فهرست مطالب

Archives of Bone and Joint Surgery
Volume:9 Issue: 4, Jul 2021

  • تاریخ انتشار: 1400/04/16
  • تعداد عناوین: 18
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  • E. Carlos RODRIGUEZ MERCHAN *, Amir R. Kachooei Pages 368-370

    Medial unicompartmental knee arthroplasty (UKA) and valgus high tibial osteotomy (HTO) are reliable treatments for medial unicompartmental knee osteoarthritis, which are often indicated in relatively young and active patients. However, when the aforementioned surgical procedures fail or the osteoarthritis progresses, patients are offered conversion to the total knee arthroplasty (TKA). It has been recently published that a previous UKA more than doubles the risk of revision than a previous HTO. Although such study has some important limitations, the aforesaid risk must be taken into account when offering surgery to help patients contribute in shared-decision making.

    Keywords: TKA, previous UKA, previous HTO, risk of revision
  • Alec Kellish, Abraham Hakim, Alisina Shahi *, Christina Gutowski, Matthew Kleiner Pages 371-378

    In this paper we present the findings of a literature review covering articles published in the last three decades describingthe application of telemedicine in orthopaedics. A review of the PubMed Central and Medline provided 75 articlesstudying the role of telemedicine, the majority directly examining the application of telemedicine in orthopaedic patients.We report the summarized findings of these studies, the financial and HIPAA considerations of using telemedicine, andprovide an example of our single urban level-1 trauma center’s strategy for incorporating telemedicine into the clinicalpractice of orthopaedic surgeons during the COVID-19 pandemic.Level of evidence: V

    Keywords: COVID-19, Orthopedics, social distancing, Telehealth, Telemedicine
  • E. Carlos RODRIGUEZ MERCHAN * Pages 379-386

    The reported dissatisfaction rate after primary total knee arthroplasty (TKA) ranges between 15% and 25%. The purposeof this article is to perform a narrative review of the literature with the aim of answering the following question: What arethe main factors contributing to patient dissatisfaction after TKA? A review of the literature was performed on patientsatisfaction after TKA. The search engines used were MedLine (PubMed) and the Cochrane Library. The keywords usedwere “TKA” and “satisfaction”. The main reported preoperative factors positively contributing to patient satisfaction werethe following: fulfilment of preoperative expectations, preoperative complete joint space collapse, increasing patellar andlateral compartment osteophyte size, and TKA communication checklist. The principal preoperative factors negativelycontributing to patient satisfaction included female sex, comorbidities, and Hispanic race. The chief perioperative factorpositively contributing to patient satisfaction was cosmetic closure, whereas the fundamental perioperative factorsnegatively contributing to patient satisfaction included joint laxity, anterior tibial component slope, and greater femoralcomponent valgus angle. The principal postoperative factors positively contributing to patient satisfaction were thefollowing: ameliorated walking distance, improved range of motion, and improvements in pain. The most importantpostoperative factors negatively contributing to patient satisfaction included poor postoperative knee stability and softtissuebalance, functional limitation, surgical complication and reoperation, staff or quality of care issues, and increasedstiffness.Level of evidence: III

