The effect of watching shoulder ROM changes on functional outcome and quality of life following arthroscopic rotator cuff repair

Purpose This study aimed to evaluate the effectiveness of watching video records of their shoulder motion changes on functional outcomes and quality of life after arthroscopic rotator cuff repair (ARCR). Methods The patients were divided into two groups. In Group 1, video records of pre- and postoperative shoulder motions were recorded and showed. In Group 2, no video was showed to the patients. In Group 1, the first postoperative evaluation was done before video watching, and the second evaluation was done just after watching video records. In Group 2, the first and second postoperative measurements were performed with 10-20 days interval. The Constant Murley score (CS), the American Shoulder and Elbow Surgeons score (ASES), the Short-Form 36 (SF-36) score, and active shoulder range of motion (ROM) values were used as an outcome tool. Results A total of 196 patients (Group 1; 76 patients and Group 2; 120 patients) with a mean age of 62.06 +/- 7.17 years were included. There was a significant improvement in postoperative scores of SF-36 subscales (except emotional well-being and energy/fatigue), ASES, CM scores, and joint ROM values when compared to preoperative values for both groups (p .05). In the second postoperative evaluation, emotional role functioning, energy/fatigue, emotional well-being, health change subscales of SF-36, and ASES scores were significantly higher in Group 1 compared with Group 2 (p < .05). Conclusion When patients watch the pre- and postoperative video records of their shoulder ROM after ARCR, patients' satisfaction and well-being perception increase in the short-term despite unchanged shoulder ROM

Time-dependent surgical instrument contamination begins earlier in the uncovered table than in the covered table

Purpose Time-dependent surgical instrument contamination and the effect of covering during arthroplasty have not been investigated. This study aimed to evaluate time-dependent contamination of surgical instruments and the effect of covering on contamination as well as to perform bacterial typing of contaminated samples. The hypothesis was that covering the surgical instruments would decrease contamination rates. Methods Sixty patients who underwent total knee arthroplasty were randomized and divided into two groups: surgical instruments covered with a sterile towel or surgical instruments left uncovered. K-wires were used to extract microbiological samples. The K-wires were placed in a liquid culture medium at 0, 15, 30, 60, 90, and 120 min. After 24-h incubation period, samples from liquid cultures were cultured on blood agar using swabs. Samples with growth after 48 h were considered contaminated. Microscopic, staining, and biochemical properties were used for bacterial typing. Results Bacterial growth started after 30 and 60 min in the uncovered and covered groups, respectively. An increase in the number of K-wires contaminated with time was detected. At least 10,000 CFU/mL bacterial load was observed in the culture samples. Contamination was more significant in the uncovered group. A statistically significant difference in contamination was found between the uncovered and covered groups at 30-, 60-, 90-, and 120 min (p = 0.035, p = 0.012, p = 0.024, and p = 0.037, respectively). The most common bacteria on the contaminated instruments were coagulase-negative Staphylococci (60.4%), Staphylococcus aureus (22.9%), and Streptococcus agalactia (16.7%), respectively. Conclusion The risk of contamination increases with time. However, it may decrease if surgical instruments are covered. In the clinical practice, empiric antibiotic regimens based on the type of identified microorganisms in this study may be developed for postoperative periprosthetic joint infection prophylaxis

Neopterin, Interleukin-6, Procalcitonin, C-reactive protein and PET-CT staining as markers in infected total knee prosthesis, a retrospective analysis

WOS: 000482218200018PubMed ID: 30423671Diagnosis in prosthetic joint infections is challenging as symptoms are variable, and currently most of the diagnostic tests are non-specific. Normal inflammatory reactions after orthopedic prosthetic surgery may generate false positives, as these tests have high sensitivity, but low specificity. Thus, specific tests, as alpha defensin, are needed to distinguish bacterial infections from reactions to surgical trauma. The aim of this study was to determine the sensitivity and specificity of several diagnostic tools for detecting bacterial infection in prostheses. Between April 2010 and December 2012, we analyzed white blood cell count, erythrocyte sedimentation rate, C-reactive protein, neopterin, interleukin-6, and procalcitonin in 45 patients with prosthetic infection confirmed by positive cultures of joint aspirate and deep tissue biopsy. In addition, these patients underwent PET-CT imaging, in accordance with infection protocols in place at our clinic. The suitability and diagnostic power of these tests were assessed by using Shapiro-Wilk test, Mann-Whitney U test, and ROC curve analysis, and by comparing to 40 age- and gender-matched volunteers who underwent unilateral total knee prosthesis with normal serum indices and without known diseases. Significant differences were observed between infected patients and control volunteers (p < 0.05) for all parameters examined. Highest sensitivity (99%) and specificity (98%) were achieved using a combination of interleukin-6 and C-reactive protein. However, PET-CT imaging had diagnostic accuracy of 93.3%. A combination of interleukin-6 and C-reactive protein also enables accurate diagnosis. PET-CT may be an important imaging modality for detecting prosthesis infection. But, these markers were found neither sensitive nor specific in the diagnosis of periprosthetic infection as alpha defensin

