Postoperative laboratory testing in the era of outpatient total joint arthroplasty: Targeted patient selection and associated cost savings.

Background: With the advent of outpatient total joint arthroplasty (TJA), the days of routinely drawing postoperative labs (complete blood counts [CBCs] and metabolic panels [CMPs/BMPs]) to monitor for complications are behind us. However, there does exist a subset of at-risk patients that may benefit from diligent postoperative monitoring, though the circumstances under which labs should be ordered remains unclear and subject to surgeon discretion. A systematic review of the literature was therefore conducted to evaluate the utility of postoperative laboratory testing, approaches to targeted patient selection and associated cost-savings. Methods: The PubMed, MEDLINE, EBSCOhost, and Google Scholar electronic databases were searched on August 17, 2023, to identify all studies published since January 1, 2000, that evaluated the role of postoperative lab testing in TJA. (PROSPERO study protocol registration: CRD42023437334). Articles were included if a full-text English manuscript was available and the study assessed the utility of routine postoperative labs in TJA. 19 studies were included comprising 34,166 procedures. The mean Methodological index for Nonrandomized Studies score was 18.2 ± 1.5. Results: Abnormal postoperative lab results were common and infrequently required clinical intervention. Among several identified risk factors for patients that may benefit from postoperative laboratory monitoring, preoperative lab values proved excellent discriminators of transfusion requirement and metabolite-associated intervention. Selective testing demonstrated the ability to generate substantial cost-savings. Conclusion: Routine postoperative laboratory testing offers little clinical utility and produces unnecessary expenditures. Preoperative lab values offer the greatest predictive utility for postoperative transfusion requirement and metabolite-associated clinical intervention, with a preoperative hemoglobin threshold of 111.5 g/L offering an area under the curve (AUC) of 0.93 for predicting postoperative transfusion. Further investigations are needed for metabolic panel predictive models and should incorporate preoperative lab values. The refinement of such models can enable targeted patient selection to avoid unnecessary labs and generate substantial cost savings without compromising patient safety.

A finite element analysis of patellofemoral joint biomechanics: Exploring potential causes of postoperative anterior knee pain following unicompartmental knee arthroplasty.

Purpose: Anterior knee pain is a common complication following unicompartmental knee arthroplasty (UKA). This study aimed to elucidate the mechanism of anterior knee pain after UKA by examining the biomechanical characteristics of the patellofemoral joint. Methods: This study employs the finite element analysis method. A healthy model of the right lower limb was created using CT scans of an intact right lower limb from a healthy woman. Based on this model, a preoperative pathological model was generated by removing the meniscus and part of the articular cartilage. The UKA prosthesis was then applied to this model with five different bearing thicknesses: 5 mm, 7 mm, 10 mm, 11 mm, and 13 mm. To simulate various degrees of knee joint flexion, the femur was rotated relative to the knee joint's rotational axis, producing lower limb models at flexion angles of 0°, 30°, 60°, 90°, and 120°. We applied a constant force from the center of the femoral head to the center of the ankle joint to simulate lower limb loading during squatting. The simulations were conducted using Ansys 17.0. Results: Both overstuffing and understuffing increased the peak stress on the patellar cartilage, with overstuffing having a more pronounced effect. Compared to healthy and balanced models, overstuffed and understuffed models exhibited abnormal stress distribution and stress concentration in the patellar cartilage during knee flexion. Conclusion: Overstuffing and understuffing lead to residual varus or valgus deformities after UKA, causing mechanical abnormalities in the patellofemoral joint. These abnormalities, characterized by irregular stress distribution and excessive stress, result in cartilage damage, exacerbate wear in the patellofemoral joint and consequently lead to the occurrence of anterior knee pain.

Adipose tissue-derived extracellular vesicles aggravate temporomandibular joint osteoarthritis associated with obesity.

