Total Knee Arthroplasty in Patients with Ipsilateral Hip Fusion: Technical Notes and Literature Review.

Numerous studies report the success and outcomes of the total knee arthroplasty (TKA); however, few papers present patients with knee osteoarthritis and ipsilateral hip fusion. One controversy when treating patients requiring a TKA with prior ipsilateral hip fusion is whether to first perform a total hip arthroplasty (THA) of the fused hip, followed by the ipsilateral TKA, or to proceed with the TKA without replacing the hip; studies suggest that the position of the fused hip is a key factor when making this therapeutical decision. In addition, performing a TKA in patients with an ipsilateral fused hip may require modifications to the surgical technique generated by the lack of joint mobility in the hip. We identified 12 studies encompassing 30 patients with hip fusion and ipsilateral TKA in current orthopedic literature, but only six offered insights on patient positioning on the operating table during surgery. This study aims to review the current literature on patients with knee osteoarthritis and prior ipsilateral hip fusion and to present some technical considerations when performing a TKA on a 75-year-old patient with hip ankylosis who underwent a total ipsilateral knee arthroplasty in our clinic.

Perception and Experience of Dupilumab in Atopic Dermatitis: A Real-Life Study.

Purpose: There are few data on the practical use of dupilumab by the patients and on the patients' experience with this treatment. Objective: The objective of our study was to describe the experience and perception of dupilumab treatment in patients with atopic dermatitis (AD). Patients and Methods: We conducted a multicenter retrospective observational study including adult patients with moderate to severe AD treated with dupilumab between January 2017 and December 2021. Clinical characteristics were collected and a questionnaire was sent to all patients. It consisted of different parts including the injection method and different numeric rating scales (NRS) evaluating the patient's satisfaction and the constraints related to the treatment. Results: Eighty-two patients were included and the information was available for 77 patients who responded to the questionnaire. Injection of dupilumab was performed by a nurse in 47% (n=36) of patients and 43% (n=33) were autonomous. Injections were performed by a family member for 7 patients or by the general practitioner (1 patient). A wearing-off of the beneficial effect of dupilumab was reported by 47% of patients leading to shorten the dosing interval. In contrast, dose spacing was reported by 9 patients (11%). After a mean follow-up time of 29.7 ± 10.7 months (median: 27 months), drug survival was 72%. From the patients' perspective, the mean patient's satisfaction NRS score was 7.5 ± 1.8, and the constraints related to the treatment were scored at 3.1 ± 2.1 on NRS. Conclusion: Although AD treatments may contribute to the burden of the disease, dupilumab was associated with a lower burden score, likely reflecting both treatment efficacy and easy of use and patient satisfaction.

Partial Articular Supraspinatus Tendon Avulsion Repair and Patch: A Technical Note for Augmenting the Supraspinatus Reinsertion with the Long Head of the Biceps Tendon.

BACKGROUND: There is no clear consensus on the treatment of partial articular-sided supraspinatus tendon avulsions. Debridement alone might not be sufficient to prevent further tendon degradation or alleviate patient complaints. Direct repair using a suture anchor without treating the concomitant conditions of the long head of the biceps tendon might come with residual anterior shoulder pain or even further loss of function in cases of failed repair. The purpose of the present study is to describe an arthroscopic technique by which the long head of the biceps tendon can be included in the partial articular-sided supraspinatus tendon avulsion repair. TECHNIQUE PRESENTATION WITH VIDEO: In this technical note we describe the arthroscopic repair and augmentation with tenotomized biceps of partial supraspinatus tendon tears to address three main concepts for successful rotator cuff repairs, namely rotator cuff biologic augmentation, tendon to bone healing and postoperative pain prevention. CONCLUSION: The biceps tendon is a mechanically robust, locally available autograft that can be used in borderline partial articular-sided supraspinatus tendon avulsions in order to biologically augment healing at the tendon-bone interface without any immunogenic reactions or morbidity following harvesting.

