Journal of Orthopaedics Trauma and Rehabilitation最新文献

{"title":"Influence of body mass index on early post-operative functional outcomes after total knee arthroplasty: A prospective, clinical and observational study","authors":"Rohit M Sane, P. Samant","doi":"10.1177/22104917231161834","DOIUrl":"https://doi.org/10.1177/22104917231161834","url":null,"abstract":"Background/Purpose: The evidence on the influence of body mass index (BMI) on functional outcomes following total knee arthroplasty (TKA) is conflicting. This study assessed and compared the effect of BMI on early mobility and function after TKA. Methods: Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA) who received unilateral TKA were recruited and then divided into normal, overweight and obese groups. The pain and functional outcomes of pre/post-TKA were examined using visual analogue scale (VAS) and Lysholm Knee Scale (LKS), respectively. Results: At 3 and 6 weeks post-TKA, LKS score was significantly higher in normal BMI group compared to overweight and obese. Lower BMI gained early improvement in functional outcome than higher BMI groups. However, patients showed considerable functional improvement at 6 months post-TKA, regardless of BMI category. Conclusion: Although BMI levels influence postoperative early functional improvement in TKA patients, the functional benefits after TKA at 6 months were similar regardless of BMI class.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"40 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74471809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal femur varus-producing osteotomy: An updated review of patellofemoral implications and clinical outcomes","authors":"Garibaldi Riccardo, T. Bonanzinga, F. M. Gambaro, Michele Palazzuolo, F. Iacono, M. Marcacci","doi":"10.1177/22104917221147687","DOIUrl":"https://doi.org/10.1177/22104917221147687","url":null,"abstract":"Background: Recent evidence seems to suggest the effectiveness of distal femur varus osteotomy in the management of patellofemoral instability in the setting of genu valgum. However, literature on this subject remains scarce and consists mostly of small case series. Hypothesis: This study aims to systematically review the literature on varus-producing distal femur osteotomy and critically analyze its implications on patellofemoral kinematics and stability. Results: The statistical analysis revealed that this surgery is able to restore a mechanical angle (mean hip–knee–ankle (HKA): 0.22°) and to improve the main clinical outcomes (Kujala score, Knee injury and Osteoarthritis Outcome Score, visual analog scale) after a mean follow up of 2.5 years. An objective of the present review was to investigate the mechanical implications of femoral osteotomy on the patellofemoral biomechanics. Indeed, the statistical analysis demonstrated changes after surgery in the main patella-femoral radiological angles (modified Insall–Salvati index, Caton–Deschamps index, Blackburne–Peel index). Interestingly the overcorrection of the mechanical axis (HKA), resulting in varus, had similar outcomes compared to studies that obtained a mechanical axis. Level of Evidence: Level II study.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"139 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76232740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What can we expect from patellar denervation in knee arthroplasty? An updated systematic review and meta-analysis","authors":"I. Wayan, Suryanto Dusak, Kartini Ciatawi, Wayan Subawa, P. Eyanoer","doi":"10.1177/22104917221150533","DOIUrl":"https://doi.org/10.1177/22104917221150533","url":null,"abstract":"Denervation by electrocauterization was proposed to be efficient in preventing anterior knee pain (AKP) following arthroplasty. The purpose of this study was to evaluate the effects of patellar denervation (PD) in primary knee arthroplasty. Systematic search was performed in PubMed, ScienceDirect, Cochrane Library, and ClinicalKey databases until July 2022 for published articles. The quantitative analyses were carried out by Review Manager 5.4 software. Twenty-one studies were included. Overall incidence of AKP, visual analog scale (VAS), and knee society score were significantly superior in PD group. Denervation also showed better outcomes in incidence of AKP at each follow-up time point, and in VAS and range of motion (ROM) at ≤3 months. Subanalyses based on depth of electrocautery showed statistically better results with 2–3 mm depth in VAS and PS compared to ≤1 mm. This study concluded that PD might contribute to lower incidence of knee pain. Patients who expect quicker recovery in pain and ROM may benefit from this procedure.