Establishing femoral component rotation using a dynamic tensioner does not improve patellar position after total knee replacement with use of anatomic implants: A case-control study.

BACKGROUND: Anterior knee pain (AKP) is one of the reasons for dissatisfaction after total knee replacement (TKR). It may result from patellofemoral joint dysfunction, caused by improper rotation of implant components. The aim of this study was to analyze patella positioning in patients after standard measured resection TKR and TKR with a use of a dynamic tensioner, and to assess the frequency of AKP, range of motion (ROM), and patient-reported outcome measures 6 weeks and 3 months postoperatively. METHODS: The study consisted of 127 patients who underwent TKR. Eighty-nine of them treated with use of the dynamic tensioner FUZION formed the study group; the remainder formed the control group. All participants received cemented PERSONA MC without patella resurfacing. All patients had a standard anteroposterior, lateral weight-bearing, long-leg view X-ray and computed tomography examination in 30° of knee flexion following the procedure. RESULTS: There were no significant differences between the study and the control groups regarding: posterior condylar axis (PCA)-patella angle, surgical transepicondylar axis (sTEA)-patella angle, PCA-sTEA angle, deviation from 90° in PCA-patella, sTEA-patella and PCA-sTEA angles. No significant difference was found in a ratio of obtaining PCA-patella angle deviation of more than 3°. Regarding clinical parameters, statistically and questionablly clinically significant difference in favor of the Study Group was found in Forgotten Joint Score 6 weeks and 3 months post-operativley and ROM 6 weeks post-operatively. However, such difference was not found by analyzing ROM 3 months post-operatively, AKP and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. CONCLUSION: Compared with the standard 3° of femoral component external rotation, use of a dynamic tensioner does not allow for more accurate restoration of the patellar facet position with reference to the PCA.

Does Restricted Ankle Joint Mobility Influence Hamstring Muscle Strength, Work and Power in Football Players after ACL Reconstruction and Non-Injured Players?

This study was aimed at observing how the limitation of ankle dorsiflexion ROM affects hamstring muscle Peak Torque/BW (%), Average Power (W), and Total Work (J), and whether this effect is similar in football players after ACL rupture and reconstruction and in those without injuries. The study included 47 professional football players who were divided into two groups: Group 1 (n = 24) after ACL reconstruction and Group 2 (n = 23) without injuries in the past 3 years. Based on the Weight-Bearing Lunge Test (WBLT), the following subgroups in Groups 1 and 2 were distinguished: N (normal ankle joint dorsiflexion) and R (restricted ankle joint dorsiflexion). The concentric isokinetic test (10 knee flexions and extensions at 60°/s) was performed on both limbs. Significantly lower values of Peak Torque/BW and Average Power were observed in Group 1 compared to Group 2, as well as in subjects with normal and restricted ankle dorsiflexion. However, no significant differences were noted for either group in any of the strength variables comparing subjects with normal and restricted ankle dorsiflexion. A poor and non-significant correlation was exhibited between the ankle joint range of dorsiflexion and all the strength variables. The area under the ROC curve (AUC) for all the evaluated variables in both groups was below 0.5, or very close to this value, indicating that ankle dorsiflexion ROM has no diagnostic accuracy for hamstring muscle strength. Based on the obtained results, it can be assumed that ankle dorsiflexion limitation, which is common in football players, is not a factor in weakening hamstring muscle strength, either in football players after ACL reconstruction or among those without injuries. However, some authors have reported that limited mobility of the ankle joint can have a destructive effect on the work of the lower limbs and may also be a factor in increasing the risk of football injuries in this area. Therefore, we have suggested that hamstring muscle weakness and increased risk of injury may occur due to factors other than limited ankle mobility. These observations may be of great importance in the selection of prevention methods by including a broad spectrum of physical techniques, not just exercises that focus on the improvement of mobility or stability of the lower limbs.

Differences in joint line level and posterior condylar offset during total knee replacement with use of gap-balancing and measured resection techniques-matched cohort study.

