Rehabilitation after Distal Radius Fractures: Opportunities for Improvement.

Background Exercises are frequently prescribed to regain function; yet there is no consensus on a standardized protocol, and adherence is low. Smart technology innovations, such as mobile applications, may be useful to provide home-based patient support in rehabilitation after distal radius fractures. Purposes Our purpose was to establish the potential of digital innovations for support and monitoring of patients and treatment adherence in rehabilitation programs, and additionally, to compare the current practice among physiotherapists to the various wrist exercise regimens and their effectiveness as described in the literature. Methods Standard practice, including the use of support tools for treatment adherence, was evaluated using a nationwide survey. Then, scientific databases were searched using "distal radius fracture" and "physiotherapy" or "exercise therapy," and related search terms, up until 23 March 2023. Results of the survey and literature review were compared. Results The survey was completed by 92 therapists. Nonstandardized support tools were used by 81.6% of respondents; 53.2% used some form of technology, including taking photos on the patients' smartphone for home reference. In the literature review, 23 studies were included, of which five described an exercise protocol. Treatment adherence was not reported in any of the included studies. Two studies described the use of smart technology or support tools. Conclusions There is no consensus on a standardized exercise protocol for rehabilitation after distal radius fractures, neither from a systematic literature search nor from a nationwide survey. Smart technology may facilitate monitoring of patients and exercise adherence, hereby supporting self-efficacy and improving adherence and outcomes.

Higher risk of 2-year cup revision of ceramic-on-ceramic versus ceramic-on-polyethylene bearing: analysis of 33,454 primary press-fit total hip arthroplasties registered in the Dutch Arthroplasty Register (LROI).

BACKGROUND AND PURPOSE: The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE). PATIENTS AND METHODS: Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007-2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time. RESULTS: 2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54-0.81]) compared to CoPE (0.44% [95% CI, 0.34-0.54]) (p = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48-0.87] (p = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) (p = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075-0.231] was seen in CoC and 0.058% [95%CI 0.019-0.097] in CoPE (p = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197-1.141] (p = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased. CONCLUSIONS: A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics.

Revision in Ceramic-on-Ceramic and Ceramic-on-Polyethylene Bearing in Primary Total Hip Arthroplasty with Press-fit Cups: A Systematic Review and Meta-analysis of Different Methodological Study Designs.

Background: The influence of bearing on revision, especially in press-fit modular cup total hip arthroplasty (THA), remains underexposed. Methods: A systematic literature review was conducted in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov in line with the PRISMA guidelines. The primary outcome was overall revision between ceramic-on-ceramic (CoC) and all sorts of ceramic-on-polyethylene (CoPE) bearings. As secondary outcomes complications and reasons for revision were compared between bearings. Outcomes were presented in subgroups based on study design (randomized controlled trials (RCT), non-randomized comparative, and registry studies). The quality of evidence was assessed using the GRADE. The risk of bias was assessed using the Cochrane collaboration's tool and the MINORS criteria. Results: This meta-analysis included twelve RCTs, three non-randomized comparative studies and two registry studies, including 38,772 THAs (10,909 CoPE and 27,863 CoC). Overall revision showed a lower risk in CoPE compared to CoC in the two registry studies (HR 0.71 (95%CI 0.53; 0.99)) (very low-quality GRADE evidence). In RCTs and non-randomized comparative studies, no difference was observed (low-quality GRADE evidence). Loosening, dislocation, infection, and postoperative periprosthetic fracture showed no significant differences in risk ratio for all designs. Conclusion: The lower risk of overall revision in registry studies of primary THA with a press-fit modular cup using CoPE bearing compared to CoC should be considered preliminary since this outcome was just slightly significant, based on very low-quality GRADE evidence and based on only two studies with several limitations. Since no difference was observed in the other methodological designs and the separate reasons for revision showed no significant difference in all designs either, no preference for CoC or CoPE can be expressed, and therefore both seem suitable options based on the available literature. More comparative long-term studies are needed to confirm the potential advantages of wear-reduction of both bearings since the currently available literature is limited.

Dynamic trial fitting of the cup in press-fit total hip arthroplasty, a feasibility study.

Trial fitting of the cup during total hip arthroplasty (THA) is done by trial cups, which do not resemble the real press-fit obtained by the definitive implant. Our goal is to judge feasibility of the X-pander® in clinical practice ; a device developed to mimic the real press-fit obtained by the definitive cup, to ensure satisfactory press-fit. In this feasibility study 45 experienced orthopaedic surgeons from 7 European countries filled in a structured survey after 78 primary THA and 31 revision surgeries, using the X-pander instead of traditional trial cups. Primary outcomes were decision change concerning cup size or further reaming and increased confidence regarding cup insertion and size. Additionally, potential association between the primary outcomes and procedure (primary or revi- sion), bone quality and experience of the surgeon were evaluated. In 33.3% of the primary and 32.2% of the revision cases the X-pander measurement changed the deci- sion and further reaming or change of cup size was decided. In 61.5% and 58.1% of respectively the primary and revision THAs the X-pander was judged to give fairly to much more reliable information than traditional trial cups. The X-pander could lead to less additional screw fixation, as stated in 37.2% of the primary and 25.8% of the revision cases and to better cup insertion in respectively 50.0% and 51.6%. This study validates that the X-pander may be a suitable option for accurate sizing and assessment of the reamed acetabulum and could replace traditional trial cups in THA.

