Arthroplasty Surgery Research Articles

UNVEILING THE INFLUENCE OF ONE-LEG STANCE AND STANDING UP FROM A CHAIR ON HUMAN HIP JOINT PROSTHESIS USING FINITE ELEMENT CONCEPTS

The hip joint plays an important role in providing stability to the human body. Factors such as aging, wear, and tear, make the hip joint degenerate and, in such cases, the same to be replaced through hip arthroplasty surgeries. The background of this study aims to investigate the contact consequence between the artificial femoral head and the acetabular cup for different bearing couples during one-leg stance and standing up from a chair, utilizing the finite element method. The three-dimensional finite dynamic contact model has been developed with different material combinations. The results obtained by the present finite element model align well with the previously available literature. The parameters investigated include maximum von Mises stress, maximum contact pressure and deformation for different material combinations. The results reveal that the pair i.e., Alumina on Ultra-high molecular weight polyethylene (UHMWPE) exhibits lower contact pressure, von Mises Stress and deformation. Therefore, the material pair i.e., Alumina on UHMWPE can be employed in the Total hip replacement (THR) to mitigate contact consequences under both static and dynamic loading conditions, thereby enhancing the durability of the artificial joints.

Periprosthetic joint infection after total knee arthroplasty. Lessons learned: a case report and literature review

Introduction. The increasing proportion of the aging population and overweight people with various joint problems leads to an increased demand for joint replacements. As the number of joint arthroplasty surgeries continues to rise, the persistent incidence of periprosthetic joint infections highlights the need for a comprehensive and evolving approach. In addition to the preoperative period, it is also necessary to consider the course of the intraoperative, and to a greater extent the postoperative period, when the development of periprosthetic infection occurs. This case is indicative of the fact that underestimation of the importance of the postoperative period and control of risk factors can lead to the recurrence of infection. This negatively affects the economy due to an increase in the number of disabilities.Case presentation. A 60-year-old female patient was diagnosed with a periprosthetic joint infection following total knee arthroplasty. The patient's premorbid background was aggravated by the presence of type 2 diabetes mellitus, arterial hypertension, secondary cardiomyopathy, and chronic iron-deficiency anemia. Single stage revision of knee arthroplasty, removal of prosthetic components, excision of degenerative tissue, prolonged antibiotic therapy as well as rehabilitation were ineffective, and the pain increased. Therefore, the patient is admitted for the two-stage revision surgery, removal of the endoprosthesis, and installation of a nonarticulating cement spacer of the left knee joint.Conclusion. Through a relevant literature search, we believe that uncorrected chronic iron-deficiency anemia in combination with uncontrolled diabetes mellitus, both in the preoperative and postoperative period for joint replacement, may increase the risk of the development of periprosthetic infection. Moreover, focusing patients' attention on the importance of the postoperative period and strict monitoring of health indicators will help reduce the likelihood of re-prosthetics.

OPTIMIZING PREOPERATIVE HAEMOGLOBIN MONITORING AND TRANSFUSION PRACTICES IN SHOULDER ARTHROPLASTY SURGERY: A COST-EFFECTIVE ANALYSIS OF PREOPERATIVE ADMISSIONS IN THE NATIONAL HEALTH SERVICE

Shoulder replacement surgery is a well-established orthopaedic procedure designed to significantly enhance patients’ quality of life. However, the prevailing preoperative admission practices within our tertiary shoulder surgery unit involve a two-stage group and save testing process, necessitating an admission on the evening before surgery. This protocol may unnecessarily prolong hospital stays without yielding substantial clinical benefits.The principal aim of our study is to assess the necessity of conducting two preoperative group and save blood tests and to evaluate the requirement for blood transfusions in shoulder arthroplasty surgeries. A secondary objective is to reduce hospital stay durations and the associated admission costs for patients undergoing shoulder arthroplasty. We conducted a retrospective observational study covering the period from 1st January 2023 to 31st August 2023, collecting data from shoulder arthroplasty procedures across three hospitals within the Aneurin Bevan University Health Board.Our analysis included 21 total shoulder replacement cases and 13 reverse shoulder replacement cases. Notably, none of the patients required postoperative blood transfusions. The mean haemoglobin drop observed was 14 g/L for total shoulder replacements and 15 g/L for reverse shoulder replacements. The mean elective admission duration was 2.4 nights for total shoulder replacements and 2 nights for reverse shoulder replacements. Our data indicated that hospital stays were extended by one night primarily due to the preoperative group and save blood tests.In light of these findings, we propose a more streamlined admission process for elective shoulder replacement surgery, eliminating the need for the evening-before-surgery group and save testing. Hospital admissions in these units incur a cost of approximately £500 per night, while the group and save blood tests cost around £30 each. This revised admission procedure is expected to optimise the use of healthcare resources and improve patient satisfaction without compromising clinical care.