BACKGROUND: Total knee replacement (TKR) is considered one of the most common elective orthopaedic procedures. The main focus of TKR is to offer patient's symptomatic relief from persistent knee pain. To achieve this it is crucial to restore joint biomechanics by performing proper bone cuts. Some surgeons favor the measured resection technique, others prefer gap balancing technique. The researchers of the presented study performed TKR using these two techniques. The aim of this study was to compare the postoperative change in joint line and posterior condylar offset after TKR with use of anatomic knee design implants between gap balancing and measured resection techniques. METHODS: Two hundred twenty-five X-rays of patients who underwent TKR performed by a single surgeon between 2020 and 2021 were analyzed. The first group of patients (101) was operated with the use of gap balancing technique and the second group (124) was operated with the use of measured resection technique. Patients included in the study were > 50 years of age, had confirmed primary knee osteoarthritis, underwent primary TKR with a PS (posterior stabilized) knee implants without patella resurfacing and had at least 15 degree flexion contracture. T-student test and U Mann-Whitney test were used in statistical analysis of results, according to the normality of distribution examined with the Shapiro-Wilk test. Post-hoc analysis was performed using the Dwass-Steel-Crichtlow-Fligner test (DSCF). RESULTS: The postoperative analysis showed a significantly elevated joint line level in the gap balancing group (-2.6 ± 4.1 vs -0.7 ± 4.8, p < 0.0005). In the gap balancing group significantly more patients had joint lines elevated > 2 mm comparing to measured resection technique. The difference between pre- and postoperative PCO (posterior condylar offset) and PCOR (posterior condylar offset ratio) results had no significant differences (100.8 ± 11.8 vs 101 ± 12.5, p > 0.05) between the groups. CONCLUSIONS: The results of the study suggest that when it comes to restoring joint line level measured resection technique seems to be superior in comparison to the gap balancing technique. What is more, results indicate measured resection is equal in terms of restoring posterior condylar offset to the gap balancing technique. TRIAL REGISTRATION: NCT04164147, date of registration: November 14, 2019.

Comparison of Femoral Component Rotation between Robotic-Assisted vs. Soft-Tissue Tensor Total Knee Arthroplasty with Anatomic Implants.

Background and Objectives: Total knee arthroplasty (TKA) is the most effective treatment method for end-stage osteoarthritis. One of the most important aspects of this surgery is adequate implant positioning, as it guarantees the desired outcome of restoring limb biomechanics. Surgical technique is being continuously improved along with hardware development. There are two novel devices designed to help establish proper femoral component rotation: soft-tissue tensor and robotic-assisted TKA (RATKA). This study compared the femoral component rotation achieved with the use of three methods: RATKA, soft tissue tensioner and the conventional measured-resection technique, all of them utilizing anatomical design prosthesis components. Materials and Methods: A total of 139 patients diagnosed with end-stage osteoarthritis underwent total knee arthroplasty between December 2020 and June 2021. After the surgery, they were divided into three groups depending on procedure technique and implant type: Persona (Zimmer Biomet) + Fuzion Balancer, RATKA + Journey II BCS or conventional TKA + Persona/Journey. Postoperatively, a computed tomography examination was performed in order to measure femoral component rotation. All three groups were compared independently during statistical analysis. Fisher's exact, Kruskal-Wallis and Dwass-Steel-Crichtlow-Fligner tests were used for particular calculations. Results: Statistically significant differences in femoral component rotation between groups were noticed. However, in terms of values other than 0° in external rotation, no significant variance was revealed. Conclusions: Additional total knee arthroplasty instruments seem to improve the outcomes of the surgery, providing better component positioning than in the conventional measured-resection technique based only on bone landmarks.

Robotic-Assisted Total Knee Arthroplasty Utilizing NAVIO, CORI Imageless Systems and Manual TKA Accurately Restore Femoral Rotational Alignment and Yield Satisfactory Clinical Outcomes: A Randomized Controlled Trial.

Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the aim of comparing patient-reported functional outcomes, radiographic outcomes and intraoperative measures between imageless (NAVIO and CORI), robotic-assisted (ra)- TKA (ra-TKA) and manual TKA (mTKA) for primary knee osteoarthritis (KOA). Materials and Methods: A total of 215 patients with the diagnosis of KOA of the knee were randomly assigned to one of the three groups: NAVIO (76 patients) or CORI (71 patients) robotic-assisted TKA, or manual technique (68 patients) TKA. The primary outcome (Knee Injury and Osteoarthritis Outcome Study [KOOS]), Visual Analogue Scale (VAS), Range of motion (ROM), femoral component rotational alignment and the secondary outcomes (surgery time, blood loss, complications, and revision at 12 months after surgery) were compared between three groups. KOOS and VAS were collected at particular follow up visits from each patient individually and ROM in flexion and extension was assessed during the physical examination. Femoral component rotational alignment was measured on the CT scan performed postoperatively utilizing the Berger's method. Statistical significance was set at p < 0.05. Results: Both the ra-TKA groups and mTKA group displayed significant improvements in the majority of the functional outcome scores at 12 months. Despite having more prominent surgery time (NAVIO: mean +44.5 min in comparison to mTKA and CORI: mean +38.5 min in comparison to mTKA), both NAVIO and CORI tend to achieve highly accurate femoral component rotational alignment with mean radiographic scores in NAVIO vs. CORI vs. mTKA of 1.48° vs. 1.33° vs. 3.15° and lower blood loss (NAVIO: 1.74; CORI: 1.51; mTKA: 2.32. Furthermore, the investigation revealed the significant difference in femoral component rotational alignment between mTKA-NAVIO and mTKA-CORI and significantly different KOOS scores in NAVIO vs. CORI vs. mTKA of 87.05 vs. 85.59 vs. 81.76. Furthermore, the KOOS analysis showed between group significant statistical differences, but did not reach minimal clinically significant difference. There were no differences in postoperative ROM and VAS. There were no differences in complications between groups. Conclusions: To achieve a successful TKA, the precise tool and individualised objective is of great importance. The results suggest satisfactory results after both ra-TKA methods and mTKA. Ra-TKA and mTKA stand for a safe and reliable treatment method for OA. Patients reported excellent alleviation in functional outcomes and the radiological results revealed that the better precision does not necessarily lead to a better outcome. Therefore, ra-TKA does not imply strong enough advantages in comparison to the manual method, especially in terms of cost-efficiency and surgical time.

The Evaluation of Asymmetry in Isokinetic and Electromyographic Activity (sEMG) of the Knee Flexor and Extensor Muscles in Football Players after ACL Rupture Reconstruction and in the Athletes following Mild Lower-Limb Injuries.

