Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review.

PURPOSE: Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS: Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS: One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS: This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.

Comparative outcomes between a new robotically assisted and a manual technique for total knee arthroplasty in patients with osteoarthritis: a prospective matched comparative cohort study.

PURPOSE: Studies comparing clinical outcomes between manual (mTKA) and robotic-assisted TKA (raTKA) are limited. This prospective comparative cohort study aimed to compare early postoperative outcomes, satisfaction, and patient-reported outcome measures (PROMS) between patients undergoing mTKA and ROSA raTKA (Zimmer Biomet, Warsaw, IN) performed by one surgeon. METHODS: Thirty ROSA raTKAs and 30 mTKAs performed by one surgeon during 2020-2021 were prospectively evaluated. Groups were matched for age, sex, and body mass index. All procedures were primary unilateral TKAs using the same posterior-stabilized prosthesis (Nexgen Legacy, Zimmer Biomet, Warsaw, IN). Length of hospital stay (LOS) and blood transfusion rate were recorded. Complications, visual analogue scale score (VAS), and Oxford Knee Score (OKS) were assessed preoperatively and for six postoperative months. The Forgotten Joint Score (FJS) and patient satisfaction were evaluated 6 months postoperatively. RESULTS: No complications and similar blood transfusion rate were recorded between groups (p = 0.228). The LOS was non-significantly shorter in raTKA than in the mTKA group (p = 0.120). Mean preoperative and third-month OKS and VAS scores were comparable between groups. However, the mean 6-month OKS (p = 0.006) and VAS score (p = 0.025) were significantly better for the raTKA group. The 6-month FJS was significantly greater for raTKA than the mTKA group (p < 0.001). One patient was unhappy in raTKA, and three in the mTKA group (p = 0.301). Significantly more raTKA patients answered that they would undergo surgery again (p = 0.038). CONCLUSION: raTKA was associated with the same complication risk, less pain level, better patient satisfaction, and PROMs on 6-month follow-up than the mTKA group.

Anterior femoral notching ≥ 3 mm is associated with increased risk for supracondylar periprosthetic femoral fracture after total knee arthroplasty: a systematic review and meta-analysis.

PURPOSE: Anterior femoral notching (AFN) may be associated with a higher risk for supracondylar periprosthetic fracture (sPPF) after total knee arthroplasty (TKA), although studies have yielded inconclusive results. We aimed to systematically investigate and meta-analyze the best available evidence regarding the association between AFN and the risk of sPPF after TKA. METHODS: A comprehensive search of PubMed, Scopus, Mendeley, Google Scholar and Cochrane databases was performed, from conception to February 29, 2020. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). I2-index was employed for heterogeneity. Newcastle-Ottawa scale was implemented for quality assessment of the included studies. RESULTS: Nine studies fulfilled the eligibility criteria, including a total of 3264 patients subjected to TKA. Among them, there were 150 patients who sustained a sPPF. Overall, patients exposed to AFN (AFN group) demonstrated an increased risk for sPPF compared to those not exposed (control group) (OR 3.91, 95% CI 1.22-12.58, p = 0.02; I2 68.52%). Subgroup analysis based on AFN depth with a cut-off value of 3 mm further clarified this association. Patients with AFN ≥ 3mm were at higher risk for sPPF compared to patients with AFN < 3 mm and control group (OR 4.85, 95% CI 2.08-11.33, p = 0.00; I2 0.0%). On the contrary, fracture risk was not significant for patients with AFN < 3 mm compared to the control group (OR 5.0, 95% CI 0.44-56.82, p = 0.19; I2 42.99%). CONCLUSION: Patients, exposed to AFN ≥ 3 mm in depth, are at higher risk for sustaining a sPPF.

Type 2 Diabetes Mellitus is Associated with Increased Risk of Sarcopenia: A Systematic Review and Meta-analysis.

