Effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury

BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.

Neuropathic pain-like symptoms and pre-surgery radiographic severity contribute to patient satisfaction 4.8 years post-total joint replacement

AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement(TJR) in people who had undergone knee or hip replacement for osteoarthritis.METHODS Participants(n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire(PDQ) to assess neuropathic pain-like symptoms(NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiveroperator characteristic(ROC) curve analysis was used to quantify the contribution of variables to post-TJR satisfaction.RESULTS After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83(95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79(0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: OR_(satisfied) = 2.06(95%CI: 1.15-3.69), P = 0.015.CONCLUSION These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.

Effects of Traditional Chinese Medicine Five-element Music Combined with Acupoint Application on Perioperative Sleep Quality in Patients Undergoing Joint Replacement Surgery

OBJECTIVE: To explore the effects of traditional Chinese medicine(TCM) five-element music combined with acupoint application on perioperative sleep quality in patients undergoing joint replacement surgery. METHODS: In this study, a total of 122 patients with joint replacement surgery in Beijing Jishuitan Hospital were targeted from 2015 to 2018. All patients were grouped by random number table method. Among them, 61 patients with routine nursing were included in the control group. On this basis, the other 61 patients with acupoint application and TCM five-element music therapy were included as the observation group. 2 weeks later, the Pittsburgh Sleep Quality Index(PSQI) was used to evaluate sleep quality in all patients. The sleep improvement of the 2 groups was evaluated, and the patient was assessed for anxiety and depression, and the curative efficacy was evaluated. RESULTS: After 2 weeks of nursing, the PSQI of the patients improved significantly. The PSQI of the observation group was only 6.6 ± 2.4, and the control group decreased to 9.9 ± 2.7. The observation group was better than the control group, and the difference was statistically significant(P < 0.05). Comparing the 2 groups, the anxiety score of the observation group decreased to 4.8 ± 1.6, which was significantly lower than that of 6.9 ± 2.2 in the control group. The depression score of the observation group decreased to 4.6 ± 1.3, which was significantly lower than that of 6.8 ± 2.3 in the control group. In the control group, the negative emotion scores after nursing were better than those before nursing, and the difference was statistically significant(P < 0.05). Comparing the 2 groups, the effective rate of sleep improvement in the observation group was 96.6%, and the cure rate was as high as 49.1%. The control group was 82.0%, and the cure rate was 18.0%. The observation group was better than the control group, and the difference was statistically significant(P < 0.05). CONCLUSION: The combination of TCM five-element music with acupoint application can improve the perioperative sleep quality of patients undergoing joint replacement surgery, and it can help patients to relieve negative emotions. It is worth promoting.

Arthroscopic Minimally Invasive Surgery for Knee Joint Gouty Arthritis

Objective:To analyse the efficacy of arthroscopic minimally invasive surgery in patients with knee joint gouty arthritis.Methods:A retrospective analysis method was carried out on randomly selected 56 patients with knee gouty arthritis from early July 2018 to the end of June 2019.All patients underwent arthroscopic minimally invasive surgery.Results:In this study,the patients were followed for 10 months.The Lysholm score of knee function was found to be significantly higher after treatment compared to the scores before treatment(P<0.05).Conclusion:Arthroscopic minimally invasive surgery is a promising method to treat for knee joint gouty arthritis.

Effect of orthognathic surgery on temporomandibular joint

AIM:To investigate the effect of temporomandibular joint position and remolding process and the signs and symptoms of temporomandibular joint in patients undergoing orthognathic surgery.METHODS:The standard Schuller’s position radiographs were used to examine the position temporomandibular joint form and condylar position change of 32 case after orthognathic surgery.Helkimo index was used to analyze the anamnestic and clinical data.RESULTS:Changes of condylar position had happened after the operation, but within one year the conlylar had resumed the same position as the preoperative.The change of temporomandibular joint symptoms and signs after orthognathic surgery was not significant.CONCLUSION:The effect of orthognathic surgery on the condylar position and TMJ form is not significant,and most of the changes are within the normal adaptability of temporomandibular joint.

