Orthopaedic Clinic Research Articles

Rapid bone destruction caused by multidrug-resistant Pseudomonas aeruginosa septic arthritis: A case report.

Infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa are strongly associated with poor outcomes, including prolonged hospitalization and an increased risk of mortality. Antimicrobial options for the treatment of severe infections due to MDR P aeruginosa are quite limited, and treatment remains challenging. A 65-year-old woman presented to our orthopedic clinic with a 3-month history of progressive pain and stiffness in her left knee. Her primary care provider administered a hyaluronic acid injection, which unfortunately resulted in worsening symptoms. Subsequent treatment included a 1-month course of intravenous gentamicin and ceftriaxone, which failed to alleviate her symptoms. MDR P aeruginosa septic arthritis of the knee. The culture isolate was tested for susceptibility to multiple antibiotics. Magnetic resonance imaging evaluations were conducted, showing notable erosive and osteolytic changes around the joint surfaces that had progressed significantly. The patient underwent arthroscopic irrigation and synovectomy. The treatment regimen included a combination of intravenous colistin and piperacillin/tazobactam administered over a 6-week period. Total knee arthroplasty was performed 6 months later without additional antibiotic treatment. Patient's knee condition remained continuously stable without abnormal findings of inflammation. The patient's knee range of motion increased 0 to 125 degrees, her pain almost disappeared, and she was able to maintain activities of daily life. This case underscores the challenges of managing infections with MDR organisms in complex clinical scenarios, emphasizing the need for timely intervention and appropriate antibiotic therapy.

Open-Label Placebo Injection for Chronic Back Pain With Functional Neuroimaging

Chronic back pain (CBP) is a leading cause of disability. Placebo treatments often provide as much pain relief as bona fide treatments, such as steroid injections. Open-label (honestly prescribed) placebos (OLPs) may relieve CBP without deception, but OLP mechanisms remain poorly understood. To investigate the long-term efficacy and neurobiological mechanisms of OLP for CBP. A randomized clinical trial of CBP with longitudinal functional magnetic resonance imaging (MRI) comparing OLP with usual care, with 1-year follow-up, was conducted in a university research setting and a community orthopedic clinic. Participants were individuals aged 21 to 70 years with CBP. The trial was conducted from November 2017 to August 2018, with 1-year follow-up completed by November 2019. Data analysis was performed from April 2020 to May 2024. The primary analysis was conducted on an intention-to-treat sample. Participants randomized to OLP received a 1-time subcutaneous lumbar saline injection presented as placebo accompanied by information about the power of placebo to relieve pain, alongside their ongoing care. Usual care participants continued their ongoing care. The primary outcome was pain intensity (0-10, with 0 indicating no pain and 10 the most intense) at 1 month posttreatment. Secondary outcomes included pain interference, depression, anxiety, anger, and sleep quality. Functional MRI was performed before and after treatment during evoked and spontaneous back pain. A total of 101 adults (52 [51.4%] females; mean [SD] age, 40.4 [15.4] years) with moderate severity CBP (mean [SD], 4.10 [1.25] intensity; duration, 9.7 [8.5] years) were enrolled. Compared with usual care, OLP reduced CBP intensity posttreatment (relative reduction, 0.61; Hedges g = 0.45; 95% CI, -0.89 to 0.04; P = .02). Through 1-year follow-up, pain relief did not persist, although significant benefits were observed for depression, anger, anxiety, and sleep disruption (Hedges g = 0.3-0.5; all P < .03). Brain responses to evoked back pain for OLP vs usual care increased in rostral anterior cingulate and ventromedial prefrontal cortex and decreased in somatomotor cortices and thalamus. During spontaneous pain, functional connectivity analyses identified OLP vs usual care increases in ventromedial prefrontal cortex connectivity to the rostral ventral medulla, a pain-modulatory brainstem nucleus. No adverse effects of treatment were reported by participants. In this randomized clinical trial of OLP vs usual care, a single nondeceptive placebo injection reduced CBP intensity for 1 month posttreatment and provided benefits lasting for at least 1 year posttreatment. Brain mechanisms of OLP in a clinical population overlap with those of deceptive placebos in healthy volunteers, including engagement of prefrontal-brainstem pain modulatory pathways. ClinicalTrials.gov Identifier: NCT03294148.

