Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study.

OBJECTIVES: The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period. METHODS AND MATERIALS: Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits. RESULTS: There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner. CONCLUSIONS: After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.

Preoperative infection risk assessment in hip arthroplasty a matched-pair study of the reliability of 3 validated risk scales.

Peri-prosthetic infection (PJI) represents one of the most devastating complications of total hip arthroplasty (THA). The aim of this study is to assess the reliability of different PJI risk assessment scales between two matched pairs of THA groups. This study included 37 patients with PJI following THA performed between 2012 and 2020 (Group A). Each patient in this group was matched, based on sex, age, and follow-up duration, with a control patient who underwent the same surgical procedure without any septic complications (Group B) during the same period. Each patient's assessment included the American Society of Anesthesiologists (ASA) score and a retrospective evaluation using three different preoperative, specific PJI risk assessment scales: the International Consensus Meeting (ICM) Preoperative Risk Calculator for PJI, the Mayo PJI Risk Score, and the KLIC-score. The two groups were statistically compared using descriptive analyses, both for binomial data and numerical variables. Statistically significant higher values were observed in the preoperative ASA score and surgical time in Group A. Statistically different higher scores were determined only with the ICM risk calculator score in Group A. No significant differences were found using the KLIC score and Mayo score between the two groups. We emphasize the reliability of the ASA score as a nonspecific preoperative assessment scale for PJI. The ICM risk calculator was confirmed as a reliable, specific preoperative assessment scale for PJI, suggesting its routine adoption in THA clinical practice.

Femoral Neck Fractures in HIV-Positive Patients: Analysis of 10 Years Short-Term Post-operative Complications.

INTRODUCTION: Aging and effect of antiretroviral therapy on bone mass could increase the risk of femoral neck fractures (FNF) in HIV patient. The aim of this study was specifically to determine whether intracapsular FNF in HIV-positive patients are more prone to short-term post-operative complications than similar fractures occurring in HIV-negative patients. MATERIALS AND METHODS: A group of 25 HIV-positive patients with intracapsular FNF were enrolled and matched to HIV-negative patient with similar fractures according to gender, age, a modified Charlson Comorbidity Index (CCI), fracture classification, surgical treatment and time interval between fracture event and surgery. For each group, length of stay, surgical time, early clinical outcomes and short-term surgical and medical complications were compared to determine the impact on the early outcome. RESULTS: At the time of the fracture occurrence, 56% of HIV-positive patients were on antiretroviral therapy and 12% started with therapy in the perioperative period. At three months follow-up, there were no statistically significant differences between the two study groups in length of stay, Harris hip score and total number of early complications. However, a statistically significant increase in urinary tract infections and longer surgical time using hip sliding screw fixation were seen in the HIV-positive group. The poorest post-operative result was seen in a patient who failed to adequately adhere to the HIV therapy protocol. CONCLUSIONS: This study failed to show any statistically significant increase in short-term complications or worse clinical outcomes for intracapsular FNF in HIV-positive patients compared to HIV-negative patients to recommend their treatment in dedicated centres.

Timing of oral feeding changes in premature infants who underwent osteopathic manipulative treatment.

BACKGROUND: The delayed transition from gavage-to-nipple feeding is one of the most significant factors that may prolong hospital length of stay (LOS). Osteopathic manipulative treatment (OMT) has been demonstrated to be effective regarding LOS reduction, but no investigations have documented its clinical validity for attaining oral feeding. OBJECTIVES: To assess OMT utility regarding the timing of oral feeding in healthy preterm infants. DESIGN: Preliminary propensity score-matched retrospective cohort study. SETTING: Data were extrapolated from the neonatal intensive care unit (NICU) of Del Ponte Hospital in Varese, Italy, during the period between March 2012 and December 2013. INTERVENTIONS: Two propensity score-matched groups of healthy preterm infants aged 28+0 to 33+6 were compared, observing those supported with OMT until hospital discharge and control subjects. MAIN OUTCOME MEASURES: Days from birth to the attainment of oral feeding was the primary endpoint. Body weight, body length, head circumference and LOS were considered as secondary endpoints. RESULTS: Seventy premature infants were included in the study as the control group (n = 35; body weight (BW) = 1457.9 ± 316.2 g; gestational age (GA) = 31.5 ± 1.73 wk) and the osteopathic group (n = 35; BW = 1509.6 ± 250.8 g; GA = 31.8 ± 1.64 wk). The two groups had analogous characteristics at study entry. In this cohort, we observed a significant reduction in TOF (-5.00 days; p = 0.042) in the osteopathic group with a greater effect in very low birth weight infants. CONCLUSIONS: These data demonstrate the utility and potential efficacy of OMT for the attainment of oral feeding. Further adequately powered clinical trials are recommended.

