Application of aspirin and low molecular weight heparin in major orthopedic surgery:Meta analysis of a randomized controlled trial

Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this paper evaluated the efficacy and safety of aspirin versus low-molecular heparin using a Meta-analysis.Methods:Ten randomized controlled studies on the application of aspirin and low-molecular heparin for the prevention of deep vein thrombosis in orthopedic major surgery were retrieved by computer searches of PubMed,CochraneLibrary,WebofScience,China Knowledge Network,Wanfang,and Vipul databases according to inclusion and exclusion criteria,and the literature was managed using Endnote software,and the data were analyzed using Revman 5.3 software was used to perform Meta-analysis of the extracted data,focusing on the effects of these two drugs on pulmonary embolism,deep vein thrombosis,major bleeding events,minor bleeding events,wound complications,mortality and blood loss within 90 days after major orthopedic surgery.Results:(1)Ten randomized controlled trials of high quality were included,with a total of 12,974 patients,7,026 in the aspirin group and 5,948 in the low-molecular heparin group;(2)Meta-analysis showed that aspirin had a higher incidence of pulmonary embolism(OR=1.59,95%CI:1.02 to 2.49,P=0.04)and deep vein thrombosis(OR=1.60,95%CI:1.26 to 2.02,P=0.0001)than low molecular heparin;(3)The incidence of major bleeding events(OR=0.85,95%CI:0.47 to 1.55,P=0.60),minor bleeding events(OR=0.79,95%CI:0.55 to 1.12,P=0.18),adverse wound reactions(OR=0.79,95%CI:0.48 to 1.31,P=0.36),mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)in both drug groups,mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)were not statistically significant.Conclusion:Low-molecular heparin was superior to aspirin in the prevention of pulmonary embolism and lower extremity deep vein thrombosis after major orthopedic surgery,but the safety and adverse drug reactions of both groups were basically similar.Based on this,the authors recommend that low-molecular heparin should be preferred for the prevention of deep vein thrombosis in major orthopaedic surgery;however,the inclusion of randomized controlled trials remains limited,necessitating high-quality,large-sample,long-term follow-up clinical studies.

Optimizing outcomes:Implementing enhanced recovery after surgery in orthopedic surgery

In the realm of orthopedics,the adoption of enhanced recovery after surgery(ERAS)protocols marks a significant stride towards enhancing patient well-being.By embracing a holistic approach that encompasses preoperative counseling,dietary optimization,minimally invasive procedures,and early postoperative mobilization,these protocols have ushered in a new era of surgical care.Despite encountering hurdles like resistance to change and resource allocation challenges,the efficacy of ERAS protocols in improving clinical outcomes is undeniable.Noteworthy benefits include shortened hospital stays and bolstered improved patient-safety measures.Looking ahead,the horizon for ERAS in orthopedics appears bright,with an emphasis on tailoring care to individual needs,integrating cutting-edge technologies,and perpetuating research endeavors.This shift towards a more personalized,streamlined,and cost-efficient model of care underscores the transformative potential of ERAS in reshaping not only orthopedic surgery but also the journey to patient recovery.This editorial details the scope and future of ERAS in the orthopedic specialty.

Acute hospital-community hospital care bundle for elderly orthopedic surgery patients:A propensity score-matched economic analysis

BACKGROUND While Singapore attains good health outcomes,Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals.An Acute Hospital-Community Hospital(AHCH)care bundle has been developed to assist patients in postoperative rehabilitation.The core concept is to transfer patients out of AHs when clinically recommended and into CHs,where they can receive more beneficial dedicated care to aid in their recovery,while freeing up bed capacities in AHs.AIM To analyze the AH length of stay(LOS),costs,and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic surgery.METHODS A total of 8621:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital(SGH)before(2017-2018)and after(2019-2021)the care bundle intervention period was analyzed.Outcome measures were AH LOS,CH LOS,hospitalization metrics,postoperative 30-d mortality,and modified Barthel Index(MBI)scores.The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.RESULTS Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention,the age distribution,sex,American Society of Anesthesiologists classification,Charlson Comorbidity Index,and surgical approach were comparable between both groups.Patients transferred to CHs after the surgery had a shorter median AH LOS(7 d vs 9 d,P<0.001).The mean total AH inpatient cost per patient was 14.9%less for the elderly group transferred to CHs(S$24497.3 vs S$28772.8,P<0.001).The overall AH U-turn rates for elderly patients within the care bundle were low,with a 0%mortality rate following orthopedic surgery.When elderly patients were discharged from CHs,their MBI scores increased significantly(50.9 vs 71.9,P<0.001).CONCLUSION The AH-CH care bundle initiated and implemented in the Department of Orthopedic Surgery appears to be effective and cost-saving for SGH.Our results indicate that transitioning care between acute and community hospitals using this care bundle effectively reduces AH LOS in elderly patients receiving orthopedic surgery.Collaboration between acute and community care providers can assist in closing the care delivery gap and enhancing service quality.