INTRAMUSCULAR MYXOMA OF THE VASTUS LATERALIS MUSCLE: A CASE REPORT

Introduction: Intramuscular myxoma is a rare benign soft tissue tumor which usually affects large muscle groups in patients aged between forty and sixty years. It is composed of hypocellular myxoid tissue. Incidence of intramuscular myxoma varies from 0.1 to 0.3 per 100,000 individuals. The aim of this study: to present the process of diagnosis and treatment of a patient with the rare soft tissue tumor. Case description: A 41-year-old female came to the Orthopedic Clinic with a 2-year history of a lump on the lateral side of her right thigh. Noticeable growth of the lesion and pain complaints started after skiing injury 7 months before the examination. The magnetic resonance imaging test demonstrated encapsulated intramuscular mass which measured 6 x 2 x 2 cm located in Vastus lateralis muscle. Due to an increasing pain and a significant size of the lesion, the patient was qualified for an excisional biopsy. After an excision, the lesion was found on histopathology to be an intramuscular myxoma. The patient did not complain of any neurological deficits, walking disorders. The follow-up imaging examination 3 months after surgery show no recurrence and the further observation was planned.

An Overview of Avascular Necrosis of the Hip in Patients with Sickle Cell Disease

Abstract Background: Avascular necrosis (AVN) of the femoral head is a devastating complication of sickle cell disease characterised by hip pain and dysfunction. The prevalence of this condition in patients with sickle cell disease in Ghana is unknown. Objectives: This study aims to look at the demographics of sickle cell disease patients presenting with AVN, the pattern of the disease on presentation, and the severity of the disease. Materials and Methods: Data were collected from patients referred to the Orthopaedic clinic over three years. Data collection forms were created and filled out for all patients. Analysis was done with Microsoft Excel (Windows 10 version), and the ensuing data were represented with descriptive statistics such as proportions, ratios, percentages, tables, and histograms. Results: A total of 134 patients were seen over a 3-year study period. The vast majority, 109 (85.3%), were below 40 years of age. The sex distribution of the patients was predominantly female (78%). Genotype SS was in the majority (89), representing (66.4%). The majority of the patients, 104 (77.6%), were regular attendees of the Ghana Institute of Clinical Genetics or other specialised sickle cell disease clinics. The main reason for referral was on account of X-ray changes seen by the referring doctor (90, 67.1%). Unilateral disease was seen in 94 (70%) patients. Seventy (52.2%) presented with stage III disease, and 42 (31%) had symptoms for more than 2 years. Conclusions: Most of our patients were young, predominantly with genotype SS. They presented late with advanced disease stages and were referred to the orthopaedic clinic only after X-ray changes were seen.

Injury Patterns in Fencing Athletes - A Retrospective Review.

Fencing is a unique and increasingly popular sport, but limited data exist regarding related injuries. To examine the types of injuries incurred by fencing athletes, and to analyze associations between age, sex, and hand dominance with type and location of injury. Cross-sectional. Retrospective chart reviews were performed to evaluate fencing related injuries in athletes evaluated in the sports medicine and orthopedic clinics of a large teaching hospital. One hundred and eighty-six patients (98 male, 88 female) were included. Average age at time of injury was 14.6 years (range 9 - 32 years). 73% of injuries involved the lower extremity, 16% involved the upper extremity and 10% affected the back. In the lower extremity, the knee (49%), ankle (16%) and hip (11%) were most commonly affected. 80% of injuries were treated with physical therapy. Only 5% required surgical intervention. Injuries of both upper and lower extremities were more commonly seen on the athlete's dominant side, and the majority of injuries (77%) occurred in athletes 13 years or older. The majority of injuries in these fencing athletes affected the lower extremity, most commonly the knee. Extensor mechanism dysfunction, primarily patellofemoral pain, was the most common diagnosis. Hand dominance, patient age, and patient sex did affect different injury characteristics. 2b.

Transportation Barriers in Pediatric Orthopaedic Clinic Visits.

