Annals of Joint最新文献

{"title":"Massive pseudotumor of unknown etiology in a cemented metal-on-polyethylene total hip arthroplasty: a case report.","authors":"Aaron Gazendam, Karim Masrouha, Snezana Popovic, Michelle Ghert, David Wilson","doi":"10.21037/aoj-22-3","DOIUrl":"10.21037/aoj-22-3","url":null,"abstract":"<p><strong>Background: </strong>The formation of destructive pseudotumors is a well-documented, albeit rare, complication of total hip arthroplasties. They tend to be progressive and, if left untreated, can result in extensive periprosthetic bony destruction. The current case presents a large benign mass consistent with a pseudotumor on both imaging and intraoperative findings but histologic findings demonstrating chronic hematoma.</p><p><strong>Case description: </strong>An 86-year-old female with a metal-on-polyethylene total hip presented with a massive pseudotumor accompanied by extensive bony lysis. Due to pain and chronic anemia, a palliative debulking procedure was undertaken as a palliative measure. At one year follow-up, the patient reported significant pain relief and was able to ambulate safely with gait aids. Her hemoglobin stabilized post-operatively and ongoing transfusions were not required. Final pathology was not supportive of particle disease despite this being the leading diagnosis. Microscopic sections showed tissue mostly composed of fibrin and blood with multiple foci of calcification and reactive papillary endothelial hyperplasia which can be seen in chronic hematomas.</p><p><strong>Conclusions: </strong>This case presents the diagnostic dilemma of a large benign mass consistent with a pseudotumor on both imaging and intraoperative findings but histologic findings consistent with a chronic hematoma. It highlights the importance of close follow-up and early intervention when periprosthetic osteolysis is detected.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for recurrence of periprosthetic joint infection following operative management: a cohort study with average 5-year follow-up.","authors":"Seper Ekhtiari, Aaron Gazendam, Ahmed Saidahmed, Danielle Petruccelli, Mitchell J Winemaker, Justin D de Beer, Vivek Shah, Thomas J Wood","doi":"10.21037/aoj-22-4","DOIUrl":"10.21037/aoj-22-4","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infections (PJIs) remain challenging to eradicate even after surgical management, which in most cases involves either debridement, antibiotics and implant retention (DAIR) or single- or two-staged revision. The purpose of this study is to determine predictors of PJI recurrence after operative management for PJI, and to determine differences in recurrence-free survival between DAIR and staged revision.</p><p><strong>Methods: </strong>This is a retrospective analysis of prospectively collected data of revision hip and knee arthroplasty surgeries due to PJI between 2011 and 2018 at an academic hospital. Any patient undergoing revision surgery for PJI was included except if the index surgery information was unknown. The primary outcome was confirmed PJI recurrence. Multivariable logistic regression analysis was utilized to determine the relationship between the predictor variables and outcome variable. Log rank testing was used to compare recurrence-free survival between DAIR and staged revision.</p><p><strong>Results: </strong>A total of 89 patients (91 joints) underwent revision surgery due to PJI. Younger age and presence of a sinus tract were statistically significant for risk of PJI recurrence. A multivariable logistic regression model including both variables was significant for predicting recurrence of PJI (χ²=10.2, P=0.006). Survival was not significantly different between patients who underwent DAIR versus a staged revision.</p><p><strong>Conclusions: </strong>Younger patients and those with a chronic sinus tract are at significantly higher risk of recurrent PJI. This study also demonstrated that PJI can be successfully managed in the majority of cases with DAIR or staged revision.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43012309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meniscus treatment: biological augmentation strategies: a narrative review.","authors":"Alberto Poggi, Davide Reale, Angelo Boffa, Luca Andriolo, Alessandro Di Martino, Giuseppe Filardo","doi":"10.21037/aoj-21-14","DOIUrl":"10.21037/aoj-21-14","url":null,"abstract":"<p><strong>Objective: </strong>An up-to-date description on the biological augmentation strategies for meniscal repair procedures was performed to highlight the main preclinical and clinical evidence available in the literature.