Antithrombotic prophylaxis following total knee arthroplasty: a level I Bayesian network meta-analysis.

INTRODUCTION: Venous thromboembolism (VTE) is a major concern following total knee arthroplasty (TKA). The optimal pharmacological prophylaxis remains, however, controversial. The present investigation compared several non-vitamin K antagonist oral anticoagulants commonly employed as VTE prophylaxis following TKA. A Bayesian network meta-analysis was conducted to compare apixaban, aspirin, dabigatran, edoxaban, enoxaparin, fondaparinux, and rivaroxaban. The outcomes of interest were to compare the rate of deep venous thrombosis (DVT), pulmonary embolism (PE), and major and minor haemorrhages. METHODS: This study was conducted according to the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-Analyses of Health Care Interventions. In March 2024, PubMed, Web of Science, and Google Scholar were accessed with no time constraints. All randomised controlled trials (RCTs) comparing two or more drugs for the prevention of VTE following TKA were considered for inclusion. RESULTS: Data from 29,678 patients were collected. Of them, 67% (19,884 of 29,678 patients) were women. The mean age of the patients was 66.8 ± 2.8 years, and the mean BMI was 29.2 ± 1.5 kg/m2. There was comparability in age, sex, and BMI at baseline. Apixaban 5 mg, dabigatran 220 mg, and rivaroxaban 10 mg were the most effective in reducing the rate of DVT. Apixaban 5 mg, enoxaparin 60 mg, and rivaroxaban 40 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, rivaroxaban 10 mg, and apixaban 10 mg were associated with the lowest rate of major haemorrhages. Apixaban 5 mg and 20 mg, and dabigatran 220 mg were associated with the lowest rate of minor haemorrhages. CONCLUSION: Administration of apixaban 5 mg demonstrated the best balance between VTE prevention and haemorrhage control following TKA. LEVEL OF EVIDENCE: Level I, network meta-analysis of RCTs.

Reliability and Accuracy of the Outerbridge Classification in Staging of Cartilage Defects.

OBJECTIVE: The decision on whether or not and how to treat a local cartilage defect is still made intraoperatively based on the visual presentation of the cartilage and findings from indentations with an arthroscopic probe. The treatment decision is then usually based on grading according to established classifications systems, which, therefore, need to have high reliability and accuracy. The aim of the present study was to evaluate the reliability and accuracy of the Outerbridge classification in staging cartilage defects. METHODS: We performed an observer arthroscopic study using the Outerbridge classification on seven fresh-frozen human cadaveric knees, which collectively exhibited nine cartilage defects. To evaluate accuracy, defect severity was verified through histological examination. Interrater and intrarater reliabilites were calculated using Cohen's kappa and the intra-class correlation coefficient (ICC 3.1). RESULTS: The interrater and intrarater reliability for the Outerbridge classification ranged from poor to substantial, with 0.24 ≤ κ ≤ 0.70 and κ = 0.55 to κ = 0.66, respectively. The accuracy evaluated by comparison with the histological examination was 63% overall. The erroneous evaluations were, however, still often at the discrimination of grade 2 and 3. We did not find any relationship between higher experience and accuracy or intraobserver reliability. Taken together, these results encourage surgeons to further use diagnostic arthroscopy for evaluating cartilage lesions. Nevertheless, especially in grade 2 and 3, deviations from the histology were observed. This is, however, the point where a decision is made on whether to surgically address the defect or not. CONCLUSION: Diagnostic arthroscopy is the standard for cartilage lesion assessment, yet interobserver reliability is fair to substantial. Caution is warranted in interpreting varied observer results. The accuracy of the "simpler" Outerbridge classification is insufficient compared to histological examinations, highlighting the need for improved techniques in guideline-based intraoperative decision-making.

Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) in patients who have undergone total knee arthroplasty: a systematic review.