Analgesic Efficacy of Intrathecal Bupivacaine with or without Morphine in Lower Limb Orthopedic Surgery. A Comparative Study

Background: Lower limb orthopaedic surgeries are commonly associated with moderate to severe postoperative pain. Adequate pain relief is essential for patients undergoing such procedures, as uncontrolled pain can lead to delayed recovery, prolonged hospitalization, and increased morbidity. Intrathecal administration of bupivacaine, a long-acting local anesthetic, has been shown to provide effective analgesia after lower limb orthopaedic surgery. However, the duration of analgesia with bupivacaine alone is limited, and the addition of an opioid, such as morphine, can prolong the duration of analgesia. Objective: The objective of this study was to document the comparative effect of adding morphine to intrathecal bupivacaine or only intrathecal bupivacaine for lower limb trauma orthopedic surgeries in terms of onset of action, duration of analgesia, pain severity, and side effects. Methods: This was a comparative longitudinal study design conducted at the Orthopaedic Unit of the Tamale Teaching Hospital. A simple random sampling technique was used to recruit 60 patients. A standard structured questionnaire was also used to collect data on the socio-demographics, and clinical features of patients, drug used,side effects and severity of pain at 24,48 and 72 hrs after surgery. Results: Co-administration of intrathecal bupivacaine with morphine produced good and long-lasting postoperative analgesia with a mean time of 1004.25 ± 310.43 minutes, whiles using only bupivacaine produced shorter postoperative analgesia with a mean time of 294.75 ± 195.53 minutes. The p-value p values of p = 0.635 and p = 0.689 respectively. Conclusion: The study revealed that co-administration of intrathecal bupivacaine with morphine emerged as a better option for postoperative pain management after lower limb orthopedic surgeries as compared to administering only bupivacaine regarding the duration of analgesia. Milder side effects like pruritus, nausea, and vomiting were seen in group B than in group A and were promptly well managed to the patient’s satisfaction.

High-flow nasal cannula oxygen therapy during anesthesia recovery for older orthopedic surgery patients: A prospective randomized controlled trial

BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM To investigate the clinical efficacy of high-flow nasal cannula oxygen(HFNCO)in the resuscitation period of older orthopedic patients.METHODS In this prospective randomized controlled trial,60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups:those who used conventional face mask and those who used HFNCO.All patients were treated with 60%oxygen for 1 h after extubation.Patients in the conventional face mask group were treated with a combination of air(2 L)and oxygen(2 L)using a traditional mask,whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34℃ and flow rate of 40 L/min.We assessed the effectiveness of oxygen therapy by monitoring the patients’arterial blood gas,peripheral oxygen saturation,and postoperative complications.RESULTS The characteristics of the patients were comparable between the groups.One hour after extubation,patients in HFNCO group had a significantly higher arterial partial pressure of oxygen(paO_(2))than that of patients in conventional face mask group(P<0.001).At extubation and 1 h after extubation,patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide(paCO_(2))than the baseline levels(P<0.001).There were no differences in the saturation of peripheral oxygen,paO_(2),and paCO_(2) between the groups before anesthesia and before extubation(P>0.05).There were statistically significant differences in paO_(2) between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation(P<0.001).However,there were no significant differences in the oxygen tolerance score before leaving the room,airway humidification,and pulmonary complications 3 d after surgery between the two groups(P>0.05).CONCLUSION HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia.Thus,HFNCO can be used to prevent postoperative hypoxemia.

Evaluation of Different Strategies for Prevention of Venous Thromboembolism in Elective Orthopedic Surgery

Our objective is to evaluate different pharmacologic strategies for VTE （venous thromboembolism） prophylaxis following orthopedic surgery at a tertiary academic medical center. This was a retrospective, observational study assessing the efficacy and safety of different strategies for VTE prophylaxis in elective total knee arthroplasty and total hip arthroplasty surgery patients. We evaluated warfarin at two different INR （international normalized ratio） goal ranges （1.5-2.5 and 1.8-2.3） and aspirin 325 mg once or twice daily. The main efficacy outcome was a composite of symptomatic deep vein thrombosis or pulmonary embolism. The main safety outcome was incidence of major or minor bleeding. From January 2010 to June 2010, there were 190 patients in the warfarin group with INR range 1.5-2.5, 214 patients in the warfarin group with INR range 1.8-2.3, and 48 patients in the aspirin group. Of the three strategies, two primary events occurred in each of the warfarin groups （1.6% vs. 1.4%; P = 0.31）. There were no primary events in the aspirin group. Rates of major or minor bleeding were 4.2% in warfarin group INR 1.5-2.5 and 4.7% in warfarin group 1NR 1.8-2.3 （P = 0.19）, and 2.1% in the aspirin arm （P = 0.29）. There were no differences in the incidence of VTE in any of the treatment arms.