    Keywords: Arthroplasty, knee, Patient Satisfaction, Total knee arthroplasty
  • Jack Graham *, Lindsay Mcalpine, Juana Medina, Priscilla Jawahier, Pedro Beredjiklian, Michael Rivlin Pages 387-390
    Background
    The recurrence of ganglion cysts after surgical excision has a reported rate of 4% to 40%. Recurrence rateafter revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cystsin patients who underwent a secondary excision procedure.
    Methods
    With Institutional Review Board approval, we retrospectively identified by CPT code and reviewed charts ofpatients who had recurrent ganglion cyst excision performed over a five-year period (2010 – 2014). Recurrence was definedas reappearance of a cyst in the same area as it was previously. Demographic information including recurrences andrevision surgeries was collected in addition to outcome variables such as patient satisfaction, pain levels, and functionallimitations.
    Results
    Out of the 42 revision cases identified 20 patients were reached. Mean time to recurrence of the cyst after the firstganglion cyst excision was 2.5 years (range: 1 month - 12 years). After the second ganglion cyst excision, three patients(15%) had a recurrence, each occurring within one year (mean: 11 months; range: 9-12). One of the three patients underwenta third successful ganglion cyst excision. The other two patients declined surgical intervention to date. Patients without asecond recurrence (n=17) reported an average pain score of 0.1 (range: 0-2) on a scale of 1-10. Three (18%) reported somedifficulty with day-to-day activities due to their scar. Seven (41%) patients reported at least transient numbness or tingling.Mean satisfaction was 9.8 on a scale of 1-10, and 100% reported that they would undergo another ganglion cyst excisionshould they ever have another recurrence.
    Conclusion
    Patients should be advised about the risk of recurrence after re-excision of ganglion cysts, which was notedto be 15% in our cohort. This rate of recurrence is similar to that of primarily excised cysts.Level of evidence: III
    Keywords: Ganglion cyst, Recurrence, Surgical excision, wrist surgery
  • Vivek Pandey *, CJ Joseph, Naveen Mathai, Sandesh Madi, Lakshmikanth Gowda, Willems Jaap Pages 391-398
    Background
    High re-tear rates after repairing large-sized posterosuperior rotator cuff tears remain a significantconcern which may affect the clinical outcome. The most optimal type of repair (single versus double-row suturebridge) suited for large size tear remains debatable.
    Methods
    In a retrospective cohort study with a minimum of five years follow up, the structural and functional outcome of103 patients with large size cuff tear repaired with single row (SR) or double row suture bridge (DRSB) were evaluated.The structural outcome was assessed with ultrasonography whereas functional outcome was evaluated with ConstantMurley (CM) and American shoulder elbow score (ASES).
    Results
    There were 55 patients in the SR group and 48 patients in the DRSB group with a mean follow-up of 74.2months (range, 60-96 months). While comparing the structural integrity in two groups, we found significantly lower retearrates in the DRSB group as compared to the SR group (10.4% vs. 32.7%; P=0.006). Also, there were more focaldefects in the SR group (25.4%) than the DRSB group (8.3%). Overall, there was no significant difference in CM andASES scores when the SR group was compared to DRSB. However, subgroup analysis between those with intact andretorn tendon revealed significant difference (P=0.0001) in the clinical scores.
    Conclusion
    At a minimum of five years follow-up, the DRSB repair of large posterosuperior cuff tear resulted insuperior structural healing over SR repair. Nevertheless, overall there was no significant functional difference betweenboth the techniques. However, the functional outcome of the healed tendon subgroup was superior to retear tendonsubgroup.Level of evidence: III
    Keywords: large size, Outcome, posterosuperior, repair, Rotator cuff tear, single row, suture bridge
  • Sanaa Atyah Alsubheen *, Joy Christine Macdermid, Kenneth John Faber, Tom Overend Pages 399-405
    Background
    Shoulder arthroplasty improves shoulder range of motion (ROM), strength and function in patientswith advanced shoulder disease. However, clinical outcomes vary and are not always predictable among patients.Pre-operative factors and patients’ characteristics may influence improvement after surgery. This study examined theimpact of the pre-operative objective measures range of motion (ROM) and strength, age, sex, and comorbidities onshoulder ROM, strength status and the amount of improvement one year following shoulder arthroplasty.
    Methods
    140 patients were assessed pre-operatively and one year after shoulder arthroplasty in this prospectivecohort study. Pearson’s correlations and multiple regression analyses were performed to test the impact of potentialpredictors on abduction, flexion, internal rotation and external rotation ROM as well as on shoulder abductors, flexors,internal rotators and external rotators strength at one year.
    Results
    Pre-operative ROM significantly predicted 10% - 37% of the improvement in ROM after surgery. Less preoperativeROM was associated with a greater improvement in ROM. Less pre-operative muscle strength was associatedwith a greater improvement in strength after surgery. Pre-operative shoulder muscles predicted 28% - 38% of thestrength status at one year, and 24% - 43% of the improvement in strength postoperatively. Older age was associatedwith less improvement in ROM and strength at one year. With other predictors, age explained 37% of the change inROM and 36% of the change in strength. Male sex was associated with greater improvement in muscle strength. Sexsignificantly predicted 24% - 36% of the change in strength.