</p><p><strong>Background: </strong>Meniscal repair is a key surgical procedure to preserve as much meniscal tissue as possible to limit the development of knee osteoarthritis (OA). Unfortunately, the results of meniscal repair procedures are not always satisfactory, reporting an overall risk of failure of 25%, likely conditioned due to the poor vascularization of the meniscal tissue. For this reason, several biologic augmentation techniques have been developed to improve the meniscal healing process, ranging from mechanical stimulations to biological products.</p><p><strong>Methods: </strong>A literature review was conducted on the main biological augmentation procedures combined to the meniscal repair process. A description of the rationale, surgical technique, and preclinical and clinical evidence was performed.</p><p><strong>Conclusions: </strong>Mechanical stimulations and fibrin clot were the first techniques applied showing several limitations and not exciting results. Recently, platelet-rich plasma (PRP) augmentation to meniscal repair is slowly spreading in the clinical practice. Early evidence from comparative studies showed a significantly lower failure rate in patients treated with PRP augmentation compared with controls. Conversely, the current few and low-level data on mesenchymal stem/stromal cells (MSCs) for meniscal augmentation repair make this a promising but anecdotal topic. Further high-quality clinical studies are needed to support and guide the use of biological strategies for the augmentation of meniscus repair, PRP.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42206782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The lateral meniscus.","authors":"Alberto Grassi, Stefano Zaffagnini","doi":"10.21037/aoj-21-33","DOIUrl":"10.21037/aoj-21-33","url":null,"abstract":"","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45937536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter, retrospective comparison of implant survival, complications and cost between plate and screw and intramedullary nail fixation for metastatic lesions of the diaphyseal humerus.","authors":"James P Norris, Jacob Shabason, Jennifer L Halpern, Herbert S Schwartz, Kristy L Weber, Ginger E Holt, Robert J Wilson","doi":"10.21037/aoj-20-101","DOIUrl":"10.21037/aoj-20-101","url":null,"abstract":"<p><strong>Background: </strong>The humerus is a common site of metastatic disease that can be fixated with either plate and screw or intramedullary nail (IMN) constructs. A multicenter retrospective comparison study was undertaken to compare implant survival, complication rate and cost between the two constructs. No prior studies have included a cost comparison.</p><p><strong>Methods: </strong>Databases of two academic practices were queried retrospectively to identify patients with metastases of the humerus. Inclusion criteria were a lesion in the proximal metaphysis to distal diaphysis and amenable to both implant options with available cost data. Follow-up was at least 6 months barring death or discharge to hospice sooner. Demographic, clinical and outcome data was recorded. Costs were estimated based on contract pricing. Operating room (OR) costs were estimated using per minute OR costs proposed by other investigators.</p><p><strong>Results: </strong>One hundred and one humeri in 96 patients were included (72 plates and 29 nails). The most common malignancies were renal cell, myeloma and lung. Half presented with a displaced fracture. Demographics were similar in both groups. Lesions were larger in the plate group. Surgical times were longer in the plate group, 146 <i>vs.</i> 75 min, P<0.001. Estimated blood loss (EBL) was higher in the plate group, 510 <i>vs.</i> 221 mL, P<0.001. A trend toward increased failure was seen in the plate group, 12.5% <i>vs.</i> 0% (P=0.056). The most common complications in the plate group were pain, stiffness and swelling compared to pain, refracture and PE in the nail group. Local disease progression was equivalent. Implant costs were higher in the IMN group ($2,753 <i>vs.</i> $1,553, P<0.001), while OR costs were lower ($2,349 <i>vs.</i> $4,395, P<0.001). Overall cost of implantation was lower in the IMN group ($5,102 <i>vs.</i> $5,949, P=0.005).</p><p><strong>Conclusions: </strong>IMN of metastases of the humerus offers a faster, potentially more durable construct with lower blood loss, faster OR times and decreased cost of implantation.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47208114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of total knee arthroplasty on golfing activity.","authors":"Doug Vanderbrook, Afshin A Anoushiravani, Casey M O'Connor, Curtis Adams, Darryl Whitney, Jason Tartaglione, Jared Roberts","doi":"10.21037/aoj-20-37","DOIUrl":"10.21037/aoj-20-37","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is frequently performed among individuals who golf. This study examines the effect of TKA on pre- and postoperative pain, frequency of sport participation, handicap, driving distance, use of a cart, and overall game enjoyment.