INTRODUCTION: Temporomandibular joint osteoarthritis (TMJ OA) is a major disease that affects maxillofacial health and is characterised by cartilage degeneration and subchondral bone remodelling. Obesity is associated with the exacerbation of pathological manifestations of TMJ OA. However, the underlying mechanism between adipose tissue and the TMJ axis remains limited. OBJECTIVES: To evaluate the effects of obesity and the adipose tissue on the development of TMJ OA. METHODS: The obesity-related metabolic changes in TMJ OA patients were detected by physical signs and plasma metabolites. The effects of adipose tissue-derived EVs (Ad-EVs) on TMJ OA was investigated through histological and cytological experiments as well as gene editing technology. Alterations of Ad-EVs in obese state were identified by microRNA-seq analysis and the mechanism by which EVs affect TMJ OA was explored in vitro and in vivo. RESULTS: Obesity and the related metabolic changes were important influencing factors for TMJ OA. Ad-EVs from obese mice induced marked chondrocyte apoptosis, cartilage matrix degradation and subchondral bone remodelling, which exacerbated the development of TMJ OA. Depletion of Ad-EVs secretion by knocking out the geranylgeranyl diphosphate synthase (Ggpps) gene in adipose tissue significantly inhibited the obesity-induced aggravation of TMJ OA. MiR-3074-5p played an important role in this process . CONCLUSIONS: Our work unveils an unknown link between obese adipose tissue and TMJ OA. Targeting the Ad-EVs and the miR-3074-5p may represent a promising therapeutic strategy for obesity-related TMJ OA. KEY POINTS: High-fat-diet-induced obesity aggravate the progression of TMJ OA in mice. Obese adipose tissue participates in cartilage damage through the altered miRNA in extracellular vesicles. Inhibition of miR-3074-5p/SMAD4 pathway in chondrocyte alleviated the effect of HFD-EVs on TMJ OA.

[Improving the Accuracy of Patient Self-Care After Joint Replacement Surgery].

BACKGROUND & PROBLEMS: Joint replacement wound stitches are typically not removed until two weeks after the operation. Therefore, patients with joint replacement must be able to execute proper wound care after discharge from the hospital to reduce the risk of wound infection. Prior data from Chang Gung Memorial Hospital's orthopedics ward indicate only 69% of joint-replacement patients are able to perform wound care properly at home. Potential causes for this noted by patients include age-related forgetfulness, being unable to discern redness or swelling in the wound, and language comprehension difficulties (i.e., Taiwanese vs. Mandarin). Poor rates of wound care may also be attributable to incomplete wound care education by nursing staff and wound care education being provided without adequate practice on the day of patient discharge. PURPOSE: This project was implemented to improve the accuracy of wound self-care performed by patients after joint replacement surgery and to enhance their related knowledge and wound-care technical correctness. RESOLUTION: A wound care education checklist, wound care cue cards, wound care video clips, wound condition red flag cue cards, and customized wound care pack were proposed and implemented. RESULTS: The rate of accuracy of wound self-care performance increased from 69% pretest to 98% posttest, showing the intervention to have effectively improved post-discharge wound care quality. CONCLUSIONS: To effectively improve the post-discharge accuracy of wound self-care in patients with joint replacement, the consistency of post-surgery wound care education given by nursing staff to patients should be improved, patients should be reminded of wound assessment and care steps, and patients should be aware that wound abnormalities require an immediate return to the hospital for follow-up treatment.

Integrated GWAS, linkage, and transcriptome analysis to identify genetic loci and candidate genes for photoperiod sensitivity in maize.