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"96 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83410049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of a standardized rehabilitation protocol for meniscal repair: A retrospective case series","authors":"Gavin Cho wai Lam, Ramon Lo Yiu, Y. Leung","doi":"10.1177/22104917221144723","DOIUrl":"https://doi.org/10.1177/22104917221144723","url":null,"abstract":"Background/Purpose: To examine clinical and functional outcomes of patients who underwent meniscal repair with a modified accelerated rehabilitation program. Methods: This study represents a case series of patients who underwent meniscal repair from 2017 to 2019. The mean patient age was 26.6 (range: 15–47) years. Of the 28 total patients, 22 had concomitant anterior cruciate ligament tears that were treated with single-bundle hamstring reconstruction at the time of meniscal repair. All patients were enrolled in a standardized rehabilitation program, allowing early-phase protected weight-bearing and knee mobilization. Patient-reported symptoms, the McMurray test, and the International Knee Documentation Committee (IKDC) were used to evaluate outcomes. The mean follow-up period was 13 ± 3.1 (range: 9–20) months. Results: Of the participating patients, 75% (22 of 28) returned to their original sports activities. Most patients displayed satisfactory clinical outcomes with significant improvements in IKDC scores. No re-tears were detected. Conclusion: Early protected weight-bearing with progressive early knee mobilization is a safe rehabilitation option after meniscal repair.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"1076 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76690542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do dislocation rates differ between different approaches to total hip arthroplasty? A systematic review and meta-analysis","authors":"Marc Koster, Anton D Luzier, O. Temmerman, S. Vos, Joyce L Benner","doi":"10.1177/22104917221147688","DOIUrl":"https://doi.org/10.1177/22104917221147688","url":null,"abstract":"Background: Different surgical approaches for total hip arthroplasty (THA) exist, without predisposition when it comes to dislocation risk. The direct anterior approach (DAA) is thought to have reduced risk since soft tissue trauma is minimalized. Therefore, we assessed the dislocation risk for different surgical approaches, and the relative dislocation risk of DAA compared to other approaches. Methods: Six electronic databases were systematically searched for prospective studies reporting dislocation following THA. Proportion meta-analyses were performed to assess the dislocation rate for subgroups of the surgical approach. Meta-analysis for binary outcomes was performed to determine the relative risk of dislocation for the DAA compared to other approaches. Results: Eleven studies with 2025 patients were included (mean age 64.6 years, 44% male, mean follow-up 10.5 months), of which four studies were also used in the risk ratio meta-analysis. Overall dislocation rate was 0.79% (95% CI 0.37–1.69). Subgroup analyses showed that most dislocations occurred in the posterior approaches group (1.38%), however non-significant. Furthermore, the DAA emerged with a non-significant lower risk of dislocation (RR 0.37, 95% CI 0.05–2.46) compared to other surgical approaches. Conclusion: Current literature shows non-significant predisposition for a surgical approach to THA regarding dislocation risk. To what extent patient characteristics influence the risk of dislocation could not be determined. Future research should focus on this, as well as on the influence of a surgeon's experience with a specific approach.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"43 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89822507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of continuous passive motion in total knee replacement patients with slow rehabilitation under ERAS pathway","authors":"Chau Ming Hong, Lee Qunn Jid, Chang Wai Yee Esther","doi":"10.1177/22104917221150532","DOIUrl":"https://doi.org/10.1177/22104917221150532","url":null,"abstract":"Background: Although we know routine use of continuous passive motion (CPM) has no clinical benefit on patients’ outcome after total knee replacement (TKR), the effect of CPM on patients with poor rehabilitation progress under ERAS (Enhanced Recovery after Surgery) pathway is unclear. We aimed to evaluate the clinical outcomes by using CPM in these patients under ERAS pathway. Methods: We performed a retrospective study for patients who had TKR done between 2017 and 2019 under ERAS pathway. Patients who were not able to reach 45 degrees of active range of movement (ROM) on postoperative day (POD) 3 would be reviewed to see if any CPM was used. Primary outcomes were the length of hospital stay and the active ROM upon discharge. Other outcomes were the active ROM in POD4 and the latest follow-up, pain score, and quadriceps power. Result: After exclusion, total of 68 patients were included in the study, with 30 were given CPM and 38 were not. Both groups had matched demographics. The study (CPM) group had significantly higher mean active ROM upon discharge (76.00 vs 68.42 degrees, p = 0.02) and longer hospital stay (7.3 vs 5.9 days, p =0.01). There were no significant effects on pain score, quadriceps power, and the active ROM in POD4 and the latest follow-up. Conclusion: For post TKR patients with limited rehabilitation progress under ERAS pathway, the use of CPM could attain better active ROM upon discharge with no adverse effect on pain control and quadriceps power, but at the expense of an increase in the length of stay.