To identify what transportation barriers pediatric patients face when traveling to a major metropolitan orthopaedic center, how these barriers affect care, and what changes can be made to address this issue. A cross-sectional transportation survey was administered to 107 caregivers of patients being seen in the orthopaedic clinic at a tertiary children's hospital in a large metropolitan area. Using logistic regression analysis, we compared socioeconomic characteristics, transportation methods, and scheduling practices among caregivers who reported missing at least one visit in the past and those who reported never missing a visit. 13% (14/108) of caregivers reported missing one or more past visits due to late arrival or transportation issues. Families that traveled more than 45 minutes to clinic (P = 0.04), waited more than one week to schedule a visit (P = 0.002), or reported difficulty scheduling a visit (P = 0.02) were significantly more likely to have a history of nonattendance. In addition, patients who were nonambulatory (P = 0.007), used a mobility device (P = 0.007), or were non-White (P < 0.05) were significantly more likely to have missed a visit. Travel time, difficult or delayed scheduling, and patient ambulatory status were all associated with missing orthopaedic clinic visits although other socioeconomic factors were not related. Interventions to improve orthopaedic clinic attendance should focus on promoting accessibility for patients with mobility limitations and encouraging simple and timely scheduling practices.

A comparison of handheld versus cart-based ultrasound in the evaluation and diagnosis of carpal tunnel syndrome

BackgroundCarpal tunnel syndrome (CTS) is responsible for over 90 % of median nerve neuropathies. Though a clinical diagnosis, evaluation of nerve conduction via electrodiagnostic studies (EDX) and median nerve cross sectional area (CSA) through sonographic imaging provides supporting evidence and insight into disease severity. The advent of handheld ultrasound devices offers a portable, cost-effective and non-invasive method for median nerve assessment, yet its accuracy compared to traditional cart-based ultrasound has not been assessed in this setting. Methods43 consecutive patients who presented to an outpatient orthopedic clinic within a large academic institution for symptoms consistent with CTS between August 2023 and April 2024 were included. Handheld sonography was performed with the Clarius Convex L20 HD3 8–20 MHz transducer. The GE Venue Go with a 4–20 MHz linear transducer was used for conventional cart-based ultrasound evaluation. A paired t-test was performed to compare the mean cross-sectional area (CSA) measured with the GE machine to the mean CSA measured with the Clarius transducer (p < 0.05). ResultsThe average CSA measurement obtained with the GE was 14.21 ± 4.89 mm2. The average CSA measurement obtained with the Clarius handheld transducer was 13.54 ± 4.50 mm2. The mean difference between the GE and Clarius groups was 0.62 mm2 (95 % CI = −1.47 to 2.71), p = 0.55. ConclusionCSA measurements of the median nerve obtained by a handheld ultrasound transducer are comparable to those measured by a traditional cart-based ultrasound machine for carpal tunnel diagnosis. The adoption of handheld ultrasounds in clinical settings holds the potential for quicker, more precise diagnoses and broader access to imaging.

Systematic Evaluation of Isometric Maximal Muscle Strength in an Orthopaedic Cohort.

Although the lower extremities are essential for movement function and human gait, no normalized isometric maximum strength values, which include the factors gender, age, weight, height, and body mass index (BMI), have been defined to date for orthopaedic patients. To systematically analyze the isometric maximal muscle strength of a cohort in an orthopaedic outpatient clinic and to evaluate its relation to gender, age, weight, height, BMI, and the differences between diseases. Cross-sectional study. Level 4. Isometric maximal muscle strength of knee extension, knee flexion, hip abduction, and hip adduction was measured in orthopaedic patients of an outpatient clinic using a specific muscle strength measurement device. Correlation analysis was performed for age, gender, height, weight, and BMI. Patients were grouped by disease characteristics. The cohort consisted of 311 subjects (sex: 164 male, 147 female; age: 48.63 years, SD = 16.595; BMI: 26.56 kg/m², SD = 4.9). Age correlated significantly with maximal isometric muscle strength. At the age of 54 years onward, based on 133 patients, a decline in maximum isometric muscle strength was detected. Gender showed a strong influence on maximal isometric muscle strength, with significantly higher values for male patients. Furthermore, weight and height, but not BMI, correlated significantly with muscle strength. For clinical studies comparing different evidence-based training interventions for rehabilitation, it is important to consider determinants such as gender, age, weight, and height for isometric maximum strength measurement. For further validation, follow-up examinations taking into account the performance level, other target groups, and other muscle groups are required to avoid the wide dispersion of isometric maximum strength values. These results and associated determinants are highly clinically relevant and can be used as a reference for further studies in the field of musculoskeletal regeneration.

Effects of Spinal Decompression and Segmental Spinal Instrumentation on Lower Limb Functionality in Patients with Spinal Osteoarthritis.