Second opinion machine learning for fast-track pathway assignment in hip and knee replacement surgery: the use of patient-reported outcome measures

BackgroundThe frequency of hip and knee arthroplasty surgeries has been rising steadily in recent decades. This trend is attributed to an aging population, leading to increased demands on healthcare systems. Fast Track (FT) surgical protocols, perioperative procedures designed to expedite patient recovery and early mobilization, have demonstrated efficacy in reducing hospital stays, convalescence periods, and associated costs. However, the criteria for selecting patients for FT procedures have not fully capitalized on the available patient data, including patient-reported outcome measures (PROMs).MethodsOur study focused on developing machine learning (ML) models to support decision making in assigning patients to FT procedures, utilizing data from patients’ self-reported health status. These models are specifically designed to predict the potential health status improvement in patients initially selected for FT. Our approach focused on techniques inspired by the concept of controllable AI. This includes eXplainable AI (XAI), which aims to make the model’s recommendations comprehensible to clinicians, and cautious prediction, a method used to alert clinicians about potential control losses, thereby enhancing the models’ trustworthiness and reliability.ResultsOur models were trained and tested using a dataset comprising 899 records from individual patients admitted to the FT program at IRCCS Ospedale Galeazzi-Sant’Ambrogio. After training and selecting hyper-parameters, the models were assessed using a separate internal test set. The interpretable models demonstrated performance on par or even better than the most effective ‘black-box’ model (Random Forest). These models achieved sensitivity, specificity, and positive predictive value (PPV) exceeding 70%, with an area under the curve (AUC) greater than 80%. The cautious prediction models exhibited enhanced performance while maintaining satisfactory coverage (over 50%). Further, when externally validated on a separate cohort from the same hospital-comprising patients from a subsequent time period-the models showed no pragmatically notable decline in performance.ConclusionsOur results demonstrate the effectiveness of utilizing PROMs as basis to develop ML models for planning assignments to FT procedures. Notably, the application of controllable AI techniques, particularly those based on XAI and cautious prediction, emerges as a promising approach. These techniques provide reliable and interpretable support, essential for informed decision-making in clinical processes.

A comparative metabolomic analysis reveals the metabolic variations among cartilage of Kashin-Beck disease and osteoarthritis.

The metabolic variations between the cartilage of osteoarthritis (OA) and Kashin-Beck disease (KBD) remain largely unknown. Our study aimed to address this by conducting a comparative analysis of the metabolic profiles present in the cartilage of KBD and OA. Cartilage samples from patients with KBD (n = 10) and patients with OA (n = 10) were collected during total knee arthroplasty surgery. An untargeted metabolomics approach using liquid chromatography coupled with mass spectrometry (LC-MS) was conducted to investigate the metabolomics profiles of KBD and OA. LC-MS raw data files were converted into mzXML format and then processed by the XCMS, CAMERA, and metaX toolbox implemented with R software. The online Kyoto Encyclopedia of Genes and Genomes (KEGG) database was used to annotate the metabolites by matching the exact molecular mass data of samples with those from the database. A total of 807 ion features were identified for KBD and OA, including 577 positive (240 for upregulated and 337 for downregulated) and 230 negative (107 for upregulated and 123 for downregulated) ions. After annotation, LC-MS identified significant expressions of ten upregulated and eight downregulated second-level metabolites, and 183 upregulated and 162 downregulated first-level metabolites between KBD and OA. We identified differentially expressed second-level metabolites that are highly associated with cartilage damage, including dimethyl sulfoxide, uric acid, and betaine. These metabolites exist in sulphur metabolism, purine metabolism, and glycine, serine, and threonine metabolism. This comprehensive comparative analysis of metabolism in OA and KBD cartilage provides new evidence of differences in the pathogenetic mechanisms underlying cartilage damage in these two conditions.