Updates on Biomaterials Used in Total Hip Arthroplasty (THA).

One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient's quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years.

Combined Reconstruction of the Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament in Skeletally Immature Patients.

The medial patellofemoral ligament (MPFL) reconstruction is challenging in skeletally immature patients due to the anatomical particularities at this age. Recently, the medial quadriceps tendon femoral ligament (MQTFL) has received great interest for its ability to restrain the patella's instability along with MPFL. No gold-standard technique has been described so far to reconstruct both MPFL and MQTFL in skeletally immature patients. We present a technique to safely reconstruct the MPFL and the MQTFL in children and adolescents. The gracilis tendon autograft is harvested and passed through the medial collateral ligament as a pulley. The free ends of the graft are passed through the patella by an "L-shaped tunnel" and tied to itself. The other free end of the graft is pulled through the medial third of the quadriceps tendon and tied to itself to achieve tension. Our technique is reproducible, implant-free and avoids complications associated with femoral drilling and graft fixation. However no long-term follow-up results are available.

Placement of a polyurethane implant is not associated with a chondroprotective effect: comparative study with cases of isolated medial meniscectomy with at least five years of follow-up.

INTRODUCTION: Our main objective was to evaluate clinically and radiologically and compare patients who had undergone partial meniscectomy alone, with those who had received a partial meniscectomy in which a polyurethane implant was placed, with a minimum follow-up of 5 years. METHODS: We performed a prospective cohort study. Patients were randomly distributed into Group A if they only received meniscectomy or Group B if they received meniscectomy plus a meniscal implant (Actifit®). We performed preoperative, postoperative, and 5-year-follow-up functional and radiological evaluations (magnetic resonance imaging). RESULTS: Twelve patients (40%) were treated with meniscal implants (Group B); 18 (60%) were treated with a conventional meniscectomy (Group A). Tegner, Lysholm and KOOS scores were evaluated prior to surgery and at 5-year follow-up. Only the Lysholm score showed a significant difference between groups, with a score increase between the preoperative evaluation and the 5-year follow-up evaluation (p = 0.013). Preoperative and postoperative MRIs were both available in 19 cases (63.3%). Long-term follow-up MRIs were performed in 11 cases of group B. No significant differences were found in functional outcomes or MRI findings (WORMS cartilage score increase p = 0.360). Although total reabsorptions of the collagen meniscus implant were not statistically significant in younger patients, a tendency towards a higher reabsorption process was seen in older patients (p = 0.015). CONCLUSION: The placement of a polyurethane implant after a wide meniscectomy is not accompanied by a chondroprotective effect over time. There is no functional difference between implant placement and isolated meniscectomy. There is a discrepancy between good clinical results and radiologic appearance of these implants and their underlying cartilage. LEVEL OF EVIDENCE: II, therapeutic study.

Post-COVID-19 enterocolitis - a cause of rebellious diarrhea, acute abdomen and liver failure.

Currently, worldwide, the coronavirus disease 2019 (COVID-19) pandemic, which first appeared in Wuhan, China, in December 2019, is capsizing the medical system and turning the attention of the entire healthcare system through the many aspects it presents, both from a pathophysiological and from a semiological view, insufficiently studied aspects. With a high rate of morbidity and mortality, the COVID-19 pandemic was initially observed as a pathology leading to a severe acute respiratory syndrome, but over time gastrointestinal and hepatic manifestations have been reported. The study includes an analysis of 21 patients in the stage of the clinical disease of COVID-19 or in the stage of recovery, hospitalized in the Departments of General Surgery II or Gastroenterology, Emergency Clinical County Hospital of Craiova, Romania, with predominantly digestive symptoms, with the clinical expression of infectious enterocolitis, although stool culture was negative for pathogenic bacteria. The evolution of patients was influenced by the appearance of peritonitis through colonic necrosis or remission of clinical symptoms under empirical therapy.

Solitary fibrous tumor developing in the right retroperitoneal space.