颞下颌关节盘复位锚固术不同入路及前附着松解方式的临床效果比较

目的 探讨不同手术方案行颞下颌关节盘复位锚固术的治疗效果,为优化此术式提供参考。方法 本研究通过医院伦理委员会批准。对颞下颌关节盘复位锚固术的患者173例(195侧关节)进行回顾性分析,根据手术方案不同分为A组(传统耳前切口-手术刀/组织剪刀松解)35例(40侧关节)、B组(传统耳前切口-等离子双极射频电极松解)42例(46侧关节)、C组(改良耳屏切口-手术刀/组织剪刀松解)50例(58侧关节)、D组(改良耳屏切口-等离子双极射频电极松解)46例(51侧关节)。术后随访6个月,比较术后1、3、6个月各组组内及组间患者的最大张口度(maximum mouth opening,MMO)差异,各组组内及组间疼痛模拟视觉评分(visual analogue scale,VAS)差异,组间关节盘复位有效率及耳前麻木、明显瘢痕发生率。结果 术后4组患者MMO均经历较术前缩小再逐渐增大过程,术后1个月复诊时等离子双极射频松解(B+D)组较手术刀/组织剪刀松解(A+C)组对患者MMO影响更小(P <0.05);4组患者术后VAS均较术前逐渐降低,其中(B+D)组患者术后1个月VAS显著低于(A+C)组(P <0.05);术后6个月4组关节盘复位有效率均高于95%,组间对比无差异(P> 0.05);改良耳屏切口(C+D)组患者较传统耳前切口(A+B)组患者耳前麻木发生率更低(4.59%vs. 12.79%,P <0.05)。(C+D)组患者明显瘢痕发生率也显著低于(A+B)组(3.67%vs. 23.26%,P <0.05)。结论 改良耳屏切口在耳颞神经保护方面优于传统耳前切口,瘢痕隐蔽。等离子双极射频电极在张口度恢复、疼痛控制等方面优于手术刀/组织剪刀。对于颞下颌关节盘复位锚固术,改良耳屏切口联合等离子双极射频电极松解关节盘前附着可作为推荐的手术方案。

关节镜下微创手术治疗老年踝关节骨折对临床指标与踝关节功能的影响分析

目的研讨关节镜下微创手术的应用价值,评估该措施在老年踝关节骨折治疗中的实施效果,分析其对临床指标与踝关节功能的影响,旨在指导后续治疗。方法选取2022年7月至2024年7月寿光市人民医院老年踝关节骨折患者80例作为此次分析对象,通过随机数字表法确立组别,对照组实施切开复位内固定术,n=40;研究组实施关节镜下微创手术治疗,n=40。对两组临床指标、踝关节功能、炎性因子、并发症发生率、治疗有效率进行对比。结果研究组术后3个月踝关节功能评分高,手术、骨折愈合、术后住院时间均较短,手术出血量低,上述各指标均与对照组相比有统计学意义(P<0.05);研究组术后3 d的炎性因子水平均低于对照组(P<0.05);研究组并发症发生例数占比均低于对照组(P<0.05);与对照组治疗有效率对比,结果显示研究组数据更高(P<0.05)。结论关节镜下微创手术治疗的实施效果显著,可以帮助患者改善踝关节功能,提升疾病治疗效果,缩短手术、骨折愈合及住院时间,对炎性因子的抑制效果好,且并发症发生率较低,利于疾病转归。