Chinese Orthopedic Surgeons' Practice Regarding Postoperative Thromboembolic Prophylaxis after Major Orthopedic Surgery

Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery. Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were surveyed concerning five key aspects of thromboembolic prophylaxis after major orthopedic surgery at the proseminar of Chinese guidelines for prevention of venous thromboembolism (VTE) after major orthopedic surgery in January of 2009. Results Totally, 208 surgeons (71.0%) responded, successfully completing the questionnaire. Of them, 57.6% respondents selected combined basic, mechanical, and pharmacologic methods for thromboprophylaxis; 51.0% respondents prefer starting prophylaxis 12-24 hours after surgery; 60.3% surgeons would use chemoprophylaxis for 7-10 days; 47.6% respondents prefer VTE prevention based on patients' special conditions and needs upon discharge. "Safety" was the most repeated and emphasized factor during VTE prophylaxis. Conclusions Multimodal thromboprophylaxis is frequently used after major orthopedic surgery. Half surgeons prefer to start chemoprophylaxis 12-24 hours after surgery. Thromboprophylaxis regimen varies for discharged patients.

Clinical Observation of Double Tube Laryngeal Mask in Fast-Track Anesthesia for Limb Orthopedic Surgery in Children with Cerebral Palsy

Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.

Establishment of a new method of digital orthopedic surgery and its widespread clinical application

Objective To create an unique new method of digital orthopedic surgery and widely apply to spinal surgery,treatment of bone and joint injuries,ligament reconstruction and repair,bone minor resection and reconstruction,serious bone and

Analysis of the Role of Nursing Intervention in Operating Room in the Prevention of Incision Infection in Orthopedic Aseptic Surgery

Objective:To explore and analyze the role of nursing in the operating room in the prevention of incision infection in aseptic orthopedic surgery.Methods:68 patients that underwent aseptic orthopedic surgery in our hospital from January 2021 to December 2022.They were divided into a research group(n=34)and a control group(n=34)by the random number table method.The patients in the control group received conventional nursing intervention in the operating room,and the patients in the study group received the optimized and modified nursing intervention in the operating room;then,the related indicators of nursing intervention of the two groups were compared.Results:The incidence of incision infection in the study group was lower than that of the control group(P<0.05);the average duration of surgery and length of stay the study group were lower than those in the control group(P<0.05);the stress response indexes of patients in the study group were lower than those in the control group 24 hours after operation(P<0.05);the degree of satisfaction of the patients in the study group to the services provided by the nursing staff was significantly higher than that of the control group(P<0.05).Conclusion:High-quality nursing intervention in the operating room for aseptic orthopedic surgery patients can significantly reduce the incidence of incision infection,reduce the stress response caused by surgery,shorten the duration of surgery and length of stay,and improve nursing satisfaction,which makes it worthy of popularization.

Artificial intelligence awareness and perceptions among pediatric orthopedic surgeons:A cross-sectional observational study

BACKGROUND Artificial intelligence(AI)is a branch of computer science that allows machines to analyze large datasets,learn from patterns,and perform tasks that would otherwise require human intelligence and supervision.It is an emerging tool in pediatric orthopedic surgery,with various promising applications.An evaluation of the current awareness and perceptions among pediatric orthopedic surgeons is necessary to facilitate AI utilization and highlight possible areas of concern.AIM To assess the awareness and perceptions of AI among pediatric orthopedic surgeons.METHODS This cross-sectional observational study was conducted using a structured questionnaire designed using QuestionPro online survey software to collect quantitative and qualitative data.One hundred and twenty-eight pediatric orthopedic surgeons affiliated with two groups:Pediatric Orthopedic Chapter of Saudi Orthopedics Association and Middle East Pediatric Orthopedic Society in Gulf Cooperation Council Countries were surveyed.RESULTS The pediatric orthopedic surgeons surveyed had a low level of familiarity with AI,with more than 60%of respondents rating themselves as being slightly familiar or not at all familiar.The most positively rated aspect of AI applications for pediatric orthopedic surgery was their ability to save time and enhance productivity,with 61.97%agreeing or strongly agreeing,and only 4.23%disagreeing or strongly disagreeing.Our participants also placed a high priority on patient privacy and data security,with over 90%rating them as quite important or highly important.Additional bivariate analyses suggested that physicians with a higher awareness of AI also have a more positive perception.CONCLUSION Our study highlights a lack of familiarity among pediatric orthopedic surgeons towards AI,and suggests a need for enhanced education and regulatory frameworks to ensure the safe adoption of AI.