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"19 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85327199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between presence of traumatic disco-ligamentous injuries as an MRI finding with the results of management of thoracolumbar and lumbar injuries","authors":"Tarek Aly","doi":"10.1177/22104917221147690","DOIUrl":"https://doi.org/10.1177/22104917221147690","url":null,"abstract":"Introduction: Radiographic study plays an important role in diagnosis of acute vertebral injuries and helps in proper management of those patients. Magnetic resonance imaging (MRI) is the modality of choice for evaluation of ligamentous and other soft tissue structures, disc, spinal cord and occult osseous injuries. Due to high cost, it is necessary to detect the best use of this technique in the evaluation of thoracolumbar spinal injuries. The purpose of this study was to evaluate the importance of MRI as indicators for vertebral ligamentous injuries and intervertebral disc injuries or herniation in management of thoracolumbar and lumbar fractures. Methods: Retrospective study using radiological measurements. Seventy-two patients with thoracolumbar and lumbar fractures were included. Radiographic parameters detected were percentage of compression, kyphosis angle, vertebral translation and scoliosis angle. Computed tomography was used to detect the degree of spinal canal narrowing, MRI was used to evaluate the condition of posterior ligamentous complex and intervertebral disc injury or herniation. American Spinal Injury Association score was recorded. Results: There were 83% AO spine type A, 6% AO spine type B and 11% AO spine type C. Correlation between fracture type and neurological status with the posterior ligamentous complex injury was found to be significant: (P = 0.0143 and P = 0.0344, respectively). Degree of vertebral body compression, kyphosis and scoliosis angles, vertebral body translation and spinal canal narrowing were found to be insignificant in correlation with posterior ligamentous complex injuries. Correlation of the above-mentioned parameters with disc injury or herniation was found to be insignificant except for kyphotic angle that was found to be significant in correlation with posttraumatic disc herniation (P = 0.0219). Conclusion: MRI finding is of great value in management plan of thoracolumbar and lumbar fractures. Injury of posterior ligamentous complex is significantly correlated with fracture severity and the neurological function. But the intervertebral disc injury or herniation was not correlated to them except that the disc herniation was significantly correlated to kyphosis angle.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79520521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study of articular surface mounting computer-assisted total knee arthroplasty in alignment, knee function, and survival","authors":"Eugene Pak-Lin Ng, H. Wong","doi":"10.1177/22104917221144700","DOIUrl":"https://doi.org/10.1177/22104917221144700","url":null,"abstract":"Background Hong Kong Chinese exhibits a greater varus lower limb mechanical axis and coronal bowing when compared to Caucasians. This anatomical difference may affect the accuracy of bone cuts in total knee arthroplasty (TKA) using western anatomy-based intramedullary TKA cutting jigs. Use of computer navigation may avoid suboptimal cuts due to altered anatomy. This is the first study evaluating clinical function, radiological alignment and long-term survival of computer-assisted TKA amongst Hong Kong Chinese patients. Methods Retrospective study comparing articular surface mounting computer-assisted TKA (ASM-CATKA) and conventional TKA performed in a single centre from 2008 to 2010. Patients were followed up for assessment of clinical parameters including range of motion, Knee Society Knee score, and radiological parameters such as limb alignment, component alignment, and survival. Results Seventy-five patients were included in this study. Baseline clinical and radiological data were similar between groups. The computer-navigated group had superior radiological mechanical alignment (p < 0.001), tibial component alignment (p = 0.016) and femoral component alignment (p < 0.01) when compared to conventional TKA. There were no differences in knee scores (p = 0.488), range of motion (p = 0.432) and survival at 117 months (p = 0.986) between the two groups. Conclusion This retrospective study showed that ASM-CATKA was more accurate in achieving neutral mechanical axis and component alignment amongst Hong Kong Chinese. Clinical outcomes and implant survival were comparable.