3D打印技术辅助前交叉韧带重建治疗前交叉韧带断裂的研究

目的探讨关节镜下前交叉韧带(ACL)重建术治疗ACL断裂使用3D打印技术的辅助效果。方法选择2021年1月至2023年12月洛阳市孟津区中医院收治的102例ACL断裂患者,按照随机数字表分为3D打印组(n=51)和对照组(n=51)。对照组患者实施常规关节镜下ACL重建术治疗,3D打印组行关节镜下3D打印技术辅助ACL重建术治疗。对比围术期指标、膝关节功能[国际膝关节主观功能评分(IKDC)、膝关节Lysholms评分]、膝关节活动范围、并发症。结果比较两组股骨骨隧道长度、住院时间,差异无统计学意义(P>0.05);相比于对照组,3D打印组手术时间短,差异有统计学意义(P<0.05);两组术后Lysholms评分、IKDC评分均高于术前,而3D打印组IKDC评分为(96.32±7.26)分、Lysholms评分为(94.25±3.85)分,高于对照组的(82.66±6.54)分、(88.20±8.25)分,差异有统计学意义(P<0.05);术后两组膝关节活动度均高于术前,而3D打印组膝关节活动度为(119.25±7.66)°,高于对照组的(98.66±8.22)°,差异有统计学意义(P<0.05);两组术后均无移植物断裂、移植物撞击、感染、深静脉血栓等并发症发生。结论关节镜下3D打印技术辅助ACL重建术治疗ACL断裂可缩短手术用时,改善患者膝关节活动度、膝关节功能,缩短住院时间,安全性较高。

基于阶段变化理论的健康教育对外科患者术后并发症及生活质量的影响研究

目的:研究基于阶段变化理论的健康教育对外科患者术后的影响。方法:选择2021年6月—2022年6月于赣州市于都县第二人民医院行髋关节置换术的60例患者作为研究对象,按随机数表法将其分为研究组和对照组,每组各30例。对照组患者采用传统健康教育,研究组患者采取基于阶段变化理论的健康教育,比较两组患者疾病知识掌握度、自护能力、依从性、生活质量综合评定问卷(GQOLI-74)、并发症情况。结果:研究组患者掌握度高于对照组,差异有统计学意义(χ^(2)=5.455,P<0.05)。干预后,研究组患者健康知识、自我护理技能、自我护理责任、自我概念评分均高于对照组,差异均有统计学意义(t=13.383、9.424、6.974、5.812,P<0.05)。研究组患者的遵医用药、功能锻炼、健康饮食、定期复查的依从性评分均高于对照组,差异均有统计学意义(t=3.055、2.671、5.302、5.003,P<0.05)。干预后,研究组患者GQOLI-74各项评分均高于对照组,差异均有统计学意义(t=14.208、12.000、15.195、11.603,P<0.05)。研究组患者并发症发生率低于对照组,差异有统计学意义(χ^(2)=4.320,P<0.05)。结论:基于阶段变化理论的健康教育不仅能够提升患者对疾病知识的掌握度,还可改善自我护理能力,使其依从性明显增加,提升患者生活质量,并发症较少。

多维度护理在全髋关节置换术患者中的应用效果分析

目的:分析多维度护理在全髋关节置换术患者中的应用效果。方法:将2021年1月—2024年4月于南京市红十字医院实施全髋关节置换术治疗的患者62例随机分为观察组(n=31,实施多维度护理)和对照组(n=31,实施常规护理)。对比两组护理效果。结果:观察组并发症总发生率低于对照组(P<0.05)。干预后,两组疼痛、关节畸形评分下降,日常活动与步态、关节活动评分升高,且观察组改善幅度大于对照组(P<0.05)。干预后,两组健康状态、身体功能、社会功能、心理健康评分及总分升高,且观察组高于对照组(P<0.05)。观察组护理态度、健康宣教、心理护理、护理操作、护理质量评分高于对照组(P<0.05)。结论:对全髋关节置换术患者实施多维度护理应用效果较好,能够降低并发症发生率,改善患者髋关节功能和生活质量,提高护理满意度。