Spinal osteoarthritis, a degenerative condition of the spine, significantly impairs quality of life, causing pain, stiffness, and limited mobility. Treatment primarily aims to improve functionality and quality of life. This study investigated the effects of lower back surgery (e.g., spinal decompression with vertebra stabilization) on upper-limb maximum strength, lower limb functionality, and quality of life in osteoarthritis patients. A total of 16 patients (♀ = 10 and ♂ = 6) patients from the orthopedic clinic who were diagnosed with osteoarthritis based on MRI and clinical symptoms underwent the surgery. Their handgrip strength, lower limb functionality (6 min walk test), and quality of life (Flanagan quality of life scale) were assessed before and after the surgery. A repeated measures ANOVA was conducted to assess differences in these metrics pre- and post-surgery across the entire patient cohort, as well as within gender-specific subgroups. A large positive effect was seen in the 6 min walk (p = 0.02, d = -0.83) test but not in the handgrip test or quality of life. However, female patients showed a trend towards better quality of life. The results of this study provide evidence for the effectiveness of surgery in the treatment of spinal osteoarthritis and underscore the need for personalized treatment approaches in the treatment of spinal osteoarthritis.

The effects of a 12-week combined motor control exercise and isolated lumbar extension intervention on lumbar multifidus muscle stiffness in individuals with chronic low back pain.

Exercise therapy is the primary endorsed form of conservative treatment for chronic low back pain (LBP). However, there is still conflicting evidence on which exercise intervention is best. While motor control exercise can lead to morphological and functional improvements of lumbar multifidus muscle in individuals with chronic LBP, the effects of exercise prescription on multifidus stiffness assessed via shear wave elastography are still unknown. The primary aim of this study is to determine the effects of a combined motor control and isolated lumbar extension (MC + ILEX) intervention on lumbar multifidus muscle stiffness. A total of 25 participants aged 18 to 65 were recruited from local orthopedic clinics and the university community with moderate to severe non-specific chronic LBP. Participants performed a 12-week MC + ILEX intervention program. Stiffness of the lumbar multifidus muscle (primary outcome) at L4 and L5 was obtained at baseline, 6-week, and 12-week using shear wave elastography. Changes in stiffness ratio (e.g., ratio of lumbar multifidus muscle stiffness from rest to contracted) were also assessed at both time points. Pre to post-intervention changes in lumbar multifidus muscle stiffness were assessed using a one-way repeated measure ANOVA. Following the 12-week intervention, there were no statistically significant changes in lumbar multifidus muscle stiffness at rest on the right side at L4 (p = 0.628) and the left side at L4 and L5 (p = 0.093, p = 0.203), but a statistically significant decrease was observed on the right side at L5 (p = 0.036). There was no change in lumbar multifidus muscle stiffness ratio. This study provides preliminary evidence to suggest that a 12-week MC + ILEX intervention had minimal effect on lumbar multifidus muscle stiffness in individuals with chronic LBP. Further investigations are needed to confirm our findings and clarify the relationship between muscle stiffness and functional outcomes.

Evaluating the Effectiveness of Physical Therapy in Patients Post-Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears.

ABSTRACT Background: Meniscal tears are among the most common knee injuries, often resulting from sports-related activities or trauma. The menisci are vital for maintaining knee health and function, and a tear can lead to pain, swelling, and impaired mobility. Arthroscopic partial meniscectomy (APM) is a common surgical intervention aimed at alleviating symptoms by removing the damaged portion of the meniscus. Despite the benefits, postoperative challenges such as pain, reduced knee function, and prolonged recovery times are common, making rehabilitation a critical component of recovery. Objective: This study aims to evaluate the effectiveness of physical therapy in patients who have undergone APM for traumatic meniscal tears. The objective is to determine the impact of structured rehabilitation on pain levels, knee function, and overall quality of life compared to standard postoperative care without intensive physical therapy. Methods: A retrospective cross-sectional study was conducted with a sample size of under 50 participants from various private and public orthopedic clinics in Karachi. The study involved patients who had undergone APM and were assessed using the Visual Analog Scale (VAS) and Lysholm scoring scale. The exclusion criteria included patients with meniscal tears less than 10mm, non-traumatic meniscal tears, other knee surgeries, and pre-existing conditions that might interfere with physical therapy outcomes. Results: The average age of participants was approximately 36 years, with a mean body weight of 69 kg. Sports-related trauma was the leading cause of meniscal tears (41.9%), followed by accidents (34.9%) and age-related degeneration (23.3%). Physical therapy led to significant improvements in knee function, with 76.7% of participants reporting good functionality and 93% noting reduced pain and swelling. However, challenges such as difficulty with stair climbing (51.2%) and muscle soreness (27.9%) were also reported. Conclusion: Physical therapy plays a crucial role in the postoperative rehabilitation of patients following APM. The findings indicate that structured rehabilitation significantly improves functional outcomes, reduces pain, and enhances the quality of life. However, variability in patient outcomes suggests the need for further research to optimize rehabilitation protocols, considering individual factors such as the extent of the injury, pre-existing conditions, and patient adherence.

