Dislocation of primary total hip arthroplasty:Analysis of risk factors and preventive options

Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.

Myelopathy as a Presentation of Cervical Spine Metastasis: A Case Report

Cervical myelopathy is a consequence of spinal cord compression in the cervical spine. Degenerative cervical spondylosis, osteophytes, discosteophyte complex, degenerative spondylolisthesis and hypertrophy of ligamentum flavum are the main etiologies of cervical myelopathy. Metastasis to cervical spine could be a rare cause of cervical myelopathy. The present study is a case report;presented a 36-year-old male with severe pain in cervical region, gait disability and impairment in sensory and motor function of upper left extremity. The patient had a history of thyroidectomy and cervical lymph node dissection due to follicular thyroid carcinoma (FTC) with improper follow-ups. He was diagnosed with metastatic cervical myelopathy and underwent surgical treatment. Cervical myelopathy due to metastasis is a rare condition and only few cases have been reported so far. So myelopathies can be a complication of metastatic cancers, and it should be considered by health professionals.

Tendon injuries of the hand

Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients.Most injuries are open injuries to the flexor or extensor tendons,but less frequent injuries,e.g.,damage to the functional system tendon sheath and pulley or dull avulsions,also need to be considered.After clinical examination,ultrasound and magnetic resonance imaging have proved to be important diagnostic tools.Tendon injuries mostly require surgical repair,dull avulsions of the distal phalanges extensor tendon can receive conservative therapy.Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair.In the postoperative course offlexor tendon injuries,the principle of early passive movement is important to trigger an"intrinsic"tendon healing to guarantee a good outcome.Many substances were evaluated to see if they improved tendon healing;however,little evidence was found.Nevertheless,hyaluronic acid may improve intrinsic tendon healing.

Estimate of the lower-limb-specific muscle parameters during bipedal walking for humans,apes and early hominids with the implications for the evolution of body proportion

Modern human has different body proportion from early hominids and great apes.Comparing with others,in general,modern human adults have relatively long lower limb and heavier body weight.Since the lower limbs provide support to the whole body and play an important role in walking,it is proposed that the ratio of the lower limb to the whole body for modern human could be beneficial to bipedal walking.This study tried to estimate the muscle parameters of the lower limb in walking for the subjects with various body proportions.Using a simplified musculoskeletal model,some muscle parameters of the lower limb,e.g.muscle force,stress,work and power,were estimated for modern human adult,child,AL 288-1(the fossil specimens of Australopithecus afarensis,3.18 million years old)and apes.The results show that with the body proportion modern human adult spends less muscle work and power in walking than other subjects.The results imply that using the cost of transport(i.e.the muscle work of the lower limb per unit of displacement)as the criteria,the early hominids,if their body proportions were structurally similar to AL 288-1,could evolve towards what modern human adult looks like,in order to save energy during bipedal walking.

Prolotherapy in Musculoskeletal Disorders, Guideline for Orthopedic Application

Purpose: Prolotherapy is a therapeutic method that involves injecting an irritant substance into injured areas of tendons, ligaments, and articular spaces. It has a wide application in orthopedic fields, including arthritis, tendinopathies, and back pain. Protocol of injection varies extensively based on the pathological condition. This review aims to discuss orthopedic applications of prolotherapy and its related outcomes, intending to introduce more specific injection protocols in each field. Methods: In a narrative review of literature, various musculoskeletal indications and contraindications of prolotherapy, as well as the method and location of injection, solution type, procedure intervals and frequencies, outcomes and side effects are investigated to reveal all aspects of the current knowledge about this new approach. Results: Chronic back pain, osteoarthritis, and tendinopathies are considered the most common indications for prolotherapy. Protocol of injection varies from one condition to another. The actual concentration of administered dextrose ranges from 12.5% to 25%. Results of the different studies indicate that prolotherapy could have a pleasing effect on improving patient’s pain and functional outcomes. No severe complication has been mentioned in previous investigations. Conclusion: Prolotherapy is a new therapeutic option that can be suggested as an effective method in recalcitrant musculoskeletal conditions.

