Size Does Matter: The Role of Patient's Body Surface Predicting Surgical Difficulty in Total Knee Replacement.

Introduction: Total knee replacement (TKR) is a frequently performed surgery with reported very positive outcomes. However, the difficulty of TKR surgery can vary greatly between patients. Many factors have been related to higher surgical difficulty in TKR, but the role of patient anthropometry is still unclear. Although patient Body Mass Index (BMI) is known to affect the postoperative outcome after TKR, it has not proved to be a reliable predictor of surgical difficulty. The aim of this work was to state whether if the patient's overall size, measured with the patient's body surface, had a direct impact on surgical difficulty. Material and methods: We retrospectively reviewed 250 patients who underwent TKR surgery in our center from January 2014 to October2014. The following data were collected from the pre-anesthesia evaluation sheet: age (in years), weight (in kilograms), height (in centimeters),BMI (using the formula weight/height2), body surface (using Dubois' formula [20], x = 0.007184 x weight (kg)0.425 x height (cm)0.725) expressed in m2, and surgical times. Statistical analyses were performed. Results: After the analyses we found there wasn't association between high BMI and higher surgical times. However, there was a direct relation between surgical times and patient body surface values. These findings were statistically significant. Conclusion: In our experience, the patient's body surface is a reliable predictor of surgical difficult

Fighting rheumatoid arthritis: Kv1.3 as a therapeutic target

Abstract Rheumatoid arthritis (RA) is a serious autoimmune disease that has severe impacts on both the wellbeing of patients and the economy of the health system. Similar to many autoimmune diseases, RA concurs with a long evolution, which eventually results in highly debilitating symptoms. Therapeutic treatments last for long periods during RA. However, their efficiency and side effects result in suboptimal conditions. Therefore, the need for specific, safer and nontoxic alternatives for the treatment of RA is essential. Kv1.3 is a voltage-gated potassium channel that has a crucial role in immune system response. The proliferation and activation of leukocytes are linked to differential expressions of this channel. The evidence is particularly relevant in the aggressive T effector memory (TEM) cells, which are the main actors in the development of autoimmune diseases. Blockage of Kv1.3 inhibits the reactivity of these cells. Furthermore, pharmacological inhibition of Kv1.3 ameliorates symptoms in animal models of autoimmune diseases, such as experimental autoimmune encephalomyelitis or induced psoriasis with no side effects. Kv1.3 is sensitive to several animal toxins and plant compounds, and several research groups have searched for new Kv1.3 blockers by improving these natural molecules. The research is mainly focused on enhancing the selectivity of the blockers, thereby reducing the potential for side effects on other related channel subunits. Higher selectivity means that treatments will potentially be less harmful. This leads to a lower discontinuation rate of the therapy than the current first-line treatment for RA. The molecular backgrounds of many autoimmune diseases implicate leukocyte Kv1.3 and suggests that a new medication for RA is feasible. Therapies could also be later repurposed to treat other immune system disorders

The relationship between ACL reconstruction and meniscal repair: quality of life, sports return, and meniscal failure rate 2- to 12-year follow-up.

Background: Few studies have approached in a long-term follow-up of meniscal repair at an amateur level, specially studying variables as a quality of life and failure rate. The purpose of this review is to study medium to long-term clinical results in patients at amateur sports patients, that have required meniscal sutures at our center, with or without ACL reconstruction. We evaluate the objective function of the knee, as well as patients' return to sports activities, quality of life, and the rate of failed repair and study of the possible reasons. Methods: This was an observational retrospective study. Ninety-two patients who regularly perform amateur sports activities (Tegner 4 to 7) were assessed, with a minimum follow-up period of 2 years, divided into 2 groups: group 1, isolated meniscal suture (43 cases) and group 2, associated to ACL reconstruction (49 cases). Each patient made this test in 2019: Lysholm and Tegner (validated for Spanish) before a knee injury and after surgery, motivation to return to sports activity (Likert scale with 3 items: low, regular, or high), and quality of life through SD-12 test. Results: High return to amateur sports rate (92%) was even higher in the isolated meniscal repair group in comparison to the group with associated ACL. We have not found statistically significant differences between sports return and age, gender, injured meniscus, chondral injuries, preoperative Tegner score, or motivation. No significant differences in physical or mental health fields between both groups. Meniscal repair failed in 12 patients (13%). Higher rate of failure in isolated bucket-handle tear injuries (p < 0.0062). No statistically significant association was found between the other variables studied. Conclusions: Good results with 92% of sports return, low rate of complications, and low retear rate, even lower when is associated with ACL reconstruction and in external meniscus repair, and high values at SF-12 between 2 groups

Surgical anatomy and technique for the treatment of Dubberley type 1, 2 and 3 capitellar fractures via a limited anterior approach to the elbow