    Conclusion
    Pre-operative ROM and strength, age, and sex are significant predictors of the improvement in theshoulder ROM and strength one year after shoulder arthroplasty. The improvement in these measures is expected todecline with age and men are expected to gain more strength than women following this surgical intervention.Level of evidence: II
    Keywords: Muscle strength, Range of motion, Shoulder Arthroplasty
  • Marine Coste, Vineet Aggarwal, Neil V. Shah, David Kim, Omar Hariri, Louis Day, Scott Pascal, Jaydev Mistry, William Urban, William Aibinder, Arvind Von Keudell, Nishant Suneja * Pages 406-411
    Background
    Relative value units (RVUs) are assigned to Current Procedural Technology (CPT) codes and giverelative economic values to the services physicians provide. This study compared the RVU reimbursements for thesurgical options of proximal humerus fractures in the elderly, which include arthroplasty (reverse [RSA] and total [TSA]),hemiarthroplasty (HA), and open reduction and internal fixation (ORIF).
    Methods
    Using the National Surgical Quality Improvement Program, a total of 1,437 patients of at least 65 yearsof age with proximal humerus fractures between 2008 and 2016 were identified. Of those, 259 underwent RSA/TSA(CPT code 23472), 418 underwent HA (CPT codes 23470 and 23616), and 760 underwent ORIF (CPT code 23615).Univariate analysis compared RVU per minute, reimbursement rate, and the average annual revenue across cohortsbased on respective operative times.
    Results
    RSA/TSA generated a mean RVU per minute of 0.197 (SD 0.078; 95%CI [0.188, 0.207]), which wassignificantly greater than the mean RVU per minute for 23470 HA (0.156; SD 0.057; 95%CI [0.148, 0.163]), 23616 HA(0.166; SD 0.065; 95%CI [0.005, 0.156]), and ORIF (0.135; SD 0.048; 95%CI [0.132, 0.138]; p <0.001). This convertedto respective reimbursement rates of $6.97/min (SD 2.78; 95%CI [6.63, 7.31]), $5.48/min (SD 2.05; 95%CI [5.22,5.74]), $5.83/min (SD 2.28; 95%CI [5.49, 6.16]) and $4.74/min (SD 1.69; 95%CI [4.62, 4.87]). After extrapolation,respective average annual revenues were $580,386, $456,633, $475,077, and $395,608.
    Conclusion
    RSA/TSA provides significantly greater reimbursement rates compared to HA and ORIF. Orthopaedicsurgeons can use this information to optimize daily procedural cost-effectiveness in their practices.Level of evidence: III
    Keywords: geriatric population, humeral fracture, relative value analysis, surgical management
  • Tyler W. Henry, Michael Gutman, Amy Backal, Surena Namdari * Pages 412-417
    Background
    The overall clinical picture surrounding native shoulder infections, and, in particular, the associatedlong-term functional outcomes of treatment are presently underreported. The purpose of this study is to examine thedemographics, diagnostic and treatment strategies, and functional outcomes of isolated shoulder joint sepsis treatedwith surgical irrigation and debridement (I&D).
    Methods
    All patients treated with I&D for native shoulder sepsis between 2007 – 2017 were identified. Those withouta minimum of one-year follow-up were excluded. Functional outcomes scores, reoperations, and predictors of pooroutcome were evaluated.
    Results
    Twenty-three patients were included in the final study population. Mean age-adjusted CCI score was 4.1 (SD= 3.4, Range = 0 – 10). Twelve patients (52.2%) were treated with open I&D, while 11 patients (47.8%) were treatedarthroscopically. Nine patients (39.1%) required multiple I&Ds (mean total number of I&Ds = 1.7, SD = 1.0, Range:1 – 4). Five patients (21.7%) had at least one documented reinfection after their initial hospitalization, with the initialrecurrence of infection occurring 2 – 15 months after the index procedure. Mean ASES score at final follow-up was 55.3(SD = 26.7, Range: 5.8 – 98.3) and mean SANE score was 53.3 (SD = 30.6, Range: 0 – 100). Stepwise multiple linearregression modeling identified intravenous drug abuse as the most significant predictor for final ASES score [F(1,18)= 6.12, p = .024, adjusted R2 = .254].
    Conclusion
    Following isolated shoulder joint sepsis, infection clearance and acceptable functional outcomes can beachieved using surgical I&D followed by a course of antibiotics, but outcomes are variable.Level of evidence: IV
    Keywords: Infection, native, outcomes, Sepsis, shoulder, Treatment
  • Dafang Zhang *, Brandon E. Earp, George Dyer Pages 418-422
    Background
    The objectives of this study were to (1) identify factors associated with skin tenting in displaced midshaftclavicle fractures and (2) analyze individual surgeon variation in this diagnosis.
    Methods
    A retrospective cohort study was performed at two Level I trauma centers of 396 patients with displacedmidshaft clavicle fractures treated by 47 surgeons with open reduction internal fixation from January 2010 to March2019. Our main outcome measure was skin tenting, as diagnosed by the treating surgeon and used as an indicationfor surgical treatment.
    Results
    Skin tenting was diagnosed by the treating surgeon in 34 out of 396 patients (9%) with displaced midshaftclavicle fractures. Multivariable logistic regression analyses showed that lower BMI (P=0.002) and fracture shortening(P=0.03) were independently associated with skin tenting in displaced midshaft clavicle fractures. There was widevariation among surgeons in the rate of diagnosis of skin tenting, ranging from 0% to 41% prevalence of skin tentingdepending on the treating surgeon (p <0.0001).
    Conclusion
    Although lower BMI and greater fracture shortening were associated with skin tenting, the diagnosisis subjective. We found wide variation in the diagnosis of skin tenting, even among surgeons within a singlemetropolitan area.Level of evidence: III
