Milder impact of the COVID-19 pandemic on the practice of orthopaedic surgery in Greece and Cyprus than other European countries.

PURPOSE: The aim of this study was to highlight the impact of the COVID-19 pandemic on the practice of orthopaedics in Greece and Cyprus. METHODS: The survey used the online questionnaire from AGA (Gesellschaft für Arthroskopie und Gelenkchirurgie; Society for Arthroscopy and Joint Surgery) to facilitate the comparison between different European countries. The questionnaire was distributed online to members of the HAOST (Hellenic Association of Orthopaedic Surgery and Trauma), the ΟΤΑΜΑΤ (Orthopaedic and Trauma Association of Macedonia and Thrace) and the CAOST (Cypriot Association of Orthopaedic Surgery and Trauma). The questionnaire consisted of 29 questions, which included demographic data, questions on the impact of the pandemic on the practice of orthopaedic surgery and questions on the impact on the personal and family life of orthopaedic surgeons. RESULTS: The questionnaire was sent to 1350 orthopaedic surgeons in Greece and Cyprus, 303 of whom responded (response rate 22.44%). 11.2% of the participants reported cancellation of overall orthopaedic procedures. According to 35.6-49.8% of the participants, arthroscopic procedures were continued. As regards elective primary arthroplasties, 35.3% of the participants reported that these continued to be performed at their hospitals. Post-operative follow-ups as well as physiotherapy were affected by the pandemic, and changes were also observed in the habits of orthopaedic surgeons in their personal and family lives. CONCLUSION: The orthopaedic service in Greece and Cyprus decreased during the first wave of the COVID-19 pandemic. Arthroscopic procedures and total joint replacements decreased significantly, but not to the same extent as in other countries. Health systems were not fully prepared for the first wave of the pandemic and the various countries took social measures at different times and to different extents. Thus, studying the impact of the pandemic on the practice of orthopaedic surgery in different countries can help health systems to better prepare for future pandemics; public health can then be shielded and hospitals can continue to provide high-quality orthopaedic care. LEVEL OF EVIDENCE: Level V.

Novel press-fit technique of patellar bone plug in anterior cruciate ligament reconstruction is comparable to interference screw fixation.

PURPOSE: Conventional press-fit technique for anterior cruciate ligament reconstruction (ACLR) is performed with extraction drilling of the femoral bone tunnel and manual shaping of the patellar bone plug. However, the disadvantages of this technique include variation in bone plug size and, thus, the strength of the press-fit fixation, bone loss with debris distribution within the knee joint, potential heat necrosis, and metal wear debris due to abrasion of the guide wire. To overcome these disadvantages, a novel technique involving punching of the femoral bone tunnel and standardized compression of the bone plug was introduced. In this study, the fixation strength and apparent stiffness were tested and compared to that of the gold-standard interference screw fixation technique in three flexion angle configurations (0°/45°/90°) in a porcine model. We hypothesized that the newly developed standardized press fit fixation would not be inferior to the gold standard method. METHODS: Sixty skeletally mature porcine knees (30 pairs) were used. Full-thickness central third patellar tendon strips were harvested, including a patellar bone cylinder of 9.5 mm in diameter. The specimens were randomly assigned to 10 pairs per loading angle (0°, 45°, 90°). One side of each pair was prepared with the press-fit technique, and the contra-lateral side was prepared with interference screw fixation. Equivalent numbers of left- and right-sided samples were used for both fixation systems. A three-way multifactor ANOVA was carried out to check for the influence of (a) fixation type, (b) flexion angle, and (c) side of the bone pair. RESULTS: The primary fixation strength of femoral press-fit graft fixation with punched tunnels and standardized bone plug compression did not differ significantly from that of interference screw fixation (p = 0.51), which had mean loads to failure of 422.4 ± 134.6 N and 445.4 ± 135.8 N, respectively. The flexion angle had a significant influence on the maximal load to failure (p = 0.01). Load values were highest in 45° flexion for both fixations. The anatomical side R/L was not a statistically significant factor (p = 0.79). CONCLUSION: The primary fixation strength of femoral press-fit graft fixation with punched femoral tunnels and standardized bone plug compression is equivalent to that of interference screw fixation in a porcine model. Therefore, the procedure represents an effective method for ACL reconstruction with patellar or quadriceps tendon autografts including a patellar bone plug.