Diabetes mellitus (DM) is associated with an increased risk of fractures, mainly due to impaired bone architecture and microvascular complications. Whether DM is also associated with increased risk of sarcopenia is not yet known, with studies yielding inconclusive results. The aim of this study was to systematically review and synthesize the best available evidence regarding the association between DM and sarcopenia risk. A comprehensive search was conducted in PubMed, CENTRAL and Scopus databases. Data are expressed as odds ratio (OR) with 95% confidence intervals (CI). The I2 index was employed for heterogeneity. Only studies which had implemented at least two of the three criteria for sarcopenia diagnosis (low muscle mass, muscle strength and/or muscle performance), as defined by the international studying groups, were included. Fifteen studies fulfilled eligibility criteria, yielding a total of 1832 patients with type 2 DM (T2DM) and 1159 cases of sarcopenia. Patients with T2DM demonstrated a higher risk of sarcopenia compared with euglycemic subjects (OR 1.55, 95% CI 1.25-1.91, p < 0.001; I2 34.6%). This risk remained significant when analysis was restricted to studies matched for age and sex. Sarcopenia risk was independent of disease definition or study design. Notably, T2DM patients presented lower muscle performance and strength compared with euglycemic subjects, whereas no difference in muscle mass was observed between groups. Patients with T2DM have an increased risk of sarcopenia compared with euglycemic subjects.

Obesity, osteoporosis and bone metabolism.

Obesity and osteoporosis have become major global health problems over the last decades as their prevalence is increasing. The interaction between obesity and bone metabolism is complex and not fully understood. Historically, obesity was thought to be protective against osteoporosis;however, several studies have challenged this belief. Even though the majority of the studies suggest that obesity has a favourable effect on bone density, it is unclear what the effect of obesity is on skeletal microarchitecture. Additionally, the effects of obesity on skeletal strength might be site-dependent as obese individuals are at higher risk of certain fractures. Several mechanical, biochemical and hormonal mechanisms have been proposed to explain the association between the adipose tissue and bone. Mechanical loading has positive effects on bone health, but this may not suffice in obesity. Low-grade systemic inflammation is probably harmful to the bone and increased bone marrow adipogenesis may lead to decreased bone mass in obese individuals. Finally, visceral abdominal fat may exert different actions to the bone compared with the subcutaneous fat. Achieving a better understanding of the association between adipose and bone tissue may help to identify new molecular therapeutic targets that will promote osteoblastic activity and/or inhibit adipogenesis and osteoclastic activity.

Anterior cruciate ligament deficiency reduces walking economy in "copers" and "non-copers".

PURPOSE: Patients with ACL injury requiring surgical treatment (non-copers) demonstrate altered neuromuscular control and gait pattern compared with those returning to their pre-injury activities without surgery (copers). Pathological gait pattern may increase the energy cost of walking. We compared the energy cost of flat, uphill, and downhill walking between ACL-deficient and healthy individuals and between "copers" and "non-copers". METHODS: Nineteen young males with unilateral ACL injury were allocated into "copers" and "non-copers" according to their ability to return to pre-injury activity without ACL reconstruction. Lysholm and IKDC scales were recorded, and a control group (n = 10) matched for physical characteristics and activity levels was included. All participants performed 8-min walking tasks at 0, +10, and -10 % gradients. Energy cost was assessed by measurement of oxygen consumption (VO2). HR and ventilation (VE), respiratory exchange ratio (RER), and VE/VO2 were also measured. RESULTS: VO2 and HR were higher in ACL-deficient patients than in controls during walking at 0, +10, and -10 % gradients (p < 0.01-0.05). There were no differences between "copers" and "non-copers" in VO2 and HR for any gradient. No differences were observed in VE, RER, and VE/VO2 among the three groups. CONCLUSIONS: The walking economy of level, uphill, and downhill walking is reduced in ACL-deficient patients. Despite the improved functional and clinical outcome of "copers", their walking economy appears similar to that of "non-copers" but impaired compared with healthy individuals. The higher energy demand and effort during locomotion in "copers" and "non-copers" has clinical implications for designing safer rehabilitation programmes. The increased energy cost in "copers" may be another parameter to consider when deciding on the most appropriate therapeutic intervention (operative and non-operative), particularly for athletes. LEVEL OF EVIDENCE: II.

