Orthopedic Surgery Research Articles

Postoperative Complications in Patients With Metabolic Syndrome Following Unicompartmental Knee Arthroplasty.

Metabolic syndrome is associated with increased risk of postoperative complications following various orthopedic surgeries. This study looked to identify specific postoperative complications in these patients following unicompartmental knee arthroplasty (UKA). Adult patients undergoing primary UKA were queried in the National Surgical Quality Improvement Program database from 2006-2019. Metabolic syndrome was defined by the simultaneous presence of hypertension, diabetes, and body mass index >30 kg/m2. Two patient groups were categorized in this study: patients with metabolic syndrome and patients without metabolic syndrome. Baseline characteristics and postoperative outcomes were compared between the two cohorts with the use of bivariate and multivariate analyses. In total, 10,557 patients underwent UKA. Of these, 9,511 patients (90.1%) did not have metabolic syndrome whereas 1,046 (9.9%) had metabolic syndrome. Following adjustment for potential confounding variables on multivariate analysis, metabolic syndrome patients had an increased risk of an extended length of stay greater than four days (OR 1.66; p=0.016) compared to patients without metabolic syndrome. Metabolic syndrome was associated with an increased risk of extended length of stay greater than four days following UKA. Physicians should be prepared for this complication as well as others when discussing treatment with metabolic syndrome patients.

Health optimisation for patients with obesity before elective orthopaedic surgery: a qualitative study of professionals’ views on restrictive approaches and future practice

BackgroundPreoperative health optimisation for elective surgery entails supporting patients to improve their health in preparation for their treatment and recovery. While there is consensus that this process should address obesity, approaches vary across England. Despite guidance from the National Institute for Health and Care Excellence to the contrary, restrictive approaches with body mass index thresholds for referral to arthroplasty are in use. This qualitative study aimed to investigate the views of professionals on the current use and future implications of these policies.MethodsSemi-structured interviews were conducted with 20 professionals including clinicians, commissioners, policymakers, and health service managers, with experience of developing and/or implementing health optimisation policies for elective arthroplasty. Participants were sampled from areas in England with and without restrictive policies. We undertook thematic analysis of the interview data.ResultsParticipants described pre-surgical health optimisation as an important trigger for health improvement but identified current resourcing and inadequacies in provision of weight management support as significant barriers to success. Participants expressed concerns about the appropriateness and fairness of including obesity as a determinant to restrict access to surgery. They described short-term financial pressures underlying the use of restrictive body mass index thresholds and a lack of an evidence base, such that policies amounted to rationing and risked exacerbations of health inequalities. The study identified four priorities for improvements to future health optimisation practices: developing and implementing national guidance with flexibility for local variation, initiating patient engagement in primary care with onward integration across all services, improving resourcing to support effective equitable impact, and addressing wider determinants of obesity through societal change.ConclusionsOverall, participants had limited expectations of the impact of health optimisation policies on obesity without additional support, investment, and national guideline implementation. They raised strong concerns over current restrictive approaches. We conclude that addressing concerns around weight management support service availability and impacts on health inequalities is essential for shaping effective health optimisation policies. Future policy direction should support health optimisation to be offered early (ideally in primary care). Health optimisation interventions should be non-restrictive, inclusive, and well-monitored, particularly around equality impact.

Failure Modes in Orthopedic Oncologic Reconstructive Surgery: A Review of Imaging Findings and Failure Rates.

Limb salvage surgeries utilizing endoprostheses and allografts are performed for a variety of oncologic conditions. These reconstructions can fail and require revision for many reasons, which are outlined and classified into mechanical failures (soft tissue failures, aseptic loosening, structural failure), non-mechanical failures (infection, tumor progression), and pediatric failures (physeal arrest, growth dysplasia). Distinct radiologic and clinical findings define specific failure subtypes but are sparsely illustrated in the radiology literature. Specifically, an understanding of the organizational structure of the failure modes can direct radiologists' search for post-reconstruction complications, enhance an appreciation of their prognostic significance, and facilitate research by standardizing the language and conceptual framework around outcomes. The purpose of this review is to highlight the key radiologic findings and imaging studies of each failure mode in orthopedic oncologic reconstructive surgery in the context of risk factors, failure rates, prognosis and survival statistics, and clinical decision-making regarding chemotherapy, radiation, and revision surgery.