Bicompartmental (uni plus patellofemoral) versus total knee arthroplasty: a match-paired study.

BACKGROUND: Osteoarthritis (OA) of the knee, whether primary or post-traumatic, does not always involve all three compartments (tibiofemoral medial and lateral and the patellofemoral ones). Bicompartmental knee arthroplasty (BKA) was proposed as a good alternative to total knee arthroplasty when two of the three knee compartments were affected. MATERIALS AND METHODS: We performed a retrospective comparative study collecting all BKAs performed between March 2010 and January 2016. During this period, we treated 27 patients with BKA for medial or lateral and patellofemoral OA. Seven of them were lost to follow-up and were not included in the study. Group A (BKA group) was compared to a homogeneous group of 20 patients who underwent TKA during the same period (group B). RESULTS: Patients treated with TKA were younger than those treated with BKA (mean age 65 vs. 67.2; p = 0.2149). BKA resulted in longer mean operating time (87 vs. 82.4 min; p = 0.2983), less blood loss (413 vs. 458 ml; p = 0.0052) but higher blood transfusion rate (12 vs. 10%). Medium follow-up was 34 months for BKA group and 38 months for TKA group. No statistically significant differences were found in KSS score between the two groups (KSS score 92.3 for BKA, 94.5 for TKA; p = 0.5221; KSS function was 87.2 for BKA and 89.2 for TKA; p = 0.4985). CONCLUSION: The most important finding of the present study was that although BKA seemed to be theoretically more favorable in terms of functional recovery and blood loss, patients of group A had lower KSS score and higher transfusion rate than those of group B. Our data confirm that BKA could be proposed as an alternative to TKA, especially in young and high-demanding patients.

Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up.

INTRODUCTION: The aim of this paper is to present our experience with femoral press-fit fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. METHODS: The patient population was randomly placed in two groups: group A (58 patients), who underwent femoral screw fixation; group B (62 patients), who underwent femoral press-fit fixation. RESULTS: At last follow-up 9.2% of patients were lost; 28% of patients in group A and 64% of patients in group B had excellent International Knee Documentation Committee score (grade A); 66% of patients in group A and 32% of patients in group B had good International Knee Documentation Committee scores (grade B). The difference was statistically significant (p < 0.05). CONCLUSIONS: Femoral press-fit fixation of bone- patellar tendon- bone autograft provides stable fixation at low cost, it ensures unlimited bone-to-bone healing and high primary stability, avoiding the disadvantages of hardware and the need for removal in case of revision.

Tibial lengthening over intramedullary nails: A matched case comparison with Ilizarov tibial lengthening.

OBJECTIVES: The purpose of this study was to compare the results and complications of tibial lengthening over an intramedullary nail with treatment using the traditional Ilizarov method. METHODS: In this matched case study, 16 adult patients underwent 19 tibial lengthening over nails (LON) procedures. For the matched case group, 17 patients who underwent 19 Ilizarov tibial lengthenings were retrospectively matched to the LON group. RESULTS: The mean external fixation time for the LON group was 2.6 months and for the matched case group was 7.6 months. The mean lengthening amounts for the LON and the matched case groups were 5.2 cm and 4.9 cm, respectively. The radiographic consolidation time in the LON group was 6.6 months and in the matched case group 7.6 months. Using a clinical and radiographic outcome score that was designed for this study, the outcome was determined to be excellent in 17 and good in two patients for the LON group. The outcome was excellent in 14 and good in five patients in the matched case group. The LON group had increased blood loss and increased cost. The LON group had four deep infections; the matched case group did not have any deep infections. CONCLUSIONS: The outcomes in the LON group were comparable with the outcomes in the matched case group. The LON group had a shorter external fixation time but experienced increased blood loss, increased cost, and four cases of deep infection. The advantage of reducing external fixation treatment time may outweigh these disadvantages in patients who have a healthy soft-tissue envelope.Cite this article: J. E. Herzenberg. Tibial lengthening over intramedullary nails: A matched case comparison with Ilizarov tibial lengthening. Bone Joint Res 2016;5:1-10. doi: 10.1302/2046-3758.51.2000577.