Comparison of acetabulum posterior wall fractures and fracture dislocations: dislocation does not affect clinical and radiological outcomes

WOS: 000482219000001PubMed ID: 30462593The aim of this study was to compare radiological and clinical outcomes of posterior wall acetabulum fractures and posterior wall fracture dislocations. Data were including 52 acetabulum fractures and fracture dislocations. 26 patients (%50) had posterior acetabulum fractures and fracture dislocations who were operatively treated. Radiographic evaluations were performed before and after the operation and at the last follow up. Clinical outcome evaluation was performed at the last follow up. Clinical and radiological outcomes were evaluated including Merle D'aubigne clinical assessment score and Matta' s radiologic measurement score. Brooker classification was used to measure heterotopic ossification.Both Merle D'aubigne and Matta scores were found higher in the acetabulum posterior wall fracture group. But there wasn't significantly difference of clinical and radiological outcomes between two groups (p > 0,05). Reduction quality and Matta radiologic scores were correlated significantly in 2 groups. Posterior dislocation may not negatively affect clinical and radiologic outcomes

Comparison of clinical and radiological outcomes of Lindgren-Turan and Chevron osteotomies in the treatment of Hallux valgus

Purpose: The aim of this study was to evaluate clinical and radiological outcomes of Lindgren-Turan and Chevron osteotomies in the treatment of hallux valgus

Factors affecting dislocation after bipolar hemiarthroplasty in patients with femoral neck fracture

Purpose: This study aimed to investigate the anatomic risk factors associated with dislocation following bipolar hemiarthroplasty for the treatment of femoral neck fracture

Traction radiographs versus CT in the evaluation of fracture morphology and consecutive treatment decisions in OTA/AO 43C3 fractures

WOS: 000459920100016PubMed ID: 30449460Background: Standard radiographs are limited in the evaluation of fracture characteristics and preoperative planning of OTA/AO 43C3 fractures. Therefore, CT imaging is an accepted as a useful method. CT is however expensive and has high radiation, and traction radiographs could be an alternative. This study aimed to compare fracture fragment and comminution zone visualization between traction radiographs and CT and any potentially resulting differences in consecutive treatment and surgical approach recommendations. Methods: Twenty orthopaedic surgeons assessed traction radiographs and CT images of 12 OTA/AO 43C3 type fractures. Each observer was required to identify the anterolateral, posterolateral, and medial malleolus fragments and the lateral, central, and medial shoulder comminution zones. They then had to recommend treatment (nonoperative, ORIF, closed reduction and external fixation, percutaneous screw fixation, or primary tibiotalar arthrodesis) with the best surgical approach (medial, anterolateral, posterolateral, posteromedial, or combined). Intra- and interobserver reliability, correct identification of fracture fragments and comminution zones on both images, and consistency of treatment recommendations and surgical approaches were analyzed. Results: The agreement of each observer's assessment of the presence or absence of specific fracture fragments and comminution zones was substantially increased for CT as compared to traction radiographs, particularly for the posterolateral (p = 0.000) and anterolateral fragment (p = 0.000), and the lateral (p = 0.000), central (p = 0.000), and medial shoulder comminution zone (p = 0.000). The interobserver reliability when assessing the three fracture fragments and comminution zones on the traction radiographs was moderate, whereas it was substantial when assessing these characteristics on CT. The medial malleolus fragment was more often correctly identified on traction radiographs than CT images (p = 0.001). The ability to correctly identify lateral, central, and medial shoulder comminution zones was higher for CT than traction radiographs (p = 0.000). The treatment and surgical approach recommendations after traction radiograph and CT evaluation were similar (p < 0.05). Conclusions: Traction radiographs may be a useful alternative to CT imaging in the preoperative planning of pilon fracture repair. Despite less reliable fracture fragment and comminution zone identification on traction radiographs, treatment recommendations and surgical approach were not influenced. (C) 2018 Elsevier Ltd. All rights reserved

Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears

WOS: 000404283600001PubMed ID: 28680898Background: Although numerous studies have assessed arthroscopic medial meniscal repairs, few studies have focused on factors affecting outcomes of vertical longitudinal and bucket-handle repairs. Purpose: To evaluate the factors affecting clinical outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle medial meniscal tears. Study Design: Case series; Level of evidence, 4. Methods: A total of 223 patients underwent arthroscopic repair for medial meniscal tears between 2007 and 2012; 140 patients had isolated tears or concurrent anterior cruciate ligament (ACL) reconstruction, and 80 patients (76 men, 4 women; mean age, 29.1 years; range, 18-49 years) had vertical longitudinal tears and were included in the study. Pre- and postoperative functional status was assessed using physical examinations with Lysholm and International Knee Documentation Committee (IKDC) scores. Barrett criteria were used for clinical assessment of meniscal healing, and magnetic resonance imaging (MRI) was used as the radiologic assessment method. The effects of tear location, length, chronicity, and type; suturing technique; concurrent ACL reconstruction; and patient age, sex, and smoking habits were also investigated. Results: The mean follow-up period was 51.2 9.4 months (range, 34-85 months). The mean Lysholm and IKDC scores improved at final follow-up (both Ps <.001). According to clinical scores, Barrett criteria, and MRI, failure was noted in 12 patients (15%). There were no significant differences in age, tear length, tear type, concurrent ACL rupture, suturing technique, or location of the meniscal repair between the success and failure groups. Failure rates were higher for red-white zone tears than for red-red zone tears (10/30, 33.3% vs 2/50, 4%; P = .004). Tear chronicity significantly affected failure rates. Early repairs had higher healing rates than late repairs (100% vs 73.4%; P = .008). Failure rates were higher for smokers than for nonsmokers (9/24, 37.5% vs 3/56, 5.3%; P = .008). Conclusion: Peripheral tears and early repairs have better outcomes and patient satisfaction. Smoking adversely affects meniscal healing

Comparison of acetabulum posterior wall fractures and fracture dislocations: Dislocation does not affect clinical and radiological outcomes

© 2018, Acta Orthopaedica Belgica.The aim of this study was to compare radiological and clinical outcomes of posterior wall acetabulum fractures and posterior wall fracture dislocations. Data were including 52 acetabulum fractures and fracture dislocations. 26 patients (%50) had posterior acetabulum fractures and fracture dislocations who were operatively treated. Radiographic evaluations were performed before and after the operation and at the last follow up. Clinical outcome evaluation was performed at the last follow up. Clinical and radiological outcomes were evaluated including Merle D'aubigne clinical assessment score and Matta' s radiologic measurement score. Brooker classification was used to measure heterotopic ossification.Both Merle D'aubigne and Matta scores were found higher in the acetabulum posterior wall fracture group. But there wasn't significantly difference of clinical and radiological outcomes between two groups (p . 0,05). Reduction quality and Matta radiologic scores were correlated significantly in 2 groups. Posterior dislocation may not negatively affect clinical and radiologic outcomes

Arthroscopic medial meniscal repair with or without concurrent anterior cruciate ligament reconstruction: A subgroup analysis

WOS: 000430159800014PubMed ID: 29162378Background: There are few large-scale, long-term studies comparing medial meniscal repairs with or without concurrent anterior cruciate ligament (ACL) reconstruction. Methods: A total of 140 patients who underwent arthroscopic medial meniscal repair were divided into two groups: Group A, meniscus repair only and Group B, meniscus repair with concurrent ACL reconstruction. Clinical assessments in- cluded physical examination findings, Lysholm score, and the International Knee Documentation Committee (IKDC) form. Barret criteria were used for the clinical assessment of healing status. Magnetic resonance imaging (MRI)was obtained to confirmhealing and failure. Subgroups of participants were compared in terms of suture technique, type of tear, and location of tear. KT-2000 arthrometer testing was used for objective evaluation of anterior-posterior knee movement. Results: Mean follow-up duration was 61 (34-85) months. Clinical outcomes in both groups were significantly improved compared to baseline (P = .0.001 vs. P = 0.001); however, there was no significant between-group difference in postoperative Lysholm and IKDC scores (P = 0.830). The outcomes of three participants (seven percent) in Group A and 11 (11.3%) in Group B were considered as treatment failures (P = 0.55). Red-red zone tears had higher scores. Mean postoperative KT2000 arthrometer values of failed participants in Groups A and B were 4.66 mm (range, four to six) and 5.2 mm (range, two to seven), respectively. Conclusion: Concurrentmedialmeniscus repair and ACL reconstruction did not have clinical superiority over meniscus repair alone. Repairs in the red-red zone appeared to be associated with better outcomes. (C) 2017 Elsevier B.V. All rights reserved