Personalized 3D Printing of Artificial Vertebrae: A Predictive Bone Density Modeling Approach for Robotic Cutting Applications

Robotic vertebral plate cutting poses significant challenges due to the complex bone structures of the lumbar spine, which consist of varying densities in cortical and cancellous regions. This study addresses these challenges by developing a predictive model for robotic vertebral plate cutting force and bone quality recognition through the fabrication of artificial vertebrae with controlled, consistent bone density. To address the variability in bone density between cortical and cancellous regions, CT data are utilized to predict target bone density, serving as a foundation for determining the optimal 3D printing process parameters. The proposed methodology integrates a Response Surface Methodology (RSM), Back Propagation (BP) neural network, and genetic algorithm (GA) to systematically evaluate the effects of key process parameters, such as the filling density, material flow rate, and layer thickness, on the printed vertebrae’s density. A one-factor experimental approach and RSM-based central composite design are applied to build an initial bone density prediction model, followed by Sobol’s sensitivity analysis to quantify the influence of each parameter. The GA-BP neural network model is then employed to rapidly and accurately identify optimal printing parameters for different bone layer densities. The resulting optimized models are used to fabricate personalized artificial lumbar vertebrae, which are subsequently validated through robotic cutting experiments. This research not only contributes to the advancement in personalized 3D printing technology but also provides a reliable framework for developing patient-specific surgical planning models in robot-assisted orthopedic surgery.

A Case of Fat Embolism Syndrome after Fracture of Tibia Fibula

Fat embolism syndrome is a fatal condition that affects several organs. It often occurs after trauma or orthopedic surgeries. Most are unnoticed, and treatment of it is primarily supportive, with early fracture repair as a preventative measure. This case report describes a patient who had a left tibia fibula fracture diagnosed using Gurd's criteria and verified by a CT pulmonary angiography and MRI, and was treated with supportive care. Bangladesh Crit Care J September 2024; 12 (2): 167-171

An immune signature of postoperative cognitive decline: A prospective cohort study.

Postoperative cognitive decline (POCD) is the predominant complication affecting patients over 60 years old following major surgery, yet its prediction and prevention remain challenging. Understanding the biological processes underlying the pathogenesis of POCD is essential for identifying mechanistic biomarkers to advance diagnostics and therapeutics. This study aimed to provide a comprehensive analysis of immune cell trajectories differentiating patients with and without POCD and to derive a predictive score enabling the identification of high-risk patients during the preoperative period. Twenty-six patients aged 60 years old and older undergoing elective major orthopedic surgery were enrolled in a prospective longitudinal study, and the occurrence of POCD was assessed seven days after surgery. Serial samples collected before surgery, and one, seven, and 90 days after surgery were analyzed using a combined single-cell mass cytometry and plasma proteomic approach. Unsupervised clustering of the high-dimensional mass cytometry data was employed to characterize time-dependent trajectories of all major innate and adaptive immune cell frequencies and signaling responses. Sparse machine learning coupled with data-driven feature selection was applied to the pre-surgery immunological dataset to classify patients at risk for POCD. The analysis identified cell-type and signaling-specific immune trajectories differentiating patients with and without POCD. The most prominent trajectory features revealed early exacerbation of JAK/STAT and dampening of inhibitory κB and nuclear factor-κB immune signaling responses in patients with POCD. Further analyses integrating immunological and clinical data collected before surgery identified a preoperative predictive model comprising one plasma protein and ten immune cell features that classified patients at risk for POCD with excellent accuracy (AUC=0.80, P=2.21e-02 U-test). Immune system-wide monitoring of patients over 60 years old undergoing surgery unveiled a peripheral immune signature of POCD. A predictive model built on immunological data collected before surgery demonstrated greater accuracy in predicting POCD compared to known clinical preoperative risk factors, offering a concise list of biomarker candidates to personalize perioperative management.

Kinematic Changes throughout Childhood in Youth with Cerebral Palsy: Influence of Age and Orthopaedic Surgery.

