Joints最新文献

{"title":"The Risk Assessment and Prediction Tool (RAPT) after Hip and Knee Replacement: A Systematic Review.","authors":"Cristiano Sconza,&nbsp;Stefano Respizzi,&nbsp;Guido Grappiolo,&nbsp;Marco Monticone","doi":"10.1055/s-0039-1693459","DOIUrl":"https://doi.org/10.1055/s-0039-1693459","url":null,"abstract":"<p><p><b>Purpose</b>  The Risk Assessment and Prediction Tool (RAPT) is an interesting instrument for predicting the discharge destination and length of stay (LOS) for patients after hip or knee arthroplasty. The aim of this review is to describe its predictive ability, current utilization, and future prospects through the analysis of scientific literature. <b>Methods</b>  The databases of PubMed, Web of Sciences, Cochrane Library, and Pedro were searched for English studies on RAPT prediction capacity. Only original prospective or retrospective articles that analyze specifically the use of RAPT were included, whereas those concerned with other preoperative prediction tools or those only considering other aspects of recovery after joint replacements were excluded. <b>Results</b>  A total of 27 references were retrieved, and 8 studies were selected. All analyzed studies demonstrated that RAPT could reduce LOS and accurately predict discharge disposition especially for high- and low-risk patients. In the intermediate risk category, a targeted intensive postoperative rehabilitation program has demonstrated good results in reducing the uncertain outcome. <b>Conclusion</b>  Although contrarily to many of the other scores, the RAPT has been validated in multiple countries with relatively similar results between different institutions; however, its validity has yet to be tested and adapted in every nation context. Further studies confirming the predictive accuracy of RAPT at other institutions are needed as well as studies assessing the effect of using RAPT to identify patients for targeted interventions in terms of LOS, discharge disposition, clinical outcomes, and financial impact. <b>Level of Evidence</b>  This is a level IV, systematic review of level III and IV study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"7 2","pages":"41-45"},"PeriodicalIF":0.0,"publicationDate":"2019-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1693459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37494260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifiable and Nonmodifiable Predictive Factors Associated with the Outcomes of Total Knee Arthroplasty.","authors":"Davide E Bonasia,&nbsp;Anna Palazzolo,&nbsp;Umberto Cottino,&nbsp;Francesco Saccia,&nbsp;Claudio Mazzola,&nbsp;Federica Rosso,&nbsp;Roberto Rossi","doi":"10.1055/s-0039-1678563","DOIUrl":"https://doi.org/10.1055/s-0039-1678563","url":null,"abstract":"<p><p>Total knee arthroplasty (TKA) is a valuable treatment option for advanced osteoarthritis in patients unresponsive to conservative treatments. Despite overall satisfactory results, the rate of unsatisfied patients after TKA remains high, ranging from 5 to 40%. Different modifiable and nonmodifiable prognostic factors associated with TKA outcomes have been described. The correction, whenever possible, of modifiable factors is fundamental in preoperative patients' optimization protocols. Nonmodifiable factors can help in predicting the outcomes and creating the right expectations in the patients undergoing TKA. The goal of this review is to summarize the modifiable and nonmodifiable prognostic factors associated with TKA outcomes.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"7 1","pages":"13-18"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1678563","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37493843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Driving after Upper or Lower Extremity Orthopaedic Surgery.","authors":"James S MacKenzie,&nbsp;Alexander M Bitzer,&nbsp;Filippo Familiari,&nbsp;Rocco Papalia,&nbsp;Edward G McFarland","doi":"10.1055/s-0039-1678562","DOIUrl":"https://doi.org/10.1055/s-0039-1678562","url":null,"abstract":"<p><p>Orthopaedic procedures can affect patients' ability to perform activities of daily living, such as driving automobiles or other vehicles that require coordinated use of the upper and lower extremities. Many variables affect the time needed before a patient can drive competently after undergoing orthopaedic surgery to the extremities. These variables include whether the patient underwent upper or lower extremity surgery, the country in which the patient resides, whether the right or left lower extremity is involved, whether the dominant arm is involved, whether the extremity is in a cast or brace, whether the patient has adequate strength to control the steering wheel, and whether the patient is taking pain medication. The type and complexity of the procedure also influence the speed of return of driving ability. Few studies provide definitive data on driving ability after upper or lower extremity surgery. Patients should be counseled not to drive until they can control the steering wheel and the pedals competently and can drive well enough to prevent further harm to themselves or to others. This review discusses the limited recommendations in the literature regarding driving motorized vehicles after upper or lower extremity orthopaedic surgery.