Correction to: Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure.

The original version of this article unfortunately contains mistake in Table 4.

Correction to: Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament.

The original version of this article unfortunately contained a mistake.

Dynamic intraligamentary stabilization of anterior cruciate ligament repair: hardware removal has no effect on knee laxity at 2-year follow-up.

INTRODUCTION: Dynamic intraligamentary stabilization (DIS) stabilizes the knee joint during anterior cruciate ligament (ACL) healing. After 6 months, tibial hardware removal is offered to the patients if local discomfort at the implant site is present. AIM: This study compared knee laxity and functional scores 2 years after DIS between patients with and without hardware removal. It is hypothesized that it does not affect ACL healing. MATERIALS AND METHODS: The study retrospectively analyzed prospectively collected data from 173 patients with either hardware removal (n = 47) or no additional intervention (n = 126). Inverse probability of treatment weighting using the propensity score was applied to balance the groups for baseline characteristics. The primary outcome was the side-to-side difference in knee laxity measured with the rolimeter at manual maximum force (Δ-Lachman). Secondary outcomes were the pivot-shift test and subjective scores. RESULTS: Mean age was 34 years in both groups, and female gender was 47% (hardware removal group) and 50% (control group), respectively. No significant differences were found for Δ-Lachman (p = 0.09), pivot-shift test (p = 0.41), and subjective scores (p > 0.10) two years after DIS. CONCLUSION: Knee laxity 2 years after DIS in patients with tibial hardware removal and patients without hardware removal was not significantly different. The groups were also similar regarding all the assessed functional scores. This study confirms the hypothesis that the healing ACL resumes its stabilizing role, and the hardware can be removed beginning 6 months after surgery without adverse consequences for joint stability. LEVEL OF EVIDENCE: Case-control study, Level III.

Implant preloading in extension reduces spring length change in dynamic intraligamentary stabilization: a biomechanical study on passive kinematics of the knee.

PURPOSE: Dynamic intraligamentary stabilization (DIS) is a primary repair technique for acute anterior cruciate ligament (ACL) tears. For internal bracing of the sutured ACL, a metal spring with 8 mm maximum length change is preloaded with 60-80 N and fixed to a high-strength polyethylene braid. The bulky tibial hardware results in bone loss and may cause local discomfort with the necessity of hardware removal. The technique has been previously investigated biomechanically; however, the amount of spring shortening during movement of the knee joint is unknown. Spring shortening is a crucial measure, because it defines the necessary dimensions of the spring and, therefore, the overall size of the implant. METHODS: Seven Thiel-fixated human cadaveric knee joints were subjected to passive range of motion (flexion/extension, internal/external rotation in 90° flexion, and varus/valgus stress in 0° and 20° flexion) and stability tests (Lachman/KT-1000 testing in 0°, 15°, 30°, 60°, and 90° flexion) in the ACL-intact, ACL-transected, and DIS-repaired state. Kinematic data of femur, tibia, and implant spring were recorded with an optical measurement system (Optotrak) and the positions of the bone tunnels were assessed by computed tomography. Length change of bone tunnel distance as a surrogate for spring shortening was then computed from kinematic data. Tunnel positioning in a circular zone with r = 5 mm was simulated to account for surgical precision and its influence on length change was assessed. RESULTS: Over all range of motion and stability tests, spring shortening was highest (5.0 ± 0.2 mm) during varus stress in 0° knee flexion. During flexion/extension, spring shortening was always highest in full extension (3.8 ± 0.3 mm) for all specimens and all simulations of bone tunnels. Tunnel distance shortening was highest (0.15 mm/°) for posterior femoral and posterior tibial tunnel positioning and lowest (0.03 mm/°) for anterior femoral and anterior tibial tunnel positioning. CONCLUSION: During passive flexion/extension, the highest spring shortening was consistently measured in full extension with a continuous decrease towards flexion. If preloading of the spring is performed in extension, the spring can be downsized to incorporate a maximum length change of 5 mm resulting in a smaller implant with less bone sacrifice and, therefore, improved conditions in case of revision surgery.

Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament.

PURPOSE: Failure of dynamic intraligamentary stabilization (DIS) that requires revision surgery of the anterior cruciate ligament (ACL) has not been studied. The aim of this study was to investigate the incidence of revision ACL surgery, and the patient characteristics and surgery-related factors that are associated with an increased risk of ACL revision after DIS. METHODS: This study analysed a prospective, consecutively documented single-centre case series using standardized case report forms over a 2.5-year follow-up period. The primary endpoint was revision ACL surgery. We used Kaplan-Meier analysis to examine the revision-free survival time, and a multiple logistic regression model of potential risk factors including age, sex, BMI, smoking status, previous contralateral ACL injury, Tegner activity score, interval to surgery, rupture pattern, hardware removal, and postoperative side-to-side difference in knee laxity. Relative risk was calculated for subgroups of significant risk factors. RESULTS: In total, 381 patients (195 male) with a mean age of 33 ± 12 years were included in the analysis. The incidence of revision ACL surgery was 30/381 (7.9%). Younger age (p = 0.001), higher Tegner activity score (p = 0.003), and increased knee laxity (p = 0.015) were significantly associated with revision ACL surgery. The increased relative risk for patients who were less than 24 years old, participated in activities at a Tegner level >5 points, or had >2 mm of side-to-side difference in knee laxity was 1.6, 3.7, and 2.3, respectively. CONCLUSION: Young age, high level of sport activity, and high knee laxity observed in follow-up examinations increased the likelihood for revision surgery after DIS. Patients undergoing DIS should be informed of their potentially increased risk for therapy failure and carefully monitored during recovery. LEVEL OF EVIDENCE: Case series, Level IV.

Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure.

PURPOSE: Studies on dynamic intraligamentary stabilization (DIS) of acute anterior cruciate ligament (ACL) ruptures reported failure rates similar to those of conventional ACL reconstruction. This study aimed to determine whether surgeon experience with DIS is associated with revision rates or patient-reported outcomes. The hypothesis was that more experienced surgeons achieved better outcomes following DIS due to substantial learning curve. METHODS: The authors prospectively enrolled 110 consecutive patients that underwent DIS and evaluated them at a minimum of 2 years. The effects of independent variables (surgeon experience, gender, age, adjuvant procedures, tear location, preinjury Tegner score, time from injury to surgery, and follow-up) on four principal outcomes (revision ACL surgery, any re-operation, IKDC and Lysholm score) were analyzed using univariable and multivariable regressions. RESULTS: From the 110 patients enrolled, 14 patients (13%) were lost to follow-up. Of the remaining 96 patients, 11 underwent revision ACL surgery, leaving 85 patients for clinical assessment at a mean of 2.2 ± 0.4 years (range 2.0-3.8). Arthroscopic reoperations were performed in 26 (27%) patients, including 11 (11%) revision ACL surgeries. Multivariable regressions revealed: (1) no associations between the reoperation rate and the independent variables, (2) better IKDC scores for 'designer surgeons' (b = 10.7; CI 4.9-16.5; p < 0.001), higher preinjury Tegner scores (b = 2.5, CI 0.8-4.2; p = 0.005), and younger patients (b = 0.3, CI 0.0-0.6; p = 0.039), and (3) better Lysholm scores for 'designer surgeons' (b = 7.8, CI 2.8-12.8; p = 0.005) and preinjury Tegner score (b = 1.9, CI 0.5-3.4; p = 0.010). CONCLUSION: Surgeon experience with DIS was not associated with rates of revision ACL surgery or general re-operations. Future, larger-scaled studies are needed to confirm these findings. Patients operated by 'designer surgeons' had slightly better IKDC and Lysholm scores, which could be due to better patient selection and/or positively biased attitudes of both surgeons and patients. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Five year results of the first ten ACL patients treated with dynamic intraligamentary stabilisation.

