Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 7 Articles
Background: The purpose of the current study was to examine the effect of a non-invasive, home-based\nbiomechanical treatment program for patients with spontaneous osteonecrosis of the knee (SONK).\nMethods: Seventeen patients with SONK, confirmed by MRI, participated in this retrospective analysis. Patients\nunderwent a spatiotemporal gait analysis and completed the Western Ontario and McMaster University Osteoarthritis\nIndex (WOMAC) and the Short-Form-36 (SF-36). Following an initial assessment, patients commenced the\nbiomechanical treatment (AposTherapy). All patients were reassessed after 3 and 6 months of treatment.\nResults: A significant reduction in pain and improvement in function was seen after 3 months of therapy with\nadditional improvement after 6 months of therapy. Pain was reduced by 53% and functional limitation reduced\nby 43%. Furthermore, a significant improvement was also found in the SF-36 subscales, including the summary\nof physical and mental scores. Significant improvements were found in most of the gait parameters including a\n41% increase in gait velocity and a 22% increase in step length. Patients also demonstrated improvement in\nlimb symmetry, especially by increasing the single limb support of the involved limb.\nConclusions: Applying this therapy allowed patients to be active, while walking more symmetrically and with\nless pain. With time, the natural course of the disease alongside the activity of the patients with the unique\nbiomechanical device led to a significant reduction in pain and improved gait patterns. Therefore, we believe\nAposTherapy should be considered as a treatment option for patients with SONK....
Background: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to\nevaluate the effect of combined femoral and sciatic nerve block (SNB) versus femoral and local infiltration\nanesthesia (LIA) after total knee arthroplasty (TKA).\nMethods: The electronic databases PubMed, Embase, Cochrane Library, and Web of Science were searched from their\ninception to 15 June 2016. Articles comparing combined femoral and SNB versus femoral and LIA for pain control were\neligible for this meta-analysis. This systematic review and meta-analysis was performed according to the PRISMA\nstatement criteria. The primary endpoint was the visual analogue scale (VAS) score with rest at 12, 24, and 48 h, which\nrepresents the pain control after TKA. Data regarding active knee flexion, length of hospital stay, anesthesia time, and\nmorphine use at 24 and 48 h were also compiled. The complications of postoperative nausea and vomiting (PONV)\nand fall were also noted to assess the safety of morphine-sparing effects. After testing for publication bias and\nheterogeneity across studies, the data were aggregated for random-effects modeling when necessary.\nResults: Seven clinical trials with 615 patients were included in the meta-analysis. The pooled results indicated that\nSNB was associated with a lower VAS score at 12 h (MD = âË?â??6.96; 95% CI âË?â??8.36 to âË?â??5.56; P < 0.001) and 48 h (MD = âË?â??2.\n41; 95% CI âË?â??3.90 to âË?â??0.91; P < 0.001) after TKA. There was no significant difference between the SNB group and the LIA\ngroup in terms of the VAS score at 24 h (MD = 0.67; 95% CI âË?â??0.31 to 1.66; P = 0.182). The anesthesia time in the LIA\ngroup was shorter than in the SNB group, and the difference was statistically significant (MD = 4.31, 95% CI 1.34 to 7.28,\nP = 0.004). There were no significant differences between the groups in terms of active knee flexion, length of hospital\nstay, morphine use, PONV, and the occurrence of falls.\nConclusions: SNB may provide earlier anesthesia effects than LIA when combined femoral nerve block (FNB); however,\nthere were no differences in morphine use, active knee flexion, and PONV between the groups. The LIA group spent\nless time under anesthesia, suggesting that LIA may offer a practical and potentially safer alternative to SNB....
Osteoarthritis (OA) is a type of chronic joint disease that is characterized by the degeneration and loss of articular cartilage\nand hyperplasia of the synovium and subchondral bone. There is reasonable knowledge about articular cartilage physiology,\nbiochemistry, and chondrocyte metabolism. However, the etiology and pathogenesis of OA remain unclear and need urgent\nclarification to guide the early diagnosis and treatment of OA. Extracellular vesicles (EVs) are small membrane-linking particles\nthat are released from cells. In recent decades, several special biological properties have been found in EV, especially in terms of\ncartilage. Autophagy plays a critical role in the regulation of cellular homeostasis. Likewise, more and more research has gradually\nfocused on the effect of autophagy on chondrocyte proliferation and function in OA. The synthesis and release of EV are closely\nassociated with autophagy. At the same time, both EV and autophagy play a role in OA development. Based on the mechanism of\nEV and autophagy in OA development, EV may be beneficial in the early diagnosis of OA; on the other hand, the combination of\nEV and autophagy-related regulatory drugs may provide insight into possible OA therapeutic strategies....
Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability.\nHypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury\nreduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls\ntreatedwithprimaryACL reconstructionundcontrols treatednonsurgicallywith functional rehabilitation.Measurements included\nanterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24\nmonths. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable\nto patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk\n(secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were\nsimilar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee\nlaxity compared to nonsurgical treatment with functional rehabilitation....
Knee dislocation is a serious and rare injury. Its rarity and the variety of injuries that\nresult from it mean that there is no adequate management that is universally accepted.\nThe aim of this study was to evaluate our emergency care strategy for these\ninjuries. Materials and methodology: This was a retrospective study conducted from\nJanuary 1992 to December 2004 on nine cases of knee dislocation. It consisted of six\nmen and three women. The average age of these subjects was 35, ranging from 15\nto 50 years. The causes for these injuries included: public road accidents (n = 4),\nhousehold accidents (n = 3), a sporting accident and a dislocation that occurred following\na fight. The dislocations were anteromedial (n = 4), posterolateral (n = 2),\nposterior (n = 2) and anterior (n = 1). Associated injuries were sore joint (n = 2),\ncontusion of the common peroneal nerve (n = 1) and vascular injury (n = 1). An angiography\nwas performed on one patient for a vascular injury and an Elecmyography\n(EMG) for a common peroneal nerve injury. Closed reduction was used for eight patients\nand open reduction for one patient. Results: Five knees were stable with normal\nrange of motion and some residual pain. Four patients had knee instability; two\nanterior, one anteroposterior and one lateral. In three of these patients, the CT arthrography/\narthro-scan confirmed central pivot damage, with meniscal damage in two\nof them. The four patients were referred to a knee surgeon in a private practice. The\npost-operational effects were minimal in vascular injury. The EMG performed for\nthe common peroneal nerve detected a nerve contusion. Conclusion: Our emergency\ncare strategy remains closed reduction. This therapeutic management is consistent,\nat least in the first 15 days, with the literature....
Background: Total knee arthroplasty is effective to regain quality of life. Standing up from and sitting down\non a chair and stair stepping motion are important in daily living. We previously reported in vivo kinematics\nof this implant during a stepping exercise. The purpose of this analysis was to assess in vivo knee motion\nduring standing up from and sitting down on a chair and determine the motion pattern in patients with\nthe unique knee prosthesis.\nMethods: A total of 15 patients implanted with Bi-Surface PS were assessed during standing up from and\nsitting down on a chair. The Bi-Surface PS knee is a posterior-cruciate substitute prosthesis with a unique\nball-and-socket joint in the mid-posterior portion of the femoral and tibial components. Patients were\nexamined during standing up from and sitting down on a chair using a two-dimensional to three-dimensional\nregistration technique.\nResults: During standing up from and sitting down on a chair from minimum to 30�° knee flexion, anterior\nfemoral translation was slight. From 30�° knee flexion to maximum flexion, the kinematic pattern was a medial\npivot and rollback.\nConclusions: This study demonstrated that the knee motion kinematic patterns observed in this study were\nnot similar to normal knee kinematics and derived from the unique design of the Bi-Surface PS....
Background.Urinary tract infections (UTIs) are the most common minor complication following total joint arthroplasty (TJA) with\nincidence as high as 3.26%. Bladder catheterization is routinely used during TJAand theCenters forMedicare andMedicaid Services\n(CMS) has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation\nseeks to identify specific risk factors for UTI in TJA patients. Methods. We retrospectively studied patients undergoing TJA for\nosteoarthritis between 2006 and 2013 in the American College of Surgeonââ?¬â?¢s National Surgical Improvement Program Database\n(ACS-NSQIP). A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics,\ncomorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI.\nResults. 1,239 (1.1%) of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are\nindependently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.6ââ?¬â??2.7), chronic steroid use (OR 2.0, 95% CI 1.2ââ?¬â??3.2),\nages 60ââ?¬â??69 (OR 1.5, 95% CI 1.0ââ?¬â??2.1), 70ââ?¬â??79 (OR 2.0, 95% CI 1.4ââ?¬â??2.9), and ââ?°Â¥80 (OR 2.3, 95% CI 1.5ââ?¬â??3.6), ASA Classes 3ââ?¬â??5 (OR 1.5,\n95% CI 1.2ââ?¬â??1.9), preoperative creatinine >1.35 (OR 1.8, 95% CI 1.3ââ?¬â??2.6), and operation time greater than 130 minutes (OR 1.8, 95% CI\n1.3ââ?¬â??2.4). Conclusions. In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables\nincluding female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should\nbe aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement....
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