Archives of Bone and Joint Surgery
Year:2020 | Volume:8 | Issue:4|Papers Count:13

Total knee arthroplasty (TKA) is one of the most successful surgical procedures performed in orthopedic surgery. Periprosthetic Joint Infection (PJI) is one of the most common mechanisms of failure and is the most feared of all the complications of TKA. When the most catastrophic sequellae of TKA – amputation and death – occur, they are usually the result of complications of infection. The prevention, detection, and treatment of infection are amongst the most important topics in orthopaedic research and great progress is being made in each of these ar eas. In this Editorial we have reviewed the most important papers on prevention of infection associated with TKA, published between November 2017 and January 2020...

Total knee arthroplasty is considered as the treatment of choice for those with end stage hemophilic arthropathy. Compared to other patients undergoing TKA, these patients have specific features such as bleeding tendency, younger age, pre-operative restricted range of motion (ROM), altered anatomy, and increased complications. This narrative review of literature is going to investigate several issues regarding the TKA in hemophilic patients including indications, perioperative factor replacement, surgical challenges, postoperative rehabilitation, outcomes, and complications.

Background: This systematic review aimed to investigate the effectiveness of proprioceptive neuromuscular facilitation (PNF) training on back pain intensity and functional disability in people with low back pain (LBP). Methods: Totally, five electronic databases, including PubMed/Medline (NLM), Scopus, Google Scholar, PEDro, and Cochrane Central Register of Controlled Clinical Trials were searched up to October 31, 2018. Clinical trials with a concurrent comparison group (s) that compared the effectiveness of PNF training with any other physical therapy intervention were selected. Publication language was restricted to English language articles. Methodologic quality was assessed using the PEDro scale. The measures of continuous variables were summarized as Hedges’ s g. Results: In total, 20 eligible trials were identified with 965 LBP patients. A large effect size (standardized mean difference [SMD]=-2. 14, 95% confidence interval [CI]=3. 23 to-1. 05) and significant effect were observed favoring the use of PNF training to alleviate back pain intensity in patients with LBP. Moreover, large effect size and the significant result were also determined for the effect of PNF training on functional disability improvement (SMD=-2. 68, 95% CI=-3. 36 to-2. 00) in population with LBP. A qualitative synthesis of results indicated that PNF training can significantly improve sagittal spine ROM. Statistical heterogeneity analysis showed that there was considerable statistical heterogeneity among the selected trials for the primary outcomes (I2 ≥ 86. 6%). Conclusion: There is a low quality of evidence and weak strength of recommendation that PNF training has positive effects on back pain and disability in LBP people. Further high-quality randomized clinical trials regarding long-term effects of PNF training versus validated control intervention in a clinical setting is recommendable.

Background: Polymethylmethacrylate antibiotic impregnated beads can be an effective treatment for chronic osteomyelitis or an adjuvant in the treatment of open fractures. It remains unclear however whether the beads cause long-term adverse events if not removed. The purpose of this study was to determine if removal of antibiotic beads was required in order to avoid long term complications. Methods: A retrospective chart review was conducted on patients with an extremity or pelvis fracture that had implantation of polymethylmethacrylate (PMMA) antibiotic beads over a five-year period. Results: Fifty-one patients met inclusion criteria for this study; thirty-seven patients (73%) did not have complications after surgical debridement and placement of PMMA antibiotic beads necessitating removal. Conclusion: Our findings suggest that polymethylmethacrylate antibiotic beads can be utilized as a means of delivering high-dose concentrations of local antibiotics and do not have to be removed in all patients.

Background: Given high rates of positive Cutibacterium acnes (C. acnes) cultures in cases of both primary and revision shoulder surgery, the ramifications of positive C. acnes cultures remain uncertain. Next generation sequencing (NGS) is a molecular tool that sequences the whole bacterial genome and is capable of identifying pathogens and the relative percent abundance in which they appear within a sample. The purpose of this study was to report the false positive culture rate in negative control specimens and to determine whether NGS has potential value in reducing the rate of false positive results. Methods: Between April 2017 and May 2017 swabs were taken during primary shoulder arthroplasty. After surgical time out, using sterile gloves, a sterile swab was opened and exposed to the air for 5 seconds, returned to its contained, and sealed. One swab was sent to our institution’ s microbiology laboratory for aerobic and anaerobic culture and held for 13 days. The other sample was sent for NGS (MicroGen Dx, Lubbock, TX), where samples were amplified for pyrosequencing using a forward and reverse fusion primer and matched against a DNA library for species identification. Results: For 40 consecutive cases, swabs were sent for culture and NGS. C. acnes was identified by culture in 6/40 (15%) swabs and coagulase negative staphylococcus (CNS) was identified in 3/40 (7. 5%). Both cases with positive NGS sequencing reported polymicrobial results with one sample (2. 5%), including a relative abundance of 3% C. acnes. At 90 days after surgery, there were no cases of clinical infection in any of the 40 cases. Conclusion: We demonstrate that the two most commonly cultured organisms (C. acnes and CNS) during revision shoulder arthroplasty are also the two most commonly cultured organisms from negative control specimens. Contamination can come from air in the operating room or laboratory contamination.

