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1.
Harefuah ; 158(10): 654-655, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576711

RESUMO

INTRODUCTION: Post-Graduate Medical Education in the surgical professions, as in other medical professions as well, has gone through an organizational revolution during the past 10-15 years. Catalyzers of this change were the information revolution, technological changes, life-work balance needs of residents, legalization of the medical system and different duty hours' restrictions that followed. These changes require rethinking traditional Post-Graduate Medical Education and adaptation of teaching methods, quality measurement methods, new definition of program director's role and more. In this article we review these changes as they appear in updated literature and the significance of the changes in the Israeli health system since the last physicians' bargaining agreement of 2011.


Assuntos
Internato e Residência , Cirurgiões , Humanos , Admissão e Escalonamento de Pessoal , Médicos , Carga de Trabalho
2.
J Arthroplasty ; 34(1): 47-55, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30352770

RESUMO

BACKGROUND: Biomechanics after total knee arthroplasty (TKA) often remain abnormal and may lead to prolonged postoperative recovery. The purpose of this study is to assess a biomechanical therapy after TKA. METHODS: This is a randomized controlled trial of 50 patients after unilateral TKA. One group underwent a biomechanical therapy in which participants followed a walking protocol while wearing a foot-worn biomechanical device that modifies knee biomechanics and the control group followed a similar walking protocol while wearing a foot-worn sham device. All patients had standard physical therapy postoperatively as well. Patients were evaluated throughout the first postoperative year with clinical measures and gait analysis. RESULTS: Improved outcomes were seen in the biomechanical therapy group compared to the control group in pain scores (88% vs 38%, P = .011), function (86% vs 21%, P = .001), knee scores (83% vs 38%, P = .001), and walking distance (109% vs 47%, P = .001) at 1 year. The therapy group showed healthier biomechanical gait patterns in both the sagittal and coronal planes at 1 year. CONCLUSION: A postoperative biomechanical therapy improves outcomes following TKA and should be considered as an additional therapy postoperatively.


Assuntos
Artroplastia do Joelho , Marcha , Articulação do Joelho , Aparelhos Ortopédicos , Osteoartrite do Joelho/cirurgia , Sapatos , Idoso , Fenômenos Biomecânicos , Feminino , Pé/cirurgia , Humanos , Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Caminhada
3.
J Surg Educ ; 76(1): 281-285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30078522

RESUMO

OBJECTIVE: Drilling through bone is a complex action that requires precise motor skills of an orthopedic surgeon. In order to minimize plunging and soft tissue damage, the surgeon must halt drill progression precisely following penetration of the far cortex. The purpose of this study was to create a low-cost and easy-to-use drilling simulator to train orthopedic residents in reducing the drill plunging depth. DESIGN, SETTING, PARTICIPANTS: This prospective observational study was performed in the division of orthopedic surgery of a single tertiary medical center. The participants included 13 residents and 7 orthopedic specialists. The simulator consisted of a synthetic femur bone model and ordinary modeling clay, and the training unit consisted of a disposable plastic tube (∼US$14), clamps (∼US$58), and a power drill + drill bit (standard hospital equipment). Plunging depths were measured by the simulator and compared between orthopedic specialists, the 6 "senior residents" (3+ years) and the 7 "junior residents" during a training session. Measurements were taken again 2 weeks following the training session. RESULTS: Initially, the plunging depths of the junior residents were significantly greater compared to those of the orthopedic specialists (7.00 mm vs. 5.28 mm, respectively, p < 0.038). There was no similarly significant difference between the senior residents and the orthopedic experts ([6.33 mm vs. 5.28 mm, respectively; p = 0.18). The senior residents achieved plunging depths of 5.17 mm at the end of the training session and 4.7 mm 2 weeks later compared to 7.14 mm at the end of the training session and 6 mm 2 weeks later for the junior residents. CONCLUSIONS: This study demonstrated the capability of a low-cost drilling simulator as a training model for reducing the plunging depth during the drilling of bone and soft tissue among junior and senior residents.

