Primary total knee arthroplasty in hemophilic arthropathy

Advanced hemophilic knee arthropathy is a frequent and devastating manifestation of severe hemophilia with significant implications for activities of daily living. Hemophilic arthropathy is caused by repeated bleeding, resulting in joint degeneration, pain, deformity and disability. In patients with hemophilia and advanced disease, total knee arthroplasty (TKA) has proven to be the most successful intervention, improves physical function and reduces knee pain. Hemophilic patients carry additional risks for complications and required specific pre/ postoperative considerations. Expert treatment center should be used to improve patient outcome. Hemophilic patients present significant surgical challenges such as joint destruction, bone loss, severe ankylosis and oligoarticular involvement. The surgeon performing the arthroplasty must be experienced to manage such problems

The economic impact of periprosthetic infection in total hip arthroplasty

© 2020 Canadian Medical Association. All rights reserved. Background: Periprosthetic joint infection (PJI) is the third leading cause of total hip arthroplasty (THA) failure. Although controversial, 2-stage revision remains the gold standard treatment for PJI in most situations. To date, there have been few studies describing the economic impact of PJI in today\u27s health care environment. The purpose of the current study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in THA and to assess the economic burden of PJI compared with primary uncomplicated THA. Methods: We conducted a review of primary THA cases and 2-stage revision THA for PJI at our institution. Patients were matched for age and body mass index. All costs associated with each procedure were recorded. Descriptive statistics were used to summarize the collected data. Mean costs, length of stay, clinic visits and readmission rates associated with the 2 cohorts were compared. Results: Fifty consecutive cases of revision THA were matched with 50 cases of uncomplicated primary THA between 2006 and 2014. Compared with the primary THA cohort, PJI was associated with a significant increase in mean length of hospital stay (26.5 v. 2.0 d, p \u3c 0.001), mean number of clinic visits (9.2 v. 3.8, p \u3c 0.001), number of readmissions (12 v. 1, p \u3c 0.001) and average overall cost (Can$38 107 v. Can$6764, t = 8.3, p \u3c 0.001). Conclusion: Treatment of PJI is a tremendous economic burden. Our data suggest a 5-fold increase in hospital expenditure in the management of PJI compared with primary uncomplicated THA

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Comprehensive Review of Adipose Stem Cells and Their Implication in Distraction Osteogenesis and Bone Regeneration

Bone is one of the most dynamic tissues in the human body that can heal following injury without leaving a scar. However, in instances of extensive bone loss, this intrinsic capacity of bone to heal may not be sufficient and external intervention becomes necessary. Several techniques are available to address this problem, including autogenous bone grafts and allografts. However, all these techniques have their own limitations. An alternative method is the technique of distraction osteogenesis, where gradual and controlled distraction of two bony segments after osteotomy leads to induction of new bone formation. Although distraction osteogenesis usually gives satisfactory results, its major limitation is the prolonged duration of time required before the external fixator is removed, which may lead to numerous complications. Numerous methods to accelerate bone formation in the context of distraction osteogenesis have been reported. A viable alternative to autogenous bone grafts for a source of osteogenic cells is mesenchymal stem cells from bone marrow. However, there are certain problems with bone marrow aspirate. Hence, scientists have investigated other sources for mesenchymal stem cells, specifically adipose tissue, which has been shown to be an excellent source of mesenchymal stem cells. In this paper, the potential use of adipose stem cells to stimulate bone formation is discussed

Direct anterior approach for femoral component revision: Surgical technique for extended trochanteric osteotomy and anterior cortical window

© 2020 Professor P K Surendran Memorial Education Foundation Objective: Direct anterior approach (DAA) is becoming a popular option for both primary and revision total hip arthroplasty (THA). Adequate exposure is crucial in the setting of revision THA. The purpose of this article is to describe two different techniques for expanded femoral exposure through the DAA, the anterior extended trochanteric osteotomy and anterior cortical window. Methods: Extensile exposure were carried out in cadavers, using the contralateral hip as a control. The exposure and technical viability were assessed. Results: It was demonstrated that both extensile techniques can be carried out safely. Conclusions: Extensile exposures including femoral osteotomies can be safely carried out for revision THA via DAA

Correlation between hip osteoarthritis and the level of physical activity as measured by wearable technology and patient-reported questionnaires

© 2019 Professor P K Surendran Memorial Education Foundation This study evaluates physical activity in patients with advanced hip OA using Fitbit and whether a correlation exists between the number of steps taken per day (SPD) and the reported outcome. Methods: 122 patients were prospective enrolled. Patient-reported outcomes were collected. Patients were asked to wear a Fitbit for 24 h a day on seven consecutive days. Result: The mean number of SPD was 5721 ± 3920. The UCLA, HHS and SF-12 PCS demonstrated a statistically significant positive correlation with the SPD. Conclusion: Wearable technology is reliable in objectively measuring the level of physical activity in hip OA and correlates with reported outcomes

Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts

Hip arthroplasty is a common procedure in elective orthopaedic surgery that has excellent outcomes. Hip replacement surgery aims to create a “forgotten” joint, i.e., a pain-free joint akin to a native articulation. To achieve such goals, hip arthroplasty must be personalised. This is achieved by restoring: the centre of rotation of the native hip; leg length equality; femoral offset; femoral orientation; soft tissue tension; joint stability with an unrestricted hip range of motion; and having appropriate stress transfer to the bone. In addition, the whole pathway should provide an uneventful and swift postoperative recovery and lifetime implant survivorship with unrestricted activities. At our institution, the preferred option is a personalized total hip arthroplasty (THA) with a large diameter head (LDH) using either monobloc or dual-mobility configuration for the acetabular component. LDH THA offers an impingement-free range of motion and a reduced risk of dislocation. The larger head-neck offset allows for a supraphysiologic range of motion (ROM). This can compensate for a patient’s abnormal spinopelvic mobility and surgical imprecision. Additionally, LDH bearing with a small clearance exerts a high suction force, which provides greater hip micro-stability. With appropriate biomechanical reconstruction, LDH THA can restore normal gait parameters. This results in unrestricted activities and higher patient satisfaction scores. We use LDH ceramic on ceramic for our patients with a life expectancy of more than 20 years and use LDH dual mobility bearings for all others

Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts

Hip arthroplasty is a common procedure in elective orthopaedic surgery that has excellent outcomes. Hip replacement surgery aims to create a “forgotten” joint, i.e., a pain-free joint akin to a native articulation. To achieve such goals, hip arthroplasty must be personalised. This is achieved by restoring: the centre of rotation of the native hip; leg length equality; femoral offset; femoral orientation; soft tissue tension; joint stability with an unrestricted hip range of motion; and having appropriate stress transfer to the bone. In addition, the whole pathway should provide an uneventful and swift postoperative recovery and lifetime implant survivorship with unrestricted activities. At our institution, the preferred option is a personalized total hip arthroplasty (THA) with a large diameter head (LDH) using either monobloc or dual-mobility configuration for the acetabular component. LDH THA offers an impingement-free range of motion and a reduced risk of dislocation. The larger head-neck offset allows for a supraphysiologic range of motion (ROM). This can compensate for a patient’s abnormal spinopelvic mobility and surgical imprecision. Additionally, LDH bearing with a small clearance exerts a high suction force, which provides greater hip micro-stability. With appropriate biomechanical reconstruction, LDH THA can restore normal gait parameters. This results in unrestricted activities and higher patient satisfaction scores. We use LDH ceramic on ceramic for our patients with a life expectancy of more than 20 years and use LDH dual mobility bearings for all others

Off-Pump Kawashima Procedure in a 10-Month-Old Infant with Heterotaxy

A ten-month-old, 9.4 kg infant with heterotaxy syndrome presented with cyanosis. The cardiac diagnosis was a double outlet right ventricle with complete atrioventricular septal defect and multilevel right ventricular outflow tract obstruction. Other multiple anomalies included dextrocardia, situs inversus, interrupted inferior vena cava with azygous continuity to a left superior vena cava (SVC), malposed great arteries, small patent ductus arteriosus, and left aortic arch with common origin of the left common carotid artery and innominate artery. Because of the chordal attachment of the atrioventricular valves, it was felt that the patient would be better served with single ventricle palliation.The SurgeryThrough a median sternotomy, a pericardiotomy was performed. The left SVC was dissected and mobilized, followed by identification of the large azygous vein and dissection and mobilization of the left pulmonary artery.Next, heparin was administered systemically. A right-angled venous cannula was placed in the left SVC, and a straight venous cannula was placed in the common atrium. Both cannulae were then connected via a Y-connector to allow passive gravity-assisted drainage. Test clamping of the left SVC showed a high pressure in the neck veins, so it was decided to convert this to a pump-assisted active drainage. The Y-connector was removed, and the SVC cannula was connected to a small circuit in which the SVC line was the inflow to the pump and the outflow was connected back to the common atrial cannula. This allowed better drainage and facilitated conducting the procedure without the need for full cardiopulmonary bypass.The left SVC was then divided between two vascular clamps, and its cardiac end was oversewn in two layers with running 5-0 polypropylene sutures. Proximal and distal control was then obtained on the left pulmonary artery and an arteriotomy was made. An end-to-side anastomosis was performed between the left SVC and the PA using running 5-0 polypropylene sutures at the back wall and multiple interrupted 6-0 polypropylene sutures at the front wall of the anastomosis to avoid any purse-string effect. All clamps were then removed, and the anastomosis was deaired.The patient’s oxygen saturation improved immediately to high 90 percent. All cannulae were then removed and their sites were secured.The rest of the procedure and chest closure were performed in the standard fashion. The patient was extubated in the operating room, received no transfusion, and the remaining postoperative course was uneventful. She was discharged on the seventh postoperative day. The patient continued to do well during her follow-up.Reference(s)1. Said SM, Mohamed A, Shakur Z, Marey G. Extracardiac Fontan completion after the Kawashima procedure with a custom-made bifurcated graft. Multimed Man Cardiothorac Surg. 2022 Oct 11;20222. Said S, Marey G. Off-pump extracardiac Fontan completion: Surgical technique and pitfalls. Multimed Man Cardiothorac Surg. 2021 Jan 28;20213. Alsoufi B, Rosenblum J, Travers C, Kanter K, Trusty PM, Yoganathan AP, Slesnick TP. Outcomes of Single Ventricle Patients Undergoing the Kawashima Procedure: Can We Do Better? World J Pediatr Congenit Heart Surg. 2019 Jan;10(1):20-274. Lively-Endicott H, Lara DA. Successful Palliation via Kawashima Procedure of an Infant With Heterotaxy Syndrome and Left-Atrial Isomerism. Ochsner J. 2018 Winter;18(4):406-412</p