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that is quite aggressive and prone to recurrence and metastasis. Most SFTs are benign, but the identification of the histological features that define the dedifferentiation of SFTs can predict the aggressiveness of the tumor and the presence of a reserved prognosis. We present a rare case of conventional SFTs with features of malignancy and highlight the diagnostic and therapeutic difficulties related to this case. Computed tomography aspect suggested a possible gastrointestinal stromal tumor. Surgical intervention was performed through median laparotomy and a tumor of approximately 15∕12 cm was found, developed from the level of the right retroperitoneal space, and pushing anteriorly the ascending colon, cecum, and terminal ileum. The immunohistochemical aspect correlated with the histopathological one suggests a SFT most likely malignant. In conclusion, the early diagnosis of SFTs is essential in establishing an appropriate treatment. Immunohistochemistry is indispensable in establishing the diagnosis of SFTs.

Nivolumab-induced capillary leak syndrome associated with chylothorax in a melanoma patient: A case report and review of the literature.

Introduction: Adverse events (AEs) of immune checkpoint inhibitors (ICIs) are frequent and mainly due to an overactivity of the immune system leading to excessive inflammatory responses (immune-related AE) that can affect any organ of the body. Beside the most frequent AEs, there are rare AEs whose diagnosis and treatment can be challenging. We report here a singular case of capillary leak syndrome (CLS) associated with chylothorax occurring in a patient who has been treated with adjuvant nivolumab (anti-PD1) for resected AJCC stage IIB primary melanoma. Case presentation: A 43-year-old woman was diagnosed with a nodular stage IIB melanoma of her left thigh, according to the AJCC 8th edition (T3bN0M0). The woman was treated with adjuvant nivolumab. She stopped the treatment after 4 infusions due to thrombopenia. Three months later, she developed facial and leg edema and ascites due to capillary leak syndrome. The CLS was associated with chylothorax and elevated vascular endothelial growth factor. The patient was initially treated with several pleural puncturing and steroids. CLS and chylothorax progressively decreased with intravenous immunoglobulins and fat-free diet without recurrence of melanoma at one-year follow-up. Conclusion: CLS is a rare and potentially life-threatening AE of ICIs such as anti-PD1. This AE may be associated with chylothorax probably related to lymphatic permeability induced by anti-PD1.

Floating-dislocated elbow in adults: Case reports and literature review.

RATIONALE: Floating-dislocated elbow is a severe and extremely rare injury in adults. Reviewing the literature, we found around 6 case reports regarding floating-dislocated elbow in adults. PATIENT CONCERNS AND DIAGNOSES: We report 2 cases of this unusual injury association. Both patients suffered a high energy trauma - fall from a height. Initial X-rays (radiography) revealed in both cases the fractures above and below the elbow (floating elbow) and associated elbow dislocation (floating-dislocated elbow). One case was a type IIIB Gustilo-Anderson open fracture-dislocation with an intra-articular component (olecranon fracture). INTERVENTIONS AND OUTCOMES: Each case had his own management problem regarding what to treat first: the dislocation or the associated fractures? Fractures were treated surgically by reduction and internal fixation, and after elbow dislocation reduction, the upper limb was immobilized in a long, well-padded plaster, with the elbow in 90° of flexion, for 3 weeks. Bone union was observed radiographically at 2 months after surgery in both cases. At the 2-year follow-up we recorded full upper limb recovery in terms of muscular trophism and elbow full range of motion. LESSONS: In addition to adding 2 new cases to a lower number of such lesion associations in adults, we also added a new variant of floating-dislocated elbow which has not been reported until now in the literature. Prompt management of these injuries, with stable fixation of the fractures allowed for early rehabilitation with excellent 2-years functional outcome.

Quadriceps tendon vs hamstring autograft in primary ACL reconstruction - a comparative study with minimum two-year follow-up.