Anatomic single-bundle anterior cruciate ligament reconstruction improves walking economy: hamstrings tendon versus patellar tendon grafts.

PURPOSE: Anterior cruciate ligament (ACL) injury is associated with a pathologic gait pattern and increased energy cost during locomotion. ACL reconstruction could improve the gait pattern. Hamstrings tendon (HAM) and bone-patellar tendon-bone (BPTB) grafts are usually used for reconstruction. The aim of this study was to compare the efficacy of anatomic ACL reconstruction with HAM and BPTB grafts on improving and normalizing the energy cost and physiologic reserves during flat, uphill, and downhill walking. METHODS: Twenty male subjects with unilateral ACL injuries were randomly assigned to ACL reconstruction with a HAM (n = 10) or BPTB (n = 10) graft. Ten matched controls were also enrolled. All participants performed three 8-min walking tasks at 0, +10, and -10 % gradients before and 9 months after surgery. Energy cost (oxygen consumption, VO2), heart rate (HR), and ventilation (VE) were measured. Lysholm/IKDC scores were recorded. RESULTS: Pre-operatively, VO2, HR, and VE were higher in the HAM and BPTB groups than in controls during walking at 0, +10, and -10 % gradients (p < 0.001-0.01). Post-operatively, both HAM and BPTB groups showed reduced VO2, HR, and VE during the three walking tasks (p < 0.001-0.01). Although the post-operative VO2 in both surgical groups reached 90-95 % of the normative (control) value during walking, it remained elevated against the value observed in controls (p < 0.001-0.01). The HAM and BPTB groups showed no differences in post-surgical VO2 or HR during walking at all three gradients. CONCLUSION: Anatomic ACL reconstruction with either HAM or BPTB graft resulted in similar short-term improvements in energy cost and nearly normalized locomotion economy and cardiorespiratory reserves during flat, uphill, and downhill walking. The improved locomotion economy is an additional benefit of anatomic ACL reconstruction, irrespective of the type of graft used, that the orthopaedic surgeons should consider. LEVEL OF EVIDENCE: II.

The effect of smoking on clinical and radiographic variables, and acute phase reactants in patients with ankylosing spondylitis.

To investigate the association between smoking and clinical, inflammatory and radiographic parameters in patients with ankylosing spondylitis (AS). One hundred and six tumour necrosis factor inhibitor naïve patients with AS were included in the study. The erythrocyte sedimentation rate, C-reactive protein, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI) and modified Stroke AS Spine Score (mSASSS) were assessed cross-sectionally for each patient. Smoking history was obtained, and smoking pack years were calculated. Current smokers had significantly higher BASDAI (p < 0.001) and a trend for higher BASFI (p = 0.059). Ever smokers had significantly higher BASFI (p = 0.035) and a trend for higher mSASSS (p = 0.063) compared to never smokers. Pack years (smoking intensity) were positively correlated with duration of inflammatory back pain (r = 0.628, p < 0.001), BASFI (r = 0.443, p < 0.001) and mSASSS (r = 0.683, p < 0.001). Multivariate regression analyses showed that current smoking was independently associated with a higher BASDAI score [regression coefficient (B) = 14.75, p < 0.001] and increasing pack years were independently associated with higher mSASSS (B = 0.26, p = 0.005). In patients with AS, current smoking was strongly and independently associated with higher disease activity, and cumulative smoking exposure with more radiographic spinal damage. In AS smokers, smoking cessation should be strongly recommended.

Mechanical and Contractile Properties of Knee Joint Muscles after Sports-Related Concussions in Women Footballers.