    Keywords: Body mass index, displaced clavicle fracture, Midshaft clavicle fracture, skin tenting, surgeon variation
  • Caitlin Brennan *, Li Yong, Jon Foley, Scott Mckie, Philippa Rust Pages 423-426
    Background
    A retrospective study was conducted to evaluate the role of distal radioulnar joint (DRUJ) effusion inaiding the diagnostic accuracy of central triangular fibrocartilage complex (TFCC) tears on non-contrast MRI.
    Methods
    89 consecutive patients who had undergone wrist arthroscopy for ulna sided wrist pain in our unit wereidentified and their preoperative imaging reviewed. Two consultant musculoskeletal Radiologists independentlyreported the presence or absence of a DRUJ effusion and or a TFCC tear. The inter-observer variability was calculatedusing weighted Kappa tests. Two by two tables were constructed to calculate the sensitivity and specificity of reportedTFCC tear or DRUJ effusion on MRI in correctly diagnosing central TFCC tears identified at arthroscopy.
    Results
    Sensitivity of MRI to report a TFCC tear was 0.56 and specificity was 0.79. Sensitivity increased to 0.89if either a DRUJ effusion or TFCC tear were seen on MRI. When observed together, the presence of both a DRUJeffusion and a TFCC tear seen on the imaging lead to a sensitivity of 0.74 and PPV of 82% when compared tofindings at arthroscopy. In the absence of both DRUJ effusion and TFCC tear, the specificity of MRI increased to 0.92.Agreement by the radiologists on the presence of DRUJ effusion was substantial (k value 0.67) and TFCC tear wasmoderate (k value 0.58).
    Conclusion
    The presence of DRUJ effusion on MRI can further improve sensitivity of MRI in diagnosing central TFCCtears. The sensitivity of detecting a central TFCC tear on MRI scan when both a DRUJ effusion and a TFCC tear wereseen (0.74) is comparable to rates demonstrated on MRA meta-analysis results (0.78). Furthermore, considering theabsence of both a DRUJ effusion and TFCC tear seen on MRI is useful in excluding the presence of a TFCC tear atarthroscopy.Level of evidence: III
    Keywords: Arthroscopy, Triangular fibrocartilage complex, Wrist injuries
  • Tyler Henry, Richard Mcentee, Jonas Matzon, Pedro K. Beredjiklian, Kevin Lutsky * Pages 427-431
    Background
    Given its low incidence, the management of deep infection following distal radius open-reduction internalfixation (ORIF) has not been well reported. In an effort to expand our current understanding, the purpose of this caseseries is to present the treatment strategies and functional outcomes associated with deep infection after distal radiusORIF.
    Methods
    All patients with deep infections after distal radius ORIF over a ten-year period were identified and theirtreatment courses asessed.
    Results
    The cohort consisted of three women and one man with an average age of 55.5 ± 17.6 years. Mean timefrom infection presentation to irrigation and debridement (I&D) with removal of hardware (ROH) was 16 days (Range:3 – 44 days). The identified bacterial species in all cases was Staphylococcus aureus (MRSA = 2, MSSA = 2). Threepatients were treated with intravenous antibiotics, while one patient was treated with oral antibiotics. Mean time frominfection presentation to final clinical follow-up was 11 months (Range: 3 – 20 months). Two patients required repeatI&D. A clinical determination of successful infection eradication was made in all cases.
    Conclusion
    The reported rate of deep infection after distal radius ORIF is less than 1%. There is no well-definedtreatment algorithm for patients with deep infection after distal radius ORIF. However, removal of hardware and postoperativeoral or intravenous antibiotic therapy appears effective, and is consistent with the standard practices oftreating infection after other orthopaedic surgeries.Level of evidence: IV
    Keywords: Distal radius, Infection, open-reduction internal fixation, Treatment
  • Cory Lebowitz *, Joseph Massaglia, Christopher Hoffman, Ludovico Lucenti, Sachin Dheer, Michael Rivlin, Pedro Beredjiklian Pages 432-438
    Background
    Computer assisted three-dimensional (3D) printing of anatomic models using advanced imaging haswide applications within orthopaedics. The purpose of this study is to evaluate the 3D printing accuracy of carpalbones.
    Methods
    Seven cadaveric wrists underwent CT scanning, after which select carpal bones (scaphoid, capitate, lunate,and trapezium) were dissected in toto. Dimensions including length, circumference, and volume were measured directlyfrom the cadaver bones. The CT images were converted into 3D printable stereolithography (STL) files. The STL fileswere converted into solid prints using a commercially available 3D printer. The 3D printed models’ dimensions weremeasured and compared to those of the cadaver bones. A paired t-test was performed to determine if a statisticallysignificant difference existed between the mean measurements of the cadavers and 3D printed models. The intraclasscorrelation coefficients (ICC) between the two groups were calculated to measure the degree of agreement.
    Results
    On average, the length and circumference of the 3D printed models were within 2.3 mm and 2.2 mm,respectively, of the cadaveric bones. There was a larger discrepancy in the volume measured, which on average waswithin 0.65 cc (15.9%) of the cadaveric bones. These differences were not statistically significant (P > 0.05). Therewas strong agreement between all measurements except the capitate’s length and lunate’s volume.
    Conclusion
    3D printing can add value to patient care and improve outcomes. This study demonstrates that 3D printingcan both accurately and reproducibly fabricate boney models that closely resemble the corresponding cadaveric anatomy.Level of evidence: V