Abnormal gait kinematics are common in youth with cerebral palsy (CP), but prior studies have not analyzed their longitudinal change throughout childhood. This study examines how age and orthopaedic surgery influence gait kinematics throughout childhood in those with ambulatory CP. In this institutional review board-approved prospective cohort study, children with spastic CP (GMFCS I-III) were recruited at age 17-40 months. Instrumented gait analysis was performed at 3-year intervals from age 4 to 21 years, collecting longitudinal kinematic data in bare feet at a self-selected speed. The change in Gait Profile Score (ΔGPS) between each pair of gait analyses (intervals) was analyzed by age distribution (<10, 10-15, ≥15 years) and by presence/absence of orthopaedic surgery. The study included 31 children (GMFCS: I [13], II [14], III [4]). A baseline instrumented gait analysis was performed at age 5.8 ± 1.6 years with subsequent analysis at 2.5 ± 1.3-year intervals. Examining ΔGPS from baseline to final outcome, 87% of limbs were improved/unchanged; 298 intervals of ΔGPS were analyzed and classified as nonsurgical or surgical. Analysis revealed greater GPS improvement in intervals with surgery versus intervals without (p = 0.0004). Surgical intervals had significantly greater GPS improvement in the <10- vs. >15-year-old groups, p = 0.0063. Improvement in gait kinematics in children with CP is significantly influenced by age and timing of orthopaedic surgical intervention for gait correction, and was most pronounced for children <10 years old. Although surgery was associated with improved outcomes in all age groups, these improvements were significantly less for children >10 years old. These results reinforce the importance of considering the timing of orthopaedic surgery.

Cannabis Use Disorder Associated With Increased Risk of Postoperative Complications After Hip or Knee Arthroplasties: A Meta-analysis of Observational Studies.

With the legalization of marijuana in the United States, the number of patients with cannabis use disorder (CUD) in the joint arthroplasty population has increased markedly. The primary purpose of this meta-analysis was to determine whether there were differences in clinical and economic outcomes after total joint arthroplasty (TJA) between patients with and without perioperative CUD. We searched PubMed, Embase, Scopus, and Web of Science databases up to July 2018 to identify all eligible studies investigating the association of CUD with postoperative outcomes in patients undergoing TJA. Postoperative outcomes assessed consisted of complications, readmission, length of stay (LOS), implant revision, and cost of care. For dichotomous outcomes, pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. We identified 10 retrospective cohort studies with a total of 17,981,628 study participants. Patients with CUD had significantly higher odds of medical complications (OR 1.33 [95% CI 1.07 to 1.66], P = 0.01) and implant-related complications (OR 1.75 [95% CI: 1.64 to 1.88], P < 0.00001) than noncannabis users. Specifically, CUD was associated with significantly increased odds of cardiac complications (OR 1.95 [95% CI 1.50 to 2.54], P < 0.00001), cerebrovascular accidents (OR 2.06 [95% CI 1.66 to 2.57], P < 0.00001), postoperative infections (OR 1.68 [95% CI 1.34 to 2.10], P < 0.00001), periprosthetic fracture (OR 1.42 [95% CI 1.19 to 1.70], P < 0.0001), mechanical loosening (OR 1.54 [95% CI 1.42 to 1.66], P < 0.00001), and dislocation/instability (OR 1.88 [95% CI 1.32 to 2.68], P = 0.0005). Longer LOS and higher cost of care were also found in patients with CUD. This study strengthens the body of evidence that patients with CUD face higher risk of postoperative complications and greater financial burden after knee and hip arthroplasties. Physicians should inform patients about adverse outcomes and undertake appropriate risk adjustments before elective orthopaedic surgery. Level III.

Efficacy and safety of 4-hydroxy-2-methyl-N-(5-methyl-2-thiazolyl)-2H-1, 2-benzothiazin-3-carboxamide 1,1-dioxide, a rapid-acting meloxicam formulation, for analgesia after orthopaedic surgery under general anaesthesia: a randomized controlled trial.

Postoperative pain management is one of the most challenging treatments after orthopaedic surgery, and improved medical treatment options are urgently needed. This study aimed to evaluate the efficacy and safety of 4-hydroxy-2-methyl-N-(5-methyl-2-thiazolyl)-2H-1, 2-benzothiazin-3-carboxamide 1,1-dioxide (QP001) for moderate to severe pain following orthopaedic surgery. This randomized clinical trial enlisted patients experiencing moderate to severe pain following orthopaedic surgery in 20 hospitals in China. We allocated randomly 132 participants to receive 30mg QP001 and 66 participants to receive 0.9% saline pre-surgery. The primary efficacy outcome was the total morphine consumption within 24h. The total morphine consumption in the QP001 group, versus placebo group, was significantly lower over the following 24h [12.53 (10.51) vs. 26.13 (13.98), P < 0.001]. The total morphine consumption in the QP001 group, versus placebo group, was also significantly decreased over the following 48h (P < 0.001). The QP001 group, versus placebo, showed a significant decrease in the effective pressing times of the analgesic pump, morphine relief analgesia ratio over the 24h and 48h periods and the area under the curve for pain intensity-time as well as a significant prolonged in the time of first pressing the analgesic pump and the time of first morphine rescue analgesia (P < 0.001). The QP001 groups, versus placebo, show no significant difference in adverse events, but the incidence of adverse drug reactions decreased (59.4% vs. 75.8%, P = 0.023). QP001 provides analgesia and reduces opioid consumption in patients with moderate to severe pain after orthopaedic surgery, with a favorable safety profile.