Drop in survivorship 13 years after AMIC procedures in aligned knees: A long-term follow-up.

Autologous matrix-induced chondrogenesis (AMIC) showed promising short-term results comparable to microfracture. This study aims to assess the 19-year outcomes of AMIC, addressing the lack of long-term data. Retrospective cohort of 34 knees treated with AMIC underwent a 19-year follow-up. The primary outcome was AMIC survival, considering total knee arthroplasty as a failure event. Survival analysis for factors that were associated with longer survival of the AMIC was also performed. Clinical and radiological outcome scores were analysed for the AMIC group. Twenty-three knees were available for follow-up analysis. Of these, 14 (61%) underwent revision surgery for total knee arthroplasty (TKA). The mean time was 13.3 ± 2.5 years (range: 9-17 years). Secondary outcomes showed that increased age at surgery (hazard ratio [HR]: 1.05; p = 0.021) and larger defect size (HR: 1.95; p = 0.018) were risk factors for failure. Concomitant proximal tibial osteotomy (HR: 0.22; p = 0.019) was associated with longer survival. The remaining nine knees (39%) were analysed as a single group. The mean clinical score atfollow-up of 18.6 ± 0.9 SD years was 79.5 ± 19.7 SD for the Lysholm score, 1.8 ± 1.5 SD for the visual analog scale score, 74.2 ± 22.4 SD for the KOOS scoreand a median of 3 (range: 3-4) for the Tegner activity scale. The mean survival time of 13.3 years indicates the durability of AMIC in properly aligned knees. Nonetheless, despite a 61% conversion to TKA, the knees that persisted until the 19-year follow-up remained stable, underscoring the procedure's longevity and consistent clinical outcomes. Level IV.

THE STUDY OF THE WORK OF THE MUSCLES RESPONSIBLE FOR THE FUNCTIONALITY OF THE HIP JOINT AFTER TOTAL HIP ARTHROPLASTY USING DIFFERENT SURGICAL APPROACHES

Muscles that can be damaged during endoprosthesis are indicated. Objective. To study the features of muscle work to ensure walking function after hip arthroplasty depending on the surgical approach. Methods. The basis of the simulation is the basic OpenSim Gate2392 model. Six models were created that predicted the condition of the muscles of the lower limb in normal conditions, during coxarthrosis and after 6 and 12 months. after surgery with lateral and anterior approaches. The results. For lateral access in 6 months. after the operation, the adductor muscles responsible for stabilizing the pelvis in the single-support phase of the step and during the transfer of the foot do not work enough, while the hip flexor muscles (in the model, the rectus femoris muscle) take over the responsibility for the step, but with overvoltage. On the contrary, with the front approach, we observe a weakening of the flexor muscles, which leads to overstrain of the gluteal muscles and hip stabilizer muscles. After 12 months, the muscle strength normalizes for most of them to 90–95 % of the norm, a 2–3 times increase in the torque of the hip flexor muscles and hip stabilizer muscles is observed. Taking a normal step causes muscle strain. During the anterior approach, the foot is transferred during the phase, that is, when most of the muscles are involved. The rectus femoris muscle, which is the strongest of the muscles discussed in the paper, does the main work of moving the foot. In the case of possible damage to the rectus muscle during anterior access, even after a year there is a violation of its work — excessive overexertion and involvement of the reserves of other muscles. Conclusions. Mathematical modeling of the work of muscles that may be damaged during hip arthroplasty surgery, conditional muscle strength for 6 months. after the operation, they are not able to develop the necessary torque to take a normal step. For muscle strength, which in the model corresponded to 12 months,the muscles are able to perform a normal function regardless of surgical access, but their overstrain is observed.

Comparison of fusion, arthroplasty and hybrid surgery outcomes in patients with two-level cervical disc disease.