BACKGROUND: The present systematic review investigated the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) of several frequent and established PROMs used to assess patients who have undergone TKA. This study was conducted according to the 2020 PRISMA statement. METHODS: In September 2023, PubMed, Web of Science, and Embase were accessed with no time constraint All clinical studies investigating tools to assess the clinical relevance of PROMs used to evaluate patients having received TKA were accessed. Only studies which evaluated the MCID, PASS, or SCB were eligible. The PROMs of interest were the Forgotten Joint Score-12 (FJS-12), the Oxford Knee Score (OKS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and its related subscales activity of daily living (ADL), pain, quality of life (QoL), sports and recreational activities, and symptoms, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the Knee Society Score (KSS) and related function score, and the Short Form-12 (SF-12) and Short Form-36 (SF-36). RESULTS: Data from 29,737 patients were collected. The overall risk of bias was low to moderate. The great variability of thresholds for MCID, SCB and PASS between questionnaires but also between investigated aspects was noted, whereby MCIDs for the SF-36 appear lower than for knee-specific questionnaires. CONCLUSION: Despite its critical role from a patient's perspective, the dimension of SCB is still neglected in the literature. Moreover, thresholds for the different concepts need to be condition-specific. We encourage authors to specifically report such data in future studies and to adhere to previously reported definitions to allow future comparison. Level of evidence Level IV, systematic review and meta-analysis.

Biomechanical and biochemical assessment of YB-1 expression in A375 melanoma cell line: Exploratory study.

Malignant melanoma is the most lethal form of skin cancer. Y-box binding protein 1 (YB-1) plays a prominent role in mediating metastatic behavior by promoting epithelial-to-mesenchymal transition (EMT). Migratory melanoma cells exhibit two major migration modes: elongated mesenchymal or rounded amoeboid. Using A375 melanoma cell line and the YB-1 knock-out model, we aimed to elucidate biochemical and biomechanical changes in migration signaling pathways in the context of melanoma metastases. We subjected A375 YB-1 knock-out and parental cells to atomic force microscopy (stiffness determination), immunolabelling, and proteome analysis. We found that YB-1 expressing cells were significantly stiffer compared to the corresponding YB-1 knock-out cell line. Our study demonstrated that the constitutive expression of YB-1 in A375 melanoma cell line appears to be closely related to known biomarkers of epithelial-to-mesenchymal transition, nestin, and vimentin, resulting in a stiffer phenotype, as well as a wide array of proteins involved in RNA, ribosomes, and spliceosomes. YB-1 knock-out resulted in nestin depletion and significantly lower vimentin expression, as well as global upregulation of proteins related to the cytoskeleton and migration. YB-1 knock-out cells demonstrated both morphological features and biochemical drivers of mesenchymal/ameboid migration. Melanoma is a highly plastic, adaptable, and aggressive tumor entity, capable of exhibiting characteristics of different migratory modes.

Preoperative analysis of radiographic findings in 516 patients with hallux valgus deformity / Análise pré-operatória de achados radiográficos em 516 pacientes com deformidade de hallux valgus

ABSTRACT Objective: This is a descriptive study to report our method of operative correction for patients with hallux valgus deformities. Methods: From 2006 to 2012, 516 consecutive patients (601 feet) with hallux valgus deformities were treated surgically in our department after conservative treatments were exhausted. The hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and degree of osteoarthritis in the first metatarsophalangeal joint were measured on preoperative plain radiographs of the weight-bearing forefoot. Results: Young patients with severe intermetatarsal deviation received a combined proximal and distal osteotomy of the first metatarsal (n = 21). Patients with low intermetatarsal deviation received a distal metatarsal chevron osteotomy (n = 196), whereas patients with severe intermetatarsal deviation and less flexible deformities without osteoarthritis received a basal metatarsal osteotomy with a distal soft tissue procedure (n = 173). Elderly active patients with osteoarthritis in the first metatarsophalangeal joint received an arthrodesis (n = 100) or resection arthroplasty (n = 58). Conclusion: Determining a few simple angles on plain radiographs of the weight-bearing forefoot in combination with the age and level of activity of patients can help simplify the operative correction method by using the schema we developed. Level of evidence IV, case series.

RESUMO Objetivo: Este é um estudo descritivo para relatar nosso método de correção cirúrgica para pacientes com deformidades de hálux valgo. Métodos: De 2006 a 2012, 516 pacientes consecutivos (601 pés) com deformidade de hálux valgo foram tratados cirurgicamente em nosso departamento, depois que os tratamentos conservadores foram esgotados. O ângulo do hálux valgo, o ângulo intermetatarsal, o ângulo articular metatarsal distal e o grau de osteoartrite da primeira articulação metatarsofalângica foram medidos em radiografias pré-operatórias simples do antepé com apoio de peso. Resultados: Os pacientes jovens com desvio intermetatarsal grave foram submetidos à combinação de osteotomia distal e proximal do primeiro metatarso (n = 21). Os pacientes com desvio intermetatarsal menor foram submetidos a osteotomia de Chevron no metatarso distal (n = 196), enquanto que os pacientes com desvio intermetatarsal grave e deformidades menos flexíveis e sem osteoartrite foram submetidos a osteotomia da base do metatarso com um procedimento distal no tecido mole (n = 173). Nos pacientes idosos ativos com osteoartrite na primeira articulação metatarsofalângica realizou-se artrodese (n = 100) ou artroplastia de ressecção (n = 58). Conclusão: Determinar alguns ângulos com radiografias simples do antepé com apoio de peso em combinação com idade e nível de atividade dos pacientes pode ajudar e simplificar o método de correção cirúrgica, usando o esquema que desenvolvemos. Nível de Evidência IV, Série de casos.