4.
J Am Geriatr Soc ; 67(4): 777-783, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30584659

RESUMO

OBJECTIVES: Previous observational research has shown that elderly patients with hip fractures who are operated early (within 48 hours from admission) benefit from less short- and long-term mortality compared to those operated later. The objective of this study was to present regulatory measures aimed at promotion of early hip fracture surgery and their effect on the rates of early surgery and on postoperative mortality. DESIGN: Retrospective cohort. SETTING: Single inner-city medical center. PARTICIPANTS: Elderly patients with hip fractures operated during three time periods: 2006 to 2009 (n = 1735, no intervention), 2010 to 2013 (n = 2104, first intervention, positive reinforcement), and 2014 to 2016 (n = 1538, second intervention, positive and negative reinforcement). INTERVENTION: Two regulatory measures were introduced consecutively: staff extra wages for afternoon operations (positive reinforcement) in 2010 and making early operation rates publicly available as the Ministry of Health Quality Care Indexes (negative reinforcement) in 2013. MEASUREMENTS: Percentage of early surgeries and mortality at 1 month and 1 year postoperatively. RESULTS: A total of 5377 patients (1595 men, 3782 women; mean age, 83.1 ± 7.2 years) underwent hip surgery between 2006 and 2016. The three study groups did not differ significantly in age on admission, sex, type of hip fracture (intracapsular or extracapsular), American Society of Anesthesiologists' score, mean hemoglobin on admission, and mean socioeconomic status. The percentage of operations performed within 48 hours was 55%, 65%, and 85%, respectively (P < .001). One-month mortality was 3.9%, 5.1%, and 5%, respectively (P > .05), and one-year mortality was 19.2%, 18.7%, and 19.6%, respectively (P > .05). CONCLUSIONS: Management pressure on the staff to expedite hip surgery and avoid negative publicity in conjunction with additional wages for afternoon surgeries was successful at promoting earlier hip surgery. Despite the substantial increase in the rates of early surgery, however, mortality rates were not affected. J Am Geriatr Soc 67:777-783, 2019.

5.
Nat Med ; 24(12): 1867-1876, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30523328

RESUMO

Multiple myeloma, a plasma cell malignancy, is the second most common blood cancer. Despite extensive research, disease heterogeneity is poorly characterized, hampering efforts for early diagnosis and improved treatments. Here, we apply single cell RNA sequencing to study the heterogeneity of 40 individuals along the multiple myeloma progression spectrum, including 11 healthy controls, demonstrating high interindividual variability that can be explained by expression of known multiple myeloma drivers and additional putative factors. We identify extensive subclonal structures for 10 of 29 individuals with multiple myeloma. In asymptomatic individuals with early disease and in those with minimal residual disease post-treatment, we detect rare tumor plasma cells with molecular characteristics similar to those of active myeloma, with possible implications for personalized therapies. Single cell analysis of rare circulating tumor cells allows for accurate liquid biopsy and detection of malignant plasma cells, which reflect bone marrow disease. Our work establishes single cell RNA sequencing for dissecting blood malignancies and devising detailed molecular characterization of tumor cells in symptomatic and asymptomatic patients.


Assuntos
Heterogeneidade Genética , Mieloma Múltiplo/sangue , Neoplasia Residual/sangue , Mieloma Múltiplo Latente/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Sequência de Bases , Progressão da Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/genética , Mieloma Múltiplo/patologia , Neoplasia Residual/genética , Neoplasia Residual/patologia , Mieloma Múltiplo Latente/genética , Mieloma Múltiplo Latente/patologia
6.
Geriatr Gerontol Int ; 18(6): 937-942, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29512305

RESUMO

AIM: Older patients with proximal femoral fractures often undergo preoperative tests due to coexisting morbidities. Our aim was to evaluate these tests and their impact on patient outcome and medical expenses. METHODS: This retrospective study includes data on head computed tomography, carotid ultrasound, echocardiography and pulmonary functional tests calculated according to the type of surgery (osteosynthesis or hip arthroplasty) carried out on 2798 patients. Time-to-surgery, test repeated postoperatively, American Society of Anesthesiology Physical Status score, additional procedures, hospitalization time, 30-day mortality and associated medical expenses were evaluated. RESULTS: A total of 921 preoperative tests were carried out in 780 (28%) patients, and 375 postoperative tests were carried out in 329 (12%) patients (P < 0.001). A total of 23 procedures were carried out after surgery, none related to the originally carried out tests. Significant group differences were found for American Society of Anesthesiology Physical Status score, days to surgery, hospitalization time (days) and mortality rates. The medical expenses of these tests were 1.3% of the average income per case, and 0.6% of the average study group income. CONCLUSIONS: Non-routine preoperative tests prolong time-to-surgery, increased hospitalization time and contribute to 30-day mortality. No postoperative procedure was related to preoperative test findings. The financial cost for these tests does not burden the medical expenses per procedure. Geriatr Gerontol Int 2018; 18: 937-942.