The study aims to explore the management of two-level cervical disc disease and to compare outcomes of anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and hybrid surgery (HS). Between December 2011 and December 2021, a total of 120 patients (76 males, 44 females; mean age: 44.8±8.1 years; range, 18 to 68 years) who were diagnosed as two-level cervical disc disease and underwent anterior cervical surgery were retrospectively analyzed. The patients were randomly divided into three groups as ACDF, CDA, and HS each consisting of 40 patients. The Neck Disability Index (NDI), Visual Analog Scale (VAS), clinical and radiological findings, and range of motion (ROM) data were evaluated. All of the groups showed a significant improvement according to clinical and radiological outcomes (p=0.01). The mean follow-up was 27.5±6.1 months for ACDF, 20.0±4.7 months for CDA, and 21.1±5.0 months for HS, showing consistency in monitoring post-surgery outcomes. The mean postoperative NDI scores were 13.4±5.6, 14.8±5.2 and 15.0±5.5 in the ACDF, CDA and HS groups, respectively (p=0.056). The mean postoperative ROM values were 20.82±5.66, 32.45±11.21 and 27.18±10.89, respectively (p=0.045). All three surgical techniques, ACDF, CDA, and HS, are safe and successful in the treatment of two-level cervical disc disease. However, HS and CDA may be more preferable over ACDF attributed to their motion-preserving benefits and effectively combining fusion and motion preservation techniques, with comparable clinical and radiological outcomes.

Use of Drains in Spine Surgery Systematic Review & Meta-Analysis

Abstract Background Wound suction drains have been used to decrease the rate of postoperative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. Although the use of surgical drains dates back to the years of Hippocrates, in the orthopedic literature these drains have not been shown to be beneficial in decreasing the rates of these complications, especially in orthopedic procedures including fracture fixation or arthroplasty surgeries. However, these drains are still commonly used throughout the orthopedic community, including spine surgery. Aim of the Work This study aims to review the use of closed suction drains in spine surgery. It aims to perform a systematic review and meta-analysis of the outcome of use of drains, their method and provide intervention recommendation by the best available evidence. Material and Methods We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. We used the following search strategy for searching different databases. “Wound drain” OR “Suction drainage” OR “Drain” OR “Spine Surgery” OR “Spine” OR “SSI” OR “Surgical Site Infection” OR “Hematoma”) AND (“Vertebral Column” OR “Column, Vertebral” OR “Columns, Vertebral” OR “Vertebral Columns” OR “Spinal Column” OR “Column, Spinal” OR “Columns, Spinal” OR “Spinal Columns” OR Vertebra OR Vertebrae). All the references of the included studies were searched for relevant studies. Results In contrast to other spine procedures, posterior spinal fusion as a surgical treatment for adolescent idiopathic scoliosis necessitates big skin incisions, a lengthy operating duration, and a higher rate of blood transfusion. This meta-analysis comprised four studies. Surprisingly, drains had no effect on total blood loss, the rate of post-surgical infection, the rate of post-operation hematoma, or hospital stay. The drain group required greater blood transfusion than the non-drain group, according to. A drain could also result in a post-durotomy fistula. Drain use is not required after intra-dural spinal cord tumor surgery. Regarding the difference in hemoglobin between preoperative and day 3 postoperative 3 studies, no difference was found between the drain group and the no drain group in all spine surgeries. Conclusion The routine use of a drain in post-operative spine surgery appears to have no effect on the likelihood of post-operative surgical site infections or post-operative epidural hematoma, according to this study. It does, however, increase total estimated blood loss without lowering hemoglobin levels, and has no effect on hospital stay length. To further strengthen any meta- analysis in the future, high-quality studies addressing their use in the spine are require.

Morphological features of the synovial membrane in patients with osteoarthritis after knee arthroplasty