BACKGROUND: In recent years, the scientific discussion has focused on new strategies to enable a torn anterior cruciate ligament (ACL) to heal into mechanically stable scar tissue. Dynamic intraligamentary stabilization (DIS) with LigamysTM was first performed in a pilot study of 10 patients. The purpose of the current study was to evaluate the five year results of this group. METHODS: Inclusion criteria were an ACL rupture not older than 14 days, patient age <45 years, no previous surgery on the injured knee, and regular participation in sports requiring pivoting of the knee joint. Ten consecutive patients (eight males, two females) underwent surgery between August 2009 and February 2010. They were treated by DIS employing an internal stabilizer to keep the unstable knee in a posterior translation, combined with microfracturing and platelet-rich fibrin induction at the rupture site to promote self-healing. Postoperative clinical outcome [Tegner, Lysholm, International Knee Documentation Committee (IKDC), visual analogue scale patient satisfaction score] and assessment of knee laxity was performed at 3, 6, 12, 24 and 60 months. RESULTS: Median patient age at time of surgery was 23.3 years (range 19-41 years). The median time to surgery was 10 days (range 5-13 days). The rupture was located in the middle third of the ligament in seven patients and in the proximal third in three patients. Eight patients showed additional meniscal lesions, which were surgically treated in six patients. Eight of the ten patients reached the five-years follow-up. Median Lysholm score was 100 (range 90-100); the IKDC score was 98.9 (range 79.3-100); Tegner score was 5.5 (range 5-7); median Lachman difference to the other side was 2 mm (range 0-4 mm). Median patient satisfaction was 10 points (range 8-10 pts.). Four of the ten patients underwent metal removal (tibial implant component) after ACL healing and a consequently stable knee joint. Two patients suffered from a re-rupture at 5 months and 4.2 years after surgery and were treated with a bone-tendon-bone ACL graft. CONCLUSIONS: Dynamic intraligamentary stabilization in ten active patients with a fresh ACL rupture showed a 5-years survival rate of 80 %. At the last follow-up all patients with a functionally healed ACL showed excellent outcomes and satisfaction with regards to the treatment result.

Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years.

BACKGROUND: In recent years, the scientific discussion has focused on new strategies to enable a torn anterior cruciate ligament (ACL) to heal into mechanically stable scar tissue. Dynamic intraligamentary stabilization (DIS) was first performed in a pilot study of 10 patients. The purpose of the current study was to evaluate whether DIS would lead to similarly sufficient stability and good clinical function in a larger case series. METHODS: Acute ACL ruptures were treated by using an internal stabilizer, combined with anatomical repositioning of torn bundles and microfracturing to promote self-healing. Clinical assessment (Tegner, Lysholm, IKDC, and visual analogue scale [VAS] for patient satisfaction scores) and assessment of knee laxity was performed at 3, 6, 12, and 24 months. A one-sample design with a non-inferiority margin was chosen to compare the preoperative and postoperative IKDS and Lysholm scores. RESULTS: 278 patients with a 6:4 male to female ratio were included. Average patient age was 31 years. Preoperative mean IKDC, Lysholm, and Tegner scores were 98.8, 99.3, and 5.1 points, respectively. The mean anteroposterior (AP) translation difference from the healthy contralateral knee was 4.7 mm preoperatively. After DIS treatment, the mean 12-month IKDC, Lysholm, and Tegner scores were 93.6, 96.2, and 4.9 points, respectively, and the mean AP translation difference was 2.3 mm. All these outcomes were significantly non-inferior to the preoperative or healthy contralateral values (p < 0.0001). Mean patient satisfaction was 8.8 (VAS 0-10). Eight ACL reruptures occurred and 3 patients reported insufficient subjective stability of the knee at the end of the study period. CONCLUSIONS: Anatomical repositioning, along with DIS and microfracturing, leads to clinically stable healing of the torn ACL in the large majority of patients. Most patients exhibited almost normal knee function, reported excellent satisfaction, and were able to return to their previous levels of sporting activity. Moreover, this strategy resulted in stable healing of all sutured menisci, which could lower the rate of osteoarthritic changes in future. The present findings support the discussion of a new paradigm in ACL treatment based on preservation and self-healing of the torn ligament.