Background: Conventional fixation methods of posterior wall acetabular fractures feature the use of plating and lag screws. However, fixation of posterior wall fractures with buttress plating alone offers potential advantages by avoiding the hardware complications related to hardware placement through the wall fragment. The purpose of this study was to examine if buttress plating alone, without screw fixation through the wall would be a viable method of treating these fractures. Our hypothesis was that this technique would not result in loss of reduction. Methods: Consecutive series of patients with isolated posterior wall acetabular fractures treated by two independent surgeons at two Level I Trauma centers without screw fixation across the fracture (Boston Medical Center/Harborview Medical Center). Results: All 72 fractures treated without a screw through the posterior wall fragment maintained reduction at an average of 1. 6 years post-operatively. For fractures fixed with buttress plating alone, 92 % were reduced within 2 mm of being anatomic compared to 94 % of fractures that had screws cross the fracture. Conclusion: The described buttress plating technique without screw fixation in the wall is an acceptable form of fixation for posterior wall acetabular fractures without the theoretical risk of intra-wall screw fixation.

Background: The purpose of this prospective study was to determine the accuracy of pedicular screw insertion without the use of fluoroscopy. Methods: This study was conducted on patients with spinal diseases in need of pedicular screw fixation and fusion. The included patients suffered from such conditions as vertebral fracture, spinal stenosis, kyphosis, tumor, and pelvic fractures and were managed with triangular osteosynthesis fixation. However, those with scoliosis deformity were excluded from the study. A total of 760 pedicular screws were inserted in C7 to S1 vertebrae without using fluoroscopy. The locations of the screws were assessed by means of computed tomography scan after the surgery. The data were analyzed in SPSS software (version 22) using the Chi-square test. Results: Out of 387 thoracic screws and 373 lumbar screws, 65 (16. 8%) and 34 (9. 1%) screws perforated the pedicle wall or vertebral body, respectively. The most frequent locations of perforation in the thoracic and lumbar spine were the anterior cortex of the vertebral body and medial wall of the pedicle, respectively. Except for the perforation of the anterior vertebral body (P=0. 0001), there was no difference between the left and right sides or between thoracic and lumbar sites in terms of the preformation of the screw. No complication was observed due to screw perforation. Conclusion: Our findings revealed the unnecessity of using fluoroscopy in spine surgeries for the insertion of pediculate screws. In this regard, the use of fluoroscopy for the placement of pedicular screw resulted in similar accuracy and complications, as compared to the free hand procedure.

Background: The ultimate goal of the treatment of infectious knee arthritis is to protect the articular cartilage from adverse effects of infection. Treatment, however, is not always hundred percent successful and has a 12% failure rate. Persistent infection is more likely to happen in elderly patients and those with underlying joint diseases, particularly osteoarthritis. Eradication of infection and restoration of function in the involved joint usually are not possible by conventional treatment strategies. There are few case series reporting two-stage primary knee arthroplasty as the salvage treatment of the septic degenerative knee joint; however, the treatment protocol remains to be elucidated. Methods: Based on a proposed approach, patients with failure of common interventions for treatment of septic knee arthritis and underlying joint degeneration were treated by two-stage TKA and intervening antibiotic loaded static cement spacer. Suppressive antibiotic therapy was not prescribed after the second stage. Results: Complete infection eradication was achieved with mean follow up of 26 months. All cases were balanced with primary total knee prosthesis. The knee scores and final range of motions were comparable to other studies. Conclusion: The two-stage total knee replacement technique is a good option for management of failure of previous surgical treatment in patients with septic arthritis and concomitant joint degeneration. Our proposed approach enabled us to use primary prosthesis in all of our patients with no need for suppressive antibiotic therapy.

