Risk factors for peri-megaprosthetic joint infections in tumor surgery: A systematic review

Background: Peri-megaprosthetic joint infections (PJI) in tumor surgery are complex and challenging complications that significantly impact the outcomes of the patients. The occurrence of PJI poses a substantial threat to the success of these operations. This review aims to identify and summarize the risk factors associated with PJI in tumor surgery with megaprosthetic reconstruction as well as to determine the overall risk of PJI in limb salvage surgery. Methods: A thorough examination of published literature, scrutinizing the incidence of PJI in tumor prostheses after limb salvage surgery was done. Research studies that documented the incidence of PJI in tumor patients who underwent limb salvage surgery, and explored the risk factors associated with the occurrence of PJI were deemed eligible. Results: A total of 15 studies were included in the analysis and underwent comprehensive examination. After the exploration of key parameters, several significant risk factors for PJI concerning the type of implant coating, surgical site characteristics, patient demographics, and procedural factors were recorded. Discussion: The findings underscore the need for a nuanced approach in managing tumor patients undergoing limb salvage surgery and megaprosthetic reconstruction, with emphasis on individualized risk assessments and individualized preventive strategies

Comparing two intramedullary devices for treating trochanteric fractures: A prospective study

<p>Abstract</p> <p>Background</p> <p>Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS) and the ENDOVIS nail.</p> <p>Materials and methods</p> <p>Two hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail.</p> <p>Results</p> <p>There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail.</p> <p>Conclusions</p> <p>These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome.</p

Is it really advantageous to operate proximal femoral fractures within 48 h from diagnosis? – A multicentric retrospective study exploiting COVID pandemic-related delays in time to surgery

Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF. Conclusion: Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis

The Efficacy of Erythropoietin on Spinal Cord Injury in a Rat Model

Purpose: Experimental and clinical studies on erythropoietin (EPO) have revealed a potential neuroprotective action. In order to evaluate the efficacy of different doses of EPO, we conducted a study using the aneurysmal clip model to produce spinal cord injury on rats. Material and Method: Thirty rats operated with posterior laminectomy at thoracic 10th vertebra. Spinal cord trauma produced by extradural placement of the aneurysm clip, for 1 min. Animals divided into three groups; the first group received a low total EPO dose (EPO- L), (2 doses of 1000 IU each s.c). The second group was the high total EPO dose (EPO-H), (14 doses of 1000 IU each s.c) and the third was the Control group which received normal saline in the same time fashion with EPO-H group. Follow up was for 6 weeks. Estimation of the functional progress of each rat was calculated using the locomotor rating scale of Basso et al, with a range from 0 to 21. Results: After surgery the animals suffered paraplegia with urinary disturbances. Rats’ witch received EPO demonstrated statistically significant functional improvement compared to the Control group, through-out study interval. On the last follow up at six weeks the EPO-L rats achieved a mean score 17.3±1.15, the EPO-H 14.7±1.82, and the control group 8.2±0.78. Conclusion: The study resulted that EPO administration has a positive impact on the clinical evolution after controlled spinal cord trauma in rats. However the most important finding is that large doses are not as beneficial as lower doses do. Probably the relative less favorable action of high EPO doses should be attributed to the erythroid function and hematocrit (Hct) increase. The clinical implication of the total amount of EPO, as well as the fragmentation of doses and the suitable therapeutic window must be further studied.Εισαγωγή: Πειραματικά δεδομένα αναφορικά με την μη ερυθροποιητική δράση της Ερυθροποιητίνης, αναδεικνύουν έναν πιθανώς σημαντικό ρόλο της, στις κακώσεις του νωτιαίου μυελού. Με σκοπό να μελετήσουμε την αποτελεσματικότητα της ερυθροποιητίνης, πραγματοποιήσαμε μια πειραματική μελέτη σε ποντίκια προκαλώντας βλάβη στο νωτιαίο μυελό. Υλικό και Μέθοδοι: Τριάντα ποντίκια χειρουργήθηκαν με οπίσθια πεταλεκτομή στο ύψος του Θ10 σπονδύλου και προκλήθηκε βλάβη του νωτιαίου μυελού εφαρμόζοντας επισκληρίδια μια αγγειολαβίδα ανευρύσματος για 60 δευτ. Μετά το χειρουργείο τα πειραματόζωα εμφάνισαν παραπληγία με διαταραχές ούρησης. Τα ποντίκια χωρίστηκαν σε τρεις ομάδες από 10 πειραματόζωα η κάθε μία . Η πρώτη ομάδα A έλαβε 2 δόσεις rhEPO 1000 IU s.c η κάθε μια, η δεύτερη ομάδα Β έλαβε 14 δόσεις και τρίτη η ομάδα Γ ελέγχου που έλαβε φυσιολογικό ορό. Η εκτίμηση της κινητικής προόδου έγινε με την κλίμακα Basso et al. επί 6 εβδομάδες. Αποτελέσματα: Τα ποντίκια που έλαβαν ερυθροποιητίνη παρουσίασαν στατιστικώς σημαντικά καλύτερα αποτελέσματα σε σχέση με την ομάδα ελέγχου, στο τέλος της μελέτης. Η ομάδα A επέτυχε τελικό score 17.3±1.15, η ομάδα Β 14.7±1.82 και η ομάδα Γ 8.2±0.78. Συμπέρασμα: Φαίνεται ότι η ερυθροποιητίνη ασκεί ευεργετική δράση στο τελικό νευρολογικό αποτέλεσμα, μετά από ελεγχόμενο τραύμα στο νωτιαίο μυελό σε ποντίκια. Ιδιαίτερο ενδιαφέρον παρουσιάζει το γεγονός ότι τα ποντίκια με τη μικρή συνολικά δόση είχαν καλύτερο τελικό κινητικό αποτέλεσμα. Η ομάδα με τις πολλές δόσεις ενώ αρχικά παρουσίαζαν τάση για γρηγορότερη κινητική βελτίωση, τελικά δεν έδειξε τόσο καλά αποτελέσματα, όπως επέτυχε η ομάδα της μικρότερης δόσης. Οι χορηγούμενες δόσεις, η οδός χορήγησης και το κατάλληλο θεραπευτικό παράθυρο είναι παράμετροι που χρίζουν διευκρίνησης