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 4","pages":"232-240"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1678562","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37493901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological Augmentation in Rotator Cuff Repair: The Real Challenge for the Future of Shoulder Surgery.","authors":"Giuseppe Milano","doi":"10.1055/s-0038-1676656","DOIUrl":"https://doi.org/10.1055/s-0038-1676656","url":null,"abstract":"In this issue of Joints, we publish an interesting article by Castagna et al from the Humanitas Research Hospital in Rozzano (Milan), Italy, entitled “Porcine dermal xenograft as augmentation in the treatment of large rotator cuff tears: clinical andmagnetic resonance results at 2-year follow-up.”1 At 2 years, the authors of this retrospective comparative study, involving 70 patients, observed a significant improvement in the clinical and functional conditions of the patients treated with a porcine dermal patch graft, as shown by their Constant score and by an approximately 11% lower retear rate in this group (21.9% vs. 33.3% in the group receiving standard treatment). Although this difference did not reach statistical significance, it is worth highlighting its clinical significance. This study probably lacked sufficient power to show a statistically significant effect of the experimental treatment, especially on the outcome “retear”which, being a dichotomous variable (yes/no), would require a much larger sample. Nevertheless, when a new treatment proves capable of producing an almost 11% greater reduction of the risk of recurrence comparedwith a standard treatment, I would say that the clinical importance of this result deserves to be analyzed, especially given the considerable implications of this study’s topic in terms of societal costs. Today,many countries are experiencing a huge increase in the demand for health care services related to the treatment of orthopaedic conditions; this is partly because the average age of the population is rising, and partly an effect of increasing functional demands, even among the elderly. This phenomenon is being accompanied by a strong tendency to choose surgical solutions for most of these problems, a trend driven partly by the interests of producers of biomedical devices and partly by the mechanisms currently in place, in both public and private health care systems, for the reimbursement of surgical interventions. Therefore, whereas, on the one hand, vast resources are being invested in the study and prevention of both general and specific health-related problems of aging, leading to important developments in the field of regenerative medicine, and in joint preservation surgery (as opposed to conservative treatments), and on the other, we are seeing an increasingly strong movement toward replacement (prosthetic) surgical solutions that apparently guarantee shorter recovery times and lower societal costs, but undoubtedly also translate into higher revenues for the manufacturers of these devices and also for surgeons. A study from a few years ago,2 which analyzed the mean societal impact of repair versus conservative treatment of rotator cuff tears, found that rotator cuff repair for symptomatic full-thickness tears produces net societal cost savings for patients under the age of 61 years. However, rotator cuff repair seems to lead to significantly improved quality of life in older patients, too; from this ","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"133-134"},"PeriodicalIF":0.0,"publicationDate":"2018-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1676656","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36810324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Porcine Dermal Xenograft as Augmentation in the Treatment of Large Rotator Cuff Tears: Clinical and Magnetic Resonance Results at 2-Year Follow-Up.","authors":"Alessandro Castagna,&nbsp;Eugenio Cesari,&nbsp;Berardo Di Matteo,&nbsp;Marcello Osimani,&nbsp;Raffaele Garofalo,&nbsp;Elizaveta Kon,&nbsp;Maurilio Marcacci,&nbsp;Claudio Chillemi","doi":"10.1055/s-0038-1676106","DOIUrl":"https://doi.org/10.1055/s-0038-1676106","url":null,"abstract":"<p><p><b>Purpose</b>  The aim of the present retrospective study is to describe the results obtained at 2-year follow-up by using a porcine dermis-derived collagen membrane implanted as augmentation to treat large rotator cuff tears. <b>Methods</b>  Thirty-five patients in total were included according to the following criteria: large or massive rotator cuff tear, confirmed during surgery, measuring between 3 and 5 cm in width and stage 1 to 2 fatty infiltration documented at magnetic resonance imaging (MRI). Patients underwent arthroscopic repair of the cuff augmented by the implantation of a porcine dermal collagen membrane. Patients were evaluated up to 24 months after surgery by the Constant score and MRI imaging to assess functional outcomes and re-tear rate. The results obtained were compared to those of a matched cohort of 35 patients operated by arthroscopic repair alone by the same surgical team. <b>Results</b>  The application of the porcine membrane proved to be safe without scaffold-related adverse events documented. A statistically significant difference in the Constant score in favor of the treatment group was documented at the final evaluation ( <i>p</i>  = 0.036 <b>).