Henry Kuechly*, Sarah Kurkowski, John Bonamer, Brian Johnson, Richard Smith, Nihar Shah, Augusto Roca, Jacob Meyer, Richard Laughlin

Department of Orthopedic Surgery and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA

Background: Fitness trackers have been used to measure postoperative mobility following arthroplasty procedures, but there is no published research using fitness tracker data to compare mobilization following screw fixation versus dynamic fixation for syndesmotic ankle injuries. The objective of this study was to measure steps and activity levels following syndesmotic fixation with either endobutton fixation or screw fixation using a wearable fitness tracker.

Methods: Patients that underwent operative management of ankle fractures with syndesmotic disruption using either a transfixation screw or endobutton were provided a Fitbit Inspire to electronically track their steps and activity level.

Results: Patients treated with endobutton fixation device had statistically significantly more mean daily steps and more mean daily very active minutes than patients treated with screw fixation at the 3, 4, 5, and 6-month time points and 4, 5, and 6 month time points respectively (p<0.05).

Conclusion: Patients with ankle fractures treated with endobutton device for syndesmotic fixation have earlier and higher levels of mobilization during the first 6 postoperative months than those treated with transfixation screw as measured by a fitness tracker. Fitness trackers are increasing in popularity and the data gathered from these devices contains significant potential for creating patient specific rehabilitation guidelines that may ultimately improve patient functional outcomes postoperatively.

DOI: 10.29245/2767-5130/2024/2.1201 View / Download Pdf

Cameron G Thomson1,2, Henry A Kuechly1*, Garrett Gordon1, Jorge Figueras1,3, Tristian Epley4, Richard Laughlin1

1Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

2Department of Orthopaedics, Warren Alpert Medical School at Brown University, Providence, RI, USA

3Department of Orthopaedic Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA

4Ohio University College of Osteopathic Medicine, Cleveland, OH, USA

Background: Recovery from open reduction internal fixation of the ankle frequently involves a decrease in activity level and some limitations in weightbearing. The purpose of this study was to evaluate weight changes during the postoperative period following ankle fracture surgery.

Methods: Hospital billing records were retrospectively reviewed to identify all patients who underwent open reduction internal fixation of bimalleolar and trimalleolar ankle fractures at our hospital system between January 1, 2018 and June 30, 2021. Weight data from outpatient encounters coinciding with the 3-month, 6-month, and 1-year postoperative time points were recorded and analyzed.

Results: 56 patients had complete weight data. The mean age at surgery was 44.6±16.2 years. There were 27 women and 29 men. At time of surgery, the mean weight was 197.2.3±53.9 lbs and BMI was 30.3±7.1 kg/m2. At 1 year postoperative, the mean weight was 219.2±51.6 lbs and BMI was 33.8±7.0 kg/m2, representing statistically significant increases of 22.0 lbs and 3.4 BMI points compared to preoperative (p=0.0491 and 0.0330, respectively). On subgroup analysis of different preoperative BMI groups (<25, 25-29, 30-34, and ≥35), only those patients with a pre-operative BMI of <25 experienced statistically significant increases in weight and BMI, 27.9 lbs and 4.8 kg/m2 respectively (p=0.029 and p=0.001).

Conclusion: This is the first study to evaluate weight changes following ankle fracture. This study showed that at 1 year patients recovering from ankle open reduction internal fixation gain an average of 22 lbs and 3.4 BMI points. Patients with a pre-operative BMI of <25 are subject to statistically significant increases in weight. We recommend monitoring patients’ weight and counseling them on the risks of weight gain. Further research is necessary to better characterize the risk of weight gain following orthopedic surgery.

Level of Evidence: 4 (retrospective cohort)

DOI: 10.29245/2767-5130/2024/2.1202 View / Download Pdf

Oliver Miles1*, Eugenia Koulaeva2, Sally Ng1,2

1Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, Australia

2Department of Plastic and Reconstructive Surgery, Eastern Health, Box Hill, Australia

Objectives: The Prevena Restor Bella.FormTM is a novel closed incisional negative pressure wound therapy with a 14 day lifespan and a large contact area. This study aims to demonstrate the utility of the Prevena Restor Bella.FormTM in high risk lower limb traumatic wounds.