Assuntos
Análise Custo-Benefício , Fraturas do Quadril/cirurgia , Cuidados Pré-Operatórios/economia , Idoso , Hospitalização/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
7.
Sci Rep ; 8(1): 5108, 2018 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-29572540

RESUMO

Pulsed electromagnetic fields (PEMFs) have been considered a potential treatment modality for fracture healing, however, the mechanism of their action remains unclear. Mammalian target of rapamycin (mTOR) signaling may affect osteoblast proliferation and differentiation. This study aimed to assess the osteogenic differentiation of mesenchymal stem cells (MSCs) under PEMF stimulation and the potential involvement of mTOR signaling pathway in this process. PEMFs were generated by a novel miniaturized electromagnetic device. Potential changes in the expression of mTOR pathway components, including receptors, ligands and nuclear target genes, and their correlation with osteogenic markers and transcription factors were analyzed. Involvement of the mTOR pathway in osteogenesis was also studied in the presence of proinflammatory mediators. PEMF exposure increased cell proliferation and adhesion and the osteogenic commitment of MSCs even in inflammatory conditions. Osteogenic-related genes were over-expressed following PEMF treatment. Our results confirm that PEMFs contribute to activation of the mTOR pathway via upregulation of the proteins AKT, MAPP kinase, and RRAGA, suggesting that activation of the mTOR pathway is required for PEMF-stimulated osteogenic differentiation. Our findings provide insights into how PEMFs influence osteogenic differentiation in normal and inflammatory environments.


Assuntos
Diferenciação Celular , Proliferação de Células , Campos Eletromagnéticos , Células-Tronco Mesenquimais/metabolismo , Osteogênese , Transdução de Sinais , Serina-Treonina Quinases TOR/metabolismo , Adulto , Células Cultivadas , Feminino , Humanos , Masculino , Células-Tronco Mesenquimais/citologia
8.
Bone ; 110: 215-220, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29475110

RESUMO

Physician recommendation for prophylactic surgical fixation of a femur with metastatic bone disease (MBD) is usually based on Mirels' criteria and clinical experience, both of which suffer from poor specificity. This may result in a significant number of these health compromised patients undergoing unnecessary surgery. CT-based finite element analyses (CTFEA) have been shown to accurately predict strength in femurs with metastatic tumors in an ex-vivo study. In order to assess the utility of CTFEA as a clinical tool to determine the need for fixation of patients with MBD of the femur, an ad hoc CTFEA was performed on a retrospective cohort of fifty patients. Patients with CT scans appropriate for CTFEA analysis were analyzed. Group 1 was composed of 5 MBD patients who presented with a pathologic femoral fracture and had a scan of their femurs just prior to fracture. Group 2 was composed of 45 MBD patients who were scheduled for a prophylactic surgery because of an impending femoral fracture. CTFEA models were constructed for both femurs for all patients, loaded with a hip contact force representing stance position loading accounting for the patient's weight and femur anatomy. CTFEA analysis of Group 1 patients revealed that they all had higher tumor associated strains compared to typical non-diseased femur bone strains at the same region (>45%). Based on analysis of the 5 patients in Group 1, the ratio between the absolute maximum principal strain in the vicinity of the tumor and the typical median strain in the region of the tumor of healthy bones (typical strain fold ratio) was found to be the 1.48. This was considered to be the predictive threshold for a pathological femoral fracture. Based on this typical strain fold ratio, twenty patients (44.4%) in Group 2 were at low risk of fracture and twenty-five patients (55.5%) high risk of fracture. Eleven patients in Group 2 choose not to have surgery and none fractured in the 5month follow-up period. CTFEA predicted that seven of these patients were below the pathological fracture threshold and four above, for a specificity of 63% Based on CTFEA, 39% of the patients with femoral MBD who were referred and underwent prophylactic stabilization may not have needed surgery. These results indicate that a prospective randomized clinical trial evaluating CTFEA as a criterion for determining the need for surgical stabilization in patients with MBD of the femur may be warranted.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Fêmur/patologia , Adulto , Neoplasias Ósseas/patologia , Feminino , Análise de Elementos Finitos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Estresse Mecânico
9.
Injury ; 48(10): 2260-2265, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28768571

RESUMO

BACKGROUND: Locked plating is one of the latest innovative options for treating supracondylar femur fractures with relatively low failure rates. Single lateral plating was often found to have a relative higher failure rate. No clinical studies of double-plating distal femur fixation have thus far been reported. The aim of this study is to present our clinical experience with this surgical approach. PATIENTS AND METHODS: Thirty-two patients (26 females and 6 males, mean age 76 years, range 44-101) were included in the study. Eight of them patients had a periprosthetic stable implant fracture and two patients were treated for a nonunion. RESULTS: All fractures, excluding one that needed bone grafting and one refracture, healed within 12 weeks. One patient needed bone grafting for delayed union and one patient needed fixation exchange due to femur re-fracture at the site of the most proximal screw. Two patients developed superficial wound infection and one patient required medial plate removal after union due to deep infection. CONCLUSIONS: Based on these promising results, we propose that the double-plating technique should be considered in the surgeon's armamentarium for the treatment of supracondylar femur fractures, particularly in patients with poor bone quality, comminuted fractures and very low periprosthetic fractures.