Background: Trunk muscles play an important role in providing both mobility and stability during dynamic tasks in athletes. The purpose of this study was to evaluate the within-day and between-day reliability of ultrasound (US) in measuring abdominal and lumbar multifidus muscle (MF) thickness in athletes with and without hamstring strain injury (HSI). Methods: Fifteen male soccer players (18-30 years old) with and without HSI were evaluated using two US probes (50 mm linear 7. 5 MHZ and 70 mm curvilinear 5 MHz). The abdominal muscle thickness as well as the cross sectional area (CSA) of the MF was measured. To determine within and between days reliabilities, the second and third measurements were repeated with two hours and one week intervals, respectively. Results: Intraclass correlation coefficients for athletes with and without HSI demonstrated good to high reliability for the abdominal muscle thickness (0. 82 and 0. 93) and CSA of the MF muscle (0. 84 and 0. 89, respectively). Conclusion: Our results indicated that US seemed to be a reliable instrument to measure abdominal and lumbar multifidus muscle thickness in soccer players with and without HSI. However, further studies are recommended to support the present study findings in other athletes.

Background: Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effective surgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varus deformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoral osteotomy in ACL-deficient knees with femoral varus deformity and medial osteoarthritis till now. This prospective study presents the technique and clinical outcome of a consecutive series of simultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction. Methods: Nineteen patients with confirmed ACL rupture and femoral varus deformity (mechanical lateral distal femoral angle ≥ 93° ) associated with medial osteoarthritis (± lateral thrust) were included the study. The patients underwent simultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction. At the end of one year follow up, the final range of motion and stability of the knees and the last alignment of extremities were recorded. Surgical outcomes were assessed on 2000 IKDS subjective scores and KOOS subscales. Results: The mean preoperative varus knee was 10. 6° (± 2. 2° ) mostly from the femoral side. The mean union time was 3. 2 (± 0. 4) months. Regarding the radiological evaluation, the alignment of extremity and mLDFA were corrected significantly compared to the pre-operative findings. At the end of one year follow up, all patients were free of knee instability. Subjective assessment based on questionnaires showed a significant improvement in all aspects of knee function after surgery, however there was no considerable change in the knees range of motion. Conclusion: Simultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction is a valuable procedure in femoral varus knees with medial osteoarthritis and anterior knee instability. After one year follow up all aspects of knee function were improved without serious complications.

Surgical reattachment of medial meniscus posterior root tear (MMPRT) with transtibial sutures can delay the presence of medial knee joint compartment osteoarthritis. Most suture configurations are placed five mm away from the torn margin in the meniscal substance which is already degenerated and may decrease the pull out strengths of repair construct. The number of meniscus penetration may also be important considering meniscus tissue damage with more complex suture techniques impose the risk of suture cut out through the meniscus substance. We introduce our loop postsuture construct technique which is simple, cheap and reproducible.

Dear Editor We have conducted a retrospective study to know the impact of a didactic session on the Ponseti method of clubfoot management. We have compared the outcome of patients managed by orthopaedic residents who attended such a session with that of patients treated by residents who didn’ t get this additional training. The results revealed that the frequency of PTA tenotomy was significantly higher in the additionally-trained group compared to the classicallytrained group, which emphasises the role of regular such meetings. About 80% of patients with clubfoot deformity belong to low and middle-income countries (1, 2). Several studies have indicated that there is a deviation from the Ponseti protocol among the practising physicians of these countries (3-5). One day training courses are carried out in many parts of the world by international organizations dealing with clubfoot to train Ponseti providers. Our institute organized such a seminar in November 2012...

Dear Editor The special issue published by Archives of Bone and Joint Surgery in April 2020 on “ COVID-19” has managed to bring together in a single volume a great deal of knowledge that is very useful for the management of musculoskeletal problems of patients who have been infected by the COVID-19, including the rehabilitation of those patients who have been most severely affected, i. e. those admitted to the Intensive Care Unit (ICU) (1-4). In this “ Letter to the Editor” we want to add to that knowledge the possible usefulness of exercise and strengthening with blood flow restriction (BFR) as a means of treatment for the weakness acquired in the ICU. Severe acute respiratory syndrome coronavirus-2, known as COVID-19, is a new coronavirus that was discovered in December 2019 in the Wuhan region of China (5). On March 11, 2020, the World Health Organization declared a global pandemic, and as of April 22, 2020, the virus is responsible for over 2. 5 million infections and 170, 000 deaths...