Total knee arthroplasty using a computerized assisted stereotaxic navigation system with bluetooth communication in obese patients - A randomized controlled study.

Correct mechanical alignment (180° hip-knee-angle (HKA)) may be difficult to obtain on a consistent basis in obese patients. This is a randomized controlled study comparing the post-operative coronal alignment in obese patients between two surgical total knee arthroplasty (TKA) techniques - conventional and computer assisted navigation. The primary outcome was the post-operative HKA. A total of 60 patients were assigned to undergo conventional total knee arthroplasty (30 patients) or computerized assisted stereotaxic navigation system with Bluetooth communication surgery (30 patients). One patient from the study group was excluded due to malfunction of the navigation system. Good quality x-rays were available in 57 patients. There was no difference between the groups. Post-operative HKA was 2.8° and 2.9° in the study and control groups, respectively (p = 0.87). In obese patients undergoing TKA, computerized navigation had no impact on post-op HKA. Clincal Trial Registration Number: HMO 0092-13.

Treatment of diabetic foot ulcers in a frail population with severe co-morbidities using at-home photobiomodulation laser therapy: a double-blind, randomized, sham-controlled pilot clinical study.

PURPOSE: To evaluate the safety and efficacy of an at-home photobiomodulation (PBM) device for the treatment of diabetic foot ulcers (DFUs) in a frail population with severe comorbidities. METHODS: Prospective, randomized, double-blind, sham-controlled pilot study. Patients (age = 63 ± 11 years, male:female 13:7) with insulin-dependent diabetes type 2, neuropathy, peripheral artery disease, significant co-morbidities, and large osteomyelitis-associated DFUs (University of Texas grade ≥ III) were randomized to receive active (n = 10) or sham (n = 10) at-home daily PBM treatments (pulsed near-infrared 808 nm Ga-Al-As laser, 250 mW, 8.8 J/cm2) for up to 12 weeks in addition to standard care. The primary outcome was the %wound size reduction. The secondary was adverse events. RESULTS: With the numbers available, PBM-treated group had significantly greater %reduction compared to sham (area [cm2], baseline vs endpoint: PBM 10[20.3] cm2 vs 0.2[2.4] cm2; sham, 7.9 [12.0] cm2 vs 4.6 [13.8] cm2, p = 0.018 by Mann-Whitney U test). Wound closure > 90% occurred in 7 of 10 PBM-treated patients but in only 1 of 10 sham patients (p = 0.006). No adverse device effects were observed. CONCLUSIONS: Photobiomodulation at home, in addition to standard care, may be effective for the treatment of severe DFUs in frail patients with co-morbidities and is particularly relevant at these times of social distancing. Our preliminary results justify the conduction of a larger clinical trial. CLINICALTRIALS: gov: NCT01493895.

Osteonecrosis of the Femoral Head and Hip Arthritis in an Adolescent Following an Isolated Fracture of the Greater Trochanter: A Case Report and Review of the Literature.

CASE: A healthy adolescent sustained an isolated fracture of the greater trochanter after falling from a height. He was treated nonoperatively. After 10 weeks of improvement, the pain recurred, and osteonecrosis of the femoral head was diagnosed. Core decompression and a bone-marrow injection were performed. Transient relief was achieved, followed by deterioration to end-stage hip arthritis. CONCLUSION: To our knowledge, 19 other cases of isolated fractures of the greater trochanter in adolescents have been reported since 1905. All high-energy injuries (10 cases) progressed to osteonecrosis, independent of the intervention; none of the low-energy cases progressed to osteonecrosis. We advocate vigilance and early magnetic resonance imaging for these injuries to detect and treat osteonecrosis in its early stages.