Everyday Orthopaedic Practice Research Articles

A clinician-run 3D-printing laboratory for orthopaedic preoperative planning: an illustrative case series

BACKGROUND: Orthopaedic surgery often benefits from innovation in biomedical engineering, with 3D printing being one of the latest examples. Proving cost-effectiveness and improved clinical outcomes remains challenging. Because of the reduced cost and increased accessibility, it has been possible to start an orthopaedic 3D-printing laboratory in a South African tertiary hospital, exploring the place for this emergent technology in orthopaedic practice. This case series aims to illustrate the clinical use of 3D-printed anatomical models and investigate the time and cost involved in their manufacture METHODS: The design and manufacturing process is discussed, and a retrospective descriptive case series is presented of all models manufactured from January 2020 to April 2021. Using three illustrative cases, we elaborate on two main usage situations: intraoperative reference models (haptic maps) or rehearsal and templating (simulation models RESULTS: In the study, 3D-printed anatomical models were manufactured for 16 patients. For 12 patients, these were simulation models, and for the other four patients, haptic maps were made. The mean time for manufacture was 33 hours (range 8-62), and the median cost per patient was ZAR 3 257.62 (range ZAR 927.17 to ZAR 7 177.09 CONCLUSION: Considering the decreasing cost and ease of using 3D-printing technology, starting a clinician-run orthopaedic 3D-printing laboratory at a South African training hospital has become possible. In this series we illustrate how 3D printing has been used at our unit for planning and rehearsal of a wide range of orthopaedic cases, and we establish a baseline of time and cost expenditure. The cost-effectiveness of implementing 3D-printing technology in everyday orthopaedic practice warrants further investigation Level of evidence: Level 5

One Year Later: What Was the Impact of the COVID-19 Pandemic on Orthopedic Practice?

The coronavirus disease 2019 (COVID-19) pandemic is an enormous challenge for health care systems worldwide.Although it is widely accepted that orthopedic service has been reduced during the COVID-19 pandemic, little is known about the magnitude and qualitative characteristics of this reduction. The aim of the present study is to quantify the impact of the COVID-19 pandemic on everyday orthopedic practice and to detect the qualitative details of this impact in order to provide data for appropriate planning of health care policy.Data from the year 2020, when the COVID-19 pandemic occurred, regarding the number of patients examined in the emergency department, outpatient clinics, as well as the number of hospital admissions, were recorded for each month. The number of surgical procedures per month was also recorded and evaluated in relation to the category and the anatomical region that these procedures pertained to. Similar data from the year 2019 were used as a control group.The mean number of patients who visited the emergency department, the outpatient clinics, and those who were admitted to the hospital per month decreased by 47.2%, 30.4%, and 9%, respectively. Overall, the mean number of orthopedic operations decreased by 11.7%, with trauma operations being reduced by 8.9% and elective operations by 13% per month.Based on the findings of the present study, the impact of the COVID-19 pandemic on orthopedic patients is definitely negative. The establishment of new guidelines and re-distribution of resources is required to return to a normal function of orthopedic practice within hospitals.

Experience of Using Telehealth for Foot and Ankle Examination During The SARS-COV-2 Crisis.

The era of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is rapidly evolving. To comply to the guidelines for social distancing and reducing travel to prevent the spread of disease, many centers made rapid adjustments to conduct follow-up appointments through telehealth mediums. We explore our center’s adaptation to the pandemic, reflecting on how we formulated telehealth clinics for our patients. We share our experience, discuss the challenges encountered, the feedback received, as well as consider the future role of telehealth in everyday orthopaedic practice.Levels of Evidence: Level V

Piriformis - štedeći pristup, da li je bolji?

Hip fractures as well as coxarthrosis are conditions that are becoming more common in everyday orthopedic practice. With the aging of the world's population, there is an increasing need for partial (HA) or total hip arthroplasty (THA). No elective procedure is as important to quality of life as total hip arthroplasty, and partial hip arthroplasty is a method of treatment in elder population who suffered fracture of the femoral neck. There are several hip approaches that can be used for arthroplasty. Hip dislocation is a serious complication after hip arthroplasty and occurs somewhat more frequently when the posterior hip approach is used. The aim of this study is to show that the piriformis sparing technique gives better results in terms of reducing the frequency of dislocations in the early postoperative period (one year). We operated od 249 patients, and after follow-up that lasted from 13 to 22 months we had four dislocations, three in patient with THA(0.021) and one after HA(0.009). Preservation of the piriformis tendon is a minor modification in the operative technique that can lead to a great benefit in the quality of treatment and a reduced risk of complications.

Hip joint contractures, leg length discrepancies, and spinopelvic alignment: impact on the development of osteoarthritis of the hip?

