Simultaneous Bilateral Femoral Osteonecrosis in Gaucher Disease.

Gaucher disease (GD) is one of the most common lysosomal storage disorders. Bone complications are the most critical irreversible consequence of GD. Osteonecrosis (ON) of the femoral head inevitably leads to osteoarthritis and may be managed by hip arthroplasty. The introduction and worldwide use of therapeutic agents (specifically enzyme replacement therapies (ERT)) lowered the prevalence of osteonecrosis events per patient. We present the cases of two female patients who sustained simultaneous bilateral femoral head osteonecrosis after receiving ERT for long periods while exposed to concomitant risk factors related to femoral head ON. Both patients suffered severe pain and deterioration of their daily activity capabilities, and thus, were offered bilateral hip arthroplasty. Surgery was performed in both hip joints during the same procedure. The current report highlights several key aspects of femoral head ON in young patients with GD.

Excessive Sagittal Slope of the Tibia Component during Kinematic Alignment-Safety and Functionality at a Minimum 2-Year Follow-Up.

The aim of this study was to assess the safety and functional outcomes of excessive sagittal alignment in the unrestricted kinematic alignment technique for total knee arthroplasty (TKA). A retrospective, single-center study was conducted between 2018 and 2020, including patients undergoing primary TKA with a minimum 2-year follow-up. EOS imaging conducted before and after surgery was reviewed for overall alignment, and a number of measurements were taken, including sagittal tibial slope and other tibia and femur component positioning. Patients were interviewed and asked to fill out several questionnaires including a visual analog scale, the Oxford Knee Score, and the Knee Injury and Osteoarthritis Outcome Score. Overall, 225 patients (66.7%) had a sagittal tibial slope angle above 5° (excessive) and 112 (33.3%) patients had an angle under 5° (moderate). A significant improvement in pain and function scores was observed in both groups following the surgery (p < 0.001). There were no significant differences between the moderate and excessive groups in the average VAS, OKS or the various subtypes of the KOOS score. However, there was a slight but significant difference in the number of patients achieving MCID in KOOS symptoms. There were no cases of early failure or loosening. Unrestricted KA and the excessive sagittal alignment of the tibial component seem to be reliable and safe in terms of restoring daily function and alleviating pain after a minimum of 2 years following the surgery.

Minimum 2-Year Radiographic and Clinical Outcomes of Unrestricted Kinematic Alignment Total Knee Arthroplasty in Patients with Excessive Varus of the Tibia Component.

Kinematic alignment (KA) total knee arthroplasty (TKA) has gained much attention in recent years. However, debate remains on whether restrictions should be made on the tibia cut. The purpose of this study was to assess the safety and functional outcomes of excessive varus cuts. A single-center, retrospective analysis of consecutive patients undergoing TKA between 2018 and 2020 who had a minimum 2-year follow-up was conducted. EOS™ imaging conducted before and after surgery was analyzed for overall alignment, as well as for tibia and femur component positioning on the coronal planes. Patients were interviewed and asked to fill several questionnaires, including the visual analog score, Oxford knee score, and knee injury and osteoarthritis outcome score. Overall, 243 patients (71.9%) had a coronal tibial plate angle under 5° (moderate) and 95 patients (28.1%) had an angle above 5° (excessive). There were no significant differences between the moderate and excessive groups in patient-reported outcomes, nor were there differences in the number of patients achieving the minimal clinical difference. There were no cases of catastrophic failure or loosening. Unrestricted KA and excessive varus of the tibial component appears to be safe and efficient in relieving pain and restoring function for a minimum of 2 years following surgery.

Minimum 2-Year Radiographic and Clinical Outcomes of Kinematic Alignment Total Knee Arthroplasty in the Valgus Knee.