Knee Osteoarthritis Progression after Distal Femur Closing Wedge Osteotomy

Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.

Impact of medial open-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee

BACKGROUND Most populations worldwide,who are used to squatting and sitting cross-legged for their activities of daily living,largely comprise the lower socioeconomic strata,thus making them candidates for exclusion for total knee arthroplasty.Proximal/high tibial osteotomy(HTO)is a preferred strategy for clinically symptomatic osteoarthritis(OA)with genu varum due to painful medial compartment OA which is not amenable to conservative measures.AIM To evaluate the outcomes of medial open-wedge HTO along with autologous bone grafting and buttress plate for the treatment of genu varum due to OA of the knee in a rural population of central India.METHODS A total of 65 knees in 56 patients with a mean age of 58.22±5.63 years with genu varum due to intractable painful knee OA were treated with medial open-wedge HTO along with autologous bone grafting and buttress plate osteosynthesis from June 2015 to May 2018.The mean preoperative radiological angle of genu varum was 13.4°.Clinical outcomes were assessed by the range of movement,knee scores,pain scores,and functional scores.Radiographic studies were performed preoperatively and at regular intervals during the follow-up period.RESULTS All patients reported pain relief immediately after the osteotomy and during the long-term analysis covering between one to three years.The genu varum angle was overcorrected to approximately four degrees in all patients.There was a loss of reduction by approximately three degrees in all patients at around six weeks postoperatively.Preoperative knee movements were restored in all patients.No major perioperative complications were noted during surgery and postoperative follow-up and the clinical scores were significantly improved during the final analysis which revealed good pain relief.CONCLUSION Medial open-wedge HTO is a reliable,safe,practical,physiological,and feasible treatment for populations who are used to increased activity in their occupation and lifestyle and is associated with excellent short-term and long-term results for OA in genu varum knees.

Adverse Wear in MOM Hip-Arthroplasty Related to the Production of Metal Fragments at Impingement Sites

Metal on metal (MOM) bearings were reintroduced as resurfacing arthroplasty (RA) for the younger, more active patient and were later incorporated into total hip arthroplasty (THA). Early results were encouraging. However, recent publications identified adverse tissue responses to metal debris, such that the majority of MOM designs have been abandoned due to the increase in cobalt-chromium (CoCr) debris and associated metal ions. Reports of MOM THA cited risks that included acetabular cups with high-inclination angles, i.e. “edge-loading”, and “trunnionosis”. Hip impingement was also a cited risk in one MOM study, with “type-IV” wear noted to be a sliding/impaction type of wear, characterized by deep scratches. Sliding/impaction wear mechanisms produced at impingement are not well represented in current MOM literature. Therefore, our objective in this review was to consolidate evidence for impingement risks. We hypothesize that hip impingement and subluxation with metal-backed acetabular cups can trigger wear mechanisms that result in, 1) femoral-neck notching, 2) release of large metal particles, 3) production of uniquely large scratches, defined as “microgrooves” on heads and cups, 4) formation of “polar” and “basal” microgrooves precisely aligning with cup profiles during impingement, and 5) equatorial microgrooves relate to soft-tissue sites of impingement. Relevant risk scenarios were evaluated and included hip impingement in both sitting and standing postures, head subluxation, wear patterns defining in-vivo component positions, and evidence for circulating metal fragments. The study relied on mapping of wear patterns to deduce in-vivo positioning of devices and relied on surrogate femoral stems of the same brand to simulate neck-cup impingement. EOS imaging techniques were used to analyze functional-sitting and functional-standing postures and prove existence of hip impingement sites in patients. The study identified 8-risk scenarios for wear damage on MOM bearings. The microgrooves on femoral-heads crossing the main-wear area (polar) and non-wear regions (basal) aligned well with cuprim profiles at impingement sites. This may represent the first description of such large scratches (40 - 300 μm wide) we termed microgrooves, that formed on femoral heads at sites representative of prosthetic impingement. As an abrasive wear process, similar to the formation of femoral-neck notches, these would have been acquired over millions of gait cycles. The pitting and linear microgrooves crossing the non-wear areas of heads (basal) represented the ingress sites of circulating metal particles. Similar micro-grooves were evident in acetabular cups, also signifying 3rd-body abrasion by large metal particles. Hip impingement and head subluxation were implicated by the unequivocal evidence of 3rd-body abrasive wear as the triggering events producing large metal fragments. One caveat regarding retrieval studies is that such damage may be only representative of failed MOM devices. This study demonstrated that emerging technologies such as EOSTM x-ray analyses can reveal subtle changes in implant positioning using patient shifts in functional postures (sitting, standing, hyper-extension, etc.), and thereby assess impingement/subluxation risks in the clinical setting before failure occurs.