The purpose of this study was to determine if women footballers have an increased lack of neuromuscular control of the knee joint after a concussion compared to a healthy cohort tested with tensiomyography (TMG). Forty-one female collegiate footballers were enrolled in this study from which there were 20 with a history of sports-related concussions (SRCs) and 21 control subjects. Results from the SRC group had significantly higher Tc (ms) (z = -5.478, p = 0.000) and significantly lower Dm (mm) (z = -3.835, p = 0.000) than the control group in the case of the rectus femoris muscle. The SRC group had significantly higher Tc (ms) (z = -2.348, p = 0.016) and significantly lower Dm (mm) (z = -4.776, p = 0.000) than the control group in the case of the vastus medialis muscle. The SRC group had significantly higher Tc (ms) (z = -5.400, p = 0.000) and significantly lower Dm (mm) (z = -4.971, p = 0.000) than the control group in the case of the vastus lateralis muscle. The SRC group had significantly higher Tc (ms) (z = -5.349, p = 0.000) than the control group in the case of the biceps femoris muscle response, whereas no significant difference was found in Dm (mm) (z = -0.198, p = 0.853) between the groups. The results of the current study may have implications for current practice standards regarding the evaluation and management of concussions and can add valuable information for knee prevention programs as well.

Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes?

INTRODUCTION: This systematic review aims to critically assess the literature comparative studies investigating collared and collarless Corail stem in primary total hip arthroplasty (THA) to find differences in revision rates, radiographic and clinical outcomes, and postoperative complications between these two types of the same stem. METHODS: Eligible studies were found by searching PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews from conception till May 2023. The PRISMA guidelines were followed. The investigation encompassed randomized controlled trials, case series, comparative, cohort, and observational studies that assessed at least one comparative outcome or complication between collared and collarless Corail stems. RESULTS: Twelve comparative studies with 90,626 patients undergoing primary THA were included. There were 40,441 collared and 58,543 collarless stems. The follow-up ranged from 12 to 360 months. Our study demonstrated no significant difference in stem revision relative risk (RR = 0.68; 95% confidence interval (CI), 0.23, 2.02; p = 0.49), number of radiolucent lines (RR = 0.3; 95% CI, 0.06, 2.28; p = 0.29) and overall complication risk (RR = 0.62; 95% CI, 0.22, 1.76; p = 0.37) between collared and collarless stems. The collared stems demonstrated significantly lesser subsidence (mean difference: 1.01 mm; 95% CI, -1.77, -0.25; p = 0.009) and risk of periprosthetic fractures (RR = 0.52; 95% CI, 0.29, 0.92; p = 0.03). CONCLUSION: The comparative studies between collared and collarless stem groups showed similar survival and overall complication rates and functional outcomes. The similar revision rates between groups make the impact of higher subsidence for collarless stems uncertain. The lower risk of periprosthetic fractures in the collared stems group must be clarified further but could be related to increased rotational stability.

Interventions used to mitigate muscle fatty degeneration following the repair of massive rotator cuff tears. A systematic review of animal studies.

BACKGROUND: Muscle fatty degeneration following rotator cuff tears has been unequivocally associated with poorer functional outcomes and increased risk for retear following rotator cuff repair. Promising results have emerged from animal studies, with the implementation of various interventions for biologic inhibition of this fatty muscle degeneration. The lack of high quality randomized human evidence on this topic, increases the impact of pooled results from animal literature. The aim of the present study was to systematically review the available published literature for animal studies evaluating the ability of several interventions used to mitigate muscle fatty degeneration following the repair of massive rotator cuff tears. PATIENTS AND METHODS: A comprehensive search was conducted on Pubmed, Scopus and Google Scholar, covering the period from conception until 16th April 2022. Datasets were stratified based on the type of intervention performed. SYRCLE risk of bias instrument was implemented for quality assessment of the included studies. RESULTS: Rotator cuff repair augmentation with Adipose derived stem cells (ADSC's), Mesenchymal stem cells (MSC's) and Nandrolone was effective against fatty infiltration, but less effective against muscle atrophy. More beneficial effect was shown by the utilization of Beige adipose tissue - Fibroadipogenic progenitors (BAT-FAP) stimulation, using either Amibregon or BAT-FAPs transplantation. Both provided good results in mitigating muscle atrophy, fatty infiltration and fibrosis. DISCUSSION: ADSC's, MSC's, Nandrolone and BAT-FAP stimulation may have a role in mitigating muscle fatty degeneration following rotator cuff tears. Large scale human studies are required to further elucidate their role in the clinical setting. LEVEL OF EVIDENCE: V; systematic review of pre-clinical studies.