Ligamentum teres lesions are associated with compositional and structural hip cartilage degenerative change: region-specific cartilage degeneration.

To investigate the association between magnetic resonance imaging (MRI)-based ligamentum teres lesions (LTL) and structural hip degeneration. Bilateral 3-T hip MRIs of participants (n = 93 [36 men]; mean age ( ± SD) 51 years ± 15.4) recruited from the community and the orthopedic clinic of a single medical center were included. Clinical and imaging data acquired included hip disability and osteoarthritis outcome scores, semi-quantitative scoring of hip osteoarthritis on MRI (SHOMRI) scores on fluid-sensitive sequences, and cartilage T1ρ/T2 compositional sequences. An MRI-based LTL scoring system, incorporating continuity, thickening, and signal intensity, ranging from 0 (normal) to 4 (complete tear) was constructed. Hip morphological features associated with LTL, based on functional or anatomical relationships to LT, were defined. Relationships between MRI-LT scores and SHOMRI, global/regional cartilage T1ρ/T2, and proposed morphological abnormalities and LTL were explored by mixed effects linear and logistic regression models. In 82 (46.1%) hips, no pain was documented; 118 (63.4%) and 68 (36.6%) hips were graded as KL-grade ≤ 1 and ≥ 2, respectively. Compared to MRI-LT score = 0 (normal), score = 4 (complete tear) revealed significantly worse subchondral bony degenerative changes for bone marrow lesions (SHOMRI-BML) and subchondral cysts (SHOMRI-sc) (p < 0.001, p = 0.015, respectively). Global acetabular T1ρ, femoral T2 were significantly increased for abnormal MRI-LT scores (p-range = 0.005-0.032). Regional analyses revealed significantly increased T1ρ/T2 in central acetabular/increased T2 in off-central femoral regions (p-range = 0.005-0.046). Pulvinar effusion-synovitis, shallow fovea, and foveal osteophytes were significantly associated with abnormal LT MRI findings (p-range = < 0.001-0.044). MRI abnormalities of LT are associated with worse SHOMRI-sc/BML scores, indicative of hip osteoarthritis and higher T1ρ and T2 that differ by region. Pulvinar effusion-synovitis and changes in femoral head morphology are associated with LTL. Abnormal ligamentum teres findings identified via MRI are associated with structural degenerative changes of the hip joint and alterations in acetabular and femoral cartilage compositions show spatial differences in relation to LTL. The clinical significance of common ligamentum teres lesions (LTL) on MRI is not well understood. LTL identified by an MRI-based scoring system is associated with worse biomarkers, indicating more advanced degenerative hip changes. Effusion-synovitis signal at pulvinar, shallow fovea capitis, and foveal osteophytes are associated with LTL on imaging.

A framework for integrated resource planning in surgical clinics

The problem under study is based on the challenges faced by the Orthopaedic Clinic at St. Olav’s Hospital in Trondheim, Norway. Variations in demand and supply cause fluctuating waiting lists, and it is challenging to level the activities between the clinic’s two units, the outpatient clinic and the operating theater, to obtain short waiting times for all activities. Based on these challenges, we describe and present a planning problem referred to as the Long-term Master Scheduling Problem (LMSP), where the objective is to construct an integrated Long-term Master Schedule (LMS) that facilitates short waiting times in both units. The LMS can be separated into two schedules, one cyclic high-level schedule, and one non-cyclic low-level schedule. The demand for outpatient clinic consultations and surgeries is stochastic, as are the waiting lists. To account for this, we propose a planning framework consisting of an optimization model to solve the LMSP, and a two-level planning procedure. In the planning procedure, we first solve the LMSP to construct the LMS for the upcoming planning horizon. Then, to adjust to the fluctuating waiting lists, we periodically refine the low-level schedule by solving a constrained LMSP. We also develop a simulation-based evaluation procedure to evaluate the planning framework in a real-life setting and use this to investigate different planning strategies. We find that imposing flexible, dynamic and agile planning strategies improve waiting time outcomes and patient throughput. Furthermore, combining the strategies yields additive improvements.