Kinematic alignment (KA) total knee arthroplasty (TKA) has gained popularity in the past decade, but outcomes of KA-TKA in the valgus knee have never been specifically evaluated. In this retrospective single institution study, we analyzed patient reported outcomes and radiographic measurements at minimum 2 years following KA-TKA for valgus knees (n = 51) and compared the results to KA-TKA performed for non-valgus knees (n = 275). The same approach, technique, and implants were used in both groups without the need to release soft tissues or use constrained implants. Surgery duration was similar between groups (p = 0.353). Lateral distal femoral angle was lower in the valgus group postoperatively (p = 0.036). In both groups significant improvement was seen in relieving pain and improving function, while average scores were superior in the non-valgus group for visual analog score (p = 0.005), oxford knee score (p = 0.013), and knee injury and osteoarthritis outcome score (p = 0.009). However, these differences did not translate to statistically significant differences in minimal clinical important difference achievement rates. In conclusion, KA-TKA is efficient in relieving pain and improving function, as reported in subjective questionnaires, and holds advantage in patients with valgus alignment by avoiding soft tissue releases and use of constrained implants. Future studies should examine whether bone loss occurs in the lateral distal femur.

Understanding changes in biocrust communities following phosphate mining in the Negev Desert.

Biocrusts are key ecosystem engineers that are being destroyed due to anthropogenic disturbances such as trampling, agriculture and mining. In hyper-arid regions of the Negev Desert, phosphate has been mined for over six decades, altering the natural landscape over large spatial scales. In recent years, restoration-oriented practices were mandated in mining sites, however, the impact of such practices on the ecosystem, particularly the biocrust layer, has not been tested. Here, we evaluated post-mining biocrust bacterial communities and compared them to undisturbed (reference) biocrusts. We collected samples from four mining sites (each restored at a different year) and their corresponding reference sites. We hypothesized that post-mining bacterial communities would differ significantly from reference communities, given the slow regeneration of the biocrust. We also hypothesized that bacterial communities would vary among post-mining plots based on their restoration age. To test these hypotheses, we assessed the abundance and diversity of bacterial communities by sequencing the 16S rDNA and their photosynthetic potential by quantifying the abundance of cyanobacteria and chlorophyll a. The bacterial diversity was lower, and community composition differed significantly between post-mining and reference biocrusts. In addition, cyanobacteria abundances and chlorophyll a content were lower in post-mining biocrusts, indicating lower photosynthetic potential. However, no significant changes in bacterial communities were detected, regardless of the restoration age. We suggest that the practices implemented in the Negev mines may not support the recovery of the biocrust bacterial communities, particularly the cyanobacteria. Thus, active restoration measures are needed to accelerate the regeneration time of biocrusts at the hyper-arid Negev mines.

Reliability and validity of the Hebrew version of the forgotten joint score for assessing the outcomes of total knee arthroplasty.

BACKGROUND: This prospective study aimed to assess the reliability and validity of the Hebrew version of the forgotten joint score-12 in patients undergoing total knee arthroplasty, because it is going to be used in the Hebrew-speaking populations in Israel. METHODS: The English version of forgotten joint score-12 was translated into Hebrew version by using the standard procedures and in collaboration with its authors. The consecutive patients who had undergone total knee arthroplasty in a single hospital were asked to fill out the Hebrew version of forgotten joint score-12, Oxford knee score, Short Form 12, and visual analog scale. A random subgroup of 60 patients were then asked to fill out a second Hebrew version of forgotten joint score-12 at a minimum of 2-week interval. The reliability was assessed in terms of internal consistency, test-retest reliability and split-half reliability. The validity was measured in terms of the outcomes as mentioned above. RESULTS: A total of 102 patients participated in the study. The Hebrew version of forgotten joint score-12 showed high reliability. The internal consistency was excellent (Cronbachs' α = 0.943) and test-retest reliability was high (Intraclass correlation = 0.97). The forgotten joint scores were correlated with the Oxford knee score, Short Form 12, and visual analog scale (r = 0.86, r = 0.72, and r=-0.8, respectively), indicating a high validity. CONCLUSIONS: The Hebrew version of forgotten joint score-12 has excellent reliability, excellent test-retest reliability and good validity. It can be safely used for assessing outcomes of TKA.

The Missing Piece: A Subtrochanteric Hip Fracture Presenting with Abdominal Pain: A Case Report.