The course of radiographic loosening, pain and functional outcome around the first revision of a total hip arthroplasty.

BACKGROUND: The published data on pain and physical function before and after revision of total hip arthroplasty (THA) is scarce. The study reports the course and interrelationships of radiographic loosening, pain and physical function 5 year before and after a first revision THA. METHODS: The study was based on the IDES-THA database. All patients with their first THA revision for aseptic loosening and a documented index surgery on the same side and at least one pre-revision and one post-revision follow-up were selected. Only patients with an intact contralateral hip joint (Charnley class-A) were included. Follow-ups within ±5.5 years around the revision time point were analyzed. Annual prevalences of radiographic component loosening and the non-desired outcomes (moderate/severe/intolerable pain, walking <30 minutes, hip flexion range <90°) were calculated. RESULTS: Signs of radiographic component loosening started to increase about 4 years before revision surgery. Two years later, a sharp increase of painful hips from 15% to 80% in the revision year was observed. In the year after revision surgery, this rate dropped back to below 10%. Walking capacity started to noticeably deteriorate 3 years before revision and in the revision year about 65% of patients could not walk longer than 30 minutes. As opposed to pain, walking capacity did not recover to pre-revision levels and the best outcome was only reached two years post-revision. Hip flexion range had the slowest and least extent of deterioration (≈45% flexed <70° in the revision year) but with the best outcomes at only three years after revision surgery it took the longest to recover. CONCLUSION: Prevalence of radiological loosening signs and/or pain intensity follow an almost parallel course around the first revision of a THA for aseptic component loosening. This process begins about 4 years (radiographic loosening) before the actual revision surgery and intensifies about 2 years later (pain). It also involves walking capacity and hip range of motion. While pain levels go back to levels similar to those after primary surgery, range of motion and even more walking capacity remain moderately compromised.

Anterior crucial ligament rupture: self-healing through dynamic intraligamentary stabilization technique.

PURPOSE: Surgery involving arthroscopic reconstruction of the injured ligament is the gold standard treatment for torn anterior cruciate ligament (ACL). Recent studies support the hypothesis of biological self-healing of ruptured ACL. The aim of the study is to evaluate, in an animal model, the efficacy of a new technique, dynamic intraligamentary stabilization that utilizes biological self-healing for repair of acute ACL ruptures. METHODS: The ACL in 11 adult female white alpine sheep was transected and in 8 sheep reconstructed by dynamic intraligamentary stabilization. To enhance the healing potential, microfracturing and collagen were used in all animals. The contralateral, non-operated knees served as controls. At 3 months postkilling, all animals were submitted to magnetic resonance imaging and biomechanical and histological evaluation. RESULTS: No surgery-related complications were observed. Postoperatively, all animals regularly used the operated leg with full weight bearing and no lameness. At the time of killing, all animals exhibited radiological and histological healing of the transacted ACL. Biomechanical tests confirmed successful restoration of anteroposterior translation in the dynamic intraligamentary stabilization knees. Histological examination revealed dense scar tissue at the ends of the transected ligaments exhibiting hypercellularity and hypervascularization. CONCLUSION: The dynamic intraligamentary stabilization technique successfully induced self-healing of ruptured ACL in a sheep model. Knee joints remained stable during the healing period allowing free range of motion and full weight bearing, and no signs of osteoarthritis or other intraarticular damage in the follow up were observed.