Assuntos
Placas Ósseas , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas Periprotéticas/cirurgia , Radiografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/fisiopatologia , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura/fisiologia , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/diagnóstico por imagem , Fraturas Periprotéticas/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
10.
J Foot Ankle Surg ; 56(4): 851-853, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28633790

RESUMO

Osteomyelitis due to Ochrobactrum anthropi, a new genus Ochrobacterum widely distributed in the environment and occasionally associated with human infection, has been described in only a few case reports. We present a report of an unusual case of osteomyelitis caused by O. anthropi that was identified 9 years after a nail puncture to the lateral cuneiform bone. The patient was an 18-year-old male with a painful foot lesion that had originally been misdiagnosed as an osteolytic tumor. He underwent surgery and 2 firm pieces of rubber measuring 7 and 10 mm were removed from the lower portion of the lateral cuneiform bone, which appeared to be affected by an infection. After surgical debridement, O. anthropi was isolated from the bone cultures. The patient was successfully treated with a 6-week course of oral ciprofloxacin and clindamycin. At 1 year after the corrected diagnosis and appropriate treatment, he was symptom free and had resumed regular activities and an athletic lifestyle.


Assuntos
Infecções por Bactérias Gram-Negativas/microbiologia , Ochrobactrum anthropi/isolamento & purificação , Osteomielite/diagnóstico , Osteomielite/microbiologia , Ferimentos Penetrantes/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Neoplasias Ósseas/diagnóstico , Ciprofloxacino/uso terapêutico , Clindamicina/uso terapêutico , Desbridamento , Diagnóstico Diferencial , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Masculino , Osteomielite/diagnóstico por imagem , Osteomielite/terapia , Ferimentos Penetrantes/terapia
12.
Connect Tissue Res ; 58(2): 215-220, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27661794

RESUMO

BACKGROUND: Anticoagulant therapy is a mainstay of treatment subsequent to major orthopedic surgeries. Evidence linking anticoagulant therapy, osteoporosis, and delayed fracture healing is not conclusive. We have previously reported that rivaroxaban significantly inhibited cell growth and energy metabolism in a human osteoblastic cell line. This study analyzed the response of primary female osteoblast cells to rivaroxaban in combination with various bone-modulating hormones. METHODS: Bone samples were taken from both premenopausal (pre-Ob) and postmenopausal (post-Ob) women. Cells were isolated from each sample and cultured to sub-confluence. Each sample was then treated with Rivaroxaban (10 µg/ml) in combination with the following hormones or with the hormones alone for 24 hours: 30nM estradiol-17ß (E2), 390nM estrogen receptor α (ERα) agonist PPT, 420nM estrogen receptor ß (ERß) agonist DPN, 50nM parathyroid hormone (PTH), and 1nM of vitamin D analog JKF. RESULTS: No effects were observed after exposure to rivaroxaban alone. When pre-Ob and post-Ob cells were exposed to the bone-modulating hormones as a control experiment, DNA synthesis and creatine kinase (CK)-specific activity was significantly stimulated with a greater response in the pre-Ob cells. When the cells were exposed to rivaroxaban in combination with bone-modulating hormones, the increased DNA synthesis and CK-specific activity previously observed were completely attenuated. CONCLUSIONS: Rivaroxaban significantly inhibited the stimulatory effects of bone-modulating hormones in both pre-Ob and post-Ob primary human cell lines. This finding may have clinical relevance for patients at high risk of osteoporosis managed with rivaroxaban or other factor Xa inhibitors.


