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.

Experimental study on the irreversible displacement evolution and energy dissipation characteristics of disturbance instability of regular joints

To investigate the disturbance-induced shear instability mechanism of structural catastrophe in the deep rock mass,MTS 815 material testing machine was used to carry out quasi-static loading tests and disturbance shear tests on symmetrical regular dentate joints of two materials at three undulation angles under specific initial static stress,disturbance frequency,and peak value.The test results indicate that:(i)the total ultimate instability displacement is only related to the intrinsic properties of the joints but not to the initial static stress and disturbance parameters;(ii)the cumulative irreversible displacement required for the disturbance instability conforms to the logistic inverse function relationship with the number of disturbances,displaying the variation trend of“rapid increase in the front,stable in the middle,and sudden increase in the rear”;(iii)the accumulation of plastic deformation energy is consistent with the evolution law of irreversible displacement of joints and the overall proportion of hysteretic energy is not large;(iv)the dissipated energy required for the instability of each group of joints is basically the same under various disturbance conditions,and this energy is mainly controlled by the initial shear stress and has no connection with the disturbance parameters.The stability of the total disturbance deformation and the disturbance energy law of the joints revealed in the tests provide data support for reasonably determining the disturbance instability criterion of joints.

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.

Bunch-length measurement at a bunch-by-bunch rate based on time–frequency-domain joint analysis techniques and its application

This paper presents a new technique for measuring the bunch length of a high-energy electron beam at a bunch-by-bunch rate in storage rings.This technique uses the time–frequency-domain joint analysis of the bunch signal to obtain bunch-by-bunch and turn-by-turn longitudinal parameters,such as bunch length and synchronous phase.The bunch signal is obtained using a button electrode with a bandwidth of several gigahertz.The data acquisition device was a high-speed digital oscilloscope with a sampling rate of more than 10 GS/s,and the single-shot sampling data buffer covered thousands of turns.The bunch-length and synchronous phase information were extracted via offline calculations using Python scripts.The calibration coefficient of the system was determined using a commercial streak camera.Moreover,this technique was tested on two different storage rings and successfully captured various longitudinal transient processes during the harmonic cavity debugging process at the Shanghai Synchrotron Radiation Facility(SSRF),and longitudinal instabilities were observed during the single-bunch accumulation process at Hefei Light Source(HLS).For Gaussian-distribution bunches,the uncertainty of the bunch phase obtained using this technique was better than 0.2 ps,and the bunch-length uncertainty was better than 1 ps.The dynamic range exceeded 10 ms.This technology is a powerful and versatile beam diagnostic tool that can be conveniently deployed in high-energy electron storage rings.

Atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability

Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were

不同类型贴布对慢性踝关节不稳患者行走时踝关节运动学的影响

背景:慢性踝关节不稳患者行走时倾向于过度足内翻,这将增加步行周期支撑相踝关节扭伤的风险。临床医生常使用肌内效贴布或运动贴布进行踝关节贴扎。由于肌内效贴布具有弹性,而运动贴布无法拉伸,因此两者技术应用和生理机制存在差异,进而可能产生不同的康复疗效。目的:对比肌内效贴布和运动贴布干预对慢性踝关节不稳患者步行支撑相足额状面和胫骨水平面运动的影响。方法:40名慢性踝关节不稳患者随机分为肌内效贴布组和运动贴布组,肌内效贴布组从后足内侧向外侧粘贴2条贴布,以产生外翻拉力;运动贴布组采用踝关节闭锁式编篮贴扎。分别于贴扎前后在电动跑台上进行行走测试,利用三维运动分析系统获取受试者足部和胫骨运动学参数。结果与结论:肌内效贴布组贴扎后于支撑相早期足外翻角度增加(P<0.05),但对支撑相晚期足的位置无影响(P>0.05);运动贴布组贴扎后于支撑相晚期胫骨内旋增加(P<0.05),而支撑相早期胫骨位置无明显改变(P>0.05)。结果表明:与运动贴布相比,肌内效贴布能够提供灵活的拉力,有利于步态周期中支撑相早期足外翻,同时不限制支撑相晚期的正常足内翻。因此,肌内效贴布可能是慢性踝关节不稳患者的实用康复疗法,在纠正踝关节异常运动的同时不限制其自然运动。

Recurrent anterior shoulder instability: Review of the literature and current concepts

The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.

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.