虚拟手术系统联合个体化导航模板在复杂胫骨平台骨折中的应用

目的 分析虚拟手术系统联合个体化导航模板在复杂胫骨平台骨折(TPF)中的应用效果。方法 选取2021年5月至2022年12月我院收治的60例复杂TPF患者,随机分为对照组和观察组,每组30例。2组均行切开复位钢板内固定治疗,对照组患者采用传统手术计划方案治疗,观察组患者采用虚拟手术系统联合个体化导航模板的手术计划方案治疗。比较2组患者骨折复位优良率、手术相关指标、膝关节活动度、膝关节功能、并发症发生率。结果 与对照组比较,观察组患者出血量、术中C型臂透视次数减少(P<0.05),住院时间、骨折愈合时间及手术时间缩短(P<0.05);观察组患者骨折复位优良率高于对照组(P<0.05);与对照组比较,观察组患者术后3个月、6个月膝关节屈曲度、伸展度较大(P<0.05);观察组患者术后3个月、6个月的膝关节协会评分标准(KSS)、纽约特种外科医院(HSS)评分高于对照组(P<0.05);观察组患者并发症发生率低于对照组(P<0.05)。结论 复杂TPF患者切开复位钢板内固定治疗中采用虚拟手术系统联合个体化导航模板能明显提高手术效率,减少手术创伤及并发症,促进患者术后康复,提高骨折复位质量,改善预后。

ACTED康复护理模式在膝关节置换术病人术后快速康复中的应用效果

目的:探讨ACTED康复护理模式对膝关节置换术病人术后快速康复的效果。方法:2022年9月—2023年9月选取徐州医科大学附属医院骨关节外科的92例膝关节置换术病人为研究对象,采用随机数字表将病人分为干预组及对照组,每组46例。对照组行围术期常规康复护理,干预组行基于ACTED的康复护理模式,比较两组干预前后功能锻炼自我效能、功能锻炼依从性及康复效果。结果:干预后干预组功能锻炼自我效能及功能锻炼依从性评分、美国膝关节综合评分标准(AKS)评分、牛津膝关节评分(OKS)、膝关节活动度(ROM)、日常生活活动能力(ADL)评分、康复满意率高于对照组,疼痛视觉模拟(VAS)评分、并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论:ACTED康复护理模式可提升膝关节置换术病人术后功能锻炼自我效能及锻炼依从性,有效预防相关并发症,改善病人膝关节功能,提升病人日常生活能力及康复满意度。

Sternoclavicular joint dislocation and its management: A review of the literature

Dislocations of the sternoclavicular joint(SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as x-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed.

Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty

To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score(CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score.

Sacroiliac joint stability: Finite element analysis of implant number, orientation, and superior implant length

AIM To analyze how various implants placement variables affect sacroiliac(SI) joint range of motion. METHODS An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the SI joint using various placement configurations of triangular implants(iF use Implant System~?). Placement configurations were varied by changing implant orientation, superior implant length, and number of implants. The range of motion of the SI joint was calculated using a constant moment of 10 N-m with a follower load of 400 N. The changes in motion were compared between the treatment groups to assess how the different variables affected the overall motion of the SI joint. RESULTS Transarticular placement of 3 implants with superior implants that end in the middle of the sacrum resulted in the greatest reduction in range of motion(flexion/extension = 73%, lateral bending = 42%, axial rotation = 72%). The range of motions of the SI joints were reduced with use of transarticular orientation(9%-18%) when compared with an inline orientation. The use of a superior implant that ended mid-sacrum resulted in median reductions of(8%-14%) when compared with a superior implant that ended in the middle of the ala. Reducing the number of implants, resulted in increased SI joint range of motions for the 1 and 2 implant models of 29%-133% and 2%-39%, respectively,when compared with the 3 implant model.CONCLUSION Using a validated finite element model we demonstrated that placement of 3 implants across the SI joint using a transarticular orientation with superior implant reaching the sacral midline resulted in the most stable construct. Additional clinical studies may be required to confirm these results.

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.