    Keywords: cadaver, Carpal bones, Computed Tomography (CT), Three-dimensional (3D)
  • Harrison Miner, David Ring, Karl Koenig * Pages 439-444
    Background
    Remote video visits (aka telemedicine, virtual care) have the potential to increase access to orthopaedicspecialty evaluation while decreasing the overall cost of care. Clinical implementation of remote video visits may benefitfrom an understanding of potential barriers to participation.
    Methods
    We enrolled one hundred and thirty participants from a university-based musculoskeletal clinic with a largeuninsured population. We asked participants to complete a survey, including demographics and scaled perceptionquestions about remote video visits. Data from these surveys were analyzed with multivariable logistic regression todetermine factors associated with willingness to participate in video visits, as well as the situations in which patientswould consider a video visit.
    Results
    Willingness to participate in video visits was associated with the perception of video visits being moreconvenient (OR 3.0) and a decreased perceived importance of physical exam (OR 0.36) but not age, technologycomfort, or travel distance to the clinic. Additionally, those with prior video visit experience were more comfortablewith technology, perceived video visits to be more convenient, and were more willing to have another video visit.Fifteen percent were willing to have a video visit for their first visit, while 78% would participate for a routine nonsurgicalfollow-up.
    Conclusion
    Musculoskeletal telemedicine programs can become established by focusing on people that prioritizeconvenience, place less importance on a hands-on exam, and are established patients.Level of evidence: II
    Keywords: musculoskeletal care, Telemedicine, Virtual, willingness
  • Hossein Akbari Aghdam *, Abolfazl Bagherifard, Mehdi Motififard, Javad Parvizi, Erfan Sheikhbahaei, Saeid Esmaeili, Saeed Saber Samandari, Amirsalar Khandan Pages 445-452
    Background
    Although bone tissue has the unique characteristic of self-repair in fractures, bone grafting is needed in somesituations. The synthetic substances that are used in such situations should bond to the porous bones, be biocompatibleand biodegradable, and do not stimulate the immune responses. Biomaterial engineering is the science of finding anddesigning novel products. In principle, the most suitable biodegradable matrix should have adequate compressive strengthof more than two megapascals. At this degradation rate, the matrix can eventually be replaced by the newly formed bone,and the osteoprogenitor cells migrate into the scaffold. This study aimed to evaluate the fabrication of a scaffold made ofpolymer-ceramic nanomaterials with controlled porosity resembling that of spongy bone tissue.
    Methods
    A compound of resin polymer, single-walled carbon nanotube (SWCNT) as reinforcement, and hydroxyapatite(HA) were dissolved using an ultrasonic and magnetic stirrer. A bio-nano-composite scaffold model was designed in theSolidWorks software and built using the digital light processing (DLP) method. Polymer-HA scaffolds with the solvent systemwere prepared with similar porosity to that of human bones.
    Results
    HA-polymer scaffolds had a random irregular microstructure with homogenizing porous architecture. The SWCNTimproved the mechanical properties of the sample from 25 MPa to 36 MPa besides having a proper porosity value near55%, which can enhance the transformation and absorption of protein in human bone.
    Conclusion
    The combined bio-nanocomposite had a suitable porous structure with acceptable strength that allowed it tobe used as a bone substitute in orthopedic surgery.
    Keywords: 3-D Printing, Biocompatible materials, carbon nanotubes, Hydroxyapatite, Tissue engineering
  • Jiang An Lim *, Azeem Thahir, Vinayak Amar Korde, Matija Krkovic Pages 453-460
    Background
    The aim of this study was to investigate the impact of the COVID-19 pandemic on the management andoutcome of patients with neck of femur fractures.
    Methods
    Data was collected for 96 patients with neck of femur fractures who presented to the emergency departmentbetween March 1, 2020 and May 15, 2020. This data set included information about their COVID-19 status.Parameters including inpatient complications, hospital quality measures, mortality rates, and training opportunitieswere compared between the COVID-19 positive and COVID-19 negative groups. Furthermore, our current cohort ofpatients were compared against a historical control group of 95 patients who presented with neck of femur fracturesbefore the COVID-19 pandemic.
    Results
    Seven (7.3%) patients were confirmed COVID positive by RT-PCR testing. The COVID positive cohort, whencompared to the COVID negative cohort, had higher rates of postoperative complications (71.4% vs 25.9%), increasedlength of stay (30.3 days vs 12 days) and quicker time to surgery (0.7 days vs 1.3 days).The 2020 cohort compared to the 2019 cohort, had an increased 30-day mortality rate (13.5% vs 4.2%), increasednumber of delayed cases (25% vs 11.8%) as well as reduced training opportunities for Orthopaedic trainees to performthe surgery (51.6% vs 22.8%).
    Conclusion
    COVID-19 has had a profound impact on the care and outcome of neck of femur fracture patients duringthe pandemic with an increase in 30-day mortality rate. There were profound adverse effects on patient managementpathways and outcomes while also affecting training opportunities.Level of evidence: VI
    Keywords: Coronavirus, COVID-19, Hip fracture, Neck of Femur Fracture, SARS-CoV-2
  • Carlo Cardile *, Carlo Cazzaniga, Beatrice Manzini, Marco Bongiovanni, Roberto Marasco, Paolo Ragni Pages 461-466