Chronic ankle instability is associated with proprioception deficits:A systematic review and meta-analysis

Background:Acute ankle injury causes damage to joint mechanoreceptors and deafferentation and contributes to proprioception deficits in patients with chronic ankle instability(CAI).We aimed to explore whether deficits of proprioception,including kinesthesia and joint position sense(JPS),exist in patients with CAI when compared with the uninjured contralateral side and healthy people.We hypothesized that proprioception deficits did exist in patients with CAI and that the deficits varied by test methodologies.Methods:The study was a systematic review and meta-analysis.We identified studies that compared kinesthesia or JPS in patients with CAI with the uninjured contralateral side or with healthy controls.Meta-analyses were conducted for the studies with similar test procedures,and narrative syntheses were undertaken for the rest.Results:A total of 7731 studies were identified,of which 30 were included for review.A total of 21 studies were eligible for meta-analysis.Compared with the contralateral side,patients with CAI had ankle kinesthesia deficits in inversion and plantarflexion,with a standardized mean difference(SMD)of 0.41 and 0.92,respectively,and active and passive JPS deficits in inversion(SMD=0.92 and 0.72,respectively).Compared with healthy people,patients with CAI had ankle kinesthesia deficits in inversion and eversion(SMD=0.64 and 0.76,respectively),and active JPS deficits in inversion and eversion(SMD=1.00 and 4.82,respectively).Proprioception deficits in the knee and shoulder of patients with CAI were not statistically significant.Conclusion:Proprioception,including both kinesthesia and JPS,of the injured ankle of patients with CAI was impaired,compared with the uninjured contralateral limbs and healthy people.Proprioception varied depending on different movement directions and test methodologies.The use of more detailed measurements of proprioception and interventions for restoring the deficits are recommended in the clinical management of CAI.

Magnetic resonance imaging in glenohumeral instability

The glenohumeral joint is the most commonly dislocated joint of the body and anterior instability is the most common type of shoulder instability.Magnetic resonance (MR) imaging,and more recently,MR arthrography,have become the essential investigation modalities of glenohumeral instability,especially for pre-procedure evaluation before arthroscopic surgery.Injuries associated with glenohumeral instability are variable,and can involve the bones,the labor-ligamentous components,or the rotator cuff.Anterior instability is associated with injuries of the anterior labrum and the anterior band of the inferior glenohumeral ligament,in the form of Bankart lesion and its variants;whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesion.Multidirectional instability often has no labral pathology on imaging but shows specific osseous changes such as increased chondrolabral retroversion.This article reviews the relevant anatomy in brief,the MR imaging technique and the arthrographic technique,and describes the MR findings in each type of instability as well as common imaging pitfalls.

Advances in the treatment of cervical rheumatoid: Less surgery and less morbidity

Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine.While it was initially thought that cervical involvement was innocuous,natural history studies have substantiated the progressive nature of untreated disease.Over the past 50 years,there has been further elucidation in the pathophysiology of the disease,as well as significant advancements in medical and surgical therapy.The introduction of disease modifying drugs and biologic agents has reduced the amount of patients with advanced stages of the disease needing surgery.Advancement in instrumentation techniques has improved patient outcomes and fusion rates.The introduction of endoscopic approaches for ventral decompression may further lower surgical morbidity.In this review,we give a brief overview of the pertinent positives of the disease.A discussion of historical techniques and the evolution of surgical therapy into the modern era is provided.With improved medical therapies and lessinvasive approaches,we will likely continue to see less advanced cases of disease and less surgical morbidity.Nonetheless,a thorough understanding of the disease is crucial,as its systemic involvement and need for continued medical therapy have tremendous impact on overall complications and outcomes even in patients being seen for standard degenerative disease with comorbid rheumatoid.

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.

Common surgical complications in degenerative spinal surgery

The rapid growth of spine degenerative surgery has led to unrelenting efforts to define and prevent possible complications, the incidence of which is probably higher than that reported and varies according to the region of the spine involved(cervical and thoracolumbar) and the severity of the surgery. Several issues are becoming progressively clearer, such as complication rates in primary versus revision spinal surgery, complications in the elderly, the contribution of minimally invasive surgery to the reduction of complication rate. In this paper the most common surgical complications in degenerative spinal surgery are outlined and discussed.

Corticospinal activity during a single-leg stance in people with chronic ankle instability

Purpose:The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability(CAI),lateral ankle sprain copers,and healthy controls.Methods:Twenty-three participants with CAI,23 lateral ankle sprain copers,and 24 healthy control participants volunteered.Active motor threshold(AMT),normalized motor-evoked potential(MEP),and cortical silent period(CSP)were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task.Results:Participants with CAI had significantly longer CSP at 100%of AMT and lower normalized MEP at 120%of AMT compared to lateral ankle sprain copers(CSP100%:p=0.003;MEP120%:p=0.044)and controls(CSP100%:p=0.041;MEP120%:p=0.006).Conclusion:This investigation demonstrate altered corticospinal excitability and inhibition of the tibialis anterior during single-leg standing in participants with CAI.Further research is needed to examine the effects of corticospinal maladaptations to motor control of the tibial anterior on postural control performance in those with CAI.

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.