Methods: 4 consecutive patients with complex traumatic lower limb wounds were included. The Prevena Restor Bella.FormTM was applied as a primary therapy or an adjunct to soft tissue reconstruction. Wounds were monitored fortnightly, limb circumference measured and patient satisfaction assessed by a questionnaire. All 4 patients healed within 6 weeks of Prevena application.

Results: No cases developed wound complications. Limb oedema, assessed by circumference, decreased in all patients within 2 weeks. All patients were satisfied with the Prevena Restor Bella.FormTM with regards to comfort and mobility.

Conclusions: Prevena Restor Bella.FormTM demonstrated clinical effectiveness in all patients, and was universally well tolerated.

Level of Evidence: IV

DOI: 10.29245/2767-5130/2024/2.1199 View / Download Pdf

Brian Johnson, Rajul Gupta, Bret Betz, Henry Kuechly*, Sarah Kurkowski, Brian Grawe

Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, USA

Context: Some studies have shown promising results with adipose-derived stem cell treatments for orthopaedic problems as a nonsurgical treatment option or an augmentation of surgical treatment.

Purpose: Review of the history and background, preparation methods, and current applications of adipose-derived stem cells in orthopedics. Provide critical appraisal of the available evidence for the use of Adipose Derived Stem Cells.

Results: Most of the studies utilizing adipose-derived stem cells are case series or meta-analyses with a small number of studies, therefore presenting a risk of selection bias. In cases of femoral head avascular necrosis and meniscal repair, no systematic review or meta-analysis has been published and available evidence is derived from smaller studies. Almost every review article concluded that large, multicenter, randomized control trials are needed to establish the value of adipose-derived stem cells in orthopaedics.

Conclusion: There is a need in orthopaedics for treatment modalities that increase biological healing potential for some pathologies and adipose derived stem cells represent a potential modality for such a purpose. However, there is a lack of high quality and robust evidence regarding the efficacy and safety of this treatment modality in orthopaedic applications. The use of adipose derived stem cells in orthopaedics requires additional studies of higher quality before they can be considered an appropriate treatment option.

Strength of Recommendation: Level C for use of Adipose-derived stem cells in orthopaedics.

DOI: 10.29245/2767-5130/2024/2.1197 View / Download Pdf

Sean T. Gerlach*, Dillon J. MacIntyre, Tim P. Gregg

Wellington Regional Hospital, Wellington, New Zealand

Purpose: The aim of this study was to look into the New Zealand Joint Registry (NZJR) data on total hip arthroplasty (THA) in paediatric and adolescent patients aged 20 and under. Specifically, indications for THA, trends in implants and outcome data.

Methods: An analysis of all patients aged 20 and under, recorded in the NZJR from December 1999 until January 2021. Review of similar international reports and NZ adult data undertaken.

Results: We identified 115 THA performed in patients aged 20 and under in the NZJR. Mean age at primary surgery is 17.9 years. Indications included avascular necrosis (24%), fracture (6%), tumour (3.5%), inflammatory conditions (16.4%), post-infective (6.1%), SUFE (8.7%) and various other disorders. A total of 9/115 THA were reported as being revised in the study period with a revision rate per 100 component years of 0.69. Bearing surface has trended towards ceramic heads. Cementless implants have been the most commonly utilized. The approach is almost exclusively posterior (79%). Head size has increased from formerly being 28 or less to now 32 and above.

Conclusions: Rates of THA in this population remain very low, in keeping with international data. Indications are similar to those seen in other registry studies. Trends mimic those seen internationally and in adult cohorts with cementless implants and larger ceramic heads being favored. Revisions were recorded in 9/115 patients with polywear being the most common indication. Outcome measures were excellent with a mean Oxford hip score of 37.4 at 6 months post operatively.