Comparison of the Effectiveness of Autologous Blood Injection and Steroid Injection in Managing Tennis Elbow.

Background Local depot steroid injections can consistently and predictably relieve tennis elbow pain in the short term. Prolotherapy, extracorporeal shockwave therapy, autologous blood, and local injections of platelet-rich plasma (PRP) are examples of novel treatment approaches. Objective The objective of this study is to compare the effectiveness of autologous blood injection and local steroid injection in providing pain relief for patients with lateral epicondylitis (tennis elbow)using the visual analog scale (VAS) over 12 weeks. Methods A descriptive case series was conducted from July 10, 2019, to July 9, 2021, at the Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital. A total of 396 patients with tennis elbow, aged 20 to 50 years, were included (198 in each group). Patients managed with non-operative methods and those with other associated injuries in the same elbow were excluded. Group I received an injection of 40 mg of methylprednisolone acetate with 1 ml of 2% lignocaine solution. Group II received an injection of 2 ml of autologous venous blood. The final outcome was assessed at 12 weeks. Results In Group I, the average age of the patients was 36.04 ± 8.26 years, while in Group II, it was 37.23 ± 7.32 years. The male-to-female ratio was2.3:1; 276 (69.81%) of the 396 patients were male, while 120 (30.19%) were female. Group I's mean baseline VASscore was 6.99 ± 0.99, while Group II's mean baseline VAS score was 6.99 ± 1.06 (p = 1.000). Group I had a mean post-therapy VAS score of 3.11 ± 1.62, while Group II had a mean score of 2.48 ± 1.26 (p = 0.0001). About 118 (59.60%) individuals in Group I and 156 (78.79%) patients in Group II experienced pain alleviation from lateral epicondylitis (p = 0.0001). Conclusion This study found that autologous blood injection significantly reduces pain in patients with lateral epicondylitis compared to steroid injection, with a statistically significant p-value of 0.0001. Pain relief was more frequent in the autologous blood group (78.79%) than in the steroid group (59.60%). These findings suggest that autologous blood injections may offer a more effectivetreatment, reducing the need for repeat procedures and improving patient outcomes.

Hand Surgical Operating Room Size Allocation: A Comparative Space Utilisation Study.

Background: This study evaluated operating room (OR) space required for various hand surgical procedures. We analysed the size requirements for hand surgical cases divided into four settings: (1) large OR setting requiring fluoroscopy and microsurgical equipment, (2) medium-sized OR setting for cases requiring fluoroscopy, (3) smaller OR setting and (4) minor procedural room without anaesthesia with the aim to describe room size requirements for hand surgery practices. Methods: A variety of hand surgical cases were selected: large cases (microvascular digit replantation), medium-sized cases (closed reduction percutaneous pinning [CRPP] of phalangeal fractures) and smaller cases (carpal tunnel release [CTR]) with and without anaesthesia. Space requirements were compared to general surgery cases (laparoscopic appendectomy) and general orthopaedic surgery cases (cephalomedullary nail [CMN]). Necessary operative equipment was measured (ft2) to calculate requirements for each procedure. Results: Large hand cases such as digit replantation necessitated the most OR space (125 ft2), followed by general orthopaedic cases (CMN; 118 ft2), medium-sized hand cases (CRPP phalanx; 107 ft2), general surgery laparoscopic appendectomy (68 ft2), small hand cases (CTR; 85 ft2) and minor procedures (49 ft2). Conclusions: Hand procedures can be divided into major procedures requiring significant OR space (125 ft2), medium procedures in standard OR suites (107 ft2), procedures in small ORs with anaesthesia (81 ft2) or office-based setting without anaesthesia (49 ft2). These findings help define space utilisation for hand procedures and may have practical implications related to efficiency, cost and patient safety in the hospital and outpatient setting. Level of Evidence: Level IV (Economic and Decision Analyses).

