Gender-based differences exist in the functional knee phenotypes classification of the osteoarthritic knee.

PURPOSE: To identify gender differences in (1) the coronal alignment of functional knee phenotypes and (2) the JLCA (joint line convergence angle) in relation to the phenotype classification. METHODS: This study is a retrospective data analysis, including 12,099 osteoarthritic knee computed tomography (5025 male, 7074 female) analysed by Medacta software for hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA) and JLCA. The data were grouped into genders and combined according to the Functional Knee Phenotypes Classification. RESULTS: Out of 127 phenotypes for males and 131 for females, 17 common phenotypes were reported. The commonest four were similar for both genders with VARHKA177° NEUFMA93° NEUTMA87° (9.8% males, 9.50% females), followed by VARHKA174° NEUFMA93°VARTMA84° (7.1%) and VARHKA174°VARFMA90° NEUTMA87° (7.0%) for males and VARHKA174° NEUFMA93° NEUTMA87° (6.1%), VARHKA174° NEUFMA93°VARTMA84° (5.1%) for females. The commonest FMA and TMA (91.5° to 94.5° and 85.5° to 88.5°, respectively) were the same for both genders, however, the rest of the male population observed greater femoral varus than the female population (p < 0.001). JLCA values ranged from -28.4° to 8.2° in the overall study population. Males and females had a mean JLCA of -2.96° (±2.6° SD) and -2.66° (±2.8°7 SD), respectively, p < 0.001. CONCLUSIONS: Gender differences exist within the osteoarthritic knee phenotype. The male varus phenotype is influenced by FMA, while TMA values are similar across genders. JLCA variations show similarities to both TMA and FMA, suggesting JLCA is influenced by bone morphology more than by gender. These differences inform surgical decision-making for the personalised approach to the primary TKA. LEVEL OF EVIDENCE: Level III.

Robotic assisted surgery in the United Arab Emirates: healthcare experts' perceptions.

The adoption of Robotic Assisted Surgery (RAS) has grown around the world. This is also the case in the Middle East and Gulf region and specifically to the United Arab Emirates (UAE). The perception of RAS has been studied in the USA, Europe, and Canada. However, there is limited research on the perception of RAS in the UAE. The study aims to examine the perception of RAS among healthcare experts in the UAE and potential challenges. This qualitative study is based on interviewing healthcare experts in the UAE. Most of the study participants were clinicians and surgeons. In the UAE, RAS is adopted in general surgery, urology, brain surgery, and obstetrics and gynecology. Our findings show that healthcare experts have positive perceptions of RAS. The cost and lack of RAS training program are considered as challenges to adopting RAS in healthcare practices. More research is encouraged to examine perception variations with surgical practices in the UAE, Gulf and the Middle East.

Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19.

Background: Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors. Methods: This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters. Results: In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7-9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters. Conclusion: Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

Percutaneous removal of sacroiliac screw following iatrogenic neurologic injury in posterior pelvic ring injury: A case report.

INTRODUCTION: Percutaneous sacroiliac fixation is an effective minimally invasive method for posterior pelvic ring stabilization. Screw misplacement, and subsequent neurologic injury are two well described complications. Managing those complications however is under-reported. CASE: A young female, sustained an unstable pelvic ring injury as a victim of motor vehicle collision. Following percutaneous sacroiliac screw fixation, she complained of L5 nerve root radiculopathy, and muscle weakness. Percutaneous removal of the screw after a wait period for fracture union resulted in immediate symptoms relief. DISCUSSION: Safe sacroiliac screw placement is technically demanding requiring good understanding of sacral complex morphology and its anatomic variants. Risk of screw misplacement, and potential neurologic injury increases in dysmorphic sacra, or with inaccurate fracture reduction. Advances in intraoperative imaging modalities have been introduced in an attempt to improve accurate screw insertion. Literature is scarce with reports discussing removal of sacroiliac screw. Technique of screw retrieval is also controversial. CONCLUSION: This case addresses management of an iatrogenic neurologic complication following percutaneous sacroiliac screw fixation. Our experience showed that, percutaneous retrieval of an intact misplaced sacroiliac screw is achievable, resulting in complete resolution of neurologic symptoms.