DOI: 10.29245/2767-5130/2024/1.1198 View / Download Pdf

Savannah Gelhard1, Sydney Vincenti1, Sara J. Pereira2*, Nicolas Contreras2,3

1University of Utah School of Medicine, Salt Lake City, Utah, USA

2Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA

3Huntsman Cancer Institute, Salt Lake City, Utah, USA

DOI: 10.29245/2767-5130/2024/1.1196 View / Download Pdf

Christine Dailey Walck

Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, Florida, USA

DOI: 10.29245/2767-5130/2024/1.1195 View / Download Pdf

Phillip J Stokey1, Anderson Lee1*, Isabell Igo1, Kyle Behrens1, Hamzeh Jajeh2, Nabil Ebraheim1

1Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA

2Department of Specialty Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA

Introduction: Ganglion cysts of the anterior cruciate ligament (ACL) and meniscus may have generalized clinical symptoms that can make them difficult to diagnose, especially considering their rarity. The aim of this study is to provide a comprehensive review of cysts arising in and around the knee with a focus on differential diagnosis to emphasize the importance of proper evaluation.

Methods: A literature search using the database PubMed, Cochrane, and Google Scholar was performed to find the information that comprehensively covered information relevant to this review.

Conclusion: Intra-articular ganglion cysts of the knee are a rare occurrence that typically cause generalized symptoms. Each type of cyst is different with regards to its origin and location, but their similar clinical presentation makes differentiation based on a history and physical exam difficult. MR imaging is of utmost importance for the evaluation of pathologies in and around the knee joint. Once a proper diagnosis is achieved, direct arthroscopic excision of the cyst or treatment of the underlying cause in the case of a meniscus cyst can definitely treat symptoms with minimal concern for recurrence.

DOI: 10.29245/2767-5130/2024/1.1188 View / Download Pdf

Michelle Jeffery1, Judy-Mae Lima2, Aditi Khokhar3, O. Folorunsho Edobor-Osula2*

1Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA

2Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA

3Pediatric Endocrinology, Goryeb Children’s Hospital, Morristown, NJ, USA

This case series details seven pediatric cases of nutritional rickets in an inner-city population of New Jersey. Eighty six percent of these patients were exclusively breast fed, and all self-identified as black or African American. Patients ranged in age from 8 months to 3 years at the time of initial diagnosis. All seven patients were male. Five patients were presented in an office setting, while two were found to have nutritional rickets in an emergency setting. Patients demonstrated classic pathognomonic findings of rickets, including three patients with rachitic rosary. The aim of this case series is to emphasize the importance of surveillance and high clinical suspicion for nutritional rickets, particularly in children with darker skin complexions and who were exclusively breast-fed during infancy. Rapid diagnosis and intervention may delay or negate the need for orthopedic surgical intervention.

DOI: 10.29245/2767-5130/2024/1.1192 View / Download Pdf

Alexandra C. Echevarria1*, Robert E. Carrier1, Anas M. Abbas1, Bongseok Jung1, Tim Reed2, Rohit B. Verma2

1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA

2Department of Orthopaedic Surgery, Northwell Health - North Shore University Hospital, Manhasset, NY, USA

Degenerative disc disease describes a ubiquitous condition involving the natural deterioration of an intervertebral disc. Conservative methods such as physical therapy and anti-inflammatories are recommended as first-line therapies for noninvasive management. However, when these interventions fail to reduce pain, surgical intervention is indicated. While laminectomies, discectomies, and spinal fusion procedures have been considered the standard treatment throughout the 20th century, the development of artificial discs has introduced an alternative surgical intervention in the form of total disc replacement. Initially, the novel devices garnered significant attention, thus leading to a rise in the rates of disc replacement procedures performed. However, several years after FDA approval of the first device, the prevalence of procedures steadily decreased. Several factors may have contributed to the downward trend, including the growing financial burden of hospitalization, stringent inclusion criteria indicating the procedure, and lack of provider familiarity and comfort with the procedure. Although the expected prevalence of disc arthroplasty remains unrealized, there is significant potential for an expanded role in the contemporary treatment of degenerative disc disease. This review illustrates the timeline and course of lumbar disc arthroplasty by describing its development, followed by its introduction in Europe and eventual arrival in the United States. The initial growth in popularity due to promising results is explained along with the surgery’s swift decline primarily due to lack of sufficient evidence promoting replacement, poor insurance coverage, lack of clear indications and complications. This review encapsulates all components and describes future directions and clinical value of lumbar disc arthroplasty.