The Severity of Wound Infection in Washing the Primary Prep Area with 70% Alcohol and Normal Saline in the Orthopedic Surgery Prepped with Povidone-Iodine: A Randomized Clinical Trial

Background: Despite significant advances in patient treatment, infection remains a complication after surgery. The present study compared the incidence and severity of wound infection with two methods of washing the primary prep area with 70% alcohol and normal saline in patients who are candidates for orthopedic surgery in Kowsar Hospital of Sanandaj, Iran. Methods: This single-blinded randomized clinical trial was conducted on 190 candidates for upper limb orthopedic surgery aged 18 to 65. Patients were randomly assigned to two alcohol and normal saline groups based on the table of random numbers. The primary outcome of this clinical trial was the incidence and severity of wound infection after surgery, which was measured by the standard scale of the Asepsis index. The results were analyzed using SPSS version 23, and statistical values less than 0.05 were considered significant. Results: Patients’ hospitalization duration in the intervention group was (3.02±1.04 days) and in the control group (2.86±1.03 days) showed no significant statistical difference (p=0.297). The frequency of wound infection in the alcohol group was lower than in the normal saline group. this difference was statistically significant (p=0.023). Also, the severity of wound infection in the 70% alcohol group (Mean=5.12, SD=3.19) was lower than in the normal saline group (Mean=7.69, SD=4.12). This difference was statistically significant (p&lt;0.001). Conclusion: The present clinical trial showed that the incidence and severity of wound infection after surgery were lower in the group washing the skin of the surgical area with alcohol compared to the group washing with normal saline.

Virtual Reality-Assisted Informed Consent for Anesthesia: A Prospective and Randomized Proof-of-Concept Study.

Background/Objectives: Informed consent for anesthesia poses both legal challenges and problems of understandable communication. Fulfilling all the requirements through anesthesiologists directly interacting with patients is a time- and staff-consuming strategy. Given today's smart technologies, notably including virtual reality (VR), we explored in a prospective randomized study whether 'VR-assisted informed consent' could improve this situation. Methods: Fifty patients scheduled for orthopedic surgery were randomized. In the control group, informed consent was obtained via patient-specialist dialogs only. The patients in the study group, wearing a head-mounted display, watched an 8 min immersive 3D movie with the standard explanations of general anesthesia, followed by a patient-specialist dialog to address open questions. The time spent on the dialogs in both groups was evaluated as the primary outcome variable. As secondary variables, we analyzed both a three-item Likert scale on patient satisfaction with the VR experience and cost differences between both groups. Results: Patient-specialist dialogs were carried on for median (IQR) durations of 93 (20-182) seconds in the study group versus 665 (261-829) seconds in the control group (p < 0.001). All the patients exposed to VR rated this experience as favorable (87.5%) or neutral (12.5%). Based on anesthesiologists' incomes in the US and UK, our approach would reduce the staff expenditure for each patient-specialist dialog by median amounts of USD ≈40 or ≈11, respectively (2 × p < 0.001). Conclusions: 'VR-assisted informed consent' for anesthesia is well accepted by patients and reduces the time requirements for patient-specialist dialogs, thus pointing out a potential avenue towards increasing the work-time efficiency of anesthesiologists.

Effect of needle types and diameters using in spinal anesthesia on optic nerve sheath diameter: Prospective randomized study.