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome.

BACKGROUND: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients' scores were assessed. Surgical tips to enhance outcomes were reviewed. METHODS: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient's age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. RESULTS: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1-84.5) and 80.5 months for dislocation (95% CI, 75.8-85.2). The mean postoperative functional scores were significantly improved (p < 0.001) at the latest follow-up. CONCLUSIONS: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs' offset relative to stem-neck impingement are necessary to maximise outcomes.

Superior Transverse Atraumatic Reconstruction (STAR) approach provides a better-compared outcome to standard Direct Superior Approach (DSA): a matched, prospective comparative single-surgeon study.

INTRODUCTION: The Direct Superior Approach (DSA) is a muscle-sparing hip approach that does not protect the piriformis and the other short external rotators. We present a DSA modification we named STAR (Superior Transverse Atraumatic Reconstruction), which has DSA advantages but always preserves piriformis. Our study compared the early postoperative, radiological, and functional results of patients undergoing primary total hip arthroplasty (THA) through the STAR approach with a matched DSA group performed by a senior surgeon. METHODS: Each group, DSA, and STAR included 200 elective primary unilateral THAs performed by the surgeon between 2016-2017 and 2020-2021, respectively. Patients were included in both groups using the same inclusion criteria. Both groups were matched for age and sex. The same postoperative pain management, chemoprophylaxis, and physiotherapy protocols were followed in both groups. Two independent orthopaedic surgeons performed the clinical and radiological follow-up. RESULTS: The STAR group had significantly lower mean incision length (p = 0.042) and hospital stay (p = 0.002) than the DSA group. The mean intraoperative blood loss (p = 0.085) and the need for blood transfusion (p = 0.228) were less for the STAR than the DSA group. The mean postoperative functional scores improvement was significantly higher for the STAR than the DSA group at the end of the first and third postoperative months. CONCLUSIONS: The STAR approach offers earlier functional improvement, shorter hospital stay and less transfusion need than DSA for patients undergoing primary THA. Both approaches showed a limited complication risk and an outstanding acetabular and femoral access enabling the procedure.

Bisphosphonates' use and risk of aseptic loosening following total hip arthroplasty: a systematic review.

Purpose: The main indication of bisphosphonates (BPs) is osteoporosis treatment. However, there is growing interest in the peri- and postoperative use of BPs to mitigate total hip arthroplasty (THA) aseptic loosening (AL) risk. This systematic review aimed to evaluate the implant survival and the AL rate in patients with elective THA receiving BPs compared to those that do not receive BPs. Secondary outcomes included the comparison of revision rate, postoperative complications, and patients' functional scores. Methods: This systematic review was conducted under the PRISMA 2020 guidelines with a pre-registered PROSPERO protocol. Three engines and grey literature were searched up until May 2022. Randomized and nonrandomized controlled trials and comparative cohort studies assessing BP and control therapy impact on THA survival were included. Results: Twelve studies embraced the inclusion criteria. A total of 99 678 patients and 99 696 THAs were included; 10 025 patients received BPs (BP group), and 89 129 made up the control group. The overall revision and AL rates were lower in the BP group (2.17% and 1.85%) than in the control group (4.06% and 3.2%). Periprosthetic fracture (PPF) cases were higher in the BP group (0.24%) than in the control group (0.04%); however, the majority of PPF cases were derived from a single study. Further complication risk was similar between groups. Most studies reported comparable functional scores between groups. Conclusion: BP treatment after elective THA seems to reduce the overall revision and AL risk. Other complications' risk and functional scores were similar between groups. Further high-quality studies are needed to validate the results due to the multifactorial AL pathogenesis.