DOI: 10.29245/2767-5130/2023/1.1190 View / Download Pdf

Samuel Kwok1*, Naveen Nara1,2,3

1Department of Orthopaedics, Ballarat Health Services, Ballarat, Victoria, Australia

2Department of Orthopaedics, St John of God Hospital, Ballarat, Victoria, Australia

3Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

Background: Hip fractures are a significant cause of morbidity and mortality in the elderly population. Surgical fixation using intramedullary nailing is common, with positioning options including lateral and supine on traction table. This meta-analysis aims to compare surgical and clinical outcomes between both techniques.

Method: A systematic search was performed on the Medline database for articles comparing lateral and supine traction nailing intertrochanteric femoral fractures, reporting at least one of the following: surgical set up time, total surgical time, blood loss, fluoroscopy use, tip apex distance, reduction quality, Harris hip scores or complications. Statistical analysis was performed using SAS v9.4. In addition to meta-analysis of differences in means, differences in standardised means were also analysed to account for heterogeneity between hospital protocols and surgical teams.

Results: Initial search returned 773 articles, of which four studies including 384 patients were included for final analysis. Set up time was increased in the supine traction group (random effects mean difference = 15.96 minutes, p = 0.026). Meta-analysis of random effects standardised means found increased total surgical time (mean difference = 0.8, p = 0.017), blood loss (mean difference = 1.1, p = 0.03) and fluoroscopy use (mean difference = 1.1, p = 0.0083). There were no statistically significant differences in tip apex distance, quality of reduction or Harris Hip Scores or complication rates between both groups.

Conclusion: Femoral nailing in the lateral position is not inferior to supine traction; and is one of the tools available for a surgeon to achieve successful fixation.

DOI: 10.29245/2767-5130/2023/4.1193 View / Download Pdf

Rafael Izquierdo-Avino

Fracture Liaison Service, Department of Trauma and Orthopaedic Surgery, Hospital Nuestra Señora de Gracia, Zaragoza, Spain

DOI: 10.29245/2767-5130/2023/4.1189 View / Download Pdf

Shaimaa Hassoun1, Jennifer Arthurs1, Shane Shapiro2*, Michael Heckman3

1Center for Regenerative Biotherapeutics, Mayo Clinic, Jacksonville, FL, USA

2Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA

3Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA

Background: The utility of cellular based therapeutic agents in management of various ailments and conditions is promising, particularly in the field of orthopedics. However, an evidence-based medicine approach must be implemented to validate these novel cellular based therapies before they can be translated into routine clinical practice. Given pain relief is a primary goal of novel treatments for orthopedic disease, future orthobiologic clinical trials will need to overcome challenges such as the placebo effect or the placebo response and difficult participant recruitment. In this paper, we describe a clinical study that evaluates the safety and efficacy of autologous stromal vascular fraction (SVF) cells that adheres to a patient blinded, randomized and placebo-controlled study design while still offering the patient the opportunity to participate in the therapeutic intervention by using cell preservation techniques.

Methods: This pilot clinical trial studies the safety and feasibility of intra-articular transplantation of SVF cells in patients with knee osteoarthritis with secondary outcomes of improving pain relief. The RCT aims to recruit 30 patients. Liposuction is performed on each patient to isolate SVF cells. 15 subjects are randomized to receive SVF injection in the same surgical procedure and 15 subjects receive placebo injection directly into their affected knee joint. The placebo group’s SVF cells are then frozen and preserved. At the 6-month follow-up visit, those who received the placebo are unblinded and have the option to receive the SVF injection as a condition for participation in the trial. Feasibility of liposuction, SVF manufacturing, cell preservation/thaw techniques and adverse outcomes are all primarily tracked. Secondary outcomes include standardized patient reported outcomes score responses to the treatments.

Discussion: The design of this pilot study offers study subjects the opportunity to receive a novel therapeutic intervention even within a placebo arm and enables the investigators to blind subjects without performing an unnecessary liposuction or discarding the resulting cellular product which could encourage hesitant individuals to participate in the trial. This may aid in overcoming the challenges associated with recruiting participants for cell therapy trials concerned with being randomized to a control arm. The results of this trial will help to assess both the safety and feasibility of SVF injections to treat knee osteoarthritis as well as help plan larger phase controlled trials.