Recently there has been growing interest in the quadriceps tendon (QUAD) as a valid option for reconstruction of the anterior cruciate ligament (ACLR). The aims of the study is to compare the outcomes achieved in anatomic ACLR involving QUAD vs. Hamstring (HT) autografts. A total of 52 consecutive patients underwent an ACLR, 25 patients with QUAD graft and 27 with HT graft. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: functional status (Lysholm, Tegner, subjective IKDC scores), joint stability (Lachman and pivot shift tests), surgical reoperation rate, complications, degree of satisfaction and return to previous level of activity. Descriptive statistics were analysed using the Student's t-test. Forty four patients were evaluated (20 QUAD, 24 HT), with a mean follow-up of 27.4 months. Two patients were re-operated in the QUAD group (including one ACL revision), and one patient in the HT group required an ACL revision. There were no significant differences between the two groups in postoperative scores: Lysholm (96.05 vs. 96.05), IKDC (86.2 vs. 91.2) and Tegner (6 vs. 5) scales. The percentage of negative Lachman and pivot shift tests was similar in the two groups (45% vs. 50% and 40% vs. 45.8%, respectively). There were no significant differences between the groups in the degree of satisfaction (95.8% vs. 80%, p = .16) or in the percentage who returned to their previous level of activity (62.5% vs. 45%, p = .17). The use of a QUAD graft in ACL reconstruction leads to similar clinical and functional outcomes to those obtained with HT.

Modified Dynamic Anterior Stabilization (DAS) and Hill-Sachs Remplissage for the Treatment of Recurrent Anterior Shoulder Dislocation.

The optimal treatment for recurrent glenohumeral instability is a subject under debate. The recently described arthroscopic technique for dynamic anterior stabilization (DAS) fills the treatment indication gap between reconstructive bony procedures and soft tissue stabilization. However, indications for DAS are considered limited or not appropriate for patients with recurrent shoulder dislocations caused by severe bone defects. In this Technical Note, we present a modified all-arthroscopic DAS technique with added infraspinatus and posterior capsule remplissage to correct the extra-articular Hill-Sachs defect in a patient with recurrent dislocations and off-track bony lesions. The patient requested an alternative treatment option, other than the complication-prone Latarjet procedure.

Omega plate for the treatment of acetabular fractures involving the quadrilateral plate.

This retrospective study aimed to assess the outcome of a modified Stoppa approach using an anatomically precontoured plate for the treatment of acetabular fractures. In total, 30 patients (mean age 50.3 years; 25 men and 5 women) with acetabular fractures were treated between January 1, 2018 and December 31, 2019. In all 30 cases, fracture reduction was performed through a modified Stoppa approach and fixed with the omega plate. In specific fracture patterns, additional approaches were needed (lateral window in 4 cases and posterior Kocher-Langenbeck approach in 7 cases). Patients were assessed for restoration of the hip joint congruency, complications, and overall fracture reduction. Quality of reduction was categorized based on Matta's radiological principles and to assess functional outcome the Merle d'Aubigné-Postel and Harris hip score was used. The average anesthesia time was 253.6 min, the mean intraoperative blood lost was 266.6 ml and the mean intraoperative fluoroscopy dose was 3.21 mGy. According to Matta criteria for reduction quality, anatomical reduction was recorded in 22 cases, imperfect reduction in 6 cases and 2 cases had poor reduction. The average follow-up was 22.5 months. Malunion, loss of reduction or implant loosening were not recorded. Late complications included one case of avascular necrosis of the femoral head and post-traumatic arthritis changes in 5 cases. At the final follow-up, a mean Merle d'Aubigné-Postel score of 13.26±4.46 and a mean Harris score of 86.03±13.37 were recorded. The possibility of an anatomically precontoured plate with subsequent lower operative time combined with stable fixation of the primary acetabular fracture fragments and the quadrilateral plate makes the omega plate a viable option for treating acetabular fractures with a very low complication rate and good to excellent results in 89% of the cases.