CASE: A 33-year-old man presented with acute abdominal and left hip pain after being struck by a motor vehicle. Radiographs revealed a comminuted left subtrochanteric femoral fracture. Computed tomography demonstrated a large pelvic hematoma and a radiopaque mass in the abdomen. Laparoscopy revealed the mass to be a large bone fragment lying within the greater omentum. The bone fragment, which seemed to be a femoral fracture fragment, was removed, and the fracture was repaired with a short cephalomedullary nail. CONCLUSION: Rarely, subtrochanteric fracture fragments can penetrate the pelvis or abdomen because of high-energy trauma. Recognizing this possibility is important to assure a correct diagnosis and subsequent treatment.

FragSAD: A database of diversity and species abundance distributions from habitat fragments.

Habitat destruction is the single greatest anthropogenic threat to biodiversity. Decades of research on this issue have led to the accumulation of hundreds of data sets comparing species assemblages in larger, intact, habitats to smaller, more fragmented, habitats. Despite this, little synthesis or consensus has been achieved, primarily because of non-standardized sampling methodology and analyses of notoriously scale-dependent response variables (i.e., species richness). To be able to compare and contrast the results of habitat fragmentation on species' assemblages, it is necessary to have the underlying data on species abundances and sampling intensity, so that standardization can be achieved. To accomplish this, we systematically searched the literature for studies where abundances of species in assemblages (of any taxa) were sampled from many habitat patches that varied in size. From these, we extracted data from several studies, and contacted authors of studies where appropriate data were collected but not published, giving us 117 studies that compared species assemblages among habitat fragments that varied in area. Less than one-half (41) of studies came from tropical forests of Central and South America, but there were many studies from temperate forests and grasslands from all continents except Antarctica. Fifty-four of the studies were on invertebrates (mostly insects), but there were several studies on plants (15), birds (16), mammals (19), and reptiles and amphibians (13). We also collected qualitative information on the length of time since fragmentation. With data on total and relative abundances (and identities) of species, sampling effort, and affiliated meta-data about the study sites, these data can be used to more definitively test hypotheses about the role of habitat fragmentation in altering patterns of biodiversity. There are no copyright restrictions. Please cite this data paper and the associated Dryad data set if the data are used in publications.

Autumn temperatures at African wintering grounds affect body condition of two passerine species during spring migration.

Most papers on the physical condition of birds during spring migration focused on food availability preceding migratory take-off. Only a few studies examined the effect of climate conditions at the wintering grounds upon autumn arrival on bird physical condition later on. Here, we hypothesized that environmental conditions upon arrival at the wintering grounds, and not necessarily upon departure, have a crucial carry-over effect on bird spring migration. Using 29,000 observations of the lesser whitethroat, Sylvia curruca, and the eastern Bonelli's warbler, Phylloscopus orientalis, we found temperatures upon arrival at the African wintering grounds to be the only climatic variable correlated with birds' body state upon spring stopover in Israel, six months later. Two different mechanisms could explain these results. One possibility is that high temperatures create favorable conditions for insect activity, which allows rapid recovery from autumn migration and hence successful winter survival and maintenance. Another possible scenario is that harsh conditions, due to the heat and dry environment, cause high mortality, permitting survival of larger individuals which, then, enjoy reduced inter- and intra-specific competition. Whatever the mechanism is, our findings suggest that conditions upon autumn arrival, and not necessarily at the end of winter as traditionally thought, may have a major impact on migrating birds.

February precipitation in the wintering grounds of the lesser whitethroat, Sylvia curruca: is it a cue for migration onset?