Effective target arrangement in a deterministic scale-free graph.

We study the random-walk problem on a deterministic scale-free network, in the presence of a set of static, identical targets; due to the strong inhomogeneity of the underlying structure the mean first-passage time (MFPT), meant as a measure of transport efficiency, is expected to depend sensitively on the position of targets. We consider several spatial arrangements for targets and we calculate, mainly rigorously, the related MFPT, where the average is taken over all possible starting points and over all possible paths. For all the cases studied, the MFPT asymptotically scales like ∼Nθ, being N the volume of the substrate and θ ranging from 1-log 2/log 3, for central target(s), to 1, for a single peripheral target.

Bi-unicompartmental versus total knee arthroplasty: a matched paired study with early clinical results.

INTRODUCTION: The authors performed a matched paired study between two groups: bi-unicompartmental (Bi-UKR) versus total knee replacements (TKR) for the treatment of isolated bicompartmental tibio-femoral knee arthritis with an asymptomatic patello-femoral joint. The Authors believe that Bi-UKR could achieve comparable outcomes than TKR, but with a real less invasive surgery and maintaining a higher joint function. MATERIALS AND METHODS: A total of 22 patients with bicompartmental tibio-femoral knee arthritis, who underwent Bi-UKR between January 1999 and March 2003, were included in the study (group A). In all the knees the arthritic changes were graded according to the classification of Alback. All patients had an asymptomatic patello-femoral joint. All patients had a varus deformity lower than 8 degrees , a body-mass index lower than 34, no clinical evidence of ACL laxity or flexion deformity and a preoperative range of motion of a least 110 degrees . At a minimum follow-up of 48 months, every single patient in group A was matched with a patient who had undergone a computer assisted TKR between August 1999 and September 2002 (group B). In the Bi-UKR group, in two cases we registered intraoperatively the avulsion of the treated tibial spines, requiring intra-operative internal fixation and without adverse effects on the final outcome. Statistical analysis of the results was performed. RESULTS: At a minimum follow-up of 48 months there were no statistical significant differences in the surgical time while the hospital stay was statistically longer in TKR group. No statistically significant difference was seen for the Knee Society, Functional and GIUM scores between the two groups. Statistically significant better WOMAC Function and Stiffness indexes were registered for the Bi-UKR group. TKR implants were statistically better aligned with all the implants positioned within 4 degrees of an ideal hip-knee-ankle (HKA) angle of 180 degrees . CONCLUSIONS: The results of this 48 months follow-up study suggest that Bi-UKR is a viable option for bicompartmental tibio-femoral arthritis at least as well as TKR but maintaining a higher level of function.

Intra-operative tibial fracture during computer assisted total knee replacement: a case report.

Recently computer-assisted joint replacement surgery has been introduced to improve implant alignment. To date no intra-operative fractures have been reported related to the insertion of the navigation trackers used in this technique. The authors present the case of a 76-year-old man who sustained an intra-operative tibial fracture at the site of insertion of the navigation tracker during computer assisted total knee replacement.

Tissue sparing surgery in knee reconstruction: unicompartmental (UKA), patellofemoral (PFA), UKA + PFA, bi-unicompartmental (Bi-UKA) arthroplasties.

Recently mini-invasive joint replacement has become one of the hottest topics in the orthopaedic world. However, these terms have been improperly misunderstood as a "key-hole" surgery where traditional components are implanted with shorter surgical approaches, with few benefits and several possible dangers. Small implants as unicompartmental knee prostheses, patellofemoral prostheses and bi-unicompartmental knee prostheses might represent real less invasive procedures: Tissue sparing surgery, the Italian way to minimally invasive surgery (MIS). According to their experience the authors go through this real tissue sparing surgery not limited only to a small incision, but where the surgeons can respect the physiological joint biomechanics.