Hip joint problems are common in every-day orthopedic practice. At the age of 60, approximately 5% of the German population suffer from symptomatic osteoarthritis of the hip. One of the main trigger is the morphological abnormality of the joint. Causes may also be overloading of the joint, developmental dysplasia of the hip with reduced coverage, as well as femoral or acetabular malpositioning, for example. The impact of hip joint contractures, leg length discrepancies, and the spinopelvic alignment and their prophylactic treatment in childhood, adolescence and early adulthood are discussed here.

Anterior cruciate ligament reconstruction: MR imaging findings.

More than two million people tear their anterior cruciate ligament (ACL) each year, and ACL reconstruction occupies a significant proportion of everyday orthopedic practice, being one of the most commonly performed sports medicine surgical procedures. Patients with postoperative symptoms are frequently imaged to monitor ligament grafts and to identify complications. Given the number of patients undergoing ACL reconstruction, knowledge of the potential complications of this surgery is essential for radiologists. This article provides a review of imaging of ACL reconstruction procedures and the potential complications specific to this surgery.

Wrist and scaphoid fractures: A 17-year review of NHSLA litigation data

Wrist and scaphoid fractures are common injuries seen and treated in everyday orthopaedic practice. The purpose of the study was to assess the trends and reasons for litigation related to wrist and scaphoid fractures within the NHS. Under a freedom of information (FOI) request, data from 1995 to 2012 were provided by the National Health Service Litigation Authority (NHSLA) on all litigation claims made as a result of wrist and scaphoid fractures. A total of 1354 claims relating to the hand and wrist were identified. Wrist and scaphoid fractures accounted for 492 (36.3%) of these claims, and 365 of these claims were settled, representing 74.2% of all wrist and scaphoid fracture claims. Overall, the most common reason for lost claims was due to incorrect, missed or delayed diagnosis (43.5%). Alleged mismanagement (29.5%), poor care (10.1%) and incompetent surgery (8.0%) were other common causes for litigation. This paper augments previous work published in this area and explores litigation trends specific to wrist and scaphoid fractures. We discuss the trends and reasons for litigation in this area, suggesting areas for improvement that may aid health-care professionals who deal with these injuries and potentially help reduce future litigation.

Our Experience with Alumina on Alumina Weight Bearing in Everyday Orthopedic Practice

The research for an ideal hip prosthesis has led to the development of several durable materials that have been tested very intensly during the past decades, both clinically and mechanically. Alumina on alumina bearing has proven to be a very reliable bearing and is used more and more often. Nevertheless, because of the lack of ductility of alumina ceramic, concerns have been raised regarding its risk of fracture. The purpose of our study is to evaluate the mid-term results (78 months follow-up) of alumina on alumina prosthesis and the complications that have appeared regarding to the properties of the implant. We have reviewed retrospectively 89 THA performed in our clinic during October 2005 – October 2013 on a follow-up period of maximum 78 months. The mean age of the patients included was 49,60 years for men and 48,44 years for women. It was used a single kind of implant with same type of alumina parts, applied only on a postero-lateral surgical approach. The survival rate of ceramic-on-ceramic bearing surface by itself was 98.87% (88 out of 89). The most frequent complication was the dislocation of the prosthesis that happened in 7 cases, mainly due to a malposition of the acetabular cup, without any damage done to the ceramic bearing surfaces. In the failed case we have encountered a cracked femoral head that has been previously resterilized by steam. We could conclude that the alumina on alumina prosthesis is a very reliable prosthesis regarding its durability and strength. It requires a very precise surgical technique when implanted, since almost all the complications were due to a malposition of the acetabular component. A postero-lateral wall of the liner might decrease the rate of dislocations and ceramic wear. Also, we might debate that the steam sterilization is not suitable for alumina implants, since the fractured femoral head was resterilized.

(ii) Wrist fractures

Abstract Wrist fractures are seen commonly in everyday orthopaedic practice. This article discusses many of the key areas around recognition, understanding, management and current opinion on fractures involving the distal radius and distal ulna.

Retransfusion of filtered shed blood in everyday orthopaedic practice

The efficiency of post-operative cell saving after major joint arthroplasty has been demonstrated in prospective studies focusing on blood management. In everyday practice, however, it is likely that transfusion policy is followed less rigorously because of a slackening in attention to blood management, with a reduced efficiency of post-operative cell saving. The primary research question of this retrospective study was whether the number of allogeneic blood transfusions administered to patients treated with a retransfusion system was similar to the results found in a preceding prospective study. A total of 438 patients treated with the Bellovac ABT retransfusion system were analysed in which the majority was operated on a total hip arthroplasty (THA) and total knee arthroplasty (TKA). The amount of retransfused shed blood, the perioperative haemoglobin levels and the number of allogeneic blood transfusions were registered. The average amount of retransfusion was 152 mL in THA and 410 mL in TKA, whereas the allogeneic blood transfusion rate was 8.4 and 5.1% in both groups, respectively. The average percentage of allogeneic blood transfusions administered in this study (i.e. 7%) proved to be marginally higher than the percentage found in a preceding prospective study (i.e. 6%) because of slackening of attention for transfusion policy in everyday practice. Limited bone resection procedures such as resurfacing THA or unicompartmental knee arthroplasty were associated with very limited shed blood and low risk of allogeneic blood transfusion, indicating the doubtful cost efficiency of using a retransfusion system in these patients. It can be concluded that the efficiency of the retransfusion system in everyday practice was similar to the efficiency shown in a preceding prospective study focusing on blood management. However, continual training of the clinical team is crucial.

