of applications, frequency and magnitude. These differences reflex on the contradictory clinical results in literature. Aim of the present study is to carry on an exhaustive review to focus on technical options on the market, clinical applications in orthopaedic practice and expected outcomes.
METHODS:
a literature review using the key words "vibration therapy" and "whole-body vibration" and "orthopaedics" was performed. After checking the available abstracts 71 full text articles were evaluated.
RESULTS:
fifty-one articles focused on the effects of VT on muscles and tendons reporting ways of action and clinical outcomes. In a similar way 20 studies focused on the influence of VT on bone tissue with regard on ways of action and clinical trials.
CONCLUSIONS:
VT provides anabolic mechanical signals to bone and musculo-tendinous system. The best effects seem to be achieved with devices that deliver low-intensity stimuli at high frequencies providing linear horizontal displacement
Unicompartmental knee replacement provides early clinical and functional improvement stabilizing over time
No full textPurpose: Unicompartmental knee replacement preserves uninvolved osteocartilaginous and soft tissue structures, thereby allowing a more physiological and early clinical and functional recovery. The aim of this study was to report the results of ZUK unicompartmental fixed metal-back prosthesis and how these results change over time. Methods: Between 2005 and 2007, 80 ZUK prostheses were implanted in 80 patients for unicompartmental osteoarthritis or osteonecrosis. Patients were clinically assessed using the International Knee Society scores. Postoperative values of mechanical axis were calculated 12 months after surgery and compared to the preoperative ones. Results: The mean International Knee Society knee and function scores improved, respectively, from 46 ± 9 and 54 ± 8 preoperatively to 82 ± 5 and 94 ± 3 at the last follow-up (P < 0.001). Average flexion increased from 110° ± 9° to 127° ± 8° (P < 0.01). Patients with unicompartmental knee reached good clinical outcome very early and remained at the same level. Age did not significantly influence clinical and functional scores. Conclusions: High success rates of the modern unicompartmental knee implants depend on the materials and design evolution, improvement of the surgical technique, and the strong restriction of indications. Level of evidence: Prospective non-randomized case-series study, Level IV. © 2011 Springer-Verlag
The Rising Moon sign is specific and sensitive in the diagnosis of bucket handle tears of the medial meniscus
No full textPurpose: Bucket handle tears of the meniscus are common and can lead to locking, extension deficit and functional impairment. The diagnosis is determined by a combination of physical examination and imaging, but in some cases the diagnosis may be challenging since specific clinical tests are lacking. The aim of the present study was to assess the value of a new clinical test, the elective pain at the anterior aspect of the joint line (defined as the “Rising Moon sign”) in the diagnosis of bucket handle tears of the medial meniscus. Methods: Forty patients treated for a bucket handle of the medial meniscus were enrolled as the study group and were compared to a matched group of 40 patients with a posterior horn tear of the medial meniscus and 50 healthy subjects. The following aspects were investigated in the groups: body mass index, extension deficit, pain at the posterior aspect of the joint line (PPJL), at the middle joint line (PMJL), at the anterior join line (PAJL) and at combined hyperflexion of the knee and external rotation of the foot (PHE). Pain at the anterior joint line (PAJL) was defined as the Rising Moon sign. Results: In the bucket handle group the average flexion contracture was 12° (0–30°). The average PPJL was one (0–2), the average PMJL was 1.6 (0–3), PAJL was 2.5 (1–3) and PHE was 1.6 (1–2). In the posterior horn tear group the average flexion contracture was 0.9° (− 10 to 5°). The average PPJL was 2.2 (1–3), the average PMJL was 1.4 (0–3), PAJL was 0.6 (0–2) and PHE was 2.5 (1–3). The rising moon showed 95% sensitivity and 98% specificity in the diagnosis of bucket handle tears. In addition it showed a positive predictive value of 97.4% and negative predictive value of 96%. Finally it also demonstrated high inter-observer reliability (0.905). Conclusions: The “Rising Moon” sign has shown to be highly predictive for bucket handle tears of the medial meniscus with very high specificity and sensitivity. In addition it is easy to perform with very high inter-observer reliability. Level of evidence: Level IV
Knee flexion after total knee arthroplasty reduces blood loss
No full textPurpose: Extensive blood loss after total knee arthroplasty (TKA) may be a potential problem since it leads to anaemia, increased need for transfusion and prolonged hospitalization. Aim of this study was to investigate the effects of postoperative knee flexion after TKA on blood loss and the need for transfusion. Methods: One hundred consecutive patients undergoing primary TKA from 2012 to 2013 were randomizely divided into two groups. In one group, the knee was extended for the first 6 h after surgery, whereas in the other was flexed at 90° for the same time. Two doses of endovenous tranexamic acid were administered in all subjects. Patients were homogeneous for all the possible confounding factors. Results: Calculated blood loss was 846 ± 197 (ml) in the flexion group and 1,242 ± 228 (ml) in the extension group (p < 0.05). Drop of haemoglobin levels at 24 h in the study group and the control group was 1.9 ± 0.8 (g/dl) and 3.0 ± 0.5 (g/dl), respectively (p < 0.01). Drop of haematocrit at 24 h was 4.5 ± 0.2 (%) in the flexion group and 6.7 ± 0.3 (%) in the extension group (p < 0.05). Blood transfusion was necessary in 5 patients in the control group and was not necessary in any patient of the study group. Average knee flexion at day 7 was 105° ± 4° in the flexion group and 98° ± 7° in the extension group. Conclusion: Knee flexion at 90° after TKA, associated with the intraoperative use of tranexamic, acid is an effective method to reduce blood loss and the need for blood transfusion. The routine use of the present protocol is effective in reducing social costs and length of hospitalization of TKA procedures. Level of evidence: Prospective comparative study, Level I. © 2014 Springer-Verlag Berlin Heidelberg
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