The cement prosthesis-like spacer: an intermediate halt on the road to healing.

BACKGROUND: Periprosthetic infections remain a devastating problem in the field of joint arthroplasty. In the following study, the results of a two-stage treatment protocol for chronic periprosthetic infections using an intraoperatively molded cement prosthesis-like spacer (CPLS) are presented. METHODS: Seventy-five patients with chronically infected knee prosthesis received a two-stage revision procedure with the newly developed CPLS between June 2006 and June 2011. Based on the microorganism involved, patients were grouped into either easy to treat (ETT) or difficult to treat (DTT) and treated accordingly. Range of motion (ROM) and the knee society score (KSS) were utilized for functional assessment. RESULTS: Mean duration of the CPLS implant in the DTT group was 3.6 months (range 3-5 months) and in the ETT group 1.3 months (range 0.7-2.5 months). Reinfection rates of the final prosthesis were 9.6% in the ETT and 8.3% in the DTT group with no significant difference between both groups regarding ROM or KSS (P = 0.87, 0.64, resp.). CONCLUSION: The results show that ETT patients do not necessitate the same treatment protocol as DTT patients to achieve the same goal, emphasizing the need to differentiate between therapeutic regimes. We also highlight the feasibility of CLPS in two-stage protocols.

High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process.

BACKGROUND: Medication errors have been reported to be a leading cause of death in hospitalized patients. In this study we focused on identifying and quantifying errors in the handwritten drug ordering and dispensing documentation processes which could possibly lead to adverse drug events. METHODS: We studied 1,934 ordered agents (165 consecutive patients) retrospectively for medication documentation errors. Errors were categorized into: Prescribing errors, transcription errors and administration documentation errors on the nurses' medication lists. The legibility of prescriptions was analyzed to explore its possible influence on the error rate in the documentation process. RESULTS: Documentation errors occurred in 65 of 1,934 prescribed agents (3.5%). The incidence of patient charts showing at least one error was 43%. Prescribing errors were found 39 times (37%), transcription errors 56 times (53%), and administration documentation errors 10 times (10%). The handwriting readability was rated as good in 2%, moderate in 42%, bad in 52%, and unreadable in 4%. CONCLUSIONS: This study revealed a high incidence of documentation errors in the traditional handwritten prescription process. Most errors occurred when prescriptions were transcribed into the patients' chart. The readability of the handwritten prescriptions was generally bad. Replacing the traditional handwritten documentation process with information technology could potentially improve the safety in the medication process.

Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?

PURPOSE: Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA. METHODS: In 50 patients (21 men, 29 women) undergoing TKA, we compared patellar blood flow at flexions 0° to 30°, 60°, 90°, and 110° before and after medial parapatellar arthrotomy to pre- and postoperative anterior knee pain scores by means of a laser Doppler flowmeter (LDF) probe. Anterior knee pain was assessed using the pain intensity numeric rating scale (NRS) of 0-10 (0-no, 10-worst pain). Based on the NRS pain values, patients were divided into two main groups: group A (n = 34) with no pain or discomfort (NRS range 0-4) and group B (n = 16) with anterior knee pain (NRS range 5-10). RESULTS: Patients of group B demonstrated a significant decrease in blood flow before arthrotomy at flexions from 0° to 90°, and 110° and from 0° to 60°, 90°, and 110° after arthrotomy. For group A, a significant decrease in blood flow was detected at flexions from 0° to 90°, and 110° before and after arthrotomy. For both groups, medial arthrotomy did not have a statistically significant influence on patellar blood flow (margin of significance P < 0.05). Prior to TKA, 16 of the 50 patients of group B (32%) complained of anterior knee pain (mean NRS 7.1 ± 1.7). At 2-year follow-up, pain significantly decreased (NRS 3.1 ± 2.1) and only 4 of the 16 patients (25%) complained of moderate anterior pain (average NRS 5.7 ± 0.5), while 8 of 16 (50%) patients reported discomfort (mean NRS 3.5 ± 1.8) around the patella. Patients in group A also demonstrated a significant decrease in pain intensity (from NRS 1.5 ± 1.4 preoperatively to NRS 0.4 ± 1.5 at 2-year follow-up). Statistical analysis demonstrated no statistically significant correlation between pre-arthrotomy/post-arthrotomy patellar blood flow and the presence of preoperative and postoperative anterior knee pain. Only the degree of flexion had an influence on patellar blood flow. CONCLUSION: Medial arthrotomy had no direct significant effect on patellar blood flow, and the diminished blood flow did not correlate with postoperative anterior knee pain. However, a significant correlation was revealed between patellar blood flow and the degree of flexion: in almost a quarter of patients, blood flow dropped to zero at flexions of 100° and above.