Optimization of a GF-AAS method for lead testing in blood and urine: A useful tool in acute abdominal pain management in emergency.

Suspicion of lead poisoning is confirmed by its concentration in blood and protoporphyrin red blood cells. At low concentrations, lead influences the synthesis of the heme in the sense of lowering it. Acute and chronic lead intoxication is extremely polymorphic in regards to its clinical manifestations, with digestive, hematological, cardiovascular, renal hepatic and neurological features. The aim of the study was to evaluate the presence of lead in human whole blood and urine harvested before and during chelation treatment in the case of lead poisoning. An atomic absorption spectroscopic method for the analysis of lead was developed using graphite furnace atomic absorption spectrophotometer (GF-AAS), Varian Spectra AA-880 with a hollow cathode lead lamp and a deuterium lamp for background correction, coupled to a GTA-100 atomizer and a programmable sample dispenser. Standard calibration solutions were used for the range 10-100 µg/l. The linearity range was 10.0 to 100.0 µg/l with the correlation coefficient of 0.999. We established that the method can be applied for the determination of lead in whole blood and urine, and the results obtained are useful for monitoring chelation therapy in cases of acute lead poisoning, a neglected cause of abdominal colic pain in an emergency situation.

The relationship between ACL reconstruction and meniscal repair: quality of life, sports return, and meniscal failure rate-2- to 12-year follow-up.

BACKGROUND: Few studies have approached in a long-term follow-up of meniscal repair at an amateur level, specially studying variables as a quality of life and failure rate. The purpose of this review is to study medium to long-term clinical results in patients at amateur sports patients, that have required meniscal sutures at our center, with or without ACL reconstruction. We evaluate the objective function of the knee, as well as patients' return to sports activities, quality of life, and the rate of failed repair and study of the possible reasons. METHODS: This was an observational retrospective study. Ninety-two patients who regularly perform amateur sports activities (Tegner 4 to 7) were assessed, with a minimum follow-up period of 2 years, divided into 2 groups: group 1, isolated meniscal suture (43 cases) and group 2, associated to ACL reconstruction (49 cases). Each patient made this test in 2019: Lysholm and Tegner (validated for Spanish) before a knee injury and after surgery, motivation to return to sports activity (Likert scale with 3 items: low, regular, or high), and quality of life through SD-12 test. RESULTS: High return to amateur sports rate (92%) was even higher in the isolated meniscal repair group in comparison to the group with associated ACL. We have not found statistically significant differences between sports return and age, gender, injured meniscus, chondral injuries, preoperative Tegner score, or motivation. No significant differences in physical or mental health fields between both groups. Meniscal repair failed in 12 patients (13%). Higher rate of failure in isolated bucket-handle tear injuries (p < 0.0062). No statistically significant association was found between the other variables studied. CONCLUSIONS: Good results with 92% of sports return, low rate of complications, and low retear rate, even lower when is associated with ACL reconstruction and in external meniscus repair, and high values at SF-12 between 2 groups.

High Precision Positioning with Multi-Camera Setups: Adaptive Kalman Fusion Algorithm for Fiducial Markers.

The paper addresses the problem of fusing the measurements from multiple cameras in order to estimate the position of fiducial markers. The objectives are to increase the precision and to extend the working area of the system. The proposed fusion method employs an adaptive Kalman algorithm which is used for calibrating the setup of cameras as well as for estimating the pose of the marker. Special measures are taken in order to mitigate the effect of the measurement noise. The proposed method is further tested in different scenarios using a Monte Carlo simulation, whose qualitative precision results are determined and compared. The solution is designed for specific positioning and alignment tasks in physics experiments, but also, has a degree of generality that makes it suitable for a wider range of applications.

Angiosarcoma: A population-based cancer registry descriptive study of 45 consecutive cases diagnosed between 1979 and 2016.