The Effect of Ball Heading and Subclinical Concussion On the Neuromuscular Control Of The Lower Limb: A Systematic Review.

Background: Soccer is unique among sports because it is the only sport that involves purposeful use of the head to control, pass, or shoot the ball. Over the previous five years, a relationship between lower extremity (LE) injury and sports related concussion (SRC) has been established in various sporting populations. Athletes at the high school, collegiate, and professional levels have demonstrated a greater risk for sustaining a LE injury post SRC. The purpose of this systematic review was to examine the relationship of the SRC with the incidence of LE injuries. Methods: Ten databases were searched with the following keywords: Lower limb, ball heading, neuromuscular control, concussion, MEDLINE, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R), EMBASE, and Scopus. The search was limited to English-language and peer-reviewed publications, until 15/12/2022. The PEDro scale was used for the assessment of the risk of bias among the included studies. All included papers were qualitatively analyzed. Results: A total of 834 studies were identified and 10 articles (four concussion-MSK biomechanics, six concussion-MSK injury) were included in the qualitative analyses. Included papers ranged from low to high quality. Due to the heterogeneous nature of the included study designs, quantitative meta-analysis was unable to be performed. All four of the included concussion-MSK biomechanics studies demonstrated, to some degree, that worse cognitive performance was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. Among the six injury related studies, two investigations failed to determine group differences in cognitive performance between subsequently injured and non-injured athletes. Conclusion: More research is needed to better understand the relationship of SRC and lower extremity injuries and the extent to which they are related to concussions and/or repetitive neurotrauma after ball heading sustained in soccer. Level of Evidence: 2.

Is thyroid disease associated with post-operative complications after total joint arthroplasty? A systematic review of the literature.

Background: This comprehensive systematic review aims to assess the literature regarding the risk of postoperative complications in patients undergoing total joint arthroplasty (TJA) with concomitant thyroid dysfunction. Methods: Studies were identified by searching PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ClinicalTrials.gov (end of search: May 2022). Inclusion criteria: Randomized control and case-control studies, cohort and observational clinical studies were included, which focused on postoperative complications and outcomes of patients undergoing TJA operations of major joints (knee, hip, ankle, elbow). All studies were assessed according to their level of evidence, the number and age of patients, and treatment complications. Analysis: Nine studies were included in this review that demonstrated a higher risk of postoperative anemia, perioperative blood loss, hemoglobin decrease, and transfusion rates in hypothyroid patients after TJA. Results: Hypothyroidism has been identified as a potential but modifiable risk factor for increased rates of deep venous thrombosis, acute kidney injury, pneumonia, and non-specified cardiac complications among hypothyroid patients who underwent TJA as well as increased rates of periprosthetic joint infection. No significant differences in the prosthesis-related mechanical complication rates have been calculated when comparing hypothyroid and euthyroid patients.

Earlier functional recovery and discharge from hospital for THA patients operated on via direct superior compared to standard posterior approach: a retrospective frequency-matched case-control study.