Could full-body digital X-ray (LODOX-Statscan) screening in trauma challenge conventional radiography?

BACKGROUND: ATLS Guidelines recommend single plain radiography of the chest and pelvis as part of the primary survey. Such isolated radiographs, usually obtained by bedside machines, can result in limited, low-quality studies that can adversely affect management. A new digital, low-radiation imaging device, the "Lodox Statscan" (LS), provides full-body anterior and lateral views based on enhanced linear slot-scanning technology in just over 5 minutes. We have the first LS in Europe at our facility. The aim of this study was to compare LS with computed tomographic (CT) scanning, as the gold standard, to determine the sensitivity of LS investigation in detecting injuries to the chest, thoracolumbar spine, and pelvis from our own experience, and to compare our findings with those of conventional radiography in the literature. METHODS: We performed a retrospective chart analysis of 245 patients with multiple injuries examined by full-body LS imaging and CT scans between October 1, 2006 and October 1, 2007 at our facility. Patients under the age of 16 years were not included. LS and CT images of chest injuries, injuries to the thoracolumbar spine, and fractures of the pelvis were compared. At our facility, we no longer perform plain radiography for C-spine and head injury, but perform CT scans according to the Canadian rules. Findings with LS were also compared with those reported for conventional radiography in the literature. RESULTS: Compared with CT scanning, sensitivity and specificity of full-body digital X-ray of blunt chest trauma were 57% and 100%, respectively, thoracic spinal injury 43% and 100%, lumbar spine lesions 74% and 100%, and pelvic injury 72% and 99%. The positive and negative predictive value of LS imaging were 99% and 90% for blunt chest trauma, 100% and 93% for overall spinal injuries, and 90% and 97% for pelvic injuries. CONCLUSION: Full-body radiography with LS visualizes skeletal, chest, and pelvic pathologies "all-in-one." This low-radiation technology detected chest, thoracolumbar spine, and pelvic injuries with an overall sensitivity of 62% and a specificity of 99%. Compared with figures in the literature, LS was more accurate than conventional X-rays. A prospective randomized study is warranted to support these data.

Treatment of joint prosthesis infection in accordance with current recommendations improves outcome.

BACKGROUND: Recently recommended treatment modalities for prosthetic joint infection (PJI) were evaluated. METHODS: A retrospective cohort analysis of 68 patients with PJI of hip or knee who were treated from 1995 through 2004 was conducted at the University Hospital Bern (Bern, Switzerland). RESULTS: A 2-stage exchange was the most frequent (75.0%) surgical strategy, followed by retention and debridement (17.6%), 1-stage exchange (5.9%), and resection arthroplasty or suppressive antimicrobial treatment (1.5%). The chosen strategy was in 88% agreement with the recommendations. Adherence was only 17% for retention and debridement and was 0% for 1-stage exchange. Most PJIs (84%) were treated with an adequate or partially adequate antimicrobial regimen. Recurrence-free survival was observed in 51.5% of PJI episodes after 24 months of follow-up. The risk of treatment failure was significantly higher for PJI treated with a surgical strategy other than that recommended (hazard ratio, 2.34; 95% confidence interval, 1.10-4.70; P = .01) and for PJIs treated with antibiotics not corresponding to recommendations (hazard ratio, 3.45; confidence interval, 1.50-7.60; P = .002). Other risk factors associated with lack of healing were a high infection score at the time of diagnosis (hazard ratio, 1.29; 95% confidence interval, 1.10-1.40; P < .001) and presence of a sinus tract (hazard ratio, 2.35; 95% confidence interval, 1.10-5.0; P = .02). CONCLUSIONS: Our study demonstrates the value of current treatment recommendations. Inappropriate choice of conservative surgical strategies (such as debridement and retention) and inadequate antibiotic treatment are associated with failure.