Investigation of the Relationship Between Hip and Knee Osteoarthritis and Disordered Spinal and Pelvic Morphology

Introduction A critical question is the causal relationship between hip or knee osteoarthritis (OA) and disordered spinal and pelvic morphology. The aim of this study is to examine this correlation. Therefore, we studied the effect of total hip or knee arthroplasty (THA/TKA) on truncal parameters to determine the causal relationship between these two situations. Materials and methods This is a prospective study of the effect of THA or TKA in patients with hip or knee OA on truncal morphological parameters. Patients with one-sided hip or knee OA who chose to undergo THA or TKA were enrolled and surveyed. A control group (CG) was also surveyed for comparison with the patients. The patients were preoperatively examined for truncal parameters using the Diers Formetric four-I) analysis system (surface topography technique) to calculate several truncal parameters in all planes at four months and 12 months postoperatively. Measurable examinations were performed using the Statistical Package for the Social Sciences (SPSS) version 17.00 (SPSS Inc., Chicago), and statistical significance was set at a p-value of &lt;0.05. Results The study examined 34 patients who underwent THA, including 19 women and 15 men with a mean age of 67.62 +/- 8.28 years. The study also examined 45 patients who underwent TKA, including 34 women and 11 men, with a mean age of 72.42 +/- 7.0 years. These patients were also compared with a CG that consisted of 25 normal individuals, including 12 women and 13 men, with a mean age of 69.28 +/- 10.11 years. The results of this study from four months after THA revealed that the lordotic angle, trunk torsion, pelvic inclination, pelvic obliquity, and pelvis rotation were improved to normal levels. At 12 months after THA, only the pelvic obliquity was improved to normal levels. At four months after TKA the lordotic angle, pelvic inclination, and pelvic obliquity were improved to normal levels. However, the fleche cervicale and vertebral rotation were worse. At 12 months after TKA, only the pelvic obliquity was improved to normal levels. Conclusions THA and TKA to correct hip and knee OA do not correct the disordered morphology of the trunk in the long term. Thus, hip or knee OA does not seem to be responsible for disordered trunk morphology. However, it cannot be ruled out whether the disturbed morphology is responsible for the appearance of the hip and knee OA

Truncal Changes in Patients After Total Hip or Knee Arthroplasty: A Surface Topography Study

Introduction Total hip and knee arthroplasty (THA/TKA) are among the most successful orthopedic operations performed, aiming at the alleviation of osteoarthritic pain. This report is a surface topography study that assesses the mechanism by which THA or TKA influences truncal parameters. This study represents the first time that surface topography has been used for the assessment of truncal parameters. Methods In total, 15 patients with THA, including nine women and six men, with a mean age of 65.07 +/- 9.73 years (range: 47-80 years), and 23 patients with TKA were assessed preoperatively and four and 12 months postoperatively. These patients were also compared with a control group (CG) that included 25 individuals, including 12 women and 13 men, with a mean age of 69.28 +/- 10.11 years (range: 55-86 years). The Diers Formetric four-D analysis system was used to calculate several truncal parameters in all planes. Results Data analysis revealed statistically significant differences in the kyphotic angle (degrees; 56.50 -&gt; 63.57, p &lt; 0.05) and the pelvic obliquity (degrees; 3.40 -&gt; 1.93, p &lt; 0.05) between measurements at baseline and 12 months after THA. Statistically significant differences were noted for the pelvic obliquity (degrees; 2.74 -&gt; 1.43, p &lt; 0.05) between measurements at baseline and 12 months after TKA. Conclusions THA and TKA are causes of truncal morphological alterations. THA and TKA improved pelvic obliquity, contributing to correct the posture in the patients

Arthroscopic Removal of Tenosynovial Giant-Cell Tumors of the Cruciate Ligaments. Presentation of Two Cases.