</b> Furthermore, a subgroup analysis revealed that patients treated by augmentation and presenting re-tear at MRI showed a significantly higher functional outcome compared with control patients with MRI evidence of re-tear ( <i>p</i>  = 0.0136). <b>Conclusion</b>  Arthroscopic repair augmented by porcine dermal xenograft for the treatment of chronic and retracted rotator cuff tears with low-grade fatty degeneration proved to be safe and also effective, with higher functional score compared with the arthroscopic repair alone. <b>Level of Evidence</b>  This is a Level III, retrospective cohort study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"135-140"},"PeriodicalIF":0.0,"publicationDate":"2018-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1676106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36810326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Challenge of Managing the \"Third-Space\" in Total Knee Arthroplasty: Review of Current Concepts.","authors":"Pierluigi Antinolfi,&nbsp;Francesco Manfreda,&nbsp;Giacomo Placella,&nbsp;Julien Teodori,&nbsp;Giuliano Cerulli,&nbsp;Auro Caraffa","doi":"10.1055/s-0038-1675845","DOIUrl":"https://doi.org/10.1055/s-0038-1675845","url":null,"abstract":"<p><p>Total knee arthroplasty (TKA) is the best treatment for advanced knee osteoarthritis and it has proven to be durable and effective. Anterior knee pain (AKP) is still one of the most frequent complications after TKA, but sometimes no recognized macroscopic causes can be found. The correct treatment of patella is considered the key for a proper management of AKP. The inclusion of patellar resurfacing during TKA has been described as a potential method for the reduction of AKP. After surgeons started to resurface the patella, new complications emerged, such as component failure, instability, fracture, tendon rupture, and soft tissue impingement. Patelloplasty has been proposed as a good alternative to resurfacing but whether or not to resurface the patella is still a controversial topic in the literature. Therefore, patellofemoral joint is a complex critical aspect in TKA and choosing between the several options of treatment of patella could not be sufficient. In this review, evidence-based studies do not succeed in resolving this difficult argument. The accurate management of the so-called \"third space\" should include an accurate assessment of cartilage layers, balance of soft tissue, preoperative anterior tracking, and positioning of the femoral and tibial components. In fact, the selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"204-210"},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675845","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36812112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analytical Observational Study of Frozen Shoulder among Patients with Diabetes Mellitus.","authors":"Redha Alwan Hasan Alhashimi","doi":"10.1055/s-0038-1676105","DOIUrl":"https://doi.org/10.1055/s-0038-1676105","url":null,"abstract":"<p><p><b>Purpose</b>  This study aims to identify the prevalence of frozen shoulder (FS) among diabetic patients and its relation to demographic features. <b>Methods</b>  This observational study of 216 patients randomly included those with diabetes mellitus (DM) attending the Misan Rheumatology and Medical Rehabilitation Department at Al-Sadder Teaching Hospital in Misan Province of Iraq and was conducted during the period from April 2014 to March 2015. Detailed medical histories were taken from patients and scratch test and hemoglobin A _1C were used in diagnostic procedure to confirm diagnosis of FS and DM, respectively. <b>Results</b>  The occurrence rate of FS was 11.5% among patients, with a higher prevalence in females versus males. The most commonly afflicted age group was 60 to 70 years old at 33.3%. Dominant shoulder was more commonly affected than nondominant one. DM presented in large number of patients with FS with a prevalence of 90.3% of cases. The onset of FS in patients with DM was most common within the chronic phase of the disease at 32.3 and 33.8% for durations of 1 to 5 and 5 to 10 years, respectively. <b>Conclusion</b>  There is a strong association between DM and FS. Females were more commonly affected than males. Aging increased shoulder disorder distribution with dominant side being mostly affected. Chronic and noncontrolling diabetic patients were more commonly affected. <b>Level of Evidence</b>  This is a Level III, analytical, observational study.