Influence of high BMI on functional outcome after total hip arthroplasty.

BACKGROUND: High body mass index (BMI) is associated with diseases of the hip joint and subsequent total hip arthroplasty (THA). Less is known about the effects of BMI on the functional postoperative status after THA in obese patients. The purpose of this study was therefore to quantify the role of high preoperative BMI on long-term pain status and functional outcome after THA. METHODS: In a multi-center cohort, study data of 20,553 primary THAs (18,968 patients) and 43,562 postoperative clinical examinations were analyzed for a follow-up period of up to 15 years. Patients were classified into three BMI groups (normal weight <25 kg/m2, overweight 25 to <30 kg/m2, and obese > or =30 kg/m2), and pain status and functional outcome were compared accordingly. RESULTS: High preoperative BMI is associated to an almost perfect dose-effect relationship with decreased ambulation during a follow-up period of 15 years, but pain relief of THA is equally efficient for all BMI groups. CONCLUSION: Overweight and obesity are modifiable risk factors that may warrant physicians giving recommendations to patients before or after THA, to improve postoperative functional outcome quality.

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices.

BACKGROUND: In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. METHODS: This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17). After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER): Follow-up and final examination in the hospital's emergency unit. Group B (GP): Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. RESULTS: Female and male patients were equally represented in both groups. The age of the patients ranged from 16 - 64 years, with a mean age of 34 years (ER) and 35 years (GP). 98% (n = 98) of all patients were satisfied with their treatment, and 93% (n = 93) were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively). 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc.) on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669). CONCLUSION: Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a general practitioner for follow-up treatment without affecting patient satisfaction regarding treatment and treatment outcome.

Reinterventions after dynamic intraligamentary stabilization in primary anterior cruciate ligament repair.

BACKGROUND: The goal of this study was to perform an in-depth analysis of the frequency and cause of secondary interventions subsequent to primary anterior cruciate ligament (ACL) repair with dynamic intraligamentary stabilization (DIS). METHODS: Between July 2009 and June 2014, 455 patients underwent DIS treatment. The minimum follow-up was 21months (mean 28months, range 21-64months). RESULTS: A total of 215 (48.2%) reinterventions were performed in 190 (42.6%) patients. One-hundred and seventy-six (39.4%) were non-revision reinterventions, and 39 (8.7%) were revision ACL reconstructions. Re-arthroscopies included 26 (5.8%) scar tissue debridements with hardware removal due to range of motion deficits, 14 (3.1%) partial meniscectomies, four (0.9%) meniscal sutures, and four (0.9%) arthroscopies due to crepitation or knee pain. Minor non-revision reinterventions performed under analgosedation consisted of 97 (21.7%) hardware removals, 20 (4.5%) hardware removals with manipulations under anesthesia, and four manipulations under anesthesia alone (0.9%). CONCLUSIONS: In our study, the revision rate was within the range of published results after ACL reconstructions. In over 90% of patients, the native ACL was preserved with no need for a secondary reconstruction. Most of the non-revision reinterventions were minor and included hardware removals and manipulations under anesthesia. The re-arthroscopy rate was lower than that after ACL reconstruction with fewer secondary meniscal sutures and partial meniscectomies. Early treatment of meniscal tears may be one crucial benefit of ACL repair with DIS.