Nevin Manimala

Acta Orthop Belg. 2022 Mar;88(1):73-85. doi: 10.52628/88.1.10.

ABSTRACT

The evidence for the functional outcome of endo- prosthetic replacement (EPR) after tumour resection has been from few cohort studies. A scoping search revealed no systematic review on patient reported outcome measures after EPR around the knee. The purpose of this study was to evaluate the functional outcome of distal femoral and proximal tibial EPR after tumour resection. A systematic review was conducted using the PRISMA guidelines. The search identified 2560 articles from MEDLINE, EMBASE, CINAHL, and Web of Science. 36 studies satisfying the selection criteria were included for data synthesis. Pooled analysis was performed for homogenous studies. Narrative synthesis was performed for all the studies due to heterogeneity in methodological and statistical analysis. Amongst the overall patient population of 2930, mean ages ranged from 18-66 years and the mean follow up periods in the studies ranged from 12 – 180 months. The weighted mean functional outcome was similar for patients who had DFEPR and PTEPR. The functional outcome scores of Rotating Hinge Knee implants (RHK) were significantly greater than that for Fixed Hinge Knee implants (FHK). The weighted mean functional outcome scores were higher after cemented fixation and after primary EPR procedures. The current evidence suggests that functional out- come after EPR in the knee is good, and RHK implants are better than FHK implants. Functional outcome after primary EPR was significantly better than following revision EPR, and this underscores the importance of minimising complications at the primary surgery.

PMID:35512157 | DOI:10.52628/88.1.10

Acta Orthop Belg. 2022 Mar;88(1):53-60. doi: 10.52628/88.1.08.

ABSTRACT

The aim of the study is to compare weight-based versus standard dosing of intravenous (IV) tranexamic acid (TXA) for blood loss and transfusion amount in total knee arthroplasty (TKA) without a tourniquet. A total of 99 patients were divided into two groups: Group 1 (standard): 1 g of IV TXA 30 min before skin incision, and 1 g at postoperative 30 min and 3 h. Group 2 (weight-based): 10 mg/kg IV TXA 30 min before the skin incision, and 10 mg/kg at postoperative 30 min, and 3 h. Hemoglobin levels, before, and 1, and 2 days after the operation, postoperative amount of decrease in hemoglobin levels, and amount of erythrocyte transfusion were recorded. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were applied in the evaluation of TKA results preoperatively, and at 1., 3., 6., and 12. months, postoperatively. In both study groups, hemoglobin levels in male patients dropped significantly more deeply than female patients. Also, in both study groups, hemo- globin levels were significantly lower in patients with comorbid illnesses. A statistically significant difference was not detected between both groups in terms of pre- and postoperative WOMAC scores, KSS knee scores, and KSS function scores. Our study showed that standard and weight-based dosing of IV TXA treatments were similar in efficacy and safety. Both treatments reduce blood loss and the need for transfusion. Also, there was no significant difference in terms of reliability between two groups.

PMID:35512155 | DOI:10.52628/88.1.08

Acta Orthop Belg. 2022 Mar;88(1):47-52. doi: 10.52628/88.1.07.

ABSTRACT

Literature into the short-term follow-up of total knee arthroplasty (TKA) using a handheld image- free robotic system are scarce. The purpose of this study was to compare the clinical outcomes and patient-reported outcome measures (PROMs) between patients operated for TKA with an image- free robotic system (robot group) or conventionally TKA (conventional group) 2 years postoperatively. A total of 147 patients were evaluated after TKA, respectively 73 in the robot and 74 in conventional group. Outcome measures included adverse events (AEs), hospital readmission rate, patient satisfaction and the following PROMs: Pain Visual Analogue Score (VAS), Oxford Knee Score (OKS), Forgotten Joint Score Knee (FJS-12) and the EuroQOL-5D (EQ-5D). There were no statistically significant differences in the number of AEs; 8 (10.8%) in the conventional group versus 7 (9.7%) in the robot group. The FJS (p ≤ 0.05) and OKS (p ≤ 0.05) differed statistically in favour of the robot group. The EQ-5D and EQ-5D VAS did not statistically differed between the groups (p=0.231 and p=0.373 respectively). The VAS pain improved statically significant in both groups when comparing the pre- and postoperative values (5.8 points). Patients operated with a handheld image-free robotic system have the ability to forget their artificial knee joint in everyday life as measured with the FJS-12 at short-term follow-up.