BACKGROUND: Inflammation of the synovial membrane is a common manifestation in osteoarthritis which plays a role in complex pathophysiology of osteoarthritis. Synovitis leads to complications during knee replacement. AIM: To give clinical and morphological characteristics of the knee joint condition by histological assessment of the synovial membrane. MATERIALS AND METHODS: In the clinic of traumatology and orthopedics of North-Western State Medical University named after I.I. Mechnikov in 2022, 187 total knee arthroplasty operations were performed in patients with osteoarthritis. For morphological study of the synovial membrane of the knee joint biopsy specimens were taken from 30 patients (19 women and 11 men) by randomized sampling method. The age of patients: from 40 to 76 years, the average age was 59,3 ± 6,7 years. Immunohistochemical reactions were performed to characterize the cellular composition of the inflammatory infiltrate; antibodies to CD68, CD3, CD20, CD138, Ki-67 were used. Morphometry was performed at ×400 magnification. RESULTS: Only 48 (25.7%) patients had at least one course of inpatient conservative or minimally invasive surgical treatment for osteoarthritis of the knee joint before total knee arthroplasty. 18 (9.6%) patients had intraoperative and postoperative complications. Among 30 morphological studies conducted, 3 (10%) patients had verified stage I osteoarthritis of the knee joint, 8 (26.7%) were diagnosed with stage II osteoarthritis, and 19 (63.3%) — stage III osteoarthritis. Significant correlation was obtained between cells stained with antibodies to CD3 and CD20 (r = 0.69; p 0.05), CD68 and CD138 (r = 0.66; p 0.05). Cluster analysis identified three groups of patients with severe (10%), moderate (30%) and weak/absent infiltration (60%). CONCLUSIONS: To correct the treatment strategy for patients with osteoarthritis of the knee joint, it is advisable to strengthen the role of arthroscopic methods in the diagnostic and treatment processes.

Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis.

Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation timeand enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologiesand manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methodsand manufacturers. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatologyand (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effectsmeta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee). Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA)and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93)and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA. Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases. Level 3 (meta-analysis including Level 3 studies).

Advanced technology in shoulder arthroplasty surgery: Artificial intelligence, extended reality, and robotics.

The purpose of this review is to provide an overview of the integration of technological advancements in orthopedic shoulder surgery. Recent technological advancements in orthopedic shoulder surgery include predictive analytics, computer-navigated instrumentation for operative planning, extended reality, and robotics. Separately, these advancements provide distinct methodological attempts to improve surgical experiences and outcomes. Together, these technologies can provide orthopedic surgeons with the tools and capabilities to improve patient care and communication in shoulder arthroplasty. From artificial intelligence-generated predictive analytics to extended reality and robotics, technical innovations may lead to improvements in patient education, surgical accuracy, interdisciplinary communication, and outcomes. A comprehensive narrative review was conducted to explore the technological advancements of orthopedic shoulder arthroplasty. Our findings emphasized the impact of these advancements, exemplified by early enhancements in efficacy and safety. However, certain challenges remain, such as a lack of reproducibly improved outcomes and cost considerations. While the reviewed studies indicate hope for improving shoulder arthroplasty, the true cost-effectiveness and applicability remains to be determined, indicating the need for further research.

Functional and Radiological Outcomes of a Newly Introduced Modified Manual Cementation Technique Versus Second-Generation Technique in Primary Cemented Hip Arthroplasty

Abstract Background: Hip arthroplasty is one of the most common reconstructive procedures done in adults.[1] The main purpose of this surgery is to eliminate pain, regain full extent of joint motion, maintaining hip stability, and improve the quality of life for patients. Objectives: This work aims to compare the clinical and radiological outcomes of two techniques; the second-generation cementation technique and a newly introduced modification of the manual technique in primary cemented hip arthroplasty. Patients and Methods: This prospective, randomized clinical trial included 44 patients. Patients were allocated into two equal groups: the case Group A; who had primary hip arthroplasty operation with the modified manual cementation technique and the control Group B; who had arthroplasty using the second generation cementation technique. The average follow-up period was about 12 months after the operation. Operation time, intraoperative parameters, postoperative clinical and radiological outcomes, and complications were compared between the two groups. Results: The operation duration was significantly longer in Group B (123.4 ± 9.0 vs. 107.5 ± 15.2, P = 0.001). No intraoperative complications were found among 77% while 13.6% showed allergic reaction to cementation 72% of them are in Group B, 6.8% needed blood transfusion, and 2.3% had pulmonary embolism on cementation. No significant difference between the two studied groups regarding postoperative Visual Analog Scale (VAS) score,[2] barrack grading,[3] complications and Harris hip score[4] at 3 months, 9 months, and 12 months was noted. Conclusion: In conclusion, this study concluded that Group A the newly introduced modified manual cementation technique might provide a cheaper and effective alternative to Group B the second-generation technique, with relatively less intraoperative complications and almost no difference in postoperative VAS, Harris hip score, and radiological outcomes over a period of 1-year follow-up.