</p><p><strong>Methods: </strong>This is a survey-based retrospective review of 71 patients after primary TKA at a tertiary medical facility in upstate New York. Patients were evaluated using postoperative pain scores and asked to complete a survey that included questions about their return to sport.</p><p><strong>Results: </strong>A total of 71 patients were included, with an average age of 70 years old. Postoperatively 85% of patients returned to play within 7.9 months, driving distance increased by 4 yards, patients' golf game improved by 1.07 strokes, and pain during and after golf was significantly decreased. Most patients did not change golf cart usage, and reported unchanged or improved performance in and enjoyment of golf.</p><p><strong>Conclusions: </strong>We found that a majority of patients undergoing TKA returned to playing golf postoperatively. Patients were more likely to report decreased pain both before and after play and positive changes to their golf game. Our results suggest that most patients can expect to return to golf after TKA and the majority will enjoy the sport with less pain postoperatively.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44748722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skeletal metastatic disease of the acetabulum: historical and evolving techniques for management.","authors":"Adam D Lindsay","doi":"10.21037/aoj-20-117","DOIUrl":"10.21037/aoj-20-117","url":null,"abstract":"<p><p>The skeleton is the third most common organ system to be involved in the spread of metastatic carcinomas. More options for systemic therapies, surgeries and adjuvant treatments are providing longer survival for patients with known metastatic carcinoma to the bone. This means more patients are living with metastatic skeletal disease than ever before. If metastatic disease results in enough bone loss it can cause significant pain and dysfunction for patients. The acetabulum and pelvis are common sites of metastatic disease. The complex anatomy of the bony pelvis and acetabulum, as well as its proximity to important neurovascular and pelvic structures, can make surgical management of acetabular metastatic disease technically difficult. Decision making for patients with symptomatic skeletal metastatic disease is complex, and multidisciplinary teams can be helpful in providing appropriate care for these patients. Systemic chemotherapies, immunotherapies or targeted therapies may not adequately treat large areas of metastatic disease in the hip and pelvis. Radiation therapy is not successful for all patients. Fortunately, there are evolving therapies that are giving patients and providers more options for treatment. This review article will cover some of those new therapies and their outcomes, focusing on newer ablative, minimally invasive and surgical reconstruction techniques for metastatic disease involving the acetabulum. Decision making in the management of a patient's metastatic acetabular disease is still made on a case by case basis. This review article hopefully will remind clinicians of the variety of treatments available to these patients.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45610804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wear and performance of a tripolar total hip replacement.","authors":"James W Pritchett","doi":"10.21037/aoj-21-7","DOIUrl":"10.21037/aoj-21-7","url":null,"abstract":"<p><strong>Background: </strong>An unconstrained tripolar hip replacement matches a large capacity two-piece metal/polyethylene acetabular component with a bipolar prosthesis. This combination of accepted technology is different than the relatively new dual mobility prosthesis. The goal is to protect against dislocation and allow close to a normal range of motion (ROM). So far there has not been enough information about wear and performance of tripolar hip replacement to support its wide use.</p><p><strong>Methods: </strong>Twenty-four tripolar prostheses were retrieved from 23 patients after a mean of 14 years (range, 5-21 years). All implants had been placed in high-demand patients who participated in adventure sports, had occupations where a dislocation would be dangerous, or in patients undergoing revision. The tripolar prosthesis has three important design features: (I) the acetabular component uses highly cross-linked polyethylene with an internal diameter of 41-54 mm, (II) the bipolar is titanium nitride-coated, and (III) the bipolar prosthesis has positive eccentricity. The retrievals were evaluated for wear, performance, and mechanical function.