Postoperative Risk of Hepatic Decompensation after Orthopedic Surgery in Patients with Cirrhosis

Background and Aims:Previous studies have shown increased hepatic decompensation in patients with cirrhosis undergoing surgery.However,there are little data available in cirrhotics undergoing orthopedic surgery compared to cirrhotics who did not undergo surgery.The aim of this study was to examine the demographics,comorbid conditions,and clinical factors associated with hepatic decompensation within 90 days in cirrhotics who underwent orthopedic surgery.Methods:This is a retrospective matched cohort study.Inclusion criteria were cirrhosis diagnosis,age > 18 years,≥ 6 months continuous health plan membership,and a procedure code for orthopedic surgery.Up to five cirrhotic controls without orthopedic surgery were matched on age,gender,and cirrhosis diagnosis date.Data abstraction was performed for demographics,socioeconomics,clinical,and decompensation data.Chart review was performed for validation.Multivariable analysis estimated relative risk of decompensation.Results:Eight hundred fifty-three orthopedic surgery cases in cirrhotics were matched with 4,263 cirrhotic controls.Among the cases and matched controls,the mean age was 60.5 years,and 52.2% were female.Within 90 days after surgery,cases had more decompensation compared to matched controls (12.8% vs 4.9%).Using multivariable analysis,orthopedic surgery,a 0.5 g/dL decrease in serum albumin,and a 1-unit increase in Charlson Comorbidity Index were associated with a significantincrease in decompensation within 90 days of surgery.Diabetes,chronic obstructive pulmonary disease,and chronic kidney disease were seen with increased frequency in cases vs.matched controls.Conclusions:Cirrhotics who underwent orthopedic surgery had a significant increase in hepatic decompensation within 90 days of surgery compared to matched controls.An incremental decrease in serum albumin and an incremental increase in the Charlson Comorbidity Index were significantly associated with hepatic decompensation after surgery.

Design and Implementation of a Control System to Mitigate Osteonecrosis in Orthopedic Bone Drilling Procedures

The drilling process in orthopedic surgery can sometimes lead to an undesired increase in temperature,which can cause serious damage to bones and soft tissues.This overheating is typically identified as a temperature above 47℃,known as the critical limit,and can result in the condition known as osteonecrosis.This study aims to develop a new control system,using a proportional-integral-derivative(PID)controller,to prevent overheating and the resulting osteonecrosis.The bone temperature is constantly measured using a thermocouple and,when it reaches the critical temperature of 47℃,the cooling device is activated by the PID-controlled system.This new control system makes the drill machine with cooling device more user-friendly and allows surgeons to set a desired temperature level manually.

Developing an enhanced recovery after surgery program for oncology patients who undergo hip or knee reconstruction surgery

Enhanced recovery after surgery(ERAS)protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team.ERAS pathways include pre-operative patient counselling,regional anesthesia and analgesia techniques,post-operative pain management,early mobilization and early feeding.Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty,compared with those who followed a traditional care approach.ERAS protocols reduce post-operative stress,contribute to rapid recovery,shorten length of stay(LOS)without increasing the complications or readmissions,improve patient satisfaction and decrease the hospital costs.We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement.These programs require good organization and handling by the multidisciplinary team.ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment.The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis,with a view to improving the surgical outcomes.