Navigated shorter incision or smaller implant in knee arthritis?

Minimally invasive approaches for unicompartmental knee arthroplasty are well-accepted for treating knee arthritis because of the smaller implant size, shorter operative time, and tissue-sparing nature of the procedure. With the introduction of computer alignment systems, a well-aligned and balanced total knee arthroplasty (TKA) can be achieved even with smaller surgical exposures. We hypothesized a unicompartmental knee arthroplasty would provide better midterm outcomes than a computer-assisted minimally invasive TKA in patients with isolated medial compartment knee arthritis. We matched (preoperative arthritis severity, age, gender, and preoperative range of motion) 64 knees that had a medial unicompartmental knee arthroplasty or a mini-incision computer-assisted TKA. All patients had a varus deformity no greater than 8 degrees and a body mass index lower than 30 kg/m. Patients were followed a minimum of 48 months. In the mini-incision computer-assisted TKA group, all the implants were positioned within 4 degrees of ideal alignment. The surgical time and hospital stay were longer in the computer-assisted TKA group. A unicompartmental knee arthroplasty was estimated to cost at least 3100 euros (approximately US $4100) less. The clinical assessment showed higher functional and Italian Orthopaedic UKA Users Group scores for the unicompartmental knee arthroplasty group.

Intertrochanteric fracture of an arthrodesed hip.

We report the case of a 74-year-old woman who sustained an intertrochanteric fracture of the femoral neck in a previously arthrodesed hip. The hip arthrodesis had been performed 53 years earlier to treat septic arthritis. The fracture was treated successfully using a double-plating technique with 4.5 mm titanium reconstruction plates.

Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study.

Patients older than 60 with unicompartmental knee arthritis can be treated with total or unicompartmental knee replacement. The aim of this study was to compare the results of matched paired groups of patients with isolated medial compartment knee arthritis replaced with either UKR (group A) or computer-assisted TKR (group B). The results included 68 knees at a minimum follow-up of 3 years. All patients had a varus deformity no greater than 8 masculine and a BMI lower than 30. Patients were matched in terms of preoperative arthritis severity, age, gender and preoperative range of motion. In the computer-assisted TKR group, all the implants were positioned within 4 masculine of the correct hip-knee-ankle angle and frontal tibial component angle. The surgical time and hospital stay were statistically longer in the CA TKR group. During the study no implant required revision. The results showed higher scores for a UKR in the treatment of isolated primary unicompartmental knee arthritis in patients older than 60 compared to a computer-assisted TKR. In this study a computer-assisted alignment system for TKR with optimal implant positioning did not produce equivalent clinical results compared to a UKR, but did increase the financial costs.

Grafting of tibial bone defects in knee replacement using Norian skeletal repair system.

INTRODUCTION: The authors have been using Norian skeletal repair system (SRS) to repair cancellous bone defects in knee replacements since 1999. Norian SRS is injectable, biocompatible calcium phosphate cement with a high mechanical strength. This product is similar to the mineral phase of bone and should undergo gradual remodeling with time. We present our experience with this bone substitute in a total of 13 knee replacement surgeries. MATERIALS AND METHODS: This included three unicompartmental knee replacements (UKR), two bilateral UKR following tibial plateau fractures, five revisions of UKR to total knee replacements (TKR), two TKR revisions and one hinged knee prosthesis for significant deformity. Full weight bearing was permitted as soon as tolerated in all patients. Patients were evaluated at the latest follow-up using both the Knee Society Score (KSS) and GIUM (Italian UKR Users Group) knee scores. RESULTS: At the latest follow-up, no poor results were seen with an improvement between pre-operative and post-operative knee scores in all cases. There was no evidence of bone loss or post-operative deformity. Complete compound resorption was seen in the first 4 cases. CONCLUSIONS: The authors state that Norian SRS is a practical alternative as bone grafting in knee replacement surgery for type 1 and 2 bone defects.

Mini-invasive computer assisted bi-unicompartimental knee replacement.