Introduction: Maize photosensitivity and the control of flowering not only are important for reproduction, but also play pivotal roles in the processes of domestication and environmental adaptation, especially involving the utilization strategy of tropical maize in high-latitude regions. Methods: In this study, we used a linkage mapping population and an inbred association panel with the photoperiod sensitivity index (PSI) phenotyped under different environments and performed transcriptome analysis of T32 and QR273 between long-day and short-day conditions. Results: The results showed that PSIs of days to tasseling (DTT), days to pollen shedding (DTP), and days to silking (DTS) indicated efficacious interactions with photoperiod sensitivity for maize latitude adaptation. A total of 48 quantitative trait loci (QTLs) and 252 quantitative trait nucleotides (QTNs) were detected using the linkage population and the inbred association panel. Thirteen candidate genes were identified by combining the genome-wide association study (GWAS) approach, linkage analysis, and transcriptome analysis, wherein five critical candidate genes, MYB163, bif1, burp8, CADR3, and Zm00001d050238, were significantly associated with photoperiod sensitivity. Discussion: These results would provide much more abundant theoretical proofs to reveal the genetic basis of photoperiod sensitivity, which would be helpful to understand the genetic changes during domestication and improvement and contribute to reducing the barriers to use of tropical germplasm.

Microarray analysis of signalling interactions between inflammation and angiogenesis in subchondral bone in temporomandibular joint osteoarthritis.

Inflammation and angiogenesis, the major pathological changes of osteoarthritis (OA), are closely associated with joint pain; however, pertinent signalling interactions within subchondral bone of osteoarthritic joints and potential contribution to the peripheral origin of OA pain remain to be elucidated. Herein we developed a unilateral anterior crossbite mouse model with osteoarthritic changes in the temporomandibular joint. Microarray-based transcriptome analysis, besides quantitative real-time polymerase chain reaction, was performed to identify differentially expressed genes (DEGs). Overall, 182 DEGs (fold change ≥ 2, P < 0.05) were identified between the control and unilateral anterior crossbite groups: 168 were upregulated and 14 were downregulated. On subjecting significant DEGs to enrichment analyses, inflammation and angiogenesis were identified as the most affected. Inflammation-related DEGs were mainly enriched in T cell activation and differentiation and in the mammalian target of rapamycin/nuclear factor-κB/tumour necrosis factor signalling. Furthermore, angiogenesis-related DEGs were mainly enriched in the Gene Ontology terms angiogenesis regulation and vasculature development and in the KEGG pathways of phosphoinositide 3-kinase-protein kinase B/vascular endothelial growth factor/hypoxia-inducible factor 1 signalling. Protein-protein interaction analysis revealed a close interaction between inflammation- and angiogenesis-related DEGs, suggesting that phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta (Pi3kcd), cathelicidin antimicrobial peptide (Camp), C-X-C motif chemokine receptor 4 (Cxcr4), and MYB proto-oncogene transcription factor (Myb) play a central role in their interaction. To summarize, our findings reveal that in subchondral bone of osteoarthritic joints, signal interaction is interrelated between inflammation and angiogenesis and associated with the peripheral origin of OA pain; moreover, our data highlight potential targets for the inhibition of OA pain.

Effects of combining rehabilitation training on the recovery of athletic ability after reconstruction of injured ligament.

This paper aims to investigate the impact of conventional rehabilitation training and neuromuscular electrical stimulation (NMES) on the recovery of motor abilities in patients following ligament injury reconstruction. Forty postoperative patients who underwent surgery for anterior cruciate ligament reconstruction (ACLR) were randomly allocated to either the conventional rehabilitation group or the NMES group. The NMES group received NMES treatment in addition to the conventional rehabilitation program starting from eight weeks postoperatively. Various parameters, including knee joint function, stability, and balance, were compared between the two groups at eight weeks and 12 weeks postoperatively. Compared to the data at eight weeks postoperatively, both groups exhibited significant improvements in all measured indicators at 12 weeks postoperatively (p < 0.05). In the 12th week after the surgery, the NMES group demonstrated a Lysholm score of 93.18 ± 3.67 points, an IKDC score of 84.65 ± 2.33 points, a KT-2000 measurement of 0.88 ± 0.45 mm, a thigh circumference difference of -1.33 ± 0.55 cm, a knee flexion angle of 130.12 ± 4.21°, a single-leg standing time of 60.12 ± 9.33 s, a YBT score of 70.26 ± 2.68 points, and a Bulgarian split squat 1RM size of 58.07 ± 6.85 kg; all of these results were significantly superior to those observed in the conventional group (p < 0.05). NMES significantly enhances the recovery of athletic ability in patients following postoperative ACLR and can be effectively applied in clinical practice.