However, precautionary measures are necessary to ensure the safety and well-being of patients receiving cell-based therapy. Proper handling and storage of the cellular product must be considered and are demonstrated here.

Trial Registration

ClinicalTrials.gov Identifier: NCT03940950

DOI: 10.29245/2767-5130/2023/3.1183 View / Download Pdf

Zhian Chen1,2, Hongbo Tan2, Tianhua Zhou2, Yongqing Xu2, Yi Cui2, Yang Li2, Rongmao Shi2*

1Kunming Medical University, Kunming, Yunnan, China

2Department of Orthopaedic Surgery, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, Yunnan, China

Far-out syndrome is an unusual type of Bertolotti’s syndrome refers to L5 nerve root compressed by osteophyte in the extraforaminal zone, which leads to radical pain of the leg by radiculopathy. Conservative treatment is generally ineffective and requires operative decompression. We present the case of a 19-years-old patient complained of pain in the right lumbosacral and lower leg, failed for 2 months of conservative treatment. The patient was confirmed as far-out syndrome by imaging examinations showed the right L5 nerve root compressed by osteophytes from pseud arthrosis between the L5 transverse process and sacral ala. The Visual analog scale (VAS) pain score was 6 and the Oswestry disability index (ODI) was 53.33%. Then the osteophytes and pseudarthrosis were surgical removed and the L5 nerve root was decompressed through a posterior approach. The patient’s symptoms were significantly relieved after surgery immediately. The VAS score was 1 and ODI was 15.56% at 1-month postoperatively. At 1-year follow up, the VAS pain score was 1 and ODI was 11.11% and complete military trainings was resumed.

DOI: 10.29245/2767-5130/2023/3.1182 View / Download Pdf

Arnold H. Menezes

Department of Neurosurgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA

The etiology of os odontoideum has been debated ever since its first description by Giacomini in 1886. There are proponents of congenital origin as well as reports of post-traumatic os odontoideum formation after early childhood craniovertebral junction (CVJ) trauma. We document CVJ ligamentous injury on MRI in an 18-month-old child with sequential imaging demonstrating the os odontoid formation. Our database of 260 surgically treated patients with os odontoideum was analyzed regarding etiology and associated abnormalities. The literature (1970-2022) is reviewed.

DOI: 10.29245/2767-5130/2023/3.1186 View / Download Pdf

Peter R. Reuter*, Mackenzie Brady

Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, Fort Myers, Florida, USA

This cross-sectional study aimed to explore the correlation between hypermobility of the spine and chronic neck/back pain in a university-aged population. Chronic musculoskeletal pain, especially joint pain, is said to be the main complaint of individuals with symptomatic joint hypermobility. Generalized joint hypermobility is usually limited to a small number of joints, with increased range of motion of the lumbar spine the most common form of joint hypermobility. The study collected data over a six-year period from undergraduate Anatomy & Physiology students at a university in the United States, using an anonymous survey. Based on the data from 1,211 respondents the study found that: 1) young adult females are more likely to have hypermobility of the spine than young adult males; 2) young females with spine hypermobility are not more likely to report chronic neck/back pain than females without spine hypermobility; 3) young adult males with spine hypermobility are more likely to report chronic neck/back pain than males without spine hypermobility; 4) young females and males with spine hypermobility experience the same average levels of pain intensity for their chronic neck/back pain than their peers without spine hypermobility; 5) young females with and without spine hypermobility report higher levels of chronic pain intensity than males for chronic neck/back pain.