This prospective randomized study aimed to investigate the impact of needle types and diameters used in spinal anesthesia (SA) on optic nerve sheath diameter (ONSD) in patients undergoing lower extremity orthopedic surgery. Patients were randomly assigned to 3 groups based on the needle type and size used for SA: Group 25w (25 gauge Whitacre needle), Group 27q (27 gauge Quincke needle), and Group 25q (25 gauge Quincke needle). Initially, 165 patients (55 in each group) were enrolled, with 146 patients ultimately included in the analysis (Group 25w, n = 49; Group 27q, n = 48; Group 25q, n = 49). ONSD measurements were conducted using ultrasound guidance at 5 time points: T0 (pre-SA), T1 (5 minutes post-SA), T2 (5 minutes post-tourniquet inflation), T3 (5 minutes post-tourniquet deflation), and T4 (24 hours post-operation). Additionally, oxygen saturation, systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, and heart rate were recorded at these time points. Analysis of ONSD measurements revealed no significant differences among the groups at time points T0,T1,T2, and T4 (P = .7293, P = .4428, P = .3676, and P = .3667, respectively). However, at T3, ONSD values were significantly higher in Group 27q compared to Group 25q (P = .0325). Across all groups, the mean ONSD values measured post-tourniquet release (T3) were higher than those at T0,T2, and T4 (P < .001 for all). The incidence of nausea was similar among the groups, and no cases of headache or visual impairment were reported within the initial 24 hours post-surgery. In conclusion, our study suggests that while subarachnoid injection and tourniquet inflation do not impact intracranial pressure (ICP), tourniquet deflation leads to an increase in ICP during lower limb surgery under SA. Therefore, caution should be exercised when using a tourniquet in patients at risk of elevated ICP.

The Use of Social Media in Orthopedic and Trauma Surgery Education: A Cross-Sectional Survey of German-Speaking Residents and Medical Students.

Social media has become a significant part of daily life, with platforms like Facebook and WhatsApp dominating usage. The COVID-19 pandemic further increased social media activity, including within the orthopedic community due to restrictions on physical gatherings. Despite the benefits of instant access to educational resources and interaction with experts, the lack of regulated editorial oversight on social media raises concerns about misinformation and privacy. This study aimed to evaluate the role of social media in orthopedic and trauma surgery education, focusing on platform use, user behavior, and engagement with educational content. A web-based survey was distributed to 912 residents and 728 medical students from the German-speaking Association for Arthroscopy and Joint Surgery (AGA) between June and July 2022. The questionnaire included 21 items covering demographics, platform use, activity patterns, engagement with educational content, and concerns about privacy. Of the 339 respondents (129 medical students), 87% reported daily social media use, primarily via smartphones (93%). The most commonly used platforms were WhatsApp (84%), Instagram (68%), and YouTube (54%). About 26% of the content consumed was related to orthopedics or trauma surgery. While 70% engaged with specialist content by liking, commenting, or sharing, only 32% posted their own content. Additionally, 77% followed healthcare professionals or institutions, and 65% benefited from case presentations with images. Notably, 15% observed content that could violate patient privacy. Orthopedic residents and students are high-volume social media users but engage more passively with professional content. While most value educational material, concerns about privacy violations and inappropriate posts remain prevalent.

Physical Therapy Dose After Orthopedic Multilevel Surgery Varies by Ambulatory Status in Children With Cerebral Palsy: A Pilot Study.

To characterize physical therapy (PT) dose for children with cerebral palsy (CP) after multi-level surgery (MLS) and examine variation by ambulatory status and surgical burden. PT dose (Frequency, Intensity, Time, Type) data were extracted from electronic records of children with CP who received outpatient PT the year after MLS. Seventeen children, mean 9 years, female (n=10), ambulatory (n=10), and high surgical burden (n=12) were included. In the year after surgery, 345 visits occurred. Intensity across visits was above average. Time was greatest for pre-functional activities, gait, and transitions/transfers. Types most often delivered were neuromuscular, musculoskeletal, and education/training. Ambulatory children received significantly more visits, higher intensity, and time in pre-functional activities and gait than non-ambulatory children. No differences in type by ambulatory status and PT dose by surgical burden were found. PT dose varied the first year after MLS indicating the need for guidelines by ambulatory status. Supplemental Digital Content available at: http://links.lww.com/PPT/A516.

Exploring the use of wearable sensors for assessing risk factors during orthopedic surgeries: A protocol for data collection

During orthopedic surgeries, surgeons are generally exposed to prolonged periods of standing, awkward and sustained body postures, and forceful movements, which can increase the likelihood of developing work-related musculoskeletal disorders (WRMSD). Therefore, this study proposes a protocol to measure parameters related to physical risk factors contributing to lower limb WRMSD, during orthopedic surgery procedures. The protocol development was preceded by an initial phase of understanding and specifying the context of use, followed by pre-tests in laboratory environment. It integrates a motion capture system, using inertial measurement units (IMU) to collect posture data from hip, knee, and ankle, and electromyography system (EMG) to measure and record data from muscle activity of biceps femoris, rectus femoris, and gastrocnemius lateralis. Pre-tests provided insights for protocol optimization, estimating a 3-hour data collection session per surgery due to sensor battery limitations, streamlining the process by placing EMG sensors before IMU and refining thigh sensor placement strategies. The protocol presents an opportunity for a real-time and quantitative approach to monitor surgeon's exposure to risk factors contributing to lower limb WRMSD while performing surgical procedures. Two months after pre-tests, the protocol implementation began in a real work context. The study's final outcomes fall outside the paper's scope.

