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OBJECTIVE: Driving a motor vehicle is one of the most important aspects of personal mobility in our society. However, there is a lack of evidence regarding driving fitness after orthopedic or trauma surgery-related diseases. Aim of this systematic review was to support the treating physician to determine the individual driving fitness in patients with musculosceletal disorders. MATERIAL AND METHODS: A systematic analysis was performed using the PubMed database. Following a predefined algorithm, all relevant articles published from 2013 to 2018 were included. RESULTS: The results were categorized according to the affected part of the body into I. lower extremity and II. upper extremity. Also, results were subcategorized into movement restrictions caused by external joint-braces, musculoskeletal diseases, and postoperative conditions. CONCLUSION: This article supports the treating physician to individually determine the driving fitness in patients with musculoskeletal disorders. However, only a few standardized tests exist to individually determine the driving fitness in patients with musculoskeletal disorders. A particular shortcoming was observed for impairments of the upper extremity.
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Conducción de Automóvil , Enfermedades Musculoesqueléticas , Humanos , Extremidad Inferior , Rango del Movimiento Articular , Extremidad SuperiorRESUMEN
BACKGROUND: Swelling and edema of the hand and forearm may occur in various traumatic and degenerative diseases. So far, no precise measurement protocol exists. The objective of this study was to evaluate an examination protocol with relevant regions of interest (ROIs) measured by a 3-dimensional (3D) scanner to achieve precise, reproducible, and objective measurements for an optimized detection of volumes of the hand and forearm. METHODS: A 3D scan protocol was developed using an Artec, 3D scanner EVA to measure discrete hand volumes of healthy volunteers. Five areas were defined as ROIs, representing volumes of the finger, metacarpus, wrist, hand, and distal forearm. Contralateral limbs were used for volume comparisons and calculation of volume differences. RESULTS: For this study, 12 individuals (58.3% women, 24 hands and forearms) with a mean age of 27.1 ± 3 years were included. Mean volume values for left and right ROIs correlated with each other, with slightly higher volumes for the right upper extremity. Volume differences showed statistically significant results for the finger region (ROI I; P = .009), the metacarpal region (ROI II; P < .001), hand region (ROI IV; P = .001), and forearm region (ROI V; P = .006), with the exception of the wrist region (ROI III; P = .722). CONCLUSIONS: Our results demonstrate that this 3D volumetric approach is a reliable and objective tool for measuring volumes and circumferences in hand and forearm. Based on our determined ROIs, further studies are needed to explore the significance for clinical applications.
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PURPOSE: Aim of this retrospective study was to evaluate the impact of the patient related factors body mass index (BMI), urinary tract infection, current smoking, gender, and American Society of Anesthesiologists (ASA) classification on the incidence of acute and chronic deep periprosthetic joint infections (PJI) in total knee arthroplasty (TKA). METHODS: All patients undergoing revision surgery for a deep PJI of primary TKA between July 2012 and December 2016 were included in this study. All relevant data was collected from the medical records. Acute deep PJI was defined when PJI was diagnosed within the first 6 weeks after primary TKA, chronic PJI was defined when patients demonstrated PJI later than 6 weeks after primary TKA. RESULTS: A total of 57 patients was included in this study with 13 cases of acute PJI and 44 of chronic PJI. Overweight patients (BMI > 25 kg/m2) represent a significantly larger proportion in both PJI groups (p < 0.05). Current smokers had an significantly increased risk for acute and chronic PJI (p < 0.05). In the acute PJI group 46.2% patients had an postoperative urinary tract infection. CONCLUSION: An elevated BMI (>25 kg/m2), current smoking and urinary tract infection are possible risk factors for acute and chronic deep PJI. After primary TKA screening for urinary tract infection is recommendable to prevent predominantly acute deep PJI.
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PURPOSE: When revision surgery is needed in total knee arthroplasty (TKA) the most frequent reasons are aseptic loosening (AL) and periprosthetic joint infection (PJI). However preoperative distinction between AL and PJI remains challenging. Aim of this study is to determine the incidence of PJI in patients with suspected AL after TKA and to evaluate a diagnostic algorithm for reliable differential diagnosis. METHODS: In this study a total of 149 symptomatic patients with radiographic signs of prosthetic loosening and suspected AL were included. Preoperatively all patients underwent a standardized diagnostic algorithm. For each patient demographics, as well as the results of laboratory and microbiological testing were collected from the medical records. RESULTS: Of the included patients 117 (78.5%) were diagnosed with AL and 32 (21.5%) with PJI. The latency period from primary arthroplasty to the presentation with symptomatic implant loosening was significantly shorter for PJI compared to AL (pâ¯<â¯0.05). The initial CRP values were significantly higher in patients with PJI compared to patients with AL (pâ¯<â¯0.05). Elevated count of white blood cells or percentage of neutrophils within the synovial fluid support the diagnosis of PJI. The sensitivity of synovial cell count (CC) count for PJI in patients with radiographic signs of loosening was 0.84 (CI 0.81-0.87) with a specificity of 0.96 (CI 0.92-0.98). The single best measure for the diagnosis of PJI was synovial fluid cultures with a specificity of 1, however this measure provides poor sensitivity. CONCLUSION: Patients with radiographic signs of loosening in TKA need thorough diagnostics. Information about primary TKA, serological testing, and results of joint aspiration can rule out a PJI in most cases.