Impact of using a local protocol for preoperative screening exams in hip arthroplasty surgeries: cross-sectional study

Purpose: To evaluate the adoption of a protocol for patients undergoing primary total hip arthroplasty (PTA). Methods: 72 medical records of patients undergoing ATPQ were evaluated between 2016 and 2022. This is a cross-sectional retrospective study. The eligible patients were divided into two groups: group 1 – 36 arthroplasties before the adoption of the protocol; group 2 – 36 arthroplasties after the adoption of the protocol. Statistical analysis was performed using SPSS 13.0. Results: The mean age of the patients was 61 ± 11.7 years, being 42 males and 30 females. Pre-existing comorbidities were: systemic arterial hypertension (58%) and diabetes (18%) patients. The dominant side was operated on in 65% of cases. Patients were treated with cementless prosthesis (54%) of the cases and with hybrid prosthesis (40.3%). Only nine (12.5%) patients had infection. A significant difference was observed with the presence of infection in the group after the implementation of the protocol with a lower incidence. There was a lower infection rate in group 2 submitted to the application of the protocol, however, statistically the significance was not confirmed. Conclusion: It is concluded that the design of the institutional protocol has the potential to reduce postoperative infections in hip arthroplasty surgeries.

Real time monitoring of carbon dioxide levels in surgical helmet systems worn during hip and knee arthroplasty

BackgroundOrthopaedic surgical helmet systems (SHS) rely on an intrinsic fan to force clean external air over the wearer. Carbon dioxide (CO2) is produced through aerobic metabolism and can potentially accumulate inside the SHS. Levels above 2500 ppm have previously been shown to affect cognitive and practical function. Maximum Health and Safety Executive (HSE) 8-h exposure limit is 5000 ppm. There is a paucity of data on real-world CO2 levels experienced during arthroplasty surgery whilst wearing a SHS. ObjectivesTo determine intra-operative levels of CO2 experienced within SHS. MethodsCO2 levels were continuously recorded during 30 elective arthroplasties, both primary and revision. Data was recorded at 0.5Hz throughout the procedure utilising a Bluetooth CO2 detector, worn inside a surgical helmet worn with a toga gown. Five surgeons contributed real time data to the study. ResultsThe average CO2 level across all procedures was 3006 ppm, with 23 of the cases measured within the surgeons’ helmets having a mean above 2500 ppm, but none having a mean above 5000 ppm. For each procedure, the time spent above 2500 and 5000 ppm was calculated, with the means being 72.6 % and 5.4 % respectively. Minimum fan speed was associated with only a marginally higher mean CO2 value than maximum fan speed. DiscussionThe use of surgical helmet systems for elective orthopaedic surgery, can result in CO2 levels regularly rising to a point which may affect cognitive function. ConclusionFurther research is needed to corroborate these findings however, we recommend that future designs of SHS include active management of exhaust gases, possibly returning to Charnley's original design principles of the body exhaust system.

Computed tomography radiomics in predicting patient satisfaction after robotic-assisted total knee arthroplasty.

After robotic-assisted total knee arthroplasty (RA-TKA) surgery, some patients still experience joint discomfort. We aimed to establish an effective machine learning model that integrates radiomic features extracted from computed tomography (CT) scans and relevant clinical information to predict patient satisfaction three months postoperatively following RA-TKA. After careful selection, data from 142 patients were randomly divided into a training set (n = 99) and a test set (n = 43), approximately in a 7:3 ratio. A total of 1329 radiomic features were extracted from the regions of interest delineated in CT scans. The features were standardized using normalization algorithms, and the least absolute shrinkage and selection operator regression model was employed to select radiomic features with ICC > 0.75 and P < 0.05, generating the Rad-score as feature markers. Univariate and multivariate logistic regression was then used to screen clinical information (age, body mass index, operation time, gender, surgical side, comorbidities, preoperative KSS score, preoperative range of motion (ROM), preoperative and postoperative HKA angle, preoperative and postoperative VAS score) as potential predictive factors. The satisfaction scale ≥ 20 indicates patient satisfaction. Finally, three prediction models were established, focusing on radiomic features, clinical features, and their fusion. Model performance was evaluated using Receiver Operating Characteristic curves and decision curve analysis. In the training set, the area under the curve (AUC) of the clinical model was 0.793 (95% CI 0.681-0.906), the radiomic model was 0.854 (95% CI 0.743-0.964), and the combined radiomic-clinical model was 0.899 (95% CI 0.804-0.995). In the test set, the AUC of the clinical model was 0.908 (95% CI 0.814-1.000), the radiomic model was 0.709 (95% CI 0.541-0.878), and the combined radiomic-clinical model was 0.928 (95% CI 0.842-1.000). The AUC of the radiomic-clinical model was significantly higher than the other two models. The decision curve analysis indicated its clinical application value. We developed a radiomic-based nomogram model using CT imaging to predict the satisfaction of RA-TKA patients at 3 months postoperatively. This model integrated clinical and radiomic features and demonstrated good predictive performance and excellent clinical application potential.