PMID:35512154 | DOI:10.52628/88.1.07

Acta Orthop Belg. 2022 Mar;88(1):1-9. doi: 10.52628/88.1.01.

ABSTRACT

The key element for differentiation between normal anatomical variants and pathological deformities is the prior definition of normal ranges for anthropometric parameters of acetabulum according to each age group. Aim of the present study is to analyze the development of the acetabulum in children/adolescents by accurate anthropometric measurements using 3D-CT scans and determine the variations occurring depending on age, gender and/or side. This retrospective observational study included 85 patients (170 hips) under 15 years of age (0-15) undergoing 1.5mm CT scanning for non-hip related reasons. The measurements were performed by 2 board-certified orthopaedic surgeons. Each year of life represented an age group forming a total of 16 groups. Median number of patients per age group was 12 (range 4-16). The anthropometric parameters included acetabular volume, inclination, version, depth (coronal and axial), width (coronal and axial), Tönnis angle as well as anterior and posterior acetabular sector angles. Mean values, range, standard deviation, p-values, intra- and interrater reliability were calculated. All measurement values correlated significantly with age. Statistically, there was no side or gender related difference. Rapid growth phases were observed at the age of 11-12. The inter- and intrarater reliability was high (range ICC 0.8-0.99, Cronbach alpha 0.86-0.99, Bland-Altman good agreement). The present data provides age- and gender-related normative values as well as growth phases describing acetabular morphology. It should help paediatricians as well as paediatric and orthopaedic surgeons as a tool for early diagnosis of deformity and guidance for possible procedures.

PMID:35512148 | DOI:10.52628/88.1.01

Am J Phys Med Rehabil. 2022 Apr 29. doi: 10.1097/PHM.0000000000002043. Online ahead of print.

ABSTRACT

OBJECTIVE: The role of kinesiotherapy in heterotopic ossification (HO) remains unclear. The goal of this study is to revisit the literature on the preventive role of kinesiotherapy against HO formation and maturation.

DESIGN: A systematic review was performed in MEDLINE, OVID, SCOPUS and Cochrane databases.

RESULTS: A high-quality clinical trial is missing from the literature. Out of 9617 studies primarily identified, 9 studies offered the proper data and were included. They infer that satisfactory results on neurogenic HO prevention were achieved with passive exercises, including continuous passive motion (CPM), that were initiated early and at a painless range of motion (ROM). On the contrary, for elbow post-traumatic HO and major joints burn-associated HO, active ROM is indicated as early as possible.

CONCLUSION: Due to the very low quality of the studies included in this review, firm conclusions cannot be drawn about the effectiveness of kinesiotherapy. Nevertheless, it is recommended that controlled passive ROM (PROM) exercises (especially CPM) be applied early and pain-free especially in the neurogenic HO patients while active ROM in painless limits is beneficial in the HO prevention of traumatic elbows or burn joints.

PMID:35512120 | DOI:10.1097/PHM.0000000000002043

Am J Health Promot. 2022 May 5:8901171221099496. doi: 10.1177/08901171221099496. Online ahead of print.

ABSTRACT

PURPOSE: To understand risk perception about cannabis use during pregnancy.

DESIGN: Mixed -Methods. Setting: Focus groups. Participants: Mothers.

METHOD: Focus groups were conducted to learn about person’s experiences with pregnancy, health-related behaviors, perception of risky behaviors (cannabis use), and receipt of health-related information during pregnancy. Participants completed the Electronic Health Literacy Scale, the Single Item Literacy Screener, and questions about whether topics were discussed during their prenatal care. Data were coded and analyzed iteratively for emerging themes. Descriptive statistics were used to characterize the sample.