Coronal plane fractures of the elbow can affect the capitellum, the trochlea (or a combination of the two), the radial head and the coronoid processes.The Kocher lateral approach is the most commonly used for open reduction of this type of fractures, although an arthroscopic technique has been used in some cases. When the fracture extends to the trochlea, the Kocher lateral approach may be inadequate for the correct visualisation, reduction and fixation of the fracture. In such cases an associated medial elbow approach may be required, or a posterior transolecranon approach may be preferred. We think that the limited anterior approach to the elbow could be a valid option when treating these types of fractures, as it does not involve the de-insertion of any muscle group or ligament, thereby facilitating the recovery process. In cases involving trochlear fracture (which may or may not be dissociated) the approach can be extended medially. We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. In the present study we describe the dissection of the medial and lateral cubital fossa of the elbow in extension in 4 specimens, paying attention to the neurovascular structures of the area. We also describe the surgical technique for the limited approach to the medial and lateral cubital fossa. We demonstrate the accessibility via the cubital fossa to the capitellum, trochlea, radial head, and coronoid process

Is elective surgery during the COVID-19 pandemic safe? A multi-center prospective study in a high incidence area

Elective surgery; COVID-19 pandemicCirugía electiva; Pandemia de COVID-19Cirurgia electiva; Pandèmia de COVID-19Objective: The aim of this study was to describe the evolution of patients admitted for elective orthopaedic surgery during the immediate post-COVID-19 peak of the pandemic. Methods: This is a multi-center, observational study conducted in 8 high complexity hospitals of Catalonia, one of the highest COVID-19 incidence areas in Spain. We included patients ≥18 years of age undergoing elective surgery (total knee or hip arthroplasty, knee or hip revision arthroplasty, shoulder or knee arthroscopy, hand or wrist surgery, forefoot surgery, or hardware removal) after the COVID-19 peak (between May 5th and June 30th, 2020). The main exclusion criterion was a positive result for SARS-CoV-2 PCR within the 7 days before the surgery. The primary outcomes were postoperative complications within 60 days (+/-30) or hospital readmission due to a COVID-19 infection. Following the recommendations of the International Consensus Group (ICM), elective surgeries were re-started when the nationwide lockdown was lifted. Before the surgery, patients were contacted by phone to rule out any exposure to confirmed COVID-19 cases, a reverse transcription-polymerase chain reaction (PCR) assay was performed in all patients 48-72 hours before hospital admission, and they were asked to maintain home confinement until the day of the surgery. Results: 675 patients were included: 189 patients in the arthroplasty group (28%) and 486 in the ambulatory surgery group (72%). Mean [SD] age was 57.6 [15.3] years. The mean Charlson Comorbidity Index score was 2.21 (SD = 2.01, Min = 0, Max = 13). A total of 84 patients (12.75%) obtained an American Society of Anesthesiologists (ASA) score ≥ 3, showing no association between the ASA score and the risk of developing COVID-19 symptoms at follow-up (χ 2 (4) = 0.77, P = 0.94). The mean occupation rate of hospital beds for COVID-19 patients was 13% and the mean occupation rate of critical care beds for COVID-19 patients was 27% at the time of re-introducing elective surgeries. These were important rates to consider to decide when to reintroduce elective surgeries after lockdown. Surgical time, time of ischemia and intra-operative bleeding were not related with a higher risk of developing COVID-19 post-operatively (χ 2 (1) = 0.00, P = 0.98); (χ 2 (2) = 2.05, P = 0.36); (χ 2 (2) = 0.37, P = 0.83). Only 2 patients (0.3 %) presented with a suspected COVID-19 infection at follow-up. None of them presented with pneumonia or required confirmation by a reverse transcription PCR assay. Hospital re-admission was not needed for these patients. Conclusion: The risk of developing COVID-19 during the immediate post-COVID-19 peak in a region with a high incidence of COVID-19 has not been proved. These data suggest that elective orthopaedic surgeries can be resumed when assertive and strict protocols are followed

Recursos de osteosíntesis en fémur porótico.

