Vol 5-2 Case Series

The Prevena Restor Bella.FormTM in the management of lower limb traumatic wounds

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
Vol 5-2 Review Article

Adipose Derived Stem Cells in Orthopaedics: History and Current Applications

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
Vol 5-1 Research Article

Hip Arthroplasty in Young Patients: Analysis of the New Zealand Joint Registry

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
Vol 5-1 Commentary

Commentary: Disparities in Gender and Diversity Representation Among Surgical Subspecialties: Are we Losing Momentum?

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
Vol 5-1 Commentary

Commentary: A Patient-Specific Lower Extremity Biomechanical Analysis of a Knee Orthotic during a Deep Squat Movement

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
Vol 5-1 Review Article

Ganglion Cysts of the ACL and Meniscus: A Review of Literature

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
Vol 5-1 Case Report

Multiple Diagnoses of Nutritional Rickets in An Inner-City Pediatric Population: A Case Series

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
Vol 5-1 Review Article

Lumbar Disc Arthroplasty: History and Analysis

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