Assuntos
Estradiol/farmacologia , Ginsenosídeos/farmacologia , Nitrilos/farmacologia , Osteoblastos/metabolismo , Pós-Menopausa/metabolismo , Pré-Menopausa/metabolismo , Rivaroxabana/farmacologia , Sapogeninas/farmacologia , Adulto , Células Cultivadas , Antagonismo de Drogas , Feminino , Ginsenosídeos/antagonistas & inibidores , Humanos , Pessoa de Meia-Idade , Nitrilos/antagonistas & inibidores , Osteoblastos/patologia , Rivaroxabana/antagonistas & inibidores , Sapogeninas/antagonistas & inibidores
13.
PLoS One ; 11(7): e0158820, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27414794

RESUMO

The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and non-experts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts' process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts' scanning is simultaneously both structured (i.e. deterministic) and unpredictable.


Assuntos
Competência Clínica/estatística & dados numéricos , Impacto Femoroacetabular/diagnóstico por imagem , Cirurgiões Ortopédicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Radiografia/estatística & dados numéricos , Adulto , Competência Clínica/normas , Medições dos Movimentos Oculares , Impacto Femoroacetabular/diagnóstico , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Masculino , Cirurgiões Ortopédicos/educação , Cirurgiões Ortopédicos/psicologia , Cirurgiões Ortopédicos/normas , Padrões de Prática Médica/normas , Radiografia/psicologia , Radiografia/normas
14.
Clin Nutr ; 35(5): 1053-8, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26231340

RESUMO

BACKGROUND & AIMS: Malnutrition is common in hip fracture elderly patients. There is no gold standard for screening nutritional risk. We compared the adequacy of 3 screening tools, their association to nutritional measurements and their ability to predict outcome. METHODS: The Mini Nutrition Assessment Short Form (MNA-SF), the Malnutrition Universal Screening Tool (MUST) and the Nutrition Risk Screening 2002 (NRS-2002) were prospectively determined. Length of stay (LOS), complications, 6 months readmission and up-to 36 months mortality were recorded. RESULTS: 215 operated patients were included: 154 (71.6%) were women; mean age was 83.5 ± 6.09 years (66-104). According to the MNA-SF, 95 patients were well-nourished, 95 were at risk of malnutrition and 25 were malnourished. Based on the MUST, 171 patients were at a low risk of malnutrition, 31 at a medium risk, 13 at a high risk. According to the NRS-2002, 134 patients were at a low risk of malnutrition, 70 at a medium risk, 11 at a high risk. A significant relationship between the nutritional groups of the 3 scores (p < 0.001) was found. In all screening tools, body mass index, weight loss and food intake prior to admission were found to be related to the patients' nutritional status (p < 0.001). No differences in LOS and complications were found between the patients' nutritional status of each screening tool; only the MNA-SF predicted that well-nourished patients would have less readmissions during a 6 month follow-up (p = 0.024). During a 36 month follow-up, 79 patients died. According to the MNA-SF, mortality was lower in the well-nourished patients vs. the malnourished (p = 0.001) and at risk of malnutrition patients (p = 0.01). A less significant association was found between the NRS-2002 patients' nutritional status and mortality (p = 0.048). The MUST did not reveal this relationship. CONCLUSIONS: All screening tools were adequate in assessing malnutrition parameters in hip fracture operated elderly patients, however, only the MNA-SF could also predict readmissions and mortality.


Assuntos
Fraturas do Quadril/terapia , Desnutrição/diagnóstico , Desnutrição/mortalidade , Avaliação Nutricional , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Seguimentos , Avaliação Geriátrica , Fraturas do Quadril/complicações , Hospitalização , Humanos , Tempo de Internação , Masculino , Desnutrição/etiologia , Estado Nutricional , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
15.
Am J Sports Med ; 44(3): 677-81, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26695395

RESUMO

BACKGROUND: Heterotopic ossification (HO) after hip arthroscopic surgery is a common complication and may be associated with clinical sequelae such as pain, impingement, and decreased range of motion. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used medications for reducing or preventing HO. HYPOTHESIS/PURPOSE: The purpose of this study was to evaluate the effectiveness of short-term selective cyclooxygenase-2 (COX-2) inhibitors used for HO prophylaxis after hip arthroscopic surgery. The hypothesis was that postoperative HO prophylaxis with 600 mg etodolac once daily for 2 weeks would significantly reduce the incidence of HO after hip arthroscopic surgery when compared with no prophylaxis. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between July 2010 and April 2014, a total of 263 consecutive patients underwent hip arthroscopic surgery, performed by a single surgeon, for various pathological abnormalities at 1 medical center. The initial 163 patients received no postoperative NSAID prophylaxis for HO, and the subsequent 100 patients received 600 mg etodolac once daily for 2 weeks postoperatively. Prophylaxis compliance data, gastrointestinal side effects, and postoperative radiographs for HO were monitored. RESULTS: A total of 100 control patients