    The Charcot knee is a progressive, degenerative disease of the joint that may represent a diagnostic challenge; atthe moment, poorly controlled diabetes mellitus is the main cause of this condition. We describe here a case of a manpresenting with an end stage joint arthropathy who was diagnosed with neurosyphilis. Tabetic arthropathy is currentlya very rare disease, but in the past represented the main cause of joint arthropathy. Finally, we discussed the differentsurgical options of Charcot arthropathy, our choice of megaprosthesis implant and the failure of such procedure mainlydue to patient’s unreliability to care leading to infective complications and peri-prosthesis fracture.Level of evidence: IV

    Keywords: Arthroplasty, Charcot, knee, Syphilis, tabetic arthropaty
  • Ashkan Sedigh, Mohammad Zohoori, Mohammad H. Ebrahimzadeh, Amir R. Kachooei * Pages 467-471

    Preoperative planning is of paramount importance in saving time as well as helping achieve a more precise correction ofthe deformities. Along with preoperative measurements, customized cutting guides can facilitate intraoperative correctionof the deformity with higher confidence. In this report, we are presenting the application of preoperative planning and3D printed customized cutting guides for correcting cubitus varus alignment of the elbow in an 18 year old male withsatisfactory intraoperative and postoperative results.Level of evidence: IV