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"52 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73870296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early or delay? The most suitable rehabilitation protocol for “no man's land” injury: Meta-analysis with trial sequential analysis—20 years trends","authors":"Celleen Rei Setiawan, Made Bramantya Karna, Andrew Sutheno, Febyan Febyan, Dary Gunawan","doi":"10.1177/22104917221147686","DOIUrl":"https://doi.org/10.1177/22104917221147686","url":null,"abstract":"Objective: The aim of this study is to analyze various rehabilitation protocol and determine which methods will yield a better outcome. Methods: The database reports were searched within 1990 until 2020, using PubMed, Cochrane library database, Ovid, Medline, and the other several published trials. A statistical analysis was made from Review Manager and Trial Sequential Analysis (TSA). Result: The mean of rerupture rate is 3.3% (n = 8) in the combination protocol and 8% (n = 48) in controlled active motion (CAM) protocol. Meta-analysis found no significant difference between Kleinert versus CAM in rerupture rate. Furhtermore, we found no significant difference in Duran versus CAM in rerupture rate. In TSA, the Z-curve does not cross both of the trial sequential boundaries, a further trial with larger sample will be required. The TSA of flexion contracture CAM versus Kleinert was indicated that CAM protocol may be superior than Kleinert to reduce the incidence of flexion contracture with the range of mean flexion contracture 6.6% (n = 18) in CAM to 23.6% (n = 76) in Kleinert protocol. Conclusion: Current meta-analysis proposed that the combination technique will result less rerupture incidence and better functional outcome in flexor zone II injuries than other techniques. The CAM method also results in less flexion contracture than others. However, a further meta-analysis with larger sample trials seems to be required to confirm this review's conclusion.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135500247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect and safety of periarticular multimodal drug injection without morphine and epinephrine in anterior cruciate ligament reconstruction","authors":"Changhun Han, Yusuke Hashimoto, Sunao Nakagawa, S. Takahashi, Yohei Nishida, S. Yamasaki, J. Takigami, Hiroaki Nakamura","doi":"10.1177/22104917221136285","DOIUrl":"https://doi.org/10.1177/22104917221136285","url":null,"abstract":"Background Periarticular multimodal drug injection (PMDI) is a safe and effective pain management technique after anterior cruciate ligament reconstruction (ACLR); however, adding morphine and epinephrine sometimes causes adverse effects. Therefore, we evaluated the efficacy of PMDI without morphine and epinephrine after ACLR. Methods This retrospective matched case-control study included patients who had undergone primary double-bundle ACLR with PMDI and were then matched one-to-one with a control group without PMDI based on sex, age, and body mass index using propensity-matched analysis. The following clinical outcomes were compared between the groups: visual analog scale (VAS) score, C-reactive protein (CRP) concentration, number of times the patients used additional analgesics, complication rate, and postoperative time to achieve straight leg raise (SLR). Results Twenty-nine patients with PMDI and 29 controls were enrolled. The VAS score at 1 day postoperatively was lower in the PMDI than the control group (1.93  ±  1.44 vs. 3.41  ±  1.75, respectively; P < 0.001). The CRP concentration at 1 and 3 days was lower in the PMDI than the control group (0.46  ±  0.47 vs. 1.00  ±  0.69 mg/dL, P < 0.001; and 1.93  ±  1.71 vs. 4.01  ±  2.55 mg/dL, P < 0.001, respectively). The average number of additional analgesics used was significantly lower in the PMDI than the control group. There were no significant differences in the frequency of occurrence of postoperative complications between the two groups. The number of patients who could achieve SLR within 1 day was 27/29 (93%) in PMDI group, which was significantly higher than the control group (12/29, 41%) (P < 0.001). Conclusion PMDI without morphine and epinephrine after ACLR reduced patients’ subjective pain level, objective inflammatory response without complications and enabled patients to achieve early functional recovery.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"133 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89651521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}