Diagnose, Differentialdiagnose und Therapie des Lymphödems

Swellings in the legs, caused by lymphedema, are encountered quite frequently in everyday orthopedic practice. The swellings are hard, pale in color and usually painful. Swellings of this kind occasionally atrain a completely disproportionate size and are the referred to as elephantiasis. Lymphedemas fall into two categories: 1. Congenital lymphedemas. These comprise lymphedemas occuring as a result of aplasias or dysplasias of lymph vessels. 2. Acquired lymphedemas: In such cases the edema may be due to mechanical causes, or it may be the result of a disturbance of lymph drainage, e.g., due to the destruction of lymph vessels by metastases, following extirpation of lymph nodes and radiation therapy; or it may be the result of inflammatory processes, e.g., following erysipelas, in filariasis or after a wound infection. Four stages of lymphedema are also distinguished: Stage I - latent lymphedema Stage II - reversible lymphedema Stage III - irreversible lymphedema Stage IV - Elephantiasis. Apart from clinical diagnosis the most comprehensive and reliable diagnostic procedure is lymphangiography. A simple and well-tried method of diagnosing lymphedema is to inject lymphotropic dye subcutaneously. The technique is outlined. The differential diagnosis of lymphedema is described. With regard to treatment, reference is made to surgical possibilities. However, these do not always augur success and the complication rate is high. Massive lymphedemas, therefore, are usually treated conservatively, by Van der Molen's tube method, with intermittent cuff pressure (pressure-curve therapy) and manual lymph drainage. The various treatment methods are described and some of the disadvantage and risks involved are pointed out.

Ultrasound of the Ankle: Anatomy of the Tendons, Bursae, and Ligaments

Ankle tendon and ligament disorders are commonly encountered in everyday orthopedic practice. Whereas tendons can be affected by traumatic, degenerative, and inflammatory conditions, ligaments are mostly involved by tears. Ultrasonography (US) has been accepted worldwide as an efficient, ready, dynamic, and noninvasive tool in assessing ankle tendons and ligaments. The recent technological advances in software and hardware of US equipment have improved the possibilities of US in ankle assessment, and modern equipment allows an accurate depiction of ankle structures. As with all imaging modalities, knowledge of the scanning technique and knowledge of normal US anatomy are prerequisites for a successful examination. In this article we briefly review the normal anatomy of ankle tendons and main ligaments relevant to the US examination. Then we present the routine US technique of examination for the anterior, posterolateral, posteromedial, and posterior region followed by a description of the normal US appearance of tendons, bursae, and ligaments.

Selecting a subjective health status measure for optimum utility in everyday orthopaedic practice

The time required to complete patient outcome questionnaires such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form General Health Survey (SF-36) and the Musculoskeletal Function Assessment (MFA) can sometimes threaten elderly, compromised patients sufficiently to compromise compliance with follow-up clinics. Incomplete questionnaires can also present problems of data bias. A little used (in the USA), patient-friendly questionnaire, the Nottingham Health Profile (NHP) has the potential to reduce the statistical and practical problems associated with the more generally used instruments. We hypothesized that NHP will produce similar results to WOMAC and SF-36 and is more sensitive to small changes in patient outcomes than SF-36 and MFA. Twenty-three patients blindly completed WOMAC, SF-36 and NHP questionnaires. Spearman's Rank Order Correlation was used to compare the component scores of each instrument. Simulation of the before and after results of 10 fictitious patient comparing MFA and NHP was conducted using the related sample t-test. Seven of nine correlation coefficients were statistically significant and ranged from 0.711 to 0.901. The significance of the before and after difference on the five-point scale response was P = 0.05 when the NHP was used and P = 0.07 when MFA was used. The before and after difference on 'yes-no' response questions was P < 0.001 when NHP was used but showed no difference when the MFA was used. Our hypothesis was supported and we suggest that NHP can be used with confidence as an alternative to other patient outcome instruments.

Multilevel callus distraction: a novel idea to shorten the lengthening time

Lower extremity inequality is a common problem in everyday orthopaedic practice. The leg discrepancy can lead to variety of other problems, i.e., spinal problems. Surgical intervention is very demanding and requires patient compliance. Wagner’s and Ilizarov’s elongation technique are most commonly used worldwide, but it gives satisfactory results only in a long period of time and as we know there could be several inconvenient outcomes. Our idea aims at shortening this time period, and avoiding some of the inconvenient outcomes. Unfortunately we do not have the opportunity to go further in our investigations, but we hope that someone interested in this field will have an idea which would make continuation possible.