Archives of Bone and Joint Surgery
Volume:10 Issue: 11, Nov 2022

The influence of bearing on revision, especially in press-fit modular cup total hip arthroplasty (THA),remains underexposed.

A systematic literature review was conducted in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov in line with the PRISMA guidelines. The primary outcome was an overall revision between ceramic-on-ceramic(CoC) and all sorts of ceramic-on-polyethylene (CoPE) bearings. As secondary outcomes complications and reasons forrevision were compared between bearings. Outcomes were presented in subgroups based on study design (randomizedcontrolled trials (RCT), non-randomized comparative, and registry studies). The quality of evidence was assessed usingthe GRADE. The risk of bias was assessed using the Cochrane collaboration’s tool and the MINORS criteria.

This meta-analysis included twelve RCTs, three nonrandomized comparative studies and two registry studies,including 38,772 THAs (10,909 CoPE and 27,863 CoC). Overall revision showed a lower risk in CoPE compared to CoCin the two registry studies (HR 0.71 (95%CI 0.53; 0.99)) (very low-quality GRADE evidence). In RCTs and nonrandomizedcomparative studies, no difference was observed (low-quality GRADE evidence). Loosening, dislocation, infection, andpostoperative periprosthetic fracture showed no significant differences in risk ratio for all designs.

The lower risk of overall revision in registry studies of primary THA with a press-fit modular cup usingCoPE bearing compared to CoC should be considered preliminary since this outcome was just slightly significant,based on very low-quality GRADE evidence and based on only two studies with several limitations. Since nodifference was observed in the other methodological designs and the separate reasons for revision showed nosignificant difference in all designs either, no preference for CoC or CoPE can be expressed, and therefore bothseem a suitable options based on the available literature. More comparative long-term studies are needed toconfirm the potential advantages of wear-reduction of both bearings since the currently available literature is limited.Level of evidence: I

Multiligament knee injuries are complex injuries that must be addressed with a comprehensive diagnostic workup andtreatment plan. Multiligament injuries are commonly observed with concomitant meniscal, chondral, and neurovascularinjuries, requiring a thorough clinical assessment and radiographic evaluation. Due to the higher failure rates associatedwith knee ligament repair following multiligament knee injury, the current literature favors single-stage anatomic kneereconstructions. Recent studies have also optimized graft sequencing and reconstruction tunnel orientation to preventgraft elongation and reduce the risk of tunnel convergence. In addition, anatomic-based ligament reconstructiontechniques and the usage of suture anchors now allow for early postoperative knee motion without the risk of stretchingout the graft. Rehabilitation following multiligament knee reconstruction should begin on postoperative day one andtypically requires 9-12 months. The purpose of this article is to review the latest principles of the surgically relevantanatomy, biomechanics, evaluation, treatment, rehabilitation, and outcomes of multiligament knee injuries.Level of evidence: V

risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite the effectiveness of usingcombined conventional and biological disease-modifying anti-rheumatic drugs(bDMARDs) in managing rheumaticdiseases, there have been concerns that taking biological agents may have an additive effect on getting infected withCOVID-19. This study evaluates the impact of taking biological agents on altering the chance of getting infected withSARS-CoV-2 in rheumatoloid and lupus patients compared to traditional DMARDs.

We carried out a cross-sectional survey study from February 2020 to January 2021 on patients diagnosedwith lupus and rheumatid arthritis. COVID-19 infection was confirmed by the presence of symptoms and signs of the diseaseand para-clinical findings such as lymphopenia and elevated C-reactive protein (CRP) and positive chest CT scanor polymerase chain reaction (PCR) of COVID-19.

Out of 591 patients included in this study, 422 (71.4%) had rheumatoid arthritis (RA), and 169 (28.6%) hadsystemic lupus erythematosus (SLE). Among them, 56 (9.5%) cases were diagnosed with COVID-19 infection. Noassociation was found between age, gender, or type of rheumatological diseases and SARS-CoV-2. There was asignificant association between COVID-19 infection and treatment with biological drugs (P-value<0.05) regardless ofthe type of rheumatologic disease. Interestingly, the analysis revealed that the type of biologic drug also altered thechance of COVID-19 infection; In fact, patients who took TNF inhibitors were significantly at a higher risk of diseasethan those taking Rituximab (P-value=0.000). Identical results were observed among RA patients (P-value<0.001),however, all 5 (3%) lupus cases treated with Rituximab infected with covid 19.

This study develops a better understanding of the risk of immunosuppressive medications for SARSCoV-2 infection. Patients treated with conventional and biological medicine had a higher disease risk than those takingexclusively conventional drugs. However, more studies are required to deliberate the relation of the reviewed factorswith the severity of COVID-19.Level of evidence: II

Half of the individuals who experience an anterior cruciate ligament reconstruction (ACLR) suffer from kneeosteoarthritis (OA) 12–14 years later. Elements that make a contribution to the appearance of OA following ACLRare anomalous anterior tibial displacement and anomalous tibial rotation in the course of the stance phase of walking(exhibited in 85% of operated knees). Individuals who undergo an early ACLR (5 days on average following anteriorcruciate ligament [ACL] breakage) have an inferior frequency of radiographically apparent tibiofemoral OA at 32–37years of follow-up than individuals with ACL who did not experience the procedure. Nevertheless, the percentage ofsymptomatic OA, radiographically apparent patellofemoral OA and knee symptoms are alike in both groups. At 15years of follow-up, 23% of knees that experienced an anatomic ACLR suffer from OA, while this percentage augmentsto 44% if the ACLR was non-anatomic. Knees of individuals who experience ACLR need total knee arthroplasty at anearlier age than healthy knees. Intra-articular injections of interleukin-1 receptor antagonist and corticosteroids mayreduce the peril of OA after ACLR.Level of evidence: III

