Clinical outcomes of remote asynchronous telerehabilitation are equivalent to traditional therapy following total knee arthroplasty: A randomized control study.

Introduction Successful post-operative telerehabilitation following total knee replacement (TKR) has been documented using synchronous (real-time) video. Bandwidth and the need for expensive hardware are cited as barriers to implementation. Web-based asynchronous visual platforms promise to address these problems but have not been evaluated. We performed a randomized control study comparing an asynchronous video-based software platform to in-person outpatient physical therapy visits following TKR. Materials and methods Fifty-one patients were randomized to either the intervention group, using an asynchronous video application on a mobile device, or the traditional group undergoing outpatient physical therapy. Outcome data were collected using validated instruments prior to surgery and at a minimum three-month follow-up. Results Twenty-nine patients completed the study. There were no statistically significant differences in any clinical outcome between groups. The satisfaction with care was equivalent between groups. Overall utilization of hospital-based resources was 60% less than for the traditional group. Discussion We report that clinical outcomes following asynchronous telerehabilitation administered over the web and through a hand-held device were not inferior to those achieved with traditional care. Outpatient resource utilization was lower. Patient satisfaction was high for both groups. The results suggest that asynchronous telerehabilitation may be a more practical alternative to real-time video visits and are clinically equivalent to the in-person care model.

Does pre-coating total knee tibial implants affect the risk of aseptic revision?

We evaluated the impact of pre-coating the tibial component with polymethylmethacrylate (PMMA) on implant survival in a cohort of 16 548 primary NexGen total knee replacements (TKRs) in 14 113 patients. In 13 835 TKRs a pre-coated tray was used while in 2713 TKRs the non-pre-coated version of the same tray was used. All the TKRs were performed between 2001 and 2009 and were cemented. TKRs implanted with a pre-coated tibial component had a lower cumulative survival than those with a non-pre-coated tibial component (p = 0.01). After adjusting for diagnosis, age, gender, body mass index, American Society of Anesthesiologists grade, femoral coupling design, surgeon volume and hospital volume, pre-coating was an independent risk factor for all-cause aseptic revision (hazard ratio 2.75, p = 0.006). Revision for aseptic loosening was uncommon for both pre-coated and non-pre-coated trays (rates of 0.12% and 0%, respectively). Pre-coating with PMMA does not appear to be protective of revision for this tibial tray design at short-term follow-up.

Compliant prestress fixation in tumor prostheses: interface retrieval data.

This article reports the first available human retrieval data following the use of a new fixation system for tumor prostheses. The compliant prestress (CPS) fixation system obviates the need for long intramedullary stems. The CPS was designed to provide a stable, high-pressure, motion-free bone-implant interface that would prevent aseptic loosening and allow osseointegration at the bone-implant interface. At 10 months, the fourth patient in the human trial required amputation. Backscatter electron microscopy revealed a buttress of new bone had formed along 70% of the bone-metal interface, with excellent bony ingrowth (average: 42%) into the transverse, porous-coated titanium interface.

Follow-up protocols in orthopedic oncology.

Little has been written about the specific timing and elements Involved in the follow-up of orthopedic oncology patients. The experience with bone tumor treatment at the First Clinic of the Istituto Rizzoli started 30 years ago and more than 15,000 patients have been treated to date. The increment of limb salvage surgery is linked with the improvements in imaging and surgical skills and with the availability of new reconstructive techniques. For this purpose it is mandatory to carry out meticulous monitoring of the patients. A large number of patients are still followed up to evaluate the results in terms of oncological and functional status. Based on this experience we developed a time schedule to better respond to the need for adequate patient evaluation.

Giant cell tumor of bone. Curettage and cement reconstruction.

A retrospective review was conducted of all consecutive giant cell tumors treated by the senior author (JOJ) between 1975 and 1990 using the technique of aggressive curettage through a large bone window followed by acrylic cement reconstruction. Steinmann pins were used as reinforcement bars within the methacrylate in large lesions. Thirty-eight patients with a mean followup of 5.2 years (range, 2-16 years) were identified. Three (8%) recurrences are reported. There were no infections or mechanical failures of the construct. Functional results were good to excellent in 84% of patients. Ninety-five percent of patients reported good or excellent stability, no deformity, and emotional acceptance of the procedure. The recurrence rate with this protocol (8%) approached that associated with wide resection or amputation (0%-5%), and was lower than that seen with simple curettage and bone grafting (27%-55%). Acrylic cement reconstruction is a safe and effective procedure that provides local adjuvant therapy and immediate stability for early rehabilitation. The authors emphasize the importance of aggressive curettage of the lesion through a large bone window and suggest the use of reinforcement bars within the cement for large defects.

Supracondylar femoral osteotomies for the correction of angular deformity about the knee in children. A follow-up study.

The results of 18 supracondylar osteotomies of the femur performed for angular deformity about the knee joint on 14 patients under the age of 18 years were reviewed. The mean follow-up was 46 months. Twelve of 18 osteotomies had a successful outcome. Six were considered failures due to recurrence of angular deformity despite bony union at the osteotomy site. Four of the six failures occurred in patients with metabolic bone disease. Special care needs to be taken when planning supracondylar osteotomies in patients with metabolic disease.

Late surgical treatment of lateral condylar fractures in children.

We describe four cases of successful late surgical treatment of lateral condylar fractures of the humerus performed 8 weeks and 2, 5, and 14 years after injury and review the literature on the subject. We suggest that children with symptomatic nonunion and malunion of these fractures can benefit from late surgical treatment at the time of diagnosis. We describe the technique of functional reduction and the regions in which anatomic reduction is precluded by remodeling or gross displacement of the fragment.