Ambulatory unicompartmental knee arthroplasty: Short outcome of 50 first cases

INTRODUCTION: The reduction in length of stay (LOS) in orthopedic surgery has been steady for several years. For the past 3 or 4 years in France, the trend toward outpatient surgery has been growing upwards, as it is a goal for hospital administration. MATERIALS AND METHODS: This is a prospective, continuous, mono-centric, single operator study on 56 UKAs. Included were all UKAs carried out between January 2014 and December 2015, meeting the following criteria: voluntary patients, supportive family environment, absence of comorbidity (oral anticoagulants, diabetes, obesity), ASA score≤3. Preoperatively, patients received: Dexamethasone 2mg/10kg, Tranexamic acid 2g, Cefazolin 2g IV. All patients were operated on under general anesthesia with the same technique: Alpina (Zimmer-Biomet) uni-prosthesis without tourniquet. The arthrotomy was closed after a capsular injection of a solution of 150mg Ropivacaine+30mg Bi-Profenid. Patient discharge on the same day evening was authorized by both surgeon and anesthesiologist. Three criteria were quantified: number of patients seen before the date of the first consultation for the removal of stitches (around day 12), Visual Pain Scale (10 points scale) on the first 12 days, and the level of satisfaction at the one-month postoperative visit. RESULTS: Six patients (11%) were not included in the ambulatory program during the initial consultation. Three patients were not able to be discharged on the same day evening due to nausea and therefore remained hospitalized for one night. Eighteen patients (38%) were reviewed before D10: 13 patients were reviewed between D1 and D4 for bleeding through the dressing and 5 for pain not controlled by level 1 and 2 analgesics. The Visual Pain Scale (VPS) reached level 6±2 by the 2nd day and then dropped to 1±1 by the 12th day. At 1 month, 85% of the patients were satisfied or very satisfied with their care. There were no general or localized complications. DISCUSSION: Ambulatory UKA surgery is possible for most patients. The inclusion rate for ambulatory UKA was 88% for Berger RA in 2010, therefore very close to this study rate of 89%. Ambulatory care is not only a change in surgical and anesthetic practice but a totally new management process involving all medical and non-medical actors. Ambulatory UKA surgery is feasible and safe for most patients. LEVEL OF EVIDENCE: IV, retrospective cohort study

トウニョウビョウ ラット キン ソンショウ チユ カテイ ニオケル セイチョウ インシ mRNA ノ カジョウ ハツゲン

糖尿病症例の創傷治癒遅延は,臨床的にしばしば経験される.しかし,創傷治癒遅延の原因について検討した報告は少ない.本研究では,糖尿病モデルラットを使用し,筋損傷治癒過程における血管新生に関連する成長因子であるvascular endothelial growth factor (VEGF), vascular endothelial growth factor receotor 1 (Fit-1), vascular endothelial growth factor receotor 2(Flk-1), basic fibroblast srowth factor (bFGF), insulin like growth factor-1 (IGF-1), transforming growth factor-beta (TGF-β), nerve growth factor (NGF)のmRNAの発現量を経時的にreal time RT-PCR法を用いて解析し,糖尿病における創傷治癒遅延の原因を検討した.糖尿病ラットでは,成長因子VEGF, bFGF, TGF-beta, NGFの産生分泌過剰を生じていること,およびVEGFのレセプターの1つであるFltの発現異常を認めた.本研究から糖尿病群では,新生血管に対する成長因子のmRNAの過剰発現が存在するにもかかわらず,創傷治癒が良好ではないことが判明した.Injury to muscles and skin is very common. We have experienced that it is difficult to cure muscle injury and gangrene with Diabetes Mellitus on clinical. It is reported that vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 1 (Fit-1), vascular endothelial growth factor receptor 2 (Flk-1), basic fibroblast growth factor (bFGF), insulin like growth factor-1 (IGF-1), transforming growth factor-bate (TGF-β), nerve growth factor (NGF) are potent stimulators of angiogenesis in vivo. We therefore analyzed dynamic state of these growth factor in tissue of rats with lacerations of the gastrocenmius muscle by real time RT-PCR method. Our findings showed that quantities of mRNA of VEGF, bFGF, TGF-beta, IGF-1, NGF in muscle regeneration of diabetic rats are more than control muscle. Quantity of mRNA of Fit in deabetic muscle compared abnormally with control muscle. Our results suggest that these growth factors and Fit appeared abnormally in diabetic muscle healing and may have a considerable effect on the treatment of diabetic muscle