    Keywords: 3D-printing, Computer-aided-design, Cubitus varus, Elbow, Osteotomy, Pre-operative Planning
  • Raju Vaishya, Sathish Kumar, Abhishek Vaish *, Y.S. Suresh Babu Pages 472-474

    Various treatment guidelines exist for the treatment of knee OA which is very common in the tropical countries. A multitude of treatment guidelines creates confusion for the primary physician to manage patients with OA. Therefore, a consensus treatment guideline is necessary to clarify this discrepancy and to manage the patients with evidence-based treatment modalities. Analysis of the six existing guidelines on the management of knee OA, based on the strength of their recommendations was performed. We studied six guidelines regarding various modes of non-operative treatment of knee OA. There is consensus on efficacy of self-management programmes, land-based exercise and weight loss. These guidelines do not recommend the use of acupuncture in OA and there was a mixed opinion for the use of physiotherapy modalities and orthotics. NSAIDS are recommended for pain relief, along with their topical forms, their long term use is not advisable. Role of paracetamol for early disease process and opioids for later part of the disease is debatable and use of Glucosamine and Chondroitin has been discouraged by most of these guidelines. Use of intra-articular steroids for acute pain and inflammation is recommended, but not for Stem cells and Platelet Rich Plasma therapy, by the majority.Use of HA is still debatable. Although there are multiple treatment guidelines described for the management of knee OA, there is no consensus on many treatment modalities. There are periodical changes in the treatment protocol due to new studies available with new results. Despite pharmacological and surgical modalities keep evolving, patient factors have to be considered while recommending the treatment in patients of knee OA.

    Keywords: knee, Osteoarthritis, Guidelines, Non-operative management, Pain, Drugs