DOES A HIGH PREOPERATIVE PAIN CATASTROPHIZATION SCORE INFLUENCE THE OUTCOMES FOLLOWING HALLUX SURGERY?

BackgroundSurgical intervention for hallux valgus and hallux rigidus is an option for patients presenting with severe pain and deformity. Literature suggest that patients with high Pain Catastrophisation Scores (PCS) have poorer outcomes in spinal and to a lesser extent in arthroplasty surgery. There is however very little evidence pertaining to foot and ankle surgery.AimWe aimed to study whether catastrophisation as measured by PCS influenced the outcomes following surgery for Hallux valgus and rigidus.MethodologyEthical approval for this prospective portfolio study was obtained from NRES Committee South Central and Oxford. Approval was granted from the local R&amp;D department prior to data collection. All patients listed for surgery for hallux pathology to the four senior authors were invited to participate. Recruitment into the study started in September 2017 and is ongoing. Pain catastrophising score (PCS), Manchester Oxford Foot Questionnaire (Mox-FQ), Visual analog scale (VAS) for pain and EQ-5D-3L questionnaires were completed Pre-op (baseline), and at 3, 6 and 12- months post-surgery.Results93 patients with minimum follow-up of 6 months were analysed using SPSS software. A P-value of less than 0.05 was considered significant. The mean age of the patients was 58.5 years and 83% were women. 70% of the patients had surgery for hallux valgus and rest for rigidus. Both PROMS and PCS improved significantly following surgical intervention. Patients with higher pre-operative PCS had a worse 6-month PROM score and more pain.ConclusionThis study confirms that pre-operative catastrophisation as demonstrated by a high PCS score has an adverse effect on outcomes following hallux surgery. Risk stratifying patients based on their Pre-op PCS scores may be a useful strategy to identify those at risk of poorer outcomes. We recommend that behavioural change interventions should be considered to try to improve outcomes in patients with pre-op PCS.

A transitional pain management program is associated with reduced opioid dependence after major shoulder surgery

BackgroundOver-prescription of opioids in the United States increases risks of opioid dependence, overdose, and death. Increased perioperative and postoperative opioid use during orthopedic shoulder surgery is a significant risk factor for long term opioid dependence. The authors hypothesized that a multidisciplinary perioperative pain management program (Transitional Pain Service or TPS) for major shoulder surgery would lead to a reduced amount of opioids required postoperatively. MethodsA TPS was implemented at a Veterans Affairs Medical Center focused on non-opioid pain management and cessation support. Opioid consumption during the implementation of the TPS was compared to a historical cohort. All patients undergoing shoulder arthroplasty or rotator cuff repair were included. The primary outcome was the proportion of patients continuing opioid use at 90 days postoperatively. Secondary outcomes included postoperative pain scores, time to opioid cessation, and median opioid tablets consumed at 90-days. A multivariable model was developed to predict total opioid use at 90-days postoperatively. Kaplan Meier curves were calculated for time to opioid cessation. ResultsThe TPS group demonstrated decreased persistent opioid use at 90 days post-discharge (12.6% vs. 28.6%; p=0.018). Independent predictors associated with increased total opioid tablet prescriptions at 90 days included length of stay (β=19.17), anxiety diagnosis (β=37.627), and number of tablets prescribed at discharge (β=1.353). Shoulder arthroplasty surgery (TSA) was associated with decreased 90-day opioid utilization (β= -32.535) when compared to cuff repair (RCR). Median time to cessation was shorter in TSA (6 days) when compared with RCR (8 days). Pain scores were reduced compared to population mean by post-discharge day 2 for TSA and by post-discharge day 7 for RCR. Median number of post-discharge opioid tablets (oxycodone 5 mg) consumed under TPS management was 25 in both RCR and TSA surgery groups (180 MME). Discussion and ConclusionsThis study demonstrates that a TPS reduces the amount of opioid use of patients undergoing shoulder arthroplasty or cuff repair at 90 days when compared with a historical control. Multivariable regression indicated that fewer opioid tablets at discharge was a modifiable factor that may aid in reducing opioid consumption and that anxiety diagnosis, increased length of stay, and cuff repair surgery were other factors independently associated with increased opioid consumption. This data will assist surgeons in counseling patients, setting narcotic use expectations, and minimizing overprescribing. Use of a similar multidisciplinary perioperative pain management program may greatly reduce opioid over prescriptions nationally.