Current Use of Patient-Reported Outcome Measures Ignores Functional Demand.

Patient-reported outcome measures (PROMs) are used in orthopaedic surgery to measure aspects of musculoskeletal function that are important to patients, such as disability and pain. However, current assessments of function using PROMs do not necessarily consider a patient's functional demands in detail. A patient's functional demands could serve as a confounder to their perception of their functional ability. Hence, functional demands may need to be adjusted for when PROMs are used to measure musculoskeletal function. We conducted a cross-sectional study in which new orthopaedic patients completed a questionnaire regarding demographics, function [Patient-Reported Outcomes Measurement Information System], functional demand (Tegner Activity Level Scale), pain self-efficacy, and symptoms of depression. 169 eligible patients with diverse orthopaedic conditions were enrolled in the study from an orthopaedic clinic, and 19 were excluded for incomplete questionnaires. The mean Patient-Reported Outcomes Measurement Information System score was 36.5 ± 9.1, and the mean Tegner score was 2.6 ± 2.0. In the multivariable regression model, patient-reported function was significantly associated with functional demand (β = 0.17, P < 0.001). Significant associations were observed for pain self-efficacy (β = 0.15, P < 0.001), acuity (β = -0.10, P = 0.004), and age 80 years or older (β = -0.16, P = 0.004). No notable association was observed with depression or age 65 to 79 years. Higher patient-reported physical function is associated with higher levels of functional demand when controlling for psychosocial factors, acuity, and age. Because of its confounding effect on measuring physical function, functional demand should be assessed and included in models using PROMs before and after surgery. For example, payment models using improvements in PROMs, such as the short form of the Hip dysfunction and Osteoarthritis Outcome Score and the Knee injury and Osteoarthritis Outcome Score after joint arthroplasty, should include functional demand in the model when assessing quality of care. Level II.

Cement Leakage after Augmentation of Osteoporotic Vertebral Bodies.

Cement leakage is the most common complication of vertebral cement augmentation. The present study investigated cement leakage rates in spinal cement augmentation procedures and identified potential risk factors for cement leakage.140 cases (258 vertebrae) in 131 consecutive patients and nine postmortem cases were evaluated. A total of 258 cement-augmented vertebrae were studied. The data for this were obtained from the hospital records of 131 patients who underwent such operations in 2 orthopaedic trauma surgery clinics in the FRG and from the examinations of 9 postmortem cases at the Institute of Forensic Medicine of the University Medical Centre Hamburg-Eppendorf.Cement leaks were identified in 64 of the 140 cases (45.7%). Local cement leaks were the most common type of leak, accounting for 73.4% of leaks (n=47). Venous leaks were evaluated in 15 cases (23.4%) and pulmonary embolisations in 2 cases (3.1%). Within the group of retrospectively studied cases (n=131), only one patient (0.8%) suffered a symptomatic cement leak. Cement augmentation of fractures to lumbar vertebrae and application of large doses of cement were identified as risk factors for cement leakage.Both the data in the literature relevant to the topic and the results of this work demonstrate a high incidence of cement leakage after vertebral body augmentation procedures. Risk factors for cement leakage are described. Despite the low percentage of symptomatic cases, the possible factors influencing cement leakage should be considered and included in the surgical planning when planning and performing cement augmentations on vertebral bodies.

Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-up of a randomised, multicentre, non-inferiority trial

ObjectiveTo assess whether decompression alone is non-inferior to decompression with instrumented fusion five years after primary surgery in patients with degenerative lumbar spondylolisthesis.DesignFive year follow-up of a randomised, multicentre, non-inferiority...