Angiosarcoma (AS) is a rare aggressive sarcoma with differentiation toward blood or lymphatic endothelium. There are few epidemiological data available on AS. To address this limitation, we investigated the epidemiological and clinical features of angiosarcoma diagnosed in a French administrative area (the Doubs department) from 1979 to 2016. A retrospective cohort study was conducted using the Doubs cancer registry database. A total of 45 patients with invasive AS were diagnosed between 1979 and 2016 in the Doubs department. Among the 45 AS, 51% were either cutaneous AS (27%), including head and neck and extremities, or breast AS (24%) as compared to visceral AS (42%). Eleven patients had metastasis at diagnosis (26%). Age-standardized incidence rate was 0.15 per 100,000 persons-years (95%CI, 0.10-0.20) for the entire study period (1979-2016) and 0.26 (95%CI, 0.15-0.42) for the last decade (2007-2016). Crude survival at 1, 3, 5 years after diagnosis was 44%, 21%, and 12%, respectively. Our population-based study provides updated data on the incidence and overall survival of AS in a French population-based cancer registry.

Pie Crust Technique of the Deep Medial Collateral Ligament in Knee Arthroscopy: Ultrasound and Anatomic Study.

This article determines compartment opening of the medial articular space of the knee after pie crust (PC) technique of the medial collateral ligament (MCL) by ultrasound measurements and anatomic dissection. This is a cadaveric study of 12 specimens. Four anatomic references were marked on the skin. Distances between the femur and tibia in the internal compartment at 30 degrees of flexion were obtained with ultrasound measurements in four situations: with and without applying valgus force both prior and after the PC technique. Ultrasound measurements of the medial articular compartment were made twice and mean value was calculated. An anatomical dissection was performed and distances between the puncture marks and the infrapatellar branch of the saphenous nerve was measured. Lilliefors test of normality was applied and variables were expressed as mean and standard deviation (SD). Qualitative variables were expressed by absolute frequencies and percentages. Statistical significance was a two-tailed p-value of < 0.05. Prior to the PC technique, mean (SD) distance between the femur and tibia in the medial compartment were 14.2 (4.0) mm in basal conditions and 17.1 (3.7) mm when applying valgus force (p = 0.003). PC technique increased the mean (SD) distance by 1.9 (1.9) mm under basal conditions (p < 0.01) and 2.9 (1.6) mm when applying valgus force (p < 0.01). The infrapatellar branches of the saphenous nerve were not damaged and the mean (SD) distance between the punctures and the nerve was 9.0 (3.3) mm. The PC is a reproducible, safe, and measurable surgical technique that opens controllably the medial compartment. PC as described avoided damage to the nerve branches.

High speed CMOS acquisition system based on FPGA embedded image processing for electro-optical measurements.

Electro-optical measurements, i.e., optical waveguides and plasmonic based electrochemical impedance spectroscopy (P-EIS), are based on the sensitive dependence of refractive index of electro-optical sensors on surface charge density, modulated by an AC electrical field applied to the sensor surface. Recently, P-EIS has emerged as a new analytical tool that can resolve local impedance with high, optical spatial resolution, without using microelectrodes. This study describes a high speed image acquisition and processing system for electro-optical measurements, based on a high speed complementary metal-oxide semiconductor (CMOS) sensor and a field-programmable gate array (FPGA) board. The FPGA is used to configure CMOS parameters, as well as to receive and locally process the acquired images by performing Fourier analysis for each pixel, deriving the real and imaginary parts of the Fourier coefficients for the AC field frequencies. An AC field generator, for single or multi-sine signals, is synchronized with the high speed acquisition system for phase measurements. The system was successfully used for real-time angle-resolved electro-plasmonic measurements from 30 Hz up to 10 kHz, providing results consistent to ones obtained by a conventional electrical impedance approach. The system was able to detect amplitude variations with a relative variation of ±1%, even for rather low sampling rates per period (i.e., 8 samples per period). The PC (personal computer) acquisition and control software allows synchronized acquisition for multiple FPGA boards, making it also suitable for simultaneous angle-resolved P-EIS imaging.