DOI: 10.29245/2767-5130/2023/3.1185 View / Download Pdf

Ryan P. Bialaszewski1*, Robert H. Ablove2

1University of Texas Rio Grande Valley, School of Medicine, Edinburg, TX, USA

2UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA

Introduction: Obesity is a global pandemic and public health crisis associated with a wide range of comorbidities, including osteoarthritis, leading to a significantly younger age at the time of primary total hip arthroplasty (THA) and an increased rate of complications compared to nonobese individuals. As our population continues to get older, combined with an increasing rate of obesity, an increased rate of consultations for total hip arthroplasty is expected. This has led to concerns regarding the implications of obesity on the need for THA itself and the associated complications, especially for arthroplasty surgeons. Unfortunately, few articles provide an all-encompassing review of different complications surrounding obesity within orthopedic surgery, and even fewer around total hip arthroplasty. This literature review aims to provide a comprehensive review of the implications obesity has on total hip arthroplasties, its associated complications, and how we can potentially modify these risks.

Methods: Sources and research articles were identified by searching the databases of PubMed, Google Scholar, and the National Center for Biotechnology Information (NCBI) from 2000 to July 2022. Our search used the specific terms located within the abstract/title, including: “total hip arthroplasty” AND “complications,” AND “obesity, OR obese.” Inclusion criteria for research articles were the English language and peer-reviewed articles published from inception to July 2022. Articles not directly examining the effect of obesity on the incidence of complications following primary THA were excluded. Studies with outcomes of interest included the incidence of postoperative complications, primary THA in obese patients, and clinical outcome measures. A total of 265 studies were identified upon initial search. Thirty-one articles were selected for reference in this literature review.

Results: Obese patients undergo primary THA at an earlier age and experience an increased duration of surgery, higher rates of infection, dislocation, periprosthetic fractures, and venous thromboembolism compared to nonobese patients. The role of pre-operative bariatric surgery before total hip arthroplasty has failed to show reductions in complication rates. Harris Hip Scores are lower in obese patients pre-operatively and post-operatively, but the degree of improvement following THA is similar compared to nonobese patients. Long-term survival of total hip prostheses is similar when compared to nonobese patients.

Conclusion: Current literature strongly suggests increased complication rates in obese patients who undergo THA. This phenomenon is not solely due to biomechanical forces and is multifactorial, including inflammatory and genetic predispositions, which need further study. The decision to perform THA on obese patients should not solely be based on BMI. Other factors, such as management of comorbidities, surgical exposure, and nursing care, should be considered when deciding on surgical candidacy.

DOI: 10.29245/2767-5130/2023/2.1184 View / Download Pdf

Rita Th. Harmsen1*, Marjolein E.M. den Ouden2, Pieter F. Schillemans3, Henk W. Elzevier1, Rob G. Nelissen1, Brenda L. Den Oudsten4

1Departments of Orthopaedics, Biomedical Data Sciences and Department of Urology and Medical Decision Making (H.W.E.), Leiden University Medical Center, The Netherlands

2Research Group Technology, Health & Care, Academy of Social Work, University of Applied Science Saxion, Enschede, The Netherlands

3Private Center of Ultra Sonography Care, NV Hoorn, The Netherlands

4Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands

Background: In-depth insight into couples’ experiences of sexual activity before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is lacking. The aim of this study was to explore patients’ and partners’ experiences, complemented by surgeons’ opinions on safe resumption of sexual activity after surgery.

Methods: Mixed method study: 1) Semi-structured interviews among sexually active couples, 1.5 years postoperatively and 2) A survey among surgeons about recommendations of sexual activity after THA/TKA.

Results: Of the 150 invited couples, 90 (60%) responded (THA: n=39; TKA: n=42). Five couples participated (THA: n=3; TKA: n=2), while 85 (94%) couples refused participation. Two themes emerged: “Couples physically and mentally adjusted to the new situation” and “Couples undoubtedly trusted the surgeon as the provider of information.” In total, 27% (47/175) of THA surgeons participated. Fifty percent agreed with the recommended sexual positions researched by Charbonnier et al. Opinions differed widely regarding when to safely resume sexual activity. Of the TKA surgeons, 36% (76/211) responded. Almost all surgeons (95%) agreed that there were no restrictions. However, some discomfort was expected when patients bend the knee or kneel during sex. Half of the surgeons indicated that providing information about sex was necessary.

Conclusions: All couples physically and mentally adapted to the new situation without considering safety measures. Patients trusted surgeons in providing safety information. Surgeons should inform patients succinct and explicitly, especially since surgeons’ recommendations showed great variability. More motion research on hip and knee may add to uniform guidelines.