This study was aimed at evaluating knee stabilizer (quadriceps and hamstring) muscle strength and the medio-lateral symmetry of hamstring fatigue in football players after ACL reconstruction and with mild lower extremity injuries. The study comprised 65 professional football players who were divided into three groups: Group 1 (n = 24; 22.7 ± 3.6 years; 175 ± 4 cm; 77.3 ± 7.6 kg) after ACL reconstruction, Group 2 (n = 21; 20.5 ± 3.7 years; 177 ± 6 cm; 74.3 ± 9.1 kg) with mild lower-limb injuries (grade 1 muscle strains) and Group 3 (n = 20; 23.1 ± 2.8 years; 178 ± 6 cm; 75.8 ± 8.8 kg) without injuries in the past 3 years. The concentric isokinetic test (10 knee flexions and extensions at 60, 180 and 300°/s with a 30 s interval for rest) was performed on both limbs. Fatigue symmetry between the medial and lateral hamstrings was measured with sEMG during 60 s of isometric contractions. In comparison to the other groups, the injured leg demonstrated significantly lower values of peak torque for the quadriceps (G1-G2 = 48%, 38%, 14%; G1-G3 = 49%, 25%, 14%) and hamstring muscles (G1-G2 = 36%, 35%, 18%; G1-G3 = 64%, 28%, 17%) as well as lower values of hamstring muscle work (G1-G2 = 262 J, 157 J; G1-G3 = 219 J, 179 J) and power (G1-G2 = 34 W; 11 W; G1-G3 = 29 W, 12 W). No significant differences were noted in strength between Groups 2 and 3. The significantly higher fatigue of the BF compared to the SEM muscle was seen in Group 1 for the involved (mean difference = 0.12) and uninvolved limbs (mean difference = -0.10), but in Group 2, a non-significant trend towards asymmetry was also noted. No asymmetry in hamstring muscle fatigue was determined in Group 3. The results of our study allow us to indicate that active football players who previously met the RTS criteria, had deficits in lower-limb muscle performance 2-3 years after reconstruction, which could lead to ACL re-injury. This observation is potentially of importance because these deficits may not be subjectively reported by such athletes and also may not be visible in regular orthopedic and physiotherapeutic assessment.

How to analyze postoperative radiographs after total hip replacement.

Total hip replacement is one of the most widely performed surgeries. It is stated as the most efficient method of treating end-stage osteoarthritis of the hip joint. What is more, it significantly improves the quality of patients' lives, relieves them from pain and restores decreased range of motion, provided that is conducted properly. Aim of this article is to indicate which constituents of prosthetic placement can be easily measured on postoperative radiographs and point out how to interpret obtained results. Multiple mechanical factors, such as center of rotation, femoral offset, acetabular offset, acetabular inclination, acetabular anteversion and leg length discrepancy can be measured on postoperative radiographs. To provide a successful surgery and to acquire both radiological and clinical satisfying results, proper prosthetic placement is crucial. Malpositioning of each element, in varying degrees may lead to dislocation or reoperation.

Levels of actigraphy-derived physical activity among Polish nurses: factors associated with the prevalence of selected metabolic disorders.

Numerous studies demonstrate a relationship between physical activity and the development of non-communicable diseases. Nurses play a crucial role in the healthcare system, and their demanding work can have an impact on their health. The objective of this cross-sectional study was to assess physical activity in relation to factors predisposing to the occurrence of specific metabolic disorders among Polish nurses. The measurements included physical activity level using ActiGraph GT3X, body weight composition using Tanita MC-980, body mass index, waist circumference, blood pressure using Welch Allyn 4200B, lipid profile, and fasting blood glucose using CardioChek PA. The results indicate that nearly one-third (31.75%) of the total sample of studied nurses do not meet the criteria for the minimum amount of physical activity of at least moderate intensity. Furthermore, over half of the surveyed nurses (55.5%) were classified as overweight or obese based on BMI, and almost half (42.86%) had abdominal obesity. The regression model, employing linear regression, revealed that factors predisposing to selected metabolic disorders were age, engaging in multiple jobs, and the number of steps per day. There is a pressing need to implement comprehensive and supportive initiatives to improve the overall health condition of nurses in Poland through increased physical activity. Activating and supporting this professional group is an investment that benefits not only the nurses themselves but also the healthcare system and the entire nation.

Hip hemiprosthesis due to femoral neck fracture in the elderly population - are we doing it right?