Prevention and Treatment of Deep Vein Thrombosis of the Lower Limbs in Patients with Complications after Orthopedic Trauma Surgery

Objective:To explore and analyze on how to prevent and treat deep vein thrombosis of the lower limbs in patients with complications after orthopedic trauma surgery.Methods:The research patients were selected from the cases of surgical treatment of orthopedic trauma in the hospital during the past two years,and a total of 58 patients were selected.The patients were randomly divided into two groups,with 29 patients in the control group treated with conventional clinical methods;and the other 29 patients were assigned to the experimental group,where targeted preventive and therapeutic measures were administered.During the research,the number of complications of postoperative deep vein thrombosis of the lower limbs and the corresponding treatment efficacy were compared between the two groups of patients.Results:According to the results of clinical experiments,the probability of patients in the experimental group suffering from deep vein thrombosis of the lower limbs after surgery was significantly lower than that of the control group(P<0.05);in addition,when complications of deep venous thrombosis of the lower limbs occurred,the treatment efficacy of the patients in the experimental group was 96.55%,and the treatment efficacy of the patients in the control group was 82.76%.There was a significant difference between the two groups(P<0.05).Conclusion:Through clinical experiments to study and analyze the prevention and treatment measures of deep vein thrombosis in patients with complications after orthopedic trauma surgery,this research proves that active and comprehensive preventive and treatment measures can effectively reduce the number of complications and improve surgery treatment efficacy.

Academic productivity correlates with industry earnings in foot and ankle fellowship programs in the United States:A retrospective analysis

BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)data,it addresses a gap in understanding the relationship between scholarly achievements and financial outcomes,providing a basis for further exploration in this specialized medical field.AIM To elucidate the trends between academic productivity and industry earnings across foot and ankle orthopedic surgery fellowship programs in the United States.METHODS This study is a retrospective analysis of the relationship between academic productivity and industry earnings of foot and ankle orthopedic surgery fellowships at an individual faculty and fellowship level.Academic productivity was defined via H-index and recorded from the Scopus website.Industry earnings were recorded from the OPD.RESULTS Forty-eight foot and ankle orthopedic surgery fellowships(100%of fellowships)in the United States with a combined total of 165 physicians(95.9%of physicians)were included.Mean individual physician(n=165)total life-time earnings reported on the OPD website was United States Dollar(USD)451430.30±1851084.89(range:USD 25.16-21269249.85;median:USD 27839.80).Mean physician(n=165)H-index as reported on Scopus is 14.24±12.39(range:0-63;median:11).There was a significant but weak correlation between individual physician H-index and individual physician total life-time earnings(P<0.001;Spearman’s rho=0.334)and a significant and moderate positive correlation between combined fellowship H-index and total life-time earnings per fellowship(P=0.004,Spearman’s rho=0.409).CONCLUSION There is a significant and positive correlation between academic productivity and industry earnings at foot and ankle orthopedic surgery fellowships in the United States.This observation is true on an individual physician level as well as on a fellowship level.

Mixed reality for visualization of orthopedic surgical anatomy

In the modern era,preoperative planning is substantially facilitated by artificial reality technologies,which permit a better understanding of patient anatomy,thus increasing the safety and accuracy of surgical interventions.In the field of orthopedic surgery,the increase in safety and accuracy improves treatment quality and orthopedic patient outcomes.Artificial reality technologies,which include virtual reality(VR),augmented reality(AR),and mixed reality(MR),use digital images obtained from computed tomography or magnetic resonance imaging.VR replaces the user’s physical environment with one that is computer generated.AR and MR have been defined as technologies that permit the fusing of the physical with the virtual environment,enabling the user to interact with both physical and virtual objects.MR has been defined as a technology that,in contrast to AR,enables users to visualize the depth and perspective of the virtual models.We aimed to shed light on the role that MR can play in the visualization of orthopedic surgical anatomy.The literature suggests that MR could be a valuable tool in orthopedic surgeon’s hands for visualization of the anatomy.However,we remark that confusion exists in the literature concerning the characteristics of MR.Thus,a more clear description of MR is needed in orthopedic research,so that the potential of this technology can be more deeply understood.

Correction of hypovitaminosis D improved global longitudinal strain earlier than left ventricular ejection fraction in cardiovascular older adults after orthopaedic surgery

Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.

Regional anesthesia for orthopedic procedures:What orthopedic surgeons need to know

Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.

Automatic Bone Surface Restoration for Markerless Computer-Assisted Orthopaedic Surgery

An automatic markerless knee tracking and registration algorithm has been proposed in the literature to avoid the marker insertion required by conventional computer-assisted knee surgery,resulting in a shorter and less invasive surgical workflow.However,such an algorithm considers intact femur geometry only.The bone surface modification is inevitable due to intra-operative intervention.The mismatched correspondences will degrade the reliability of registered target pose.To solve this problem,this work proposed a supervised deep neural network to automatically restore the surface of processed bone.The network was trained on a synthetic dataset that consists of real depth captures of a model leg and simulated realistic femur cutting.According to the evaluation on both synthetic data and real-time captures,the registration quality can be effectively improved by surface reconstruction.The improvement in tracking accuracy is only evident over test data,indicating the need for future enhancement of the dataset and network.