DOI: 10.29245/2767-5130/2023/2.1181 View / Download Pdf

Akshay V. Daji1, Devin Q. John1, Raj D. Rao2*

1HCA JFK Hospital/University of Miami Miller School of Medicine Orthopaedic Surgery Residency Program, FL, USA

2West Palm Beach VA Healthcare System, West Palm Beach, FL, USA

DOI: 10.29245/2767-5130/2023/2.1178 View / Download Pdf

Dariush Dowlat Alizadeh2*, Seyyed Mohammad Jalil Abrisham1, Mohammad Reza Sobhan1

1Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2Orthopedic Surgery, Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Background and Aim: Sagittal imbalance is often presented as one of the major problems in individuals suffering from orthopedic pain, particularly those affected by destructive hip joint osteoarthritis. In this regard, total hip arthroplasty (THA) as a therapeutic procedure for such patients has resulted in the restoration of sagittal balance. Therefore, the present study aimed to evaluate the changes in sagittal balance using EOS imaging before and after THA and also reflect on its effect on hip joint function, knee pain, and disability percentage due to low back pain (LBP).

Methods: Utilizing a prospective cohort study, a total number of 24 patients suffering from extreme unilateral hip osteoarthritis and in need of unilateral THA were selected based on the inclusion and exclusion criteria, and then, sagittal balance parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sacrofemoral angle (SFA), sacrofemoral distance (SFD), lumbar lordosis (LL), and stem angle (SA) were investigated after performing standing radiographs by means of the EOS device. One year after THA, all the above-mentioned parameters were also measured by EOS imaging before and after the surgery and the patients completed some questionnaires, which is the Oswestry Low Back Pain Disability Index (OLBPDI) to evaluate disability percentage resulting in LBP, the Knee Injury and Osteoarthritis Outcome Score (KOOS) instrument to assess knee pain, and the Harris Hip Score (HHS) measure to rate hip joint function, and then the results were analyzed using the SPSS Statistics software (ver. 17).

Results: The patients consisted of 13 males (54.2%) and 11 females (45.8%) with the mean age of 52.87±13.05. The mean score of the preoperative PI was also equal to 54.74±10.66 and it was 58.19±11.58 after the surgery (p=0.025). However, the mean values of other parameters at the preoperative stage did not show any significant changes. As well, hip joint function and knee pain resulting from LBP improved in the patients after the surgery (p<0.001).

Conclusion: The study findings demonstrated that THA probably influenced sagittal balance through PI. Moreover, the postoperative hip joint function, knee pain, and disability percentage caused by LBP significantly enhanced compared with those before the surgery. Thus, it was concluded that the evaluation of sagittal balance parameters could help patients with orthopedic pain.

DOI: 10.29245/2767-5130/2023/2.1164 View / Download Pdf

Michael Tang1, William Fowler1, Oday Al-Dadah1,2*

1Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, Harton Lane, South Tyneside, United Kingdom

2Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle-upon-Tyne, United Kingdom

Objectives: The Nottingham hip fracture score (NHFS) and the Surgical outcome risk tool (SORT) are both validated scoring systems used to predict mortality rates in patient with Fractured neck of femur (FnF). The primary aim of this study was to compare the accuracy of the predicted 30-day mortality rates between NHFS and SORT in patients with FnF. The secondary aim was to investigate the influence of patient and surgical factors on 30-day mortality.

Methods: The NHFS and SORT score was collected from 212 patients admitted with FnF. Variables including hip fracture type, surgical procedure and peri-operative haemoglobin, gender and ASA grade were also collected and further analysed to assess their influence on 30-day mortality rates.

Results: Overall actual 30-day mortality rate for the study population was 11.3% (n=24). There was a significant difference between the mean predicted 30-day mortality for the NHFS (8.0%) and the SORT score (7.0%, p=0.006). The was no difference in mortality rates between the different fracture types (p=0.889). There was a significant difference in mortality rates when comparing surgical procedures (p=0.031). Patients who had a notable fall in haemoglobin peri-operatively had significantly higher mortality rates (p<0.001). Males had significantly higher mortality rates compared to females (20.0% vs 8.6% respectively, p=0.027). Higher ASA grades also had significantly higher mortality rates (p=0.003).