Method for assessing the similarity and distance between curves/trials and its applications in gait analysis

In clinical assessment or sports exercise,it is common that a subject is required to repeat a specific per- formance so that a stable movement pattern is obtained and analysed.In practice,however,the trials done by a sub- ject vary more or less,depending on the psychological or physical conditions.Some of the trials can be used as rep- resentatives of the stable movement pattern,and some not.Therefore,there is a demand for a new method to identify which trials/curves are similar.The traditional methods used to assess curve similarity are not perfectly suitable for the case where there are only a few of trials available.This study proposes a similarity-distance coefficient to assess the similarity of curves/trials.A group of designed curves are used to validate the coefficient.The results show that given joint kinematic data during gait as examples,the proposed coefficient can be used to quantitatively evaluate the similarity of trials,and thus find which trials would be representative (s) for the gait investigated.The proposed method could be applied in various situations where repeat movements have to be measured and analysed.

Distal femoral extension and shortening osteotomy as a part of multilevel surgery in children with cerebral palsy

Background:There are several reports describing an increase in anterior pelvic tilt after hamstring lengthening in children with cerebral palsy (CP).Distal femoral extension and shortening osteotomy (DFESO) is an alternative treatment for correction of flexed knee gait,but investigations analyzing outcome and influence on adjacent joint are few in the literature.The purpose of this study was to analyze the influence of DFESO on knee and pelvis in children with CP.Furthermore,it was of interest if an additional patellar tendon advancement (PA) influences outcome.Methods:In this retrospective study,31 limbs of 22 children (GMFCS Ⅰ-Ⅲ;mean age:12.1±3.1 years),who received DFESO were included and kinematic parameters (knee,pelvis) measured by 3-D-gait analysis were compared before and at least 1 year after surgery (mean follow-up period:15.6 months).Results:After surgery,during stance phase minimum knee flexion improved significantly by 20.5° (P<0.001) and mean anterior pelvic tilt increased by 4.0 degrees (P=0.045).In 16 limbs,the postoperative increase in maximum anterior pelvic tilt was more than 5°.Limbs who received an additional PA showed the biggest increase in anterior pelvic tilt.Conclusions:DFESO is an effective method for correction of flexed knee gait in children with CP.Furthermore,the results of this study indicate that DFESO may lead to an increase in anterior pelvic tilt,which may lead to a recurrence of flexed knee gait.In this context,PA seemed to aggravate the effect on the pelvis.