Numerous studies report shifts in bird migration phenology, presumably owing to global warming. However, most studies focus on migration patterns in the Northern Hemisphere. In this study, we investigated associations between weather conditions in African wintering grounds of the lesser whitethroat, Sylvia curruca, and spring arrival time in Eilat, Israel. Using multivariate regression models, we analysed a 30-year dataset in order to examine correlations between median springtime arrival and 46 climate variables of the wintering quarters. The model obtained exhibited a highly statistical fit, involving mean precipitation in February and March with negative effects and number of wet days during November-February. February precipitation levels were also the major factor associated with the interquartile range of arrival time. Interestingly and contrary to published results, annual or seasonal precipitation showed no correlation with spring arrival time, nor did temperature. Moreover, winter in this region falls into dry season with negligible rainfall quantities. Hence, it is unlikely that precipitation effect on habitat productivity is a driving force of migration, as suggested by other studies. Instead, we propose that precipitation in February acts as a cue for the birds, indicating the approach of spring and migration time.

Correction: Joint Effect of Habitat Identity and Spatial Distance on Spiders' Community Similarity in a Fragmented Transition Zone.

[This corrects the article DOI: 10.1371/journal.pone.0168417.].

Joint Effect of Habitat Identity and Spatial Distance on Spiders' Community Similarity in a Fragmented Transition Zone.

Understanding the main processes that affect community similarity have been the focus of much ecological research. However, the relative effects of environmental and spatial aspects in structuring ecological communities is still unresolved and is probably scale-dependent. Here, we examine the effect of habitat identity and spatial distance on fine-grained community similarity within a biogeographic transition zone. We compared four hypotheses: i) habitat identity alone, ii) spatial proximity alone, iii) non-interactive effects of both habitat identity and spatial proximity, and iv) interactive effect of habitat identity and spatial proximity. We explored these hypotheses for spiders in three fragmented landscapes located along the sharp climatic gradient of Southern Judea Lowlands (SJL), Israel. We sampled 14,854 spiders (from 199 species or morphospecies) in 644 samples, taken in 35 patches and stratified to nine different habitats. We calculated the Bray-Curtis similarity between all samples-pairs. We divided the pairwise values to four functional distance categories (same patch, different patches from the same landscape, adjacent landscapes and distant landscapes) and two habitat categories (same or different habitats) and compared them using non-parametric MANOVA. A significant interaction between habitat identity and spatial distance was found, such that the difference in mean similarity between same-habitat pairs and different-habitat pairs decreases with spatial distance. Additionally, community similarity decayed with spatial distance. Furthermore, at all distances, same-habitat pairs had higher similarity than different-habitats pairs. Our results support the fourth hypothesis of interactive effect of habitat identity and spatial proximity. We suggest that the environmental complexity of habitats or increased habitat specificity of species near the edge of their distribution range may explain this pattern. Thus, in transitions zones care should be taken when using habitats as surrogate of community composition in conservation planning since similar habitats in different locations are more likely to support different communities.

The Sphygmomanometer Pain Test: A Simple Method for Identifying Patients at Risk of Excessive Pain after Total knee Arthroplasty.

BACKGROUND: Despite the overall success of total knee arthroplasty (TKA), a relatively large proportion of patients remain dissatisfied with the outcome. We hypothesized that patients with a lower threshold for pain were more likely to have worse outcomes after TKA. METHODS: Forty-eight consecutive patients with primary knee osteoarthritis graded a standardized painful stimulus caused by inflating a sphygmomanometer placed on the forearm, on a visual analog scale (VAS) scale before their TKA. We compared the VAS scores to patients' Knee Society scores and Knee Society function scores 2 years after TKA. RESULTS: Patients with a severe VAS score (>74 mm) had significantly worse Knee Society scores compared to patients with mild (0-44 mm) and moderate (45-74 mm) VAS scores (55 ± 20.5 vs 81.5 ± 11.1 and 84.8 ± 13, respectively, P = .04) and worse Knee Society Function scores (34 ± 20.7 vs 75.2 ± 17.3 and 77 ± 17.4, respectively, P = .027) at 2 years after TKA. CONCLUSIONS: Patients with a lower threshold for pain, as determined by a standardized painful stimulus, are more likely to have lower Knee Society pain and function scores after TKA.

Combined effects of climatic gradient and domestic livestock grazing on reptile community structure in a heterogeneous agroecosystem.