Objetivos. Exponer dos técnicas quirúrgicas de refuerzo de una osteosíntesis convencional en situaciones especiales de debilidad ósea del fémur, como son las fracturas periprotésicas, las fracturas patológicas y los fracasos de osteosíntesis previas en pacientes de edad avanzada. La debilidad del hueso puede llegar a dificultar la realización de osteosíntesis estables en fracturas de fémur porque impide el correcto anclaje del material, ya sean agujas, cerclajes o especialmente tornillos. Material y método. Se evaluaron 13 pacientes (media de edad de 78,3 años), 9 de los cuales sufrieron fracturas periprotésicas de fémur, dos fracasos de osteosíntesis previas, un caso de pseudoartrosis tras una fractura periprotésica y una fractura diafisaria en un fémur muy osteoporótico, en los cuales se han utilizado dos técnicas de refuerzo del hueso: el cementado endomedular y el implante de contraplacas atornilladas de aloinjerto óseo congelado. Resultados. Se realizó un seguimiento de estos pacientes en un período que oscila entre 12 y 72 meses (media de 26,2 meses). En un caso se produjo una pseudoartrosis de la fractura por ocupación accidental del foco de fractura por el cemento acrílico. En los 12 casos restantes se consiguió la consolidación. Conclusiones. El cementado endomedular y la utilización de contraplacas atornilladas de aloinjerto óseo son dos recursos técnicos útiles en situaciones especiales en las que es necesario realizar una osteosíntesis estable sobre un hueso muy débil

Therapeutic education and functional readaptation in obese patients on a waiting list for total knee replacement. A case-control study

Background Studies show patients with knee osteoarthritis (OA) on waiting list for total knee replacement (TKR) underused conservative treatment, did not adhere to clinical guidelines on knee OA management, and potentially had earlier surgery and a higher risk of revisions. Therapeutic education and functional readaptation (TEFR) plus conventional therapy in waiting list patients improved function and adherence. TKR patients are often obese, negatively influencing TKR results, many patients are dissatisfied after TKR, and around 14% of TKR are inappropriate..

Head-to-head antisense transcription and R-loop formation promotes transcriptional activation

The mechanisms used by antisense transcripts to regulate their corresponding sense mRNAs are not fully understood. Herein, we have addressed this issue for the vimentin (VIM) gene, a member of the intermediate filament family involved in cell and tissue integrity that is deregulated in different types of cancer. VIM mRNA levels are positively correlated with the expression of a previously uncharacterized head-to-head antisense transcript, both transcripts being silenced in colon primary tumors concomitant with promoter hypermethylation. Furthermore, antisense transcription promotes formation of an R-loop structure that can be disfavored in vitro and in vivo by ribonuclease H1 overexpression, resulting in VIM down-regulation. Antisense knockdown and R-loop destabilization both result in chromatin compaction around the VIM promoter and a reduction in the binding of transcriptional activators of the NF-κB pathway. These results are the first examples to our knowledge of R-loop–mediated enhancement of gene expression involving head-to-head antisense transcription at a cancer-related locus

Knee osteoarthritis and periarticular structure quantified by ultrasound. A case-control study

Background Assessment of pain and physical function is complex in patients with knee osteoarthritis (OA), as standard criteria are lacking.A previous study examining correlations between functional capacity and pain (WOMAC) and anthropometric characteristics and periarticular knee structure (quantified by ultrasound imaging) in females with knee OA found increased quadriceps muscle density was associated with higher functional disability and pain scores, suggesting that not only joint wear and symptom severity are involved and more objective measures are necessary..

Total knee replacement from the patient's perspective. A qualitative study

Total knee replacement (TKR) is effective in relieving pain and improving function in patients with severe osteoarthritis (OA) However, studies report that 14-30% of patients are dissatisfied with the result and do not achieve the expected benefits, especially in function. Objectives: To examine the factors influencing decision-making before TKR. Methods: We made a phenomenological study of the determinants that lead patients to accept, delay or reject TKR (this study is part of a larger study). Demographic and clinical data were collected and pain intensity measured by the WOMAC scale. Focus groups were conducted and the results transcribed and analysed using the 4-stage analysis of qualitative data according to Ritchie, Spencer and O'Connor (2003). Results: 12 patients (9 female, mean age 71.58 + 6.02 years, BMI 37.43 + 5.32, mean comorbidities 6.73 + 2.19 and mean WOMAC pain 14.9 + 8.89, function 15.77 + 8.6, total 15. 71 + 8. 22) were included: 6 had received, 4 were waiting for and 2 had rejected TKR. Focus groups identified widespread pain (pain intensity functional limitations), causal beliefs and perceptions (OA a natural process associated with age, obesity, physical work, sport) mood (importance of optimism), professional-user relationship (communication, experience of OA) expectations (need for surgery conditioned by pain, lost function, surgical risks), and social support (promotion of healthy habits and adherence conditioned by family and social support) as factors influencing attitudes to undergoing TKR. Conclusions: The process of deciding to undergo TKR is complex and influenced by multiple factors. TKR improves a small proportion of an aging painful body. Our results suggest the need of care before and after TKR, psychosocial support and preventive and educational programmes. References: Ritchie J, Spencer L, O'Connor W. Carrying out qualitative analysis. In Ritchie J. and Lewis J. (eds.) guide for social science students and researchers Oaks; New Delhi. Qualitative research practice: A. Sage: London; Thousand; 2003 Disclosure of Interest: None declare