In-office Maximal Voluntary Ventilation Testing Demonstrates Pulmonary Improvement Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Pulmonary function can be impaired in patients with adolescent idiopathic scoliosis (AIS). Maximal voluntary ventilation (MVV) has been shown to be more strongly correlated with major coronal curve, and a more easily obtained measurement of pulmonary function, than forced vital capacity (FVC). We evaluated changes in pulmonary function using these 2 measures in patients with AIS in relation to changes in major coronal curves over time. Forty-seven patients with AIS with thoracic curves ≥10 degrees performed pulmonary function tests using the Carefusion MicroLoop Spirometer at enrollment and 1 year later. Major coronal curve worsening >5 degrees was considered curve progression. At enrollment, 47 patients had a mean major coronal curve of 38 degrees (range: 10 to 76 degrees). One year later, 17 patients had undergone posterior spinal fusion, 9 had curve progression >5 degrees, and 21 had no progression. MVV and major coronal curve were negatively correlated (r = -0.36, P = 0.01) at enrollment. After fusion, the major coronal curve improved by a mean of 41 degrees, and MVV improved by 23% (P < 0.01), but FVC did not improve significantly (6%, P = 0.29). In stable curves, MVV improved 12% (P = 0.01) and FVC improved 9% (P = 0.007). In patients without surgery whose curves progressed an average of 11 degrees, there was no significant change in MVV or FVC (P > 0.44). This is the first study using office-based spirometry in an orthopaedic clinic showing improved pulmonary function with posterior spinal fusion and growth in patients with AIS. It is notable that MVV improved after spinal fusion, but FVC did not, as MVV appears to be a more sensitive measurement for the assessment of pulmonary function in these patients. Level II.

The Effect of Video-Assisted Education on Knee Function and Quality of Life after Total Knee Replacement: A Randomized Controlled Trial

Objective: This study aims to investigate the effect of video-assisted patient education (VPE) on knee functions, quality of life (QoL) and decrease complications in total knee replacement (TKR) patients. Methods: This study is designed as a prospective, parallel, two-arm, randomized clinical trial. It included 44 patients who underwent elective TKR at an orthopedics and traumatology clinic. The VPE group received VPE including early postoperative care for TKR, activities of daily living, and gradual exercise program in addition to the existing routine care at the clinic. The control group received only routine care. The results were collected with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form-36 (SF-36) scores measured at baseline, 1st and 3rd months after TKR. Results: The mean scores of the VPE group on the pain, stiffness, and physical function of the WOMAC were significantly lower in 3rd month after TKR than the control group. The VPE group had significantly higher scores than the control group on SF-36 of all subcategories except pain, emotional role, and mental health in 3rd month after TKR. Conclusion: The VPE can improve knee function and QoL in TKR patients. Nurses can use the VPE method in patients to improve knee functions and QoL after TKR.

Association of fear of falling with performance-based physical function and low back pain in older adults: a cross-sectional study in Iran

ObjectivesThis study investigated the association of fear of falling with performance-based physical function and low back pain (LBP) among older adults.DesignCross-sectional study.SettingParticipants were selected via convenient sampling from Iran University...

Enhancing Outcomes in Prosthetic Joint Infections: The Significance of the Periprosthetic Joint Infection Tumor, Node, and Metastasis (PJI-TNM) Classification and Biodegradable Antibiotic Beads.

Periprosthetic joint infections (PJIs) that occur after hip and knee arthroplasty have a major influence on patient outcomes and healthcare expenses. This study assesses the effectiveness of the PJI tumor, node, and metastasis (PJI-TNM) categorization system and the latest developments in local antibiotic delivery methods for the treatment of PJIs. The study involved a retrospective analysis of 23 patients who received treatment for septic hip or knee prostheses at the SUUB Orthopedics and Traumatology Clinic between January 1, 2022, and February 10, 2024. Approval was gained following ethical considerations. Patients were categorized using the PJI-TNM system, and their therapy was customized based on the severity of the infection. The surgical procedures involved either one-stage or two-stage revisions, utilizing vancomycin and gentamicin antibiotic-loaded calcium sulfate beads to administer antibiotics locally. Data pertaining to demographics, clinical characteristics, and microbiology were gathered and examined. The study comprised 14 male and 9 female patients, with an average age of 68 years. The presence of chronic infections was mostly seen, indicating the development of mature biofilm. Prevalent coexisting medical conditions included diabetes, obesity, and heart failure. The duration of infection control measures was, on average, six months, and 65% of patients reported experiencing enhanced mobility. Acute infections with positive antibiotic responses underwent one-stage modifications. For the majority of patients, a treatment approach involving two-stage modifications, which includes the use of antibiotic-loaded spacers followed by the installation of a prosthesis, proved to be beneficial. The PJI-TNM classification system improves the management of PJI by offering a systematic method for customized therapy. Calcium sulfate beads, which are biodegradable carriers for antibiotics, provide notable advantages, especially for individuals with severe comorbidities. Continuous progress in diagnostic techniques and localized administration of antibiotics is essential for enhancing the therapy of PJI and improving patient outcomes.