Conclusion: NHFS was found to be significantly more accurate at calculating 30-day mortality rates compared to the SORT score in patients with FnF. Surgical procedure and patient factors including gender, ASA grade and peri-operative haemoglobin also significantly influenced mortality rates but fracture type did not.

DOI: 10.29245/2767-5130/2023/1.1166 View / Download Pdf

Thomas J. Kean

Biionix Cluster, Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, USA

DOI: 10.29245/2767-5130/2023/1.1172 View / Download Pdf

Amina Ait Belmahjoub Aamre MD1, Sergio Barroso Rosa FEBOT PhD1,2*

1Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

2Department of Orthopaedics, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain

Introduction: Currently there are limited options for shoulder adhesive capsulitis treatment, some of which do not have sufficient backing scientific evidence. This entails a relevant setback for patients, especially in severe or refractory cases. In recent years, remote arterial embolization therapies have demonstrated usefulness in the management of diverse musculoskeletal conditions. This systematic review examines the therapeutic role of arterial embolization in patients with shoulder adhesive capsulitis.

Methods: A systematic review of articles published to date was performed, according to the methodology in the Cochrane Systematic Reviews Manual (MECIR) and the PRISMA checklists. PubMed, Scopus, Google Scholar, three other databases and three trial registries were examined for relevant studies. The ROBINS-I tool was used for quality assessment of included studies.

Results: Ninety four potential articles were found, seven of which were included. In the selected studies, arterial embolization was carried out in 127 patients, 113 of whom had abnormal vessels. In all studies, a reduction in pain and improvement in mobility was observed in less than six months after the procedure. There were no major adverse effects or recurrent symptoms reported. Due to large data heterogeneity, a meta-analysis was not performed. Three literature reviews were also included as part of the background discussion.

Conclusions: Arterial embolization is an effective and safe treatment option in patients with shoulder adhesive capsulitis, resulting in reduced pain and restored joint function. Controlled randomized trials are required to evaluate the attributable effect of the technique to the reported clinical improvement.

DOI: 10.29245/2767-5130/2023/1.1170 View / Download Pdf

Lauren McMichan1*, Dawn A. Skelton2, Sebastien F.M. Chastin2,3, Alexandra Mavroeidi1

1Department of Physical Activity for Health, School of Psychological Science and Health, University of Strathclyde, Glasgow, UK

2Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK

3Department of Movement and Sports Science, Ghent University, Ghent, Belgium

Introduction: Understanding daily movement patterns (i.e., the relative proportion of time spent on Sedentary behaviour (SB), light physical activity (LPA), moderate-vigorous physical activity (MVPA) and sleep) to establish links with chronic diseases is a contemporary topic. Little research has looked at the effects of 24-hour movement behaviour on bone health (particularly bone mineral density (BMD)) despite investigation on other health parameters.

The aim of this rapid narrative review was to build on previous work published on the association between SB and BMD in older adults by investigating the association of the more holistic 24- hour movement behaviours in relation to BMD.

Methods: A database search of Web of Science and NIH PubMed was conducted using broad MeSH terms (older adults, sedentary, and bone). Searches were limited from the year 2019 onward.

Results/Discussion: Five published articles were reviewed, and there are discrepancies amongst the findings which could be attributed to the different measurement methods (Peripheral Quantitative Computed Tomography (pQCT) versus Dual-energy X-Ray Absorptiometry (DEXA)) and the sites of measured BMD. There are also notable differences between genders, with BMD in men appearing to be most reliant on time spent in MVPA, compared to women who appear to see benefit to BMD with replacement of SB with LPA and not require more time spent in MVPA. This highlights the complexity of movement behaviours and requires further research.

DOI: 10.29245/2767-5130/2022/3.1167 View / Download Pdf

Marcus Wong*, Jonathan J Lee, Jaime Guerrero, Sean M Barber

Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA

DOI: 10.29245/2767-5130/2022/3.1165 View / Download Pdf