Stem cells sources for intervertebral disc regeneration

Intervertebral disc regeneration field is rapidly growing since disc disorders represent a major health problem in industrialized countries with very few possible treatments.Indeed, current available therapies are symptomatic, and surgical procedures consist in disc removal and spinal fusion, which is not immune to regardable concerns about possible comorbidities, cost-effectiveness, secondary risks and long-lasting outcomes. This review paper aims to share recent advances in stem cell therapy for the treatment of intervertebral disc degeneration. In literature the potential use of different adult stem cells for intervertebral disc regeneration has already been reported. Bone marrow mesenchymal stromal/stem cells, adipose tissue derived stem cells, synovial stem cells, muscle-derived stem cells, olfactory neural stem cells, induced pluripotent stem cells, hematopoietic stem cells, disc stem cells, and embryonic stem cells have been studied for this purpose either in vitro or in vivo. Moreover, several engineered carriers(e.g., hydrogels), characterized by full biocompatibility and prompt biodegradation, have been designed and combined with different stem cell types in order to optimize the local and controlled delivery of cellular substrates in situ. The paper overviews the literature discussing the current status of our knowledge of the different stem cells types used as a cell-based therapy for disc regeneration.

Male osteoporosis: A review

Osteoporosis in men is a heterogeneous disease that has received little attention.However,one third of worldwide hip fractures occur in the male population.This problem is more prevalent in people over70 years of age.The etiology can be idiopathic or secondary to hypogonadism,vitamin D deficiency and inadequate calcium intake,hormonal treatments for prostate cancer,use of toxic and every disease or drug use that alters bone metabolism.Risk factors such as a previous history of fragility fracture should be assessed for the diagnosis.However,risk factors in men are very heterogeneous.There are significant differences in the pharmacological treatment of osteoporosis between men and women fundamentally due to the level of evidence in published trials supporting each treatment.New treatments will offer new therapeutic prospects.The goal of this work is a revision of the present status knowledge about male osteoporosis.

Comparison of a new single-donor human fibrin adhesive with suture for posterior tibial nerve repair in rat： biomechanical resistance and functional analysis

血纤维蛋白粘合剂的 ObjectiveThe 使用在神经修理有一个宽广背景。当前，单个施主的血纤维蛋白粘合剂的非最优的物理性质限制了他们的用法。表演和修改血纤维蛋白胶水的物理特征在 rat.MethodsForty Wistar 老鼠的以后的胫骨的神经的修理从单个施主的人的血浆准备了的现在的实验研究被划分成 5 个组；在控制组，胫骨的神经是，完全， transected 和没有处理在四个试验性的组被做神经树桩被一缝术，三缝术，有血纤维蛋白胶水的一缝术和血纤维蛋白胶水分别地独自重新连接。在 8 星期后续期间，胫骨的函数索引每周被测量，粘合剂力量，发炎和疤形成在 study.ResultsNerve 树桩裂开率的结束被估计，粘合剂力量在所有试验性的组是类似的并且显著地不同于控制组(P&#xA0； <&#xA0； 0.05 ) 。在第八个后续星期末，一和三个缝术组的功能的恢复比血纤维蛋白胶水在被用于修理的组显著地高(P&#xA0； <&#xA0； 0.05 ) 。发炎和疤织物形成的数量在准备单个施主的血纤维蛋白粘合剂举办的所有 groups.ConclusionThe 学习结果表演之中是类似的能从长远的观点看提供要求的粘着性和抓住神经树桩的可接受的机械性质；然而，我们承认更多的研究被需要改进单个施主血纤维蛋白粘合剂修理的功能的结果。

Feet injuries in rock climbers

While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described.

Supernumerary brachioradialis-Anatomical variation with magnetic resonance imaging findings:A case report

BACKGROUND In this single case report study,we describe an anatomical variance of a brachioradialis muscle with two muscle bellies and two tendons with their common insertion on the suprastyloid crest of a distal radius.CASE SUMMARY After a self-mutilating forearm injury of a borderline personality patient,we observed the anatomical variation of brachioradialis tendon.After tendon repair and aftercare the muscle function recovered completely.Five months after surgery the forearm magnetic resonance imaging was done revealing a supernumerary brachioradialis muscle.CONCLUSION Anatomical variations of forearm muscles and tendons are not rare.The treating surgeons should be aware of their existence and anatomical relationships.