RESULTS: Twenty-one persons (mean age = 34.4, 57% African American, 38% White, 5% Multi-racial) participated in 4 focus groups. One-third of the participants used cannabis; 24% used alcohol; and 48% used tobacco during pregnancy. Participant’s perceptions and use of cannabis during pregnancy were shaped by relief from pregnancy-related symptoms, recommendations from health care providers that cannabis is safe, anecdotal stories from friends and family, fear associated with prescription medications, and preference for “natural” remedies. The context of distrust of providers permeated these themes. The sample displayed poor e-health literacy compared to other adult samples.

CONCLUSION: Inter-related factors that influence cannabis use among persons who are pregnant should be considered when establishing trust between patients and providers, creating messages for patients about cannabis use during pregnancy, and when implementing interventions to improve provider-patient communication about health risk behaviors.

PMID:35512115 | DOI:10.1177/08901171221099496

J Gerontol A Biol Sci Med Sci. 2022 May 4:glac085. doi: 10.1093/gerona/glac085. Online ahead of print.

ABSTRACT

BACKGROUND: The association of pulmonary function (PF) with motor function and disability remains unclear. We investigate the association of PF with motor function trajectories and disability progression, and explore the role of social activity, cognitive function and cardiovascular diseases (CVDs) in this relationship.

METHODS: Within the Rush Memory and Aging Project, 1,403 disability-free participants (mean age: 79.28 years) were followed for up to 22 years. PF was measured with a composite score based on peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity at baseline. Global motor function including dexterity, gait, and hand strength was assessed annually using 10 motor tests. Disability was evaluated according to the basic activities of daily living. Social activity was defined as the frequency of common types of social interaction. Global cognitive function was assessed using a battery of 19 cognitive performance tests. CVDs (including stroke, congestive heart failure, and heart diseases) were ascertained at baseline. Linear mixed-effects models were used.

RESULTS: Compared to high PF, low PF was related to faster decline in global motor function (β= -0.005, 95% CI: -0.008 to -0.001) and all three specific motor abilities (P < 0.05), as well as faster progression of disability (β= 0.012, 95% CI: 0.009 to 0.014). There was a statistically significant interaction between PF and social activity/cognitive function on disability progression (β: 0.005, 95% CI: 0.001 to 0.009, P= 0.010/β: 0.004, 95% CI: 0.001 to 0.009, P= 0.025).

CONCLUSIONS: Poor PF accelerates motor function decline and the progression of disability. A high level of social activity and cognitive function appear to decelerate disability progression related to poor PF.

PMID:35512113 | DOI:10.1093/gerona/glac085

Medicine (Baltimore). 2022 Apr 29;101(17):e29201. doi: 10.1097/MD.0000000000029201.

ABSTRACT

The impact of serum prealbumin in patients with esophageal carcinoma after undergoing esophagectomy remains unclear, we speculated that serum prealbumin is associated with anastomotic leak (AL) after surgery, low serum prealbumin level may lead to AL. The aim of the study was to evaluate the relationship between serum prealbumin levels and AL after esophagectomy, to explore the value of serum prealbumin as an early predictor of AL after esophagectomy.Between January 2014 and December 2018, 255 patients were enrolled in this study, their basic characteristics and perioperative serum prealbumin levels were retrospectively analyzed. Statistical analysis by t test, nonparametric test and logistic regression were used to analyze data for patients with and without AL. Based on a receiver operator characteristic curve, a cut-off value for serum prealbumin levels as a predictor of AL was determined.Among the 255 patients, 18 patients were diagnosed with AL. The overall AL rate was 7.0% (18/255) including 12 cases of intrathoracic AL and 6 cases of cervical AL. By univariate analysis, we identified postoperative serum prealbumin level as a risk factor for AL (P < .001). Multivariate analysis also demonstrated postoperative serum prealbumin level (P = .028) to be an independent risk factor for AL. The best cut-off value of postoperative serum prealbumin level was 131 mg/L for predicting AL, with 83.3% sensitivity and 72.2% specificity.Postoperative serum prealbumin level was significantly associated with AL. it may help the early prediction of postoperative AL.