Evaluation of the effects of a team-based systematic prevention and management program for postoperative orthopedic older patients: A retrospective cohort study.

This study aimed to evaluate a team-based systematic prevention and management program for delirium (a multicomponent intervention addressing potentially modifiable risk factors based on the DELirium Team Approach [DELTA]) in older patients undergoing orthopedic surgery within a real-world clinical setting. The DELTA program was initiated at our hospital in January 2019. A retrospective before-after study was conducted during a preintervention period (January 1, 2017 to December 31, 2018) and a postintervention period (January 1, 2020 to December 31, 2021) at orthopedic wards of an advanced acute care hospital in Japan. A total of 787 inpatients were evaluated before the preintervention period, and 833 inpatients were evaluated after the postintervention period. After the DELTA program's implementation, a significant decrease in benzodiazepine receptor agonist prescriptions (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.29-0.53) and an increase in prescriptions of either melatonin receptor agonists or dual orexin receptor antagonists (OR, 3.83; 95% CI, 2.49-5.88) were observed. However, no significant difference was observed in the incidence of falls, self-extubation, or required level of medical and nursing care, including risky behavior and inability to follow medical or care instructions following the intervention, despite a reduction in the length of hospital stay and institutionalization. Implementing the DELTA program for older patients undergoing orthopedic surgery contributed to optimizing the prescription of hypnotics; however, the impact on other patient outcomes, such as falls, self-extubation, and required level of medical and nursing care was limited.

Comparison of the effect of different doses of phenylephrine infusion on the prevention of hypotension in the elderly under spinal anaesthesia in orthopaedic surgery.

Considering the vasopressor drug categories and doses that can be used for elderly patients following hypotension are few, the present trial aimed to compare the effect of different doses of phenylephrine infusion on the prevention of hypotension in elderly patients undergoing orthopaedic lower extremities surgery. This randomised, double-blind prospective clinical trial was conducted by including 60 elderly patients older than 60 years and classified as American Society of Anesthesiology class I and II who were candidates for femur fracture fixation surgery. White and black cards randomly allocated patients to: group A (25µg/kg/h phenylephrine) or group B (35µg/kg/h phenylephrine). At the T3-T7 time points, group A's systolic and diastolic blood pressure was significantly higher than in group B's (p < 0.05). However, after 27 minutes (T0-T7) of phenylephrine infusion, statistical analysis showed no significant difference between the two groups regarding blood pressure (T8-Tend). The frequency of bradycardia and reactive hypertension in group B were significantly higher than in group A (p = 0.02) and (p = 0.03), respectively. There was no significant difference between the bleeding loss, blood transfusion and crystalloid volume in both groups (p > 0.05). Our trial illustrated that high-dose phenylephrine infusion could not assure haemodynamic stability and may cause some side effects.

A Systematic Review of the Incidence and Pattern of Surgical Site Infection in Orthopedic Surgery in Africa.

Surgical site infections (SSIs) are a major health challenge in Africa, leading to poor patient outcomes. This study aims to systematically review and summarize existing research on the rate and patterns of SSIs in orthopedic surgery across Africa. A thorough search was conducted using databases such as Embase (via Ovid), PubMed, Scopus, African Journals Online (AJOL), and Google Scholar for literature published between January 2000 and July 2024. The search used terms such as "surgical site infection," "SSI," "surgical wound infection," "orthopedic surgery," and "Africa." After screening, studies that did not meet the criteria were excluded, leaving seven studies (five retrospective and two prospective) with 989 patients who had undergone orthopedic procedures in both elective and emergency settings. The overall incidence of SSIs was 10.5%, affecting 104 patients, with rates ranging from 4.2% in Ethiopia to 39% in Togo. Of the infections reported, 43% were superficial, 26% were deep, 11% affected organ space, and 20% were chronic. This review sheds light on the high rates of SSIs in orthopedic surgeries in Africa, emphasizing the need for better infection control and improved surgical practices. More research is necessary to fill the gaps and develop strategies that can be applied in different healthcare settings.