Outcome of Trapeziectomy and Ligament Reconstruction and Tendon Interposition for Patients Aged Less Than 56 Years: A Retrospective Study With a Minimum 5-Year Follow-Up.

PURPOSE: The purpose of this study was to determine the long-term consequences of trapeziectomy and ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal osteoarthritis in patients aged less than 56 years. METHODS: A retrospective study was performed to investigate the outcome of trapeziectomy and LRTI with a follow-up period of greater than 5 years in patients aged less than 56 years at the time of surgery. Patients completed the Disabilities of Arm, Shoulder, and Hand (DASH), the Patient-Rated Wrist Evaluation (PRWE), and a 10-point visual analog score for pain (VAS). Objective assessments included thumb opposition, palmar and radial abduction angles, and grip, lateral key, and thumb tip pinch strengths. Radiographic assessments of the thumb carpometacarpal joint were performed in three planes, and the trapezial space and trapezial space to metacarpal height ratios were calculated. RESULTS: Between January 2005 and December 2017, 105 patients were treated. Forty-eight patients with 58 thumbs returned for review. The mean patient age at the time of surgery was 52.5 years, and 96% of the patients were women. The mean follow-up period from surgery was 11 years. The mean VAS score was 1. A significant association was found between younger age at the time of surgery and increased proximal migration of the metacarpal, between high VAS pain scores and high PRWE and DASH scores, weak grip, lateral key pinch and thumb tip pinch strength, and Kapandji score, and between the follow-up period and increasing VAS pain, PRWE, and DASH scores. CONCLUSIONS: Trapeziectomy and LRTI are effective procedures for patients aged less than 56 years. The benefits of surgery should be balanced against the deterioration in the outcome measures of DASH and PRWE and increasing VAS scores with increasing intervals from surgery. TYPE OF STUDY/LEVEL EVIDENCE: Therapeutic IV.

The effects of environments and adhesive layer thickness on the failure modes of composite material bonded joints.

In this study, a structural adhesive was used to bond unidirectional prepreg and fiber fabric in a single lap joint. The mechanical properties of the structural adhesive were investigated under room temperature dry state (RTD) and elevated temperature wet state (ETW, 71 â„ƒ/85% RH), and different adhesive layer thicknesses (0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm). The fracture surfaces of the bonded joints were examined using scanning electron microscopy (SEM), and finite element simulations were conducted to observe the failure modes and failure paths. Additionally, the specimens were immersed in water and hydraulic oil, and their tensile shear strength was tested to evaluate their liquid sensitivity. The experimental results indicated that with increasing adhesive layer thickness, the strength of the specimens decreased by 21% in the RTD and by 52% in the ETW. The strength differences between different environments were minimal for adhesive layer thicknesses of 1 mm and 1.5 mm. The shear strength of the specimens decreased after immersion in water and hydraulic oil, with reductions of 43.78% and 39.21%, compared to the room temperature dry respectively. SEM observations of the bonded joint sections revealed that the primary failure modes were adherend failure and adhesive layer failure. Finite element simulations indicated that fiber tearing and crack initiation occurred in stress concentration areas during loading, leading to structural failure.

Correlation of the single-segment dynamic stabilization with different segmental mobility and zygapophysial (facet) joint degeneration: a retrospective study in northern China.