Influence of age on parameters for femoroacetabular impingement and hip dysplasia in x-rays / Influência da idade sobre os parâmetros para impacto femoroacetabular e diplasia do quadril em radiografias

ABSTRACT Objective: While several radiographic parameters have been established to describe the geometry and pathology of the hip, their reference values and clinical significance remain a matter of dispute. The present study tests the hypothesis that age has a relevant impact on radiographic hip parameters. Method: Pelvic antero-posterior views were measured for CE angle, Sharp's angle, acetabular depth-to-width ratio, femoral head extrusion index, roof obliquity, caput-collum-diaphyseal (CCD) angle, and Murray's femoral head ratio, and the values obtained were correlated with age. Results: Significant weak and moderate linear correlations (all Ps<0.001) were observed between age and CE angle (ρ=0.31), Sharp's angle (ρ=-0.38), extrusion index (ρ=-0.22), CCD angle (ρ=-0.15), depth-to-width ratio (ρ=-0.38), and roof obliquity (ρ=-0.19), while Murray's femoral head ratio (ρ=0.05; P=0.274) was not associated with age. Interestingly, the parameters describing the acetabulum all showed a relevant increase in coverage with age, leading to CE-angles well beyond 40° and a Sharp's angle below 35° in a large portion of asymptomatic older adults. Conclusion: While a decrease in CCD angle with age is described in most orthopedic textbooks, the changes observed with age in acetabular geometry far exceed those measured at the femoral head-neck junction. We recommend considering these alterations that may be attributable to age when formulating a radiographic diagnosis. Level of Evidence III, Diagnostic Studies - Investigating a Diagnostic Test.

RESUMO Objetivo: Embora tenham sido estabelecidos vários parâmetros radiográficos para descrever a geometria e a patologia do quadril, seus valores de referência e significância clínica continuam sendo uma questão controversa. O presente estudo testa a hipótese de que a idade tem impacto relevante sobre os parâmetros radiográficos do quadril. Método: As vistas pélvicas anteroposteriores foram medidas quanto ao ângulo CE, ângulo de Sharp, proporção entre profundidade e largura acetabular, índice de extrusão da cabeça do fêmur, obliquidade do lábio do acetábulo (teto), ângulo cabeça-colo-diafisário (CCD) e razão da cabeça do fêmur de Murray e os valores obtidos foram correlacionados com a idade. Resultados: Foram observadas correlações lineares significantes, fracas e moderadas (todos os P < 0,001) entre idade e ângulo CE (ρ = 0,31), ângulo de Sharp (ρ = -0,38), índice de extrusão da cabeça do fêmur (ρ = -0,22), ângulo CCD (ρ = -0,15), proporção entre profundidade e largura acetabular (ρ = -0,38) e obliquidade do lábio do acetábulo (ρ = -0,19), enquanto a razão da cabeça do fêmur de Murray (ρ = 0,05; P = 0,274) não foi associada à idade. Curiosamente, todos os parâmetros que descrevem o acetábulo mostraram um aumento relevante de cobertura com idade, levando a ângulos CE bem além de 40° e ângulos de Sharp abaixo de 35° em uma grande parcela de idosos assintomáticos. Conclusão: Embora a diminuição do ângulo CCD com a idade seja descrita na maioria dos livros didáticos de ortopedia, as alterações na geometria acetabular observadas com a idade ultrapassam, de longe, as medidas na junção entre cabeça e colo do fêmur. Recomendamos considerar essas alterações que podem ser atribuídas à idade ao formular um diagnóstico radiográfico. Nível de Evidência III, Estudos Diagnósticos - Investigação de um Exame para Diagnóstico.