PMID:35512077 | DOI:10.1097/MD.0000000000029201

Oral Radiol. 2022 May 5. doi: 10.1007/s11282-022-00613-2. Online ahead of print.

ABSTRACT

OBJECTIVES: The present radiological observational controlled study aims to evaluate the impact of secondary hyperparathyroidism (SHPT) due to chronic kidney disease (CKD) as well as the duration of dialysis on the mineralization of the mandible by standardized qualitative evaluation of digital panoramic radiographs.

METHODS: Panoramic radiographs of CKD patients with SHPT and healthy controls were used for the qualitative analysis of the mandibular cortical index (MCI), the trabecular bone pattern (TBP), and calcification and resorption foci. Radiomorphometric indices were correlated to biochemical parameters and the duration of dialysis using the Spearman Rho test. Group comparisons were conducted using the Mann-Whitney U test and Fisher’s exact test at a significance level of α ≤ 0.05. Interrater reliability of two physicians was estimated using Cohen’s kappa.

RESULTS: Inclusion and exclusion criteria were fulfilled by N = 41 patients. Statistically significant differences in the MCI (p < 0.001) as well as the TBP (p = 0.002) could be detected for the experimental group in comparison to the healthy control group. Focusing on calcification and resorption foci, no statistically significant difference could be detected between the groups (p = 0.244). The level of the detected parathyroid hormone (PTH) significantly correlated with TBP (Rho = 0.338; p = 0.031), while no significant relationship between TBP and the duration of the dialysis could be found.

CONCLUSIONS: Patients with SHPT due to CKD show statistically significant bone changes in the panoramic radiograph, whereby the grade of trabecular bone change correlates to PTH values.

PMID:35511337 | DOI:10.1007/s11282-022-00613-2

Int Ophthalmol. 2022 May 5. doi: 10.1007/s10792-022-02310-9. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate ocular blood flow and, retinal, choroidal and retinal nerve fiber layer thickness in children with familial Mediterranean fever (FMF) with patients who had at least five attacks.

METHODS: Fifty-six patients with FMF and 56 healthy subjects were enrolled in the study. Each participant’s choroidal thickness (CT) and retinal thickness (RT) measurements were performed in the foveola and at horizontal nasal and temporal quadrants within 500-μm intervals up to 1.500 μm from the foveola using spectral-domain optical coherence tomography as well as the retinal nerve fiber layer thickness (RNFLT). Disc boundaries were determined manually by identifying seven points on the inner edge of the scleral ring. Following complete ophthalmological evaluation, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) values in the central retinal artery (CRA), ophthalmic artery (OA), and nasal posterior ciliary artery (NPCA) were measured using color Doppler ultrasonography (CDU) in the left eyes of the patients diagnosed with FMF and the controls. The results were subsequently compared.

RESULTS: No statistically significant differences were observed between the groups in terms of all RNFLT quadrant and RT measurements. All CT measurements were thinner in patients with FMF than in the controls (For Central and Temporal_1500 p = 0.01; For Temporal_500, Nasal 500 and Nasal_1000 p < 0.001; Temporal_1000 p = 0.002) except than the Nasal_1500 point. For nasal_1500 p = 0.121). The PSV and EDV values in the OA, CRA, and NPCA were significantly lower in patients with FMF compared to healthy controls (p < 0.001 for all). In contrast, the RI values of all arteries were significantly higher than in the control group (Regarding OA, CRA and NPCA RI, p = 0.003, p = 0.039, and p = 0.039, respectively).

CONCLUSIONS: The results of this study support the idea that chronic inflammation and frequent attacks in FMF may have an effect on decreased ocular blood flow and choroidal thinning.

PMID:35511318 | DOI:10.1007/s10792-022-02310-9