OBJECTIVE: To compare the clinical and radiographic outcomes of single-segment posterior decompression combined with two different non-fusion dynamic stabilization systems, Isobar EVO and Isobar TTL, in the context of facet joint degeneration and segmental mobility. METHOD: A retrospective study was conducted on 47 patients who underwent single-segment surgery at the L4/5 level using either the Isobar EVO (n = 23) or Isobar TTL (n = 24) systems. We assessed facet joint degeneration on both sides of the fixed (L3/4, L4/5) and superior adjacent (L2/3) segments using the Fujiwara MRI grading system. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain at baseline, 12 months, and 24 months postoperatively. RESULT: Both groups exhibited significant facet joint degeneration at the fixed segments (L3/4 and L4/5) at 24 months. The TTL group also showed significant degeneration at the superior adjacent segment (L2/3), whereas the EVO group did not. Restoration of lumbar lordosis was significantly better in the EVO group. Pain and disability scores improved more in the EVO group than in the TTL group at both 12 and 24 months postoperatively. CONCLUSION: The Isobar EVO system, with its enhanced mobility, may delay facet joint degeneration in the superior adjacent segment compared to the Isobar TTL system. However, both systems result in degeneration at the fixed segment, indicating a need for further improvements to mimic the natural biomechanics of the spine more closely.

Impact of whole-body vibration training on ankle joint proprioception and balance in stroke patients: a prospective cohort study.

BACKGROUND: Although whole-body vibration (WBV) training is acknowledged for its benefits in enhancing motor functions across several neurological disorders, its precise influence on ankle joint proprioception and balance in stroke patients is still not well understood. This research seeks to assess the impact of WBV training on ankle joint proprioception and balance in stroke patients, thereby filling this important research void. METHODS: In this prospective cohort study, thirty-five stroke patients were randomly assigned to either the WBV group (n = 17) or a control group (n = 18) using a random number table method. The control group received daily general rehabilitation for four weeks, while the WBV group received an additional 30 min of WBV training each day with the Trunsan S110 Vibration Training System. Blinded outcome assessments were conducted at baseline and post-treatment, utilizing the Berg balance scale (BBS), Functional reach test (FRT), Romberg test length (RTL) and area (RTA), and completion rates of ankle joint dorsiflexion-plantar flexion (DP) and inversion-eversion (IE) tests. Follow-up assessments were performed after four weeks of intervention, focusing on RTL, RTA, DP, and IE as primary outcomes. RESULTS: Analysis of intra-group changes from baseline to post-treatment revealed significant improvements across the BBS, FRT, RTL, RTA, and DP and IE assessments (p < 0.001). Notably, the WBV group showed significant enhancements compared to the control group in DP and IE (p < 0.001 and p < 0.05, respectively), with mean values increasing from 13.556 to 16.765 (23.7%) and from 5.944 to 8.118 (36.6%), respectively. However, WBV did not provide additional benefits over the control treatment for balance recovery parameters such as BBS, FRT, RTL, and RTA (p > 0.05). CONCLUSIONS: This study demonstrates that WBV therapy is equally effective as conventional methods in enhancing proprioception and balance in stroke patients, but it does not provide additional benefits for balance recovery. WBV significantly improves proprioceptive functions, particularly in DP and IE parameters. However, it does not surpass traditional rehabilitation methods in terms of balance recovery. These findings indicate that WBV should be incorporated into stroke rehabilitation primarily to enhance proprioception rather than to optimize balance recovery. TRIAL REGISTRATION: This study was retrospectively registered in the ISRCTN Registry on 29/07/2024 ( https://www.isrctn.com/ , ISRCTN64602845).

Are Red Blood Cell Distribution Width and Platelet Count Useful for Diagnosing Periprosthetic Joint Infection in Patients Undergoing Re-Revision Arthroplasty.