Introduction: Femoral neck fracture is one of the most common orthopaedic traumas affecting the elderly population. The standard treatment method is hip hemiarthroplasty and total hip arthroplasty. In hip hemiprostheses surgeons mainly have to reconstruct the femoral offset and limbs' length to obtain the correct gait biomechanics and a satisfactory surgical outcome.The aim of this study is to examine the radiological results of patients after hip hemiarthroplasty for femoral neck fracture and to evaluate the reconstruction of the femoral offset using standard neck angle stems. Material and methods: A consecutive series of 97 patients diagnosed with femoral neck fracture treated with a hip hemiprosthesis between 2017 and 2021 was identified and met the inclusion criteria. On preoperative images, the neck-shaft angle and the femoral offset on the healthy limb were measured. The femoral offset of the operated limb was measured on the postoperative X-rays. Results: There was a significant positive moderate correlation between neck-shaft angle and femoral offset change (r = 0.568, p < 0.0001). There was a statistically significant difference between femoral offset change and neck-shaft angle (24:52 vs. 14:7, p = 0.005). This means that in patients with coxa vara the change in femoral offset was more often < -5 mm. Less than half of operated patients had the femoral offset restored within a safe range (between -5 and 5 mm). Conclusions: Our study proved that it is sometimes hard to achieve femoral offset within a safe range while performing hip hemiarthroplasty in patients with coxa vara. The topic of using high offset stems in partial hip arthroplasty has not been thoroughly researched worldwide. However, taking into account the results of our study, during a hip hemiarthroplasty the usage of high offset stems for varus hips should be considered in order to improve the clinical outcome and improve patients' quality of life and functioning.

Ligament Alteration in Diabetes Mellitus.

Connective tissue ageing is accelerated by the progressive accumulation of advanced glycation end products (AGEs). The formation of AGEs is characteristic for diabetes mellitus (DM) progression and affects only specific proteins with relatively long half-lives. This is the case of fibrillar collagens that are highly susceptible to glycation. While collagen provides a framework for plenty of organs, the local homeostasis of specific tissues is indirectly affected by glycation. Among the many age- and diabetes-related morphological changes affecting human connective tissues, there is concurrently reduced healing capacity, flexibility, and quality among ligaments, tendons, bones, and skin. Although DM provokes a wide range of known clinical disorders, the exact mechanisms of connective tissue alteration are still being investigated. Most of them rely on animal models in order to conclude the patterns of damage. Further research and more well-designed large-cohort studies need to be conducted in order to answer the issue concerning the involvement of ligaments in diabetes-related complications. In the following manuscript, we present the results from experiments discovering specific molecules that are engaged in the degenerative process of connective tissue alteration. This review is intended to provide the report and sum up the investigations described in the literature concerning the topic of ligament alteration in DM, which, even though significantly decreasing the quality of life, do not play a major role in research.

Continuous glycemia monitoring in perioperative period in patients undergoing total knee or hip arthroplasty: A protocol for a prospective observational study.

In every surgical subspecialty surgical site infection (SSI) or implant infections, although occur seldom, pose a threat to patients' health. Risk factors of such states is diabetes mellitus (DM), considered one of the most widespread health-related problems of the 21st century. Orthopedists perform big joint replacements that usually concern older adults and therefore often deal with patients suffering from comorbidities. DM is frequently one of them and can furthermore often remain underdiagnosed. The other risk for complication is a rapid beginning of the rehabilitation which starts on the day following the surgery. To eliminate the debilitating impact of DM and hypoglycemia on surgical patients, we aim to investigate the relationship between the glycemia values and the postoperative outcomes in certain periods of time in patients undergoing orthopedic surgeries. Participants meeting inclusion criteria will have inserted a glycemia measuring device (Dexcom G5, Inc., San Diego, CA) in the periods of time. First time it will take place 14 days prior to the surgery and right after the surgery for the second time for the period of another 14 days. All patients will undergo standard total knee arthroplasty or total hip arthroplasty procedures. Patients will be assessed preoperatively and 14 days, 1, 3, 6, 12, and 24 months postoperatively. The assessment of the joint condition will consist of: patient-reported outcomes (The Knee injury and Osteoarthritis Outcome Score, Harris Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]); assessment of potential SSI and cardiovascular complications (the Finnish Diabetes Risk Score [FINDRISC], the Systematic Coronary Risk Evaluation [SCORE]) and the clinical examination. To investigate the influence of orthopedic surgery (anesthesia) on glycemia and the significance and safety of early patients mobilization after the big joints surgeries. To investigate changes of glycemia in patients with normal glycemia metabolism, potentially protecting them from hypoglycemia during hospital stay and increasing their awareness of potential development of DM in the future. Additionally, this study will correlate perioperative glycemic levels with risk of cardiovascular events in one year follow-up, and its influence on SSI and implant complications.