Studies have proved that in addition to the inlet and outlet views, the intraoperative lateral sacral viewis required to ensure the correct entry point, reduce operating time, and lower radiation exposure. Considering thecomplex anatomy of the sacrum, we showed a safe corridor for sacroiliac joint (SIJ) screw insertion that was accessibleusing only inlet and outlet fluoroscopic views. From 2013 to 2020, we enrolled 215 patients who underwent percutaneous SIJ screw insertion. Ourexperience in SIJ screw insertion is presented using only two views (inlet and outlet). We reported on the radiationexposure time, operating time, rate of screw malposition, neurologic injury, and revision surgery. The screw malposition rate was 5.5%, including 11 foraminal perforations and one perforated anterior sacralcortex. Paresthesia after the surgery was observed in six patients (2.8%). No revision surgery or screw removal wasperformed. The radiation exposure and operation time for each screw were 21 ± 4.5 s and 13.5 min, respectively. The most anterior and the lowest part of the S1 vertebra can be easily found using intraoperative inletand outlet views. It is a safe corridor for SIJ screw insertion with low radiation time, neurologic injury, and revision rates.Level of evidence: IV

Compare the recurrence rate of paresthesias in patients undergoing primary cubital tunnel surgery inthose with and without wrapping of the ulnar nerve with the human amniotic membrane (HAM). A retrospective investigation of patients undergoing primary cubital tunnel surgery with a minimum90-day follow-up was performed. Patients were excluded if the nerve was wrapped using another material, associated traumatic injury,simultaneous Guyon’s canal release, or revision procedures. Failure was defined as those patients who experiencedinitial complete resolution of symptoms (paresthesias) but then developed recurrence of paresthesias. A total of 57 controls (CON) and 21 treated with HAM met our inclusion criteria. There was a difference inthe mean age of CON (48.4 ± 13.5 years) and HAM (30.6 ± 15) (P< 0.0001). There was no difference in gender mix(P=0.4), the severity of symptoms (P=0.13), and length of follow-up (P=0.084). None of 21 (0%) treated with HAMdeveloped recurrence of symptoms compared to 11 of 57 (19.3%) (P=0.03) (CON). Using a multivariate regressionmodel adjusted for age and procedure type, CON was 24.4 (95% CI=1.26-500, P=0.0348) times higher risk than HAMof developing a recurrence of symptoms. The HAM wrapping used in primary cubital tunnel surgery significantly reduced recurrence rates ofparesthesias. Further prospective studies with randomization should be carried out to better understand the role HAMcan play in cubital tunnel surgery.Level of evidence: III

Pull-out suture fixation is widely used to fix zone one flexor tendon injuries. The original technique of Bunnell generallyhas good results. However, in some cases, it may result in complications, including nail deformity and infection. Theall-inside techniques for fixation of the tendon at this zone cannot totally replace the Pull-out technique. In this article,we propose a modification of the pull-out technique, which can reduce the complications and report the results of ourpatients’ series.Level of evidence: IV

The removal of a broken intramedullary nail is a challenging procedure. Several surgical techniques have beendescribed to remove the distal end of the nail. Here, we report the surgical technique for removing broken Fitbone®lengthening nail using a cerclage wire. This is an effective and reproducible technique that does not require specializedequipment, the development of a cortical window, or an arthrotomy and is applicable for all types of intramedullary nails.Level of evidence: IV

The primary goal of this study is to characterize orthopaedic residency programs’ use of various social media platforms. The secondary aims include evaluating whether social media presence and engagement correlates with program diversity and/or reputation ranking.

Instagram, Twitter, and Facebook were searched for orthopaedic residency program-specific accounts, using the list of accredited allopathic orthopaedic residency programs gathered from the 2021 Electronic Residency Application Service. Program ranks were recorded according to Doximity Reputation Ranking and US News and World Report websites. AAMC Careers in Medicine Residency & Fellowship Program Search was used to extract diversity data.

Of the 187 programs analyzed, there were 92 residency program-specific Instagram accounts, 25 Twitter accounts, and 23 Facebook accounts. Programs in the top quartile according to Doximity Reputation ranking had more Instagram followers (1215.9 vs 870.6, 762.4, 610.7, P <0.01) and these programs were more likely to have an Instagram account (88.64% vs 54.55%, 36.36%, 29.55%, P <0.01) compared to the lower quartiles. Similar trends were seen in programs affiliated with US News and World Report ranked hospitals compared to unaffiliated programs (1126.1 vs 914.6 followers, P = 0.0133, 77.14% vs 44.46%, P = 0.0012). 82.55% of residents at programs without Instagram accounts were white, whereas 75.48% of residents at programs with Instagram accounts were white (P = 0.0036). 14.39% of residents were females at programs that have Instagram accounts, compared to 13.14% at programs without accounts (P = 0.3836).

Instagram is the most commonly used social media platform by orthopaedic residency programs. Higher ranked programs are more popular on social media and have a stronger presence online. Social media presence of a program has no correlation to gender diversity, but programs with fewer white residents have a higher social media presence.