Cost analysis of total knee arthroplasty surgeries in Turkey.

While working with increasing costs, hospital enterprises try to develop strategies to provide high quality services. In this study, we intended to perform the cost analysis of total knee arthroplasty. A total of 503 patients who were treated with total knee arthroplasty surgery due to gonarthrosis at Nevşehir State Hospital Orthopedics and Traumatology clinic were included in the study. Procedures performed while the patient is in hospital were analyzed by dividing them into the costs of the implant applied to the patient, surgical procedure, medications used, blood and blood products transfusion, medical tests, anesthesia procedure, bed fee and other applied procedures. The mean total cost was 7560.2 Turkish Lira (TL). The mean cost of the implant applied to the patient was 4847.7 TL, that of surgical procedure was 1800 TL, medications used 371.1 TL, blood and blood products transfusion 38.7 TL, medical tests 38.3 TL, anesthesia procedures 142.7 TL, bed fee 195.2 TL and other applied procedures 122.9 TL. In the cost analyses made in this study, it is observed that the share of implant, surgical procedure and anesthesia costs within the total cost is approximately 90%. It is not possible to cut back on the producedures in this 90% part and to modify them. To reduce the total cost, it seems most reasonable to focus on the costs of blood and blood products transfusion, medical tests, medications used and bed fees.

Increased Risk of Postoperative Complications in Patients Who Have Obstructive Sleep Apnea Undergoing Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundObstructive sleep apnea (OSA) has been linked to multiple adverse health outcomes and postoperative complications. Despite the high prevalence of OSA in patients undergoing total joint arthroplasty (TJA), few studies have evaluated the postoperative course of OSA patients after joint arthroplasty surgery. MethodsPubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, and COMPENDEX) were used to conduct a systematic review of articles from inception to July 2023. Primary studies comparing postoperative outcomes following TJA between patients who had and did not have OSA were included. Postoperative medical complications, utilization of critical care, hospital stay, and mortality data were extracted. Descriptive statistics and random-effects meta-analysis models were used to analyze the available data. Included studies were evaluated for methodological risks of bias using the risk of bias in non-randomized studies of interventions. This review was registered on the International Prospective Register of Systematic Reviews (ID: CRD42023447610). ResultsThere were 7 studies with a total of 20,977 patients (9,425 hip; 11,137 knee; 415 hip or knee) that were included. Pulmonary complications were most frequently studied, followed by thromboembolic events. Cardiac, gastrointestinal, hematologic, genitourinary, and delirium events were also reported across studies. Meta-analysis revealed that OSA patients had 4-fold increased odds of overall medical complications (OR [odds ratio], 4.23; 95% confidence interval (CI), 2.97 to 6.04; P < .001; I2 = 0%), 4-fold increased odds of pulmonary complications (OR, 4.31; 95% CI, 2.82 to 6.60; P < .001; I2 = 0%), 2-fold increased odds of thromboembolic complications (OR, 1.92; 95% CI, 1.22 to 3.03; P = .005; I2 = 9%), and 4-fold increased odds of delirium (OR, 3.94; 95% CI, 1.72 to 9.04; P = .001; I2 = 0%). ConclusionsA significant association was found between OSA and overall medical, pulmonary, and thromboembolic complications. These patients also had a higher incidence of postoperative delirium. The present findings underscore the need for comprehensive perioperative strategies to mitigate these risks in OSA patients who elect to undergo TJA.