</p><p><strong>Results: </strong>The total volumetric wear was 24 mm³/yr. compared to 54 mm³/yr. For a dual mobility prosthesis and 38 mm³/yr. for a 40 mm conventional hip replacement. The jump distance was 16 mm compared to 12 mm for a 36 mm hip replacement. There was no osteolysis. The combined flexion/extension was 145 compared to 119 for a conventional prosthesis. The mean UCLA score was 7.9. Radiographs showed continued shared movement between the inner and outer articulations. The prosthetic bipolar separation force was 2,180 N. High-demand activities generate approximately 340 N.</p><p><strong>Conclusions: </strong>The wear of this tripolar hip prosthesis is low below the osteolytic threshold. The increased ROM and increased jump distance provide the most stable unconstrained hip replacement available. The wear and mechanical performance seen in this study suggest a lifetime of use is possible in even the highest demand patients. The absence of intraprosthetic dislocation, metal wear reaction, and limited acetabular stress shielding make this a safer technology compared to a dual mobility prosthesis.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47076519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent medial and lateral bucket handle meniscal tear repair in a chronic anterior cruciate ligament-deficient knee: a case report.","authors":"Gerard Si Yong Bong, Yee Han Dave Lee","doi":"10.21037/aoj-21-20","DOIUrl":"10.21037/aoj-21-20","url":null,"abstract":"<p><p>Bucket handle meniscus tears (BHMTs) are seen in the active population, especially young athletes. They often occur with anterior cruciate ligament (ACL) injury, causing significant knee symptoms and affecting the patients' quality of life. All-inside meniscus repair can be effective in the treatment for BHMT to improve symptoms and to preserve the native meniscus. We report a case of a 25-year-old female retired soccer player who presented with a three-year history of right knee pain, swelling and instability. She was diagnosed with BHMT of medial and lateral menisci and complete tear of the ACL on magnetic resonance imaging (MRI). She underwent arthroscopic medial and lateral meniscus repair with concomitant ACL reconstruction. Both the medial and lateral BHMT were reduced and repaired using an all-inside meniscus repair. We present her examination findings, functional outcomes and radiological imaging pre-operatively and 6 years post-operatively, which show an intact and stable ACL graft and repaired medial and lateral menisci with minimal progression to knee osteoarthritis. This shows that with good reduction and fixation, all-inside meniscus repair can achieve good mid-term results for the repair of bicompartmental chronic bucket handle tears.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44632777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative review of the epidemiology, economic burden, and societal impact of metastatic bone disease.","authors":"Matthew R DiCaprio, Hamza Murtaza, Bradford Palmer, Makenzi Evangelist","doi":"10.21037/aoj-20-97","DOIUrl":"10.21037/aoj-20-97","url":null,"abstract":"<p><p>As the prevalence of cancer continues to rise in the United States due to a combination of both early detection and increased life expectancy, the number of clinically symptomatic skeletal metastases will continue to grow. Healthcare expenditures on cancer treatment have steadily increased each decade to our estimated level of approximately $200 billion in 2020. Metastatic bone disease is a significant driver of this cost, accounting for nearly one-fifth of the total cost of oncologic treatment. Understanding the impact of metastatic bone disease can help to identify the gaps between diagnosis and initiation of treatment in an effort to decrease the socioeconomic and psychosocial implications of the disease. In this paper, we review the epidemiology and economic burden of metastatic bone disease in addition to other sequelae that affect patients, including financial hardship, caregiver burden, diminished quality of life and psychological impact. Upon literature review of multiple studies investigating these factors, we found that advanced metastatic bone disease had overall poor outcomes with regards to the socioeconomic and psychosocial effects on not only patients and their families, but also society at large. These consequences may be improved by early referral to orthopedic specialists and establishment of a multi-disciplinary team.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44719591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}