OBJECTIVE: Accurate and prompt identification of periprosthetic joint infections (PJIs) is critical prior to re-revision arthroplasty to ensure optimal surgical outcomes. Among routinely measured blood indices, red blood cell distribution width (RDW) and platelet count (PLT) have shown strong correlations with infection presence. This study aimed to assess the utility of RDW and PLT for diagnosing PJI in patients scheduled for re-revision arthroplasty. METHODS: This retrospective research encompassed all patients who underwent re-revision hip or knee arthroplasty at our institution from 2008 to 2022. Participants were categorized into either the PJI (n = 41) or the non-PJI (n = 47) group following the guidelines established in the 2013 International Consensus Meeting on PJI. In this analysis, RDW and PLT counts were evaluated alongside conventional inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The efficacy of these diagnostics was evaluated by the area under the receiver operating characteristic (ROC) curve ([area under the curve AUC]). RESULTS: RDW demonstrated a modest AUC of 0.678 with sensitivity at 61.0% and specificity at 71.7%, using a threshold of 14.5%. PLT was on par with ESR, showing an AUC of 0.773, and both sensitivity and specificity around 73% at a threshold of 201 × 109/L. CRP presented the highest diagnostic accuracy with an AUC of 0.815, achieving a sensitivity of 82.9% and specificity of 73.9% at a 6.9 mg/L threshold, surpassing ESR's AUC of 0.754. None of the biomarkers, individually or combined, outperformed CRP alone (p > 0.05). CONCLUSIONS: In the context of re-revision arthroplasty, RDW and PLT demonstrate limited efficacy as diagnostic biomarkers for PJI. However, CRP retains its reliability as a biomarker when the diagnostic threshold is appropriately recalibrated.

Characteristics of upper limb joint mechanics with increased cane dependence during walking.

[Purpose] This study investigated the effects of differences in cane dependence on the mechanical work at the shoulder, elbow, and wrist joints during walking. [Participants and Methods] Fifteen volunteers participated in this study (mean ± standard deviation [SD] age: 24.9 ± 2.7 years, height: 1.73 ± 0.04 m, and body mass: 68.5 ± 8.9 kg). The participants walked under three conditions: (1) without a cane, (2) with a cane at 10% body weight (BW), and (3) with a cane at 20% BW. The shoulder, elbow, and wrist joint work was calculated to evaluate the mechanical load. [Results] The results indicated a significant interaction between load conditions and positive joint work, as well as between load conditions and negative joint work. The positive work in the shoulder and elbow joints significantly increased in the 20% BW condition compared to that in the 10% BW condition. [Conclusion] Increased cane dependence did not uniformly increase the positive and negative work of the shoulder, elbow, and wrist joints. Increased cane dependence during walking increases energy generation in the shoulder and elbow joints, which can result in adverse musculoskeletal strain on the shoulder and elbow joints.

Evaluation of the review models and approval timelines of authorities participating in the East African Medicine Regulatory Harmonisation initiative: alignment and strategies for moving forward.

Introduction: Medicines regulatory harmonisation has been embraced by many national regulatory authorities (NRAs) to improve public health through faster availability of safe, high-quality, and effective medical products to patients and enhanced standardisation of technical guidelines and work sharing, leading to reduced cost to pharmaceutical companies. After ten years of implementing regulatory harmonisation by the East African Community Medicines Registration Harmonization (EAC-MRH) initiative, it is now imperative for participating NRAs to rely on each other to minimise duplication of use of limited resources. Major challenges in implementing reliance are the lack of clear registration processes and delays in the approval. The aim of this study was to compare review models, target timelines and data requirements used in assessing applications by EAC-MRH NRAs so as to align and propose strategies for improvement. Methods: A validated questionnaire that standardises and captures review processes was completed by the head of the medicine's registration division in each of the seven EAC-MRH NRAs. A country report based on the completed questionnaire was developed for each NRA and validated by the heads of the respective authorities. Results: Most applications received by all countries were for generics except Kenya, which received a significant number of new active substance applications (55 and 53 in 2020 and 2021). Mean approval times for generics using full review varied, with Tanzania's time declining for the three years. Target timelines for full review for the five countries ranged between 180 calendar days (Tanzania) to the highest 330 days (Zanzibar). The three countries (Kenya, Rwanda and Uganda) utilising the verification review model had a target timeline of 90 days. All six authorities conducted abridged reviews and fast-track assessments through a priority review track. The common technical document format was mandatory for applications in all authorities. The target timeline for key milestones in the review process varied for each country with a few similarities. Discussion: The study has provided a baseline for review models, target timelines and data requirements utilised in assessing applications for registration by EAC-MRH NRAs. Implementing the recommendations from this study will enable the NRAs to align and improve their registration processes.

A Robotic Clamped-Kinematic System to Study Knee Ligament Injury.

Knee ligament injury is among the most common sports injuries and is associated with long recovery periods and low return-to-sport rates. Unfortunately, the mechanics of ligament injury are difficult to study in vivo, and computational studies provide limited insight. The objective of this study was to implement and validate a robotic system capable of reproducing natural six degree-of-freedom clamped-kinematic trajectories on human cadaver knees (meaning that positions and orientations are rigidly controlled and resultant loads are measured). To accomplish this, we leveraged the field's recent access to high-fidelity bone kinematics from dynamic biplanar radiography (DBR), and implemented these kinematics in a coordinate frame built around the knee's natural flexion-extension axis. We assessed our system's capabilities in the context of ACL injury, by moving seven cadaveric knee specimens through kinematics derived from walking, running, drop jump, and ACL injury. We then used robotically simulated clinical stability tests to evaluate the hypothesis that knee stability would be only reduced by the motions intended to injure the knee. Our results show that the structural integrity of the knee was not compromised by non-injurious motions, while the injury motion produced a clinically relevant ACL injury with characteristic anterior and valgus instability. We also demonstrated that our robotic system can provide direct measurements of reaction loads during a variety of motions, and facilitate gross evaluation of ligament failure mechanisms. Clamped-kinematic robotic evaluation of cadaver knees has the potential to deepen understanding of the mechanics of knee ligament injury.

Dorsal blocking orthoses for proximal interphalangeal joint volar plate injuries: A retrospective cohort study investigating the impact of joint angle on patient outcomes.

BACKGROUND: Injuries to the proximal interphalangeal joint (PIPJ) of the fingers are commonly treated in hand therapy departments. Conservative management for PIPJ volar plate injuries typically involves a dorsal blocking orthosis and flexion exercises. Historically hand therapists have placed the PIPJ in varying degrees of flexion but the optimal angle is unknown. PURPOSE: To compare the outcomes of two treatment groups who received dorsal blocking orthoses: Those who the orthosis was positioned in neutral compared to those in 25-30° of flexion. STUDY DESIGN: Retrospective cohort study. METHOD: Patients treated by the hand therapy service at a major metropolitan hospital network in Melbourne, Australia, for conservative management of a PIPJ volar plate injury over a three-year period were included in our study. Data regarding patient demographics, digits affected and injury type were collected. Outcomes included presence of a fixed flexion deformity (FFD), amount of hand therapy received and total active flexion at the PIPJ. RESULTS: One hundred and eleven participants were included in our study. The mean age was 26 and 59 (53%) were males. Seventy two (64%) participants received a dorsal blocking orthosis positioned in neutral and 39 (35%) were positioned in 25-30° flexion at the PIPJ. Participants whose orthosis was positioned at 25-30° had an average of 24 more minutes in hand therapy (which equates to approximately one appointment) compared to those whose PIPJ was positioned in neutral (p=0.006, d=0.5). Eight percent less participants developed a FFD (p = 0.24) and 13% more participants achieved full flexion (p = 0.06) in the group who received a dorsal blocking orthosis in neutral, however these results were not statistically significant. CONCLUSION: PIPJ volar plate injures treated in an orthosis positioned in neutral required fewer hand therapy appointments. There was no statistically significant difference between groups regarding development of a FFD or full flexion.

Impact of gender, posture and phase on back and lower extremity moments and muscle excitation during lifting task: a cross-sectional study.

Purpose: The aim of this work was to investigate and compare back and lower extremity joint moments and muscle excitation during stoop and squat postures by incorporating gender-based differences and analyzing lifting phases. Methods: 18 healthy adults (9 males and 9 females; age: 24.44 ± 4.96 years, body mass: 66.00 ± 12.10 kg, height: 170.11 ± 9.20 cm, lean body mass: 48.46 ± 7.66 kg) lifted an object 30% of their lean body mass using squat and stoop postures. Marker-based motion capture, force plate, and surface electromyography were synchronously used to acquire joint moments and muscle excitation. A 3-way mixed model analysis was performed to determine the effect of gender, posture, and phase on internal joint moments and muscle excitation of the lower back and extremities. Results: Significant differences were observed in the interaction of lifting posture and phase on lower extremity moments and excitation of rectus femoris and medial gastrocnemius. Individual effects of posture were significant for peak internal joint moments of the lower extremities only. Anterior lower extremity muscles showed significantly increased excitation during squat, whereas medial gastrocnemius was higher in stoop. Joint moments and muscle excitations were all higher during the lifting than the bending phase. Gender differences were found only in the peak lumbosacral sagittal plane moment and rectus femoris muscle excitation. Conclusions: The study identified significant variations in the joint moments and muscle excitation in lifting, influenced by gender, posture, and phase, highlighting its complex nature. Overall interactions were lacking, however individual effects were evident, necessitating larger future studies.

Chronic Bilateral Olecranon Bursitis: A Case Report.

Olecranon bursitis is a common condition that primarily affects men between the ages of 30 and 60. Although the conservative treatment of acutely inflamed olecranon bursitis is relatively straightforward, managing chronic olecranon bursitis can be challenging. In this publication, we report a case of rare bilateral chronic olecranon bursitis and discuss the rationale for choosing the best treatment option.

The Prevalence of Temporomandibular Disorders Among Dental and Medical Students in Taif, Saudi Arabia: A Cross-Sectional Study.

Objectives  This study was undertaken to investigate the prevalence of temporomandibular disorders (TMDs) and the impact of various contributing factors among undergraduate healthcare students in the region of Taif, Saudi Arabia. Methods A total of 100 undergraduate students were recruited from both the College of Medicine and the College of Dentistry at Taif University, Taif, Saudi Arabia. Data were collected on demographic parameters and the Helkimo's index (anamnestic {Ai} and clinical dysfunction {Di} component) using an anonymous self-administered questionnaire, as well as clinical examinations.  Results A significantly high prevalence (97%) of TMDs was observed among the sampled students, with most of them (44.0%) experiencing severe symptoms that might negatively impact their quality of life. On clinical examinations, most of the students (75.0%) showed signs of mild clinical dysfunction, which might indicate an early stage of TMD. Moreover, factors that include older age, majoring in "dentistry" studies, being allergic, having oral habits, poor mental health, and previous COVID-19 infections were found to be significantly associated with TMDs. Conclusion The findings indicate a relatively high TMD prevalence among the sampled undergraduate healthcare students, especially those studying "dentistry". Curriculum modifications, coupled with more awareness and education, are recommended to achieve early diagnosis and help in reducing the incidence of TMD among this population.

Assessment of Hip and Lumbar Spine Range of Motion After Total Hip Arthroplasty Using a Single Camera Markerless System.

BACKGROUND: Total hip arthroplasty (THA) is one of the most cost-effective and successful procedures in orthopedics. However, assessing the post-operative range of motion (ROM) remains a challenge due to the limitations of traditional measurement methods. This study aimed to evaluate hip and spine ROM post-operatively and single-leg balance, using a single-camera markerless motion capture system, and compare outcomes with pre-operative ROM and with an age-matched healthy control group. METHODS: An interventional study was conducted from January 2018 to December 2021. Twenty patients with hip osteoarthritis underwent THA and were assessed using a single-camera markerless system (Kinetisense software). Measurements were taken one month pre-operatively and one year post-operatively. RESULTS: Significant improvements were observed in hip and lumbar spine ROM variables after THA. The most notable enhancements were in hip and spinal flexion. Compared to the control group, the THA group showed minor deficits in hip ROM, particularly in external rotation. Single-leg balance demonstrated improved stability post-operatively. CONCLUSIONS: The single-camera markerless motion capture system offers a promising alternative for assessing hip and lumbar spine ROM, presenting potential advantages over manual goniometry and traditional 3D motion capture systems. Using this system for the evaluation of patients after THA, it seems that THA significantly enhances hip and lumbar spine ROM. Future research should focus on validating the accuracy of markerless systems.