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"141-144"},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1676105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36810327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Treatment of Infected Shoulder Arthroplasty: Current Concepts Review.","authors":"Giulio Maria Marcheggiani Muccioli,&nbsp;Enrico Guerra,&nbsp;Tommaso Roberti di Sarsina,&nbsp;Domenico Alesi,&nbsp;Stefano Fratini,&nbsp;Eugenio Cammisa,&nbsp;Vito Gaetano Rinaldi,&nbsp;Giada Lullini,&nbsp;Roberto Rotini,&nbsp;Stefano Zaffagnini","doi":"10.1055/s-0038-1675800","DOIUrl":"https://doi.org/10.1055/s-0038-1675800","url":null,"abstract":"<p><p>Periprosthetic shoulder infection (PSI) is an emerging pathology which requires many improvements in diagnosis and treatment to obtain a satisfying success rate. Different approaches have been described. This article summarizes current concepts of diagnostic process and main treatments described in the literature.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"173-176"},"PeriodicalIF":0.0,"publicationDate":"2018-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncommon Complications after Anterior Cruciate Ligament Reconstruction.","authors":"Anna Palazzolo,&nbsp;Federica Rosso,&nbsp;Davide Edoardo Bonasia,&nbsp;Francesco Saccia,&nbsp;Roberto Rossi","doi":"10.1055/s-0038-1675799","DOIUrl":"https://doi.org/10.1055/s-0038-1675799","url":null,"abstract":"<p><p>Anterior cruciate ligament reconstruction (ACL-R) is a common surgical procedure, with good outcome in 75 to 97% of the cases. However, different complications have been described including infection, hemarthrosis, deep vein thrombosis (DVT), and pulmonary embolism (PE) with a rate ranging from 1 to 15%. There are few case reports in the literature describing rare complications after ACL-R and they can be divided into: (1) complications related to the fixation device (rupture, migration); (2) fractures (tibial or femoral side); (3) infections due to uncommon bacteria, mycobacterium, and mycosis; (4) rare vascular injuries; (5) nerve injuries; and (6) other rare complications. In case of fixation device rupture or migration, device removal can be easy but the diagnosis may be challenging. Patellar fracture after ACL-R may be related to harvesting and it is not uncommon. Conversely, femoral or tibial fractures are most frequently due to bone weakness related to bone tunnels. Some rare infections related to uncommon bacteria or mycosis are also described with potentially devastating joint damage. Popliteal artery injuries are uncommon in ACL-R but minor vessels damages are described with possible severe consequences for patients. Injuries to the infrapatellar branch of the saphenous nerve are not uncommon in ACL-R. However, there are few case reports also describing injuries to the saphenous nerve, the common peroneal nerve and the sciatic nerve. The aim of this paper is to review the literature describing uncommon complications after ACL-R, giving some more information about diagnosis and treatment.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"188-203"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675799","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giovanni Alfonso Borelli: The Precursor of Medial Pivot Concept in Knee Biomechanics.","authors":"Nicola Piolanti,&nbsp;Simone Polloni,&nbsp;Enrico Bonicoli,&nbsp;Michele Giuntoli,&nbsp;Michelangelo Scaglione,&nbsp;Pier Francesco Indelli","doi":"10.1055/s-0038-1675164","DOIUrl":"https://doi.org/10.1055/s-0038-1675164","url":null,"abstract":"<p><p>A new philosophy of science and medicine had spread throughout the 17th-century Italy: the \"Scientific Revolution.\" Giovanni Alfonso Borelli (1608-1679) was one of the most charismatic and brilliant scientists of his generation in Europe. He extended to biology the rigorous analytic methods developed by his indirect mentor Galileo in the field of mechanics. In his masterpiece \" <i>De Motu Animalium</i> ,\" Borelli analyzed structure, motion, balance, and forces concerning almost all the principal joints of the human body, in static and dynamic situations. In particular, he accurately studied the anatomy and biomechanics of the knee joint. He sustained that femoral condyles shift backward during flexion, allowing a wider range of movement. Furthermore, he observed that, when the knee flexes, the lateral condyle moves backward more than the medial condyle: this concept is nowadays known as medial pivoting. The aim of this article is to describe the life and work of this important Italian scientist and to present his unrecognized contribution to modern knee biomechanics.</p>","PeriodicalId":37852,"journal":{"name":"Joints","volume":"6 3","pages":"167-172"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36853776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}