BACKGROUND: Tenosynovial giant-cell tumor (GCT) arising from cruciate ligaments consists a rather rare entity. Predominantly areas where this tumor appears are the palmar sides of fingers and toes. The involvement of larger joints such as the knee or the ankle is rather rare, but, in the case of synovial joints, the knee joint is particularly affected. Furthermore, rare seems to be the intra-articular localization of the tenosynovial GCT of the tendon sheath. Hereby, we present an arthroscopic approach of treatment with two cases. CASE REPORTS: The first case was a 32-year-old male with a GCT arising from the anterior cruciate ligament (ACL). The second case was a 26-year-old male with a GCT arising from the posterior cruciate ligament (PCL). In the first case, a round-shaped mass with a reddish-brown color was located just anterior to the ACL and impeded the full extension of the knee joint, while, in the second case, a well-circumscribed oval-shaped mass was found with a peduncle attached to the synovium of the PCL. After arthroscopic excision, both patients became asymptomatic, with complete lack of pain and full ROM. CONCLUSIONS: There is a lack of clinical features for the GCT of the knee, and thus, a thorough clinical examination is prudent. Usually, the diagnosis is set after an investigation based on suspicion. This entity can present with symptoms of instability and patients may present signs of mechanical derangement. With the knee joint, meniscal symptoms and locking are often present. The best non-invasive technique to diagnose this tumor has been reported to be the magnetic resonance imaging. Arthroscopic excision has been reported as a safe and effective procedure for treatment

Spaghetti wrist: Transverse injury, axial incision, layered microsurgical reconstruction

Introduction: Among various patterns of complex injuries of the wrist and forearm, “spaghetti wrist” refers to an extensive volar forearm laceration, in which several of the 12 tendons, 2 major nerves and 2 major arteries are transected, leading to lifelong disability and psychological, social and economic consequences. The aim of the study is to emphasize the keynote principles for the management of these injuries through retrospective review of a large group of patients treated by a team of experienced hand surgeons. Material-Methods: Data were retrospectively obtained for 61 patients (49 males and 12 females with average age of 34.7 years) treated for spaghetti wrist lacerations and followed for a minimum period of two years, in two accredited Orthopaedic / Hand-Upper Extremity Surgery and Microsurgery Departments in Greece. All patients were treated within 16 hours of injury and underwent primary, layered reconstruction of all injured structures through an axial forearm exposure. Results: The most frequent mechanism of injury was glass-related lacerations. Overall, 541 structures were reconstructed, of which 417 were tendons, 76 nerves, and 48 arteries. An average of 8.86 structures were injured per patient, including 6.83 tendons, 1.24 nerves, and 0.79 arteries. The majority of the patients (28/61) had &gt;= 10 structures injured (45.9%), while 32.7% (20/61) and 21.3% (13/61) of patients had 6-9 and 3-5 injured structures respectively. Almost 80% (49/61) of patients had excellent/good grading in all six tests used for the functional assessment post-operatively. Discussion: Spaghetti wrist injuries usually occur in a transverse wound pattern and necessitate timely and definitive operative reconstruction of all injured structures in layers, through an axial approach, by experienced hand surgeons to maximize outcome and to avoid complications. The most important prognostic factor of functional recovery is not the number of transected tendons, but the involvement of ulnar and/or median nerve injury. (C) 2021 Elsevier Ltd. All rights reserved

Understanding the Role of Radio-Sensitizing Nanoparticles in Enhancing Pathologic Response in Soft Tissue Sarcomas

High-atomic-number (Z) nanoparticles produce a cascade of low-energy secondary electrons and characteristic X-rays when ionized by X-ray irradiation. These secondary particles deposit their energy in the vicinity of the nanoparticles and, provided that the latter are selectively accumulated within tumor cells, this results in increased DNA damage and tumor cell deaths. This study reviews the utilization of high-Z nanoparticles in the treatment of soft tissue sarcomas (STS). Both in vitro and in vivo experiments demonstrated that the dose is enhanced by approximately 1.2 when polyethelyne glycol (PEG)-modified gold nanoparticles, and from 1.4 to 1.8 when hafnium oxide nanoparticles (NBTXR3, Nanobiotix SA, France) are introduced into tumor cells and activated by X-ray beams. In a phase 2/3 clinical trial investigating the therapeutic benefit of using nanoparticles in preoperative external beam radiotherapy for locally advanced STS, the proportion of patients with a pathological complete response in their resected tumor was doubled when NBTXR3 nanoparticles were used. Additionally, a higher percentage of patients with complete tumor resection was observed in the NBTXR3 plus radiotherapy group. Similar toxicity profiles were found for both the NBTXR3 plus radiotherapy and the radiotherapy alone patient groups. The incorporation of radio-sensitizing nanoparticles in the preoperative radiotherapy of STS could enhance treatment outcomes