Characterization of the "deqi" response in acupuncture

<p>Abstract</p> <p>Background</p> <p>Acupuncture stimulation elicits <it>deqi</it>, a composite of unique sensations that is essential for clinical efficacy according to traditional Chinese medicine (TCM). There is lack of adequate experimental data to indicate what sensations comprise <it>deqi</it>, their prevalence and intensity, their relationship to acupoints, how they compare with conventional somatosensory or noxious response. The objective of this study is to provide scientific evidence on these issues and to characterize the nature of the <it>deqi phenomenon </it>in terms of the prevalence of sensations as well as the uniqueness of the sensations underlying the <it>deqi </it>experience.</p> <p>Methods</p> <p>Manual acupuncture was performed at LI4, ST36 and LV3 on the extremities in randomized order during fMRI in 42 acupuncture naïve healthy adult volunteers. Non-invasive tactile stimulation was delivered to the acupoints by gentle tapping with a von Frey monofilament prior to acupuncture to serve as a sensory control. At the end of each procedure, the subject was asked if each of the sensations listed in a questionnaire or any other sensations occurred during stimulation, and if present to rate its intensity on a numerical scale of 1–10. Statistical analysis including paired t-test, analysis of variance, Spearman's correlation and Fisher's exact test were performed to compare responses between acupuncture and sensory stimulation.</p> <p>Results</p> <p>The <it>deqi </it>response was elicited in 71% of the acupuncture procedures compared with 24% for tactile stimulation when thresholded at a minimum total score of 3 for all the sensations. The frequency and intensity of individual sensations were significantly higher in acupuncture. Among the sensations typically associated with <it>deqi</it>, aching, soreness and pressure were most common, followed by tingling, numbness, dull pain, heaviness, warmth, fullness and coolness. Sharp pain of brief duration that occurred in occasional subjects was regarded as inadvertent noxious stimulation. The most significant differences in the <it>deqi </it>sensations between acupuncture and tactile stimulation control were observed with aching, soreness, pressure and dull pain. Consistent with its prominent role in TCM, LI4 showed the most prominent response, the largest number of sensations as well as the most marked difference in the frequency and intensity of aching, soreness and dull pain between acupuncture and tactile stimulation control. Interestingly, the dull pain generally preceded or occurred in the absence of sharp pain in contrast to reports in the pain literature. An approach to summarize a sensation profile, called the <it>deqi composite</it>, is proposed and applied to explain differences in <it>deqi </it>among acupoints.</p> <p>Conclusion</p> <p>The complex pattern of sensations in the <it>deqi </it>response suggests involvement of a wide spectrum of myelinated and unmyelinated nerve fibers, particularly the slower conducting fibers in the tendinomuscular layers. The study provides scientific data on the characteristics of the <it>'deqi' </it>response in acupuncture and its association with distinct nerve fibers. The findings are clinically relevant and consistent with modern concepts in neurophysiology. They can provide a foundation for future studies on the <it>deqi </it>phenomenon.</p

Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

<p>Abstract</p> <p>Background</p> <p>Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy.</p> <p>Methods/design</p> <p>A randomised single-blinded clinical trial will be conducted to investigate the clinical efficacy and cost effectiveness of foot orthoses in the management of patellofemoral pain syndrome. One hundred and seventy-six participants aged 18–40 with anterior or retropatellar knee pain of non-traumatic origin and at least six weeks duration will be recruited from the greater Brisbane area in Queensland, Australia through print, radio and television advertising. Suitable participants will be randomly allocated to receive either foot orthoses, flat insoles, physiotherapy or a combined intervention of foot orthoses and physiotherapy, and will attend six visits with a physiotherapist over a 6 week period. Outcome will be measured at 6, 12 and 52 weeks using primary outcome measures of usual and worst pain visual analogue scale, patient perceived treatment effect, perceived global effect, the Functional Index Questionnaire, and the Anterior Knee Pain Scale. Secondary outcome measures will include the Lower Extremity Functional Scale, McGill Pain Questionnaire, 36-Item Short-Form Health Survey, Hospital Anxiety and Depression Scale, Patient-Specific Functional Scale, Physical Activity Level in the Previous Week, pressure pain threshold and physical measures of step and squat tests. Cost-effectiveness analysis will be based on treatment effectiveness against resource usage recorded in treatment logs and self-reported diaries.</p> <p>Discussion</p> <p>The randomised clinical trial will utilise high-quality methodologies in accordance with CONSORT guidelines, in order to contribute to the limited knowledge base regarding the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome, and provide practitioners with high-quality evidence upon which to base clinical decisions.</p> <p>Trial registration</p> <p>Australian Clinical Trials Registry ACTRN012605000463673</p> <p>ClinicalTrials.gov NCT00118521</p

Endoprosthesis vs. nail-cement spacer application for reconstruction after oncologic proximal humeral resection: is there a difference in functional outcome?

Background: The proximal humerus is a common site for primary malignant and benign aggressive bone tumors, necessitating wide resection and subsequent skeletal defect reconstruction. Various reconstruction options include osteoarticular allografts, autografts, endoprosthesis, nail-cement spacer, reverse shoulder arthroplasty, and allograft-prosthesis composites. However, there is no consensus on the optimal reconstruction method. This study aims to compare functional outcomes and complications between these two methods. Methods: A total of 40 patients with proximal humerus tumors who underwent endoprosthesis or nail-cement spacer reconstruction between March 2012 and December 2020 were included. The mean follow-up in the study was 31.37 +/− 12 months. Demographic and clinical data were collected, and functional outcomes were assessed using the Musculoskeletal Tumor Society 93 scoring system and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Complications and oncological outcomes were recorded. Results: Both groups were similar in terms of demographic and clinical variables. Endoprosthesis reconstruction demonstrated significantly better active shoulder forward flexion compared to nail-cement spacer (45.8 vs. 25.2 degrees) (P = .015). Endoprosthesis group also exhibited greater active shoulder internal rotation (68.25 vs. 63.25 degrees) (P = .004). No statistically significant differences were observed in overall functional outcomes. Complications, including radial nerve palsy and infection, were comparable between groups, with one case of spacer loosening. Conclusion: Both endoprosthesis and nail-cement spacer reconstruction provide comparable functional outcomes and complication rates following proximal humerus tumor resection. Nail-cement spacer offers a cost-effective alternative for patients in resource-constrained settings

Вілен Феодосійович Венгер

The article is dedicated to the memory of the famous Ukrainian scientist orthopedic and traumatologist, veteran of Odessa National Medical University, doctor of medical sciences, Professor Venger Vilen Feodosievych.Статья посвящена памяти известного украинского ученого ортопеда-травматолога, ветерана Одесского Национального медицинского университета, доктора медицинских наук профессора Венгера Вилена Феодосиевича.Статтю присвячено пам’яті відомого українського вченого ортопеда-травматолога, ветерана Одеського національного медичного університету, доктора медичних наук професора Венгера Вілена Феодосійовича

Андрій Петрович Лябах

The article is dedicated to the 60th birthday of the head of the foot pathology and complex prosthetics department of the Institute of Traumatology and Orthopedics of the Academy of Medical Sciences of Ukraine, Doctor of medical sciences Professor Lyabakha A. P.Статья посвящена 60-летию со дня рождения руководителя отдела патологии стопы и сложного протезирования ГУ «Институт травматологии и ортопедии АМН Украины», доктора медицинских наук профессора Лябаха А. П.Стаття присвячена 60-ти річчю від дня народження керівника відділу патології стопи та складного протезування ДУ «Інститут травматології та ортопедії НАМН України», доктора медичних наук професора Лябаха А. П