Grazing plays an important role in shaping ecological communities in human-related ecosystems. Although myriad studies have explored the joint effect of grazing and climate on plant communities, this interactive effect has rarely been studied in animals. We hypothesized that the effect of grazing on the reptile community varies along a climatic gradient in relation to the effect of grazing on habitat characteristics, and that grazing differentially affects reptiles of different biogeographic regions. We tested our hypotheses by collecting data on environmental characteristics and by trapping reptiles in four heterogeneous landscapes experiencing differing grazing intensities and distributed along a sharp climatic gradient. We found that while reptile diversity increased with grazing intensity at the mesic end of the gradient, it decreased with grazing intensity at the arid end. Moreover, the proportion of reptile species of differing biogeographic origins varied with the interactive effect of climate and grazing. The representation of species originating in arid biogeographic zones was highest at the arid end of the climatic gradient, and representation increased with grazing intensity within this area. Regardless of the climatic context, increased grazing pressure results in a reduction in vegetation cover and thus in changes in habitat characteristics. By reducing vegetation cover, grazing increased habitat heterogeneity in the dense mesic sites and decreased habitat heterogeneity in the arid sites. Thus, our results suggest that the same direction of habitat alteration caused by grazing may have opposite effects on biodiversity and community composition in different climatic contexts.

Severe vascular complications and intervention following elective total hip and knee replacement: A 16-year retrospective analysis.

INTRODUCTION: Iatrogenic vascular injuries associated with elective orthopaedic joint procedures are relatively rare, however when they do occur they carry a risk of significant morbidity and mortality. The aim of this study was to investigate the incidence of vascular complications and resultant need for specialist intervention following elective total hip replacement (THR) and total knee replacement(TKR). METHODS: This was a retrospective analysis of prospectively collected data. The primary outcome measure was vascular complication requiring an interventional radiology procedures or vascular surgery. As a secondary outcome measure postoperative Modified Knee Society Scores and Harris Hip Scores were analysed to assess long term clinical outcome. RESULTS: Six cases of vascular injury requiring specialist intervention were identified. From 2073 total TKRs there were one cases of popliteal artery injury, one case of venous injury and two case of lateral geniculate artery injury (0.19%). From 1601 THRs there were two cases (0.12%) of arterial injury. All patients were treated successfully by a vascular surgeon or an interventional radiologist. Patient outcome varied considerably with the poorest results seen in the THR group. CONCLUSIONS: Iatrogenic vascular complications following elective THR and TKR carry a risk of significant morbidity and mortality. It is important that surgeons and trainees performing these procedures are conscious of these risks and able to identify vascular injuries promptly when they occur. Detailed preoperative assessment, an awareness of anatomical variants and close liaison with a vascular surgeon may all help to reduce the number and severity of adverse outcomes.

New approach for the rehabilitation of patients following total knee arthroplasty.

PURPOSE: To investigate the effect of a biomechanical therapy on gait, function and clinical condition in patients following total knee arthroplasty (TKA). METHODS: Seventeen TKA patients participated in the study. Patients received a biomechanical therapy AposTherapy). Patients underwent a gait test, clinical examination and an assessment of pain, function and quality of life (QOL). Patients were examined again at one, three and six month follow-ups. RESULTS: A significant improvement over time was found in most gait measurements. Significant improvements were also found in pain, function and QOL. CONCLUSIONS: The examined biomechanical therapy may help in the rehabilitation process following TKA.

A non-invasive biomechanical device and treatment for patients following total hip arthroplasty: results of a 6-month pilot investigation.