Corticosteroid Injections in Posterior Ankle Impingement Syndrome: A Survey of Professional and Elite Student Ballet Dancers.

Posterior ankle impingement syndrome (PAIS) involves pain at the posterior as- pect of the ankle, due in dancers largely to repetitive hyperplantarflexion. In daily practice, corticosteroid injection is often used to relieve the pain of PAIS, but little has been recorded with regard to its effectiveness. The primary objective of this study was to determine the ef- fect on pain of corticosteroid injections in professional and elite student ballet dancers with PAIS. The secondary ob- jectives were to evaluate the prevalence of PAIS, the duration of the effect of injection, patient satisfaction with the effect of injection, time to return to class and performance, and ability to dance after injection. All members of the Dutch National Ballet and the National Ballet Academy Amsterdam received a self-administered questionnaire focused on the use and effect of corticosteroid injections in the treatment of PAIS. The response rate was 61% (77 of 126). Of the included dancers, 38% (29 of 77) had suffered from PAIS, and 38% (11 of 29) had received at least one injection. The numeric rating scale (NRS) was used to assess the severity of pain before and 2 and 6 weeks after injections. The median NRS pain before injection was 9.0 (IQR 8.0-9.5), 3.0 (IQR 0.5-6.5) 2 weeks after injection, and 3.0 (IQR 0.5-6.0) 6 weeks after injection. Overall median NRS satisfaction with the effect of injection was 7.0 (IQR 0-10), and satisfaction with the duration of the effect was 5.0 (IQR 2.0-10). It is concluded that there is a high prevalence of PAIS in ballet dancers and corticosteroid injections are regularly used for pain reduction with good results.

Ceramic-on-ceramic vs ceramic-on-polyethylene, a comparative study with 10-year follow-up.

BACKGROUND: In press-fit total hip arthroplasty (THA) ceramic-on-ceramic (CoC) bearings are a potential for overcoming the wear that is seen in ceramic-on-polyethylene (CoPE) bearings, and can lead to wear-induced osteolysis, resulting in loosening of the implant. However, CoC bearings show disadvantages as well, such as squeaking sounds and being more fragile, which can cause ceramic head or liner fracture. Because comparative long-term studies are limited, the objective of this study was to determine the long-term difference in wear, identify potential predictive factors for wear, investigate radiological findings such as osteolysis, and evaluate clinical functioning and complications between these bearings. AIM: To determine 10-year differences in wear, predictive factors for wear, and investigate radiological findings and clinical functioning between CoC and CoPE. METHODS: This observational prospective single-center cohort study with a 10-year follow-up includes a documented series of elective THAs. Primary outcome was wear measured by anteroposterior (AP) radiographs. Secondary outcomes were potential predictive factors for wear, complications during follow-up, Harris hip score (HHS), and radiological findings such as presence of radiolucency, osteolysis, atrophy, and hypertrophy around the cup. Due to the absence of wear in the CoC group, stratified analysis to identify risk factors for wear was only performed in the CoPE group by use of univariate linear regression analysis. HHS was expressed as a change from baseline and the association with bearing type was assessed by use of multivariate linear regression analysis, adjusted for potential confounders. RESULTS: A total of 17 CoPE (63.0%) and 25 CoC (73.5%) cases were available for follow-up and showed a linear wear of respectively 0.130 mm/year (range 0.010; 0.350) and 0.000 mm/year (range 0.000; 0.005), which was significant (P < 0.001) between both groups. Wear always occurred in the cranial direction. Cup inclination was the only predictive factor for polyethylene (PE) wear. No dislocations, ceramic head, or liner fractures were seen. The HHS showed a mean change from baseline of 37.1 points (SD 18.5) in the CoPE group and 43.9 (SD 17.0) in the CoC group. This crude difference of 6.8 (range -5.2; 18.7) in favor of the CoC group was not significant (P = 0.26) and was not significant when adjusted for age, gender, and diagnosis either (P = 0.99). No significant differences in complications and radiological findings were seen between groups. CONCLUSION: CoC bearing shows lower wear rates compared to CoPE at 10-year follow-up with cup inclination as a predictive factor for wear and no differences in complications, HHS, and radiological findings.

Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty, a five-year Roentgen stereophotogrammetric analysis randomised controlled trial.

BACKGROUND: Polyethylene (PE) particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty (THA). As highly cross-linked polyethylene (HXLPE) is presumed to give lower wear rates, in vivo studies are needed to confirm this. AIM: To compare the wear of REXPOL, a HXPLE, with conventional PE within the first five years after implantation using Roentgen stereophotogrammetric analysis (RSA). METHODS: Patients were randomised to receive either a HXLPE (REXPOL) or a conventional PE insert during primary THA. RSA images were obtained directly postoperative and after 6 wk, 12 wk, 6 mo, 12 mo, 24 mo and five years. Functional outcomes were assessed using the Hip Injury and Osteoarthritis Outcome Score and Harris Hip Score at baseline and five years after surgery. RESULTS: The HXLPE (REXPOL) showed less wear in the latero-medial direction. Significant wear rates of conventional PE were seen in the latero-medial and center-proximal direction and in volume and corrected volume, whereas the REXPOL did not show these outcomes over time. Improvement from baseline in functional outcome did not significantly differ. CONCLUSION: Total 3D wear is less in THAs inserted with a REXPOL inlay than a conventional PE inlay after five years. This study confirms, for the first, that the REXPOL HXLPE inlay is preferred to standard PE.