In the treatment of knee osteoarthritis there are no reports using bi-unicompartimental implants and many orthopaedic surgeons are sceptical about this demanding surgical procedure despite its theoretical advantages in terms of less invasive surgery. The bi-unicompartmental approach also offers the potential advantage of maximal preservation of normal anatomy, with benefits for functional aspects such as gait, muscle activity, and proprioception.Computer-aided knee replacement surgery has been gaining popularity and an improvement in limb alignment and kinematics has been demonstrated in several studies. During the procedure the surgeon can check both implant position and ligament balance during the full range of joint movements, which helps to reduce the complications traditionally associated with failure in the past. The authors present a computer-aided technique for performing bi-unicompartimental knee replacement which permits a less invasive alternative for knee replacement surgery.

Comparison of a mobile with a fixed tibial bearing unicompartimental knee prosthesis: a prospective randomized trial using a dedicated outcome score.

Between February 1996 and December 1997, forty consecutive patients with medial compartment knee arthritis were assigned randomly into two groups. All underwent a unicompartimental knee replacement. The tibial prosthesis in group A (20 knees) had a fixed bearing and in group B (20 knees) a mobile bearing. The average age was 69. Five in group A and 71 in group B. Pre-operatively, and at an average follow-up of 5.7 years, all the knees were assessed using both a dedicated UKR score specifically developed and adopted by the Italian Orthopaedic Unicompartimental Knee Replacement Users Group (GIUM) and the Knee Society Score. During surgery in group B we experienced a medial tibial plateau fracture fixed intra-operatively. One prosthesis in group A required an early revision to a TKR because of a continuous pain without any evident sign of loosening. There were no meniscal dislocations in group B. No statistically significant difference in outcome was observed between the two groups at the latest follow-up.

Is closed-suction drain necessary in unicompartmental knee replacement? A prospective randomised study.

In a prospective randomised trial we evaluated the use of a post-operative closed-suction drain in unicompartmental knee replacement (UKR). Seventy-eight patients were divided into two groups: one without a post-operative closed-suction drain (Group A) and one with a drain (Group B). Both groups were matched for age, sex and pre-operative haemoglobin. In group A we observed a lower day one post-operative analgesic requirement, smaller knee circumference 3 days post-operatively and less local wound complications. Drain usage in UKR resulted in no significant advantage in post-operative pain, range of motion and hospital stay. Post-operative drainage does, however, increase the cost of the procedure both in labour and equipment expenditure. No deep infections occurred in either group during the follow-up period. We conclude that avoiding post-operative closed-suction drainage in UKR does not influence the outcome.

Knee arthrodesis after infected total knee arthroplasty using the Ilizarov method.

Numerous treatments have been proposed for infected total knee arthroplasty. In selected patients, a knee arthrodesis is a well-recognized salvage procedure. However, there are no reports in the literature discussing the treatment of infected total knee arthroplasty using the Ilizarov method. The authors reviewed their experience with this technique in infected total knee arthroplasty, presenting six patients (four women, two men) treated between 1992 and 1998. The average age was 56.6 years (range, 23-70 years) and the mean number of previous surgical procedures was seven (range, 4-10 procedures). From the time of frame removal, the patients were followed up for a mean of 34.2 months (range, 12.4-87.5 months). Full weight-bearing was allowed 1 week after surgery if half-pins were used and after a mean of 2.6 months if Kirschner wires were used. Of the five patients who have completed treatment, all have obtained a stable knee arthrodesis after a mean external fixation time of 6.8 months without additional surgical procedures or bracing. All of the patients were satisfied with the treatment. The authors recommend knee arthrodesis by the Ilizarov method for infected total knee arthroplasty, particularly in patients with extensive bone loss, significant limb shortening or axial deformity or both, active infection, or previous failed arthrodesis.

The Ilizarov method for failed knee arthrodesis following septic TKR.

Knee arthrodesis is a well-recognized salvage procedure in patients with infected total knee arthroplasties. If a fusion is achieved, it offers the opportunity for a stable lower limb and eradication of infection, but at the expense of knee motion. However, knee arthrodesis in this setting may be difficult to achieve because of poor bone stock, persistent infection, soft tissue compromise, and often the poor general health of the patient. We report two cases of failed knee arthrodesis following periprosthetic infection where a fusion was successfully achieved with open debridement and a hybrid advanced Ilizarov fixator.