Jumbo cup in hip joint renovation may cause the center of rotation to increase

BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects.However,with the use of the jumbo cup,the center of the hip joint may become elevated relative to the primary acetabulum,and the diameter of the large cup is greater.AIM To study the height and the significance of the elevation of the hip joint center.METHODS Eighty-eight patients matched the criteria for this condition and were included in the study.The center height of the hip joint was measured relative to the opposite normal hip joint.The diameter of the jumbo cup was measured and checked according to operation notes,and the diameter of the jumbo cup was measured with a prosthesis label.Then,the horizontal and vertical centers of rotation were measured on the surgical side and opposite side.The average center height of the hip joint on the renovated side and the opposite side and the position of the hip cup relative to the teardrop were compared using a paired t-test.RESULTS Radiometric analysis showed that the average hip joint center was elevated by 7.6 mm.The rotational center height delta of the renovated hip was 7.6±5.6 mm,and there was an obvious difference between the two groups(P=0.00).The difference in horizontal distance was 0.5±5.1 mm(-11.5-14.0 mm),and there was no obvious difference between the two groups(P=0.38).According to the foreign standard,the rotational center height delta of the renovated hip was 7.5±6.2 mm,and there was a significant difference between the two groups(P=0.00).There was no obvious difference between the domestic and foreign standards(P>0.05)between the two groups.CONCLUSION The application of the jumbo cup elevates the rotational center of the hip joint,but it is feasible and effective to use the jumbo cup.

“Meniscal” scar as a landmark for the joint line in revision total knee replacement

AIM To determine whether tissue identified at the joint line was actually remnant "meniscal" scar tissue or not. METHODS Nine patients undergoing revision knee surgery following informed consent had meniscal scar tissue sent to the histology department for analyses. All revisions were performed where joint line had been raised or lowered at earlier surgery. Although preoperative radiographic evaluations suggested that the joint line had been altered, intraoperatively there was scar tissue at the level of the recreated joint line. This scar tissue has traditionally been described as meniscal scar, and to identify the origins of this tissue, samples were sent for histological analyses. The tissue samples were stored in formalin, and embedded and sectioned before undergoing histochemical staining. All samples underwent macroscopic and microscopic examination by a histopathologist who was blind to the study aims. The specific features that were examined included tissue organisation, surface and central composition, cellular distribution including histiocytes, nuclear ratio and vasculature. Atypical and malignant features, inflammation and degeneration were specifically looked for. A statistical review of the study was performed by a biomedical statistician.RESULTS The histological findings for the nine patients showingthe macroscopic and microscopic findings, and the conclusion are outlined in a Table. The histological analyses were reviewed to determine whether the tissue samples were likely to be meniscal scar tissue. The response was yes(2, 22%), no(6, 67%) and maybe(1,11%) based on the conclusions. The results were "yes"when on macroscopy, firm cream tissue was identified.In these two "yes" samples, microscopic analyses showed organised fibrous tissue with focal degenerative areas with laminated pattern associated with histiocytes peripherally but no inflammation. The "no" samples were assessed macroscopically and microscopically and were deemed to have appearances representing fibrous synovial tissue and features in keeping with degenerate scar tissue or connective tissue. One sample was indeterminate and microscopically contained fibrocollagenous tissue with synovial hyperplasia. It also contained some degenerate hyalinised tissue that may represent cartilage, but the appearances were not specific. CONCLUSION Based on our pilot study, we recommend reliance on a number of markers to identify the joint line as outlined above, and to exercise caution in using the "meniscal"scar.

Role of joint aspiration before re-implantation in patients with a cement spacer in place

BACKGROUND The usefulness of a mandatory joint aspiration before re-implantation in patients with a cement spacer already in place is unclear.AIM To evaluate the role of culturing synovial fluid obtained by joint aspiration before re-implantation in patients who underwent a two-stage septic revision.METHODS A retrospective observational study was conducted,including patients that underwent a two-stage septic revision(hip or knee)from 2010 to 2017.After the first stage revision and according to intraoperative culture results,all patients were treated with an antibiotic protocol for 6-8 wk.Following 2 wk without antibiotics,a culture of synovial fluid was obtained.The results of these cultures were recorded and compared with cultures obtained during re-implantation surgery.RESULTS Forty-one patients(20 hip and 21 knee spacers)were included in the final analysis.In 39 cases,the culture of synovial fluid was negative,while in the remaining 2 cases(knee spacers)no analysis was possible due to dry tap.In 5 of the patients,two or more intraoperative cultures taken during the re-implantation surgery were positive.CONCLUSION We found no evidence to support mandatory joint aspiration before re-implantation in patients with a cement spacer in place.

Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coexists with the patient’s orthopedic conditions. The systemic effects and associated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.