BACKGROUND: The purpose of the study was to examine the effect of a foot-worn biomechanical device on the clinical measurements and gait patterns of patients with total hip arthroplasty (THA). METHODS: Nineteen patients, up to 3 months post-THA, were enrolled to the study. Patients underwent a computerized gait analysis to calculate spatiotemporal parameters and completed the Western Ontario and McMaster Universities osteoarthritis index and the SF-36 health survey. Patients then began therapy with a non-invasive foot-worn biomechanical device coupled with a treatment methodology (AposTherapy). Patients received exercise guidelines and used the device daily during their regular activities at their own environment. Follow-up examinations were conducted after 4, 12, and 26 weeks of therapy. Repeated measures ANOVA was used to evaluate changes over time. The clinical significance of the treatment effect was evaluated by computing the Cohen's effect sizes (ES statistic). RESULTS: After 26 weeks of therapy, a significant improvement was seen in gait velocity (50.3%), involved step length (22.9%), and involved single limb support (16.5%). Additionally, a significant reduction in pain (85.4%) and improvement in function (81.1%) and quality of life (52.1%) were noted. CONCLUSIONS: Patients following THA demonstrated a significant improvement in gait parameters and in self-assessment evaluations of pain, function, and quality of life. We recommend further RCTs to examine the effect of this therapy compared to other rehabilitation modalities following THA and compared to healthy matched controls. TRIAL REGISTRATION: Clinical trial registration number NCT01266382.

Long-Term Effects of AposTherapy in Patients with Osteoarthritis of the Knee: A Two-Year Followup.

Several biomechanics treatments for knee osteoarthritis (OA) have emerged with the goal of reducing pain and improving function. Through this, researchers have hoped to achieve a transition from the pathological gait patterns to coordinated motor responses. The purpose of the study was to determine the long-term effects of a therapy using a biomechanical device in patients with knee OA. Patients with knee OA were enrolled to active and control groups. The biomechanical device used in therapy (AposTherapy) was individually calibrated to each patient in the active group. Patients in the control group received standard treatment. Outcomes were the Western Ontario and McMaster Osteoarthritis Index (WOMAC), Aggregated Locomotor Function (ALF), Short Form 36 (SF-36), and Knee Society Score assessments. The active and control groups were similar at the baseline (group difference in all scores P > 0.05). The active group showed a larger improvement over time between groups in all three WOMAC categories (F = 16.8, 21.7, and 18.1 for pain, stiffness, and function; all P < 0.001), SF-36 Physical Scale (F = 5.8; P = 0.02), Knee Society Knee Score (F = 4.3; P = 0.044 ), and Knee Society Function Score (F = 6.5; P = 0.014 ). At the two-year endpoint, the active group showed significantly better results (all P ≤ 0.001). The groups showed a difference of 4.9, 5.6, and 4.7 for the WOMAC pain, stiffness, and function scores, respectively, 10.8 s in ALF score, 30.5 in SF-36 Physical Scale, 16.9 in SF-36 Mental Scale, 17.8 in Knee Society Knee Score, and 25.2 in Knee Society Function Score. The biomechanical therapy examined was shown to significantly reduce pain and improve function and quality of life of patients with knee OA over the long term.

The outcome of a novel biomechanical therapy for patients suffering from anterior knee pain.

BACKGROUND: This study was devised to examine the effect of a novel biomechanical therapy for patients suffering from anterior knee pain (AKP). METHODS: A retrospective analysis of 48 patients suffering from AKP was performed. Patients underwent a gait evaluation, using an electronic walkway mat, and completed the SF-36 health survey and the WOMAC questionnaire at baseline and after 3 and 6months of therapy. A special biomechanical device was individually calibrated for each patient. AposTherapy is a functional, non-invasive rehabilitation therapy consisting of a biomechanical foot-worn device that is used during activities of daily living. Repeated measures analyses were performed to compare gait parameters and self-evaluation questionnaires between baseline, 3months and 6months. RESULTS: Walking velocity significantly increased by 5.7cm/s, cadence increased by 1.6 steps/minute, and stride length increased by 3.4cm in relation to pretreatment testing (p<0.001 for all). End-point evaluation revealed additional improvement of these parameters; however these did not significantly differ from that of mid-treatment. Pain decreased by 36.6% and 49.2% following 13 and 26 weeks of treatment, respectively (P<0.01) and function improved by 25.2% and 41.7% following 13 and 26 weeks of treatment, respectively (P=0.01). CONCLUSIONS: Based on the current study's results it may be concluded that this therapy might have a positive effect for patients with AKP.