BACKGROUND: The direct superior hip approach (DSA) has been less researched than other approaches in the literature. We retrospectively compared the early postoperative and functional outcomes of patients with hip osteoarthritis undergoing total hip arthroplasty (THA) via DSA with a matched control group using a standard posterior approach (SPA). METHODS: The DSA group comprised 100 THAs performed via DSA by a senior surgeon between January 2018 and May 2019. Patients with primary osteoarthritis and ASA score ⩽3 who were eligible for surgery were included. The DSA group was compared to a matched cohort of 100 patients operated on with a SPA in the same period by another chief surgeon. Patients were matched for age, sex, and ASA score. All patients received the same postoperative chemoprophylaxis, pain management and physiotherapy. 2 independent attending arthroplasty surgeons assessed the incision length, operative time, blood loss, hospital stay, and complications. VAS, HHS, and HOOS scores were also evaluated for a year postoperatively. RESULTS: Mean incision length and hospital stay were significantly lower in the DSA group. DSA patients had non-significantly lower intraoperative blood loss, transfusion needs, and postoperative pain than SPA patients. Mean operation time and complication rate did not differ between groups. The DSA group demonstrated significantly greater functional scores than the SPA group at the first postoperative month. No differences in scores were recorded following the third month. CONCLUSIONS: The DSA approach may provide earlier functional recovery and hospital discharge for THA patients compared with SPA. DSA was equivalent to SPA concerning pain and blood loss, showing minimal complication rates.

Participation in athletic activities may be associated with later development of hip and knee osteoarthritis.

Participation in physical activity and recreational sports is critical for maintaining overall health; athletic activities and reduction in the incidence of several "lifestyle" diseases seem to have a dose-dependent relationship. Also, quality of life is enhanced in people who are active and regularly participate in sports. However, sports-related joint loading and strenuous occupational loading have been shown to increase the risk of osteoarthritis (OA), which seems to have a multifactorial etiology. This article reviews the literature on known connections between participation in sports and athletic activities and development of secondary OA in the joints of the major upper and lower limbs (ie, knee, hip, elbow, and shoulder) in athletes without injury. Most studies examining the connection between participation in sports and later development of OA usually provide low-level evidence and have many methodological weaknesses. Based on the literature reviewed in this article, it may be concluded that the connection between participation in athletic activities and development of OA has not been proven; however, the condition is highly likely to occur in the hip and knee joints. Definite conclusions regarding the connection between development of glenohumeral and/or elbow OA and participation in athletic activities cannot be drawn.

Association of Matrix Metalloproteinase (MMP) Gene Polymorphisms With Knee Osteoarthritis: A Review of the Literature.

Progressive matrix metalloproteinase (MMP)-induced degradation of the extracellular matrix (ECM) of the articular cartilage is one of the major pathogenic osteoarthritis (OA) events. Several single nucleotide polymorphisms (SNPs) in genes encoding MMPs have been identified as affecting MMP expression, production, and enzymatic activity. This study systematically reviews the literature regarding the association between the SNPs of genes encoding MMPs and the risk of knee OA. An electronic search in the PubMed and Web of Science databases from conception to January 2021 was performed addressing studies relating MMPs genetic polymorphisms with the risk of knee OA. We included case-control studies that used validated genotyping methods to detect the SNPs' association in MMP genes with primary knee OA risk. Ten studies were finally included in this systematic review, evaluating different SNPs in six MMP genes in terms of knee OA pathogenesis: MMP-1 (3 SNPs), MMP-2 (1 SNP), MMP-3 (9 SNPs), MMP-8 (10 SNPs), MMP-9 (6 SNPs), and MMP-13 (1 SNP). Among them, nine SNPs of four MMP genes have been associated with knee OA: (a) MMP-1 -1607 1G/2G (Turkish, Chinese), (b) MMP-3 rs650108, rs650108, rs520540, rs602128, rs679620 (Chinese), (c) MMP-8 rs1940475 and rs376520 (Finnish), and (d) MMP-13 77A/ (rs2252070) (Chinese). The present review summarizes all known SNPs of MMP genes related to a higher risk of knee OA. There are at least nine SNPs in four MMP genes associated with knee OA. No solid correlation between MMP genotype and knee OA phenotype exists. More high-quality studies and modern genetic testing methods are needed to fully elucidate the role of polymorphisms of MMP genes in knee OA pathogenesis.