Longitudinal analysis of resting energy expenditure and body mass composition in physically active children and adolescents.

BACKGROUND: Monitoring body composition and changes in energy expenditure during maturation and growth is significant, as many components can influence body structure in adulthood. In the case of young players, when these changes can influence their strength and power, it seems to be equally important. Our aim was to examine whether resting energy expenditure (REE) and body composition would change after 10 months from baseline in physically active children and adolescents. METHODS: We obtained data from 80 children and adolescents aged 9 to 17 years at two measurement points: the baseline in September 2018 and after 10 months in July 2019. The study was carried out using a calorimeter (Fitmate MED, Cosmed, Rome, Italy), a device used to assess body composition using by the electrical bioimpedance method by means of a segment analyzer (TANITA MC-980). The Student's t-test and linear regression analysis were used. Using the stepwise forward regression procedure, the selection of factors in a statistically significant way that describes the level of REE was made. RESULTS: We noticed that REE was not significantly different between baseline (1596.94 ± 273.01 kcal) and after 10 months (1625.38 ± 253.26 kcal). When analyzing the difference in REE between studies girls, we found body height as a significant predictor. The results of our study show a negative relationship between growth and REE. Differences between sexes and age in REE between baseline and after 10 months were not significant. CONCLUSIONS: Our study involving physically active children and adolescents, which used repeated objective measures and longitudinal statistical modeling to analyze them, was unable to demonstrate any interaction between body weight change, body composition measurements, and REE.

Is Kummell's Disease a Misdiagnosed and/or an Underreported Complication of Osteoporotic Vertebral Compression Fractures? A Pattern of the Condition and Available Treatment Modalities.

This narrative review provides the outcomes of minimally invasive surgery (MIS) and describes the available conservative treatment options for patients with osteoporotic vertebral compression fractures (OVCFs) that have risk factors for Kummell's disease (KD). It aims to explore the evidence, emphasize the possible therapy complications, and aims to propose the most efficient clinical strategies for maintaining a good overall condition of individuals who may suffer from neurological deficits from a late-diagnosed OVCF complication. The secondary objective is to sum up the diagnostic particularities concerning individuals prone to OVCFs and KD, as the major risk factor for developing these severe conditions remains osteoporosis. Findings of our narrative review are based on the results found in PubMed, Embase, and Google Scholar from the beginning of their inception to December 2020, described independently by two authors. All of the studies included in the review focus on reporting the following treatment methods: conservative methods, vertebroplasty, kyphoplasty, targeted percutaneous vertebroplasty, frontal and side-opening cannula vertebroplasty, SpineJack, bone-feeling mesh container treatment, and the difference in the cement viscosity used (high vs. low) and the approach used (unilateral vs. bilateral). The comparison of randomized control trials (RCTs) as well as prospective and retrospective case series showed a comparable efficacy of kyphoplasty and vertebroplasty, and described cement-augmented screw fixation and the SpineJack system as effective and safe. Although it should be noted that several studies revealed inconsistent results in regards to the efficacy of using back braces and analgesics in patients who had vertebral fractures that were overlooked or not enrolled in any active surveillance program to track the patient's deterioration immediately. Nevertheless there are non-standardized guidelines for treating patients with OVCFs and their complications already established. Using these guidelines, a treatment plan can be planned that takes into consideration the patients' comorbidities and susceptibilities. However, the primary approach remains the management of osteoporosis and that is why prophylaxis and prevention play a crucial role. These measures reduce the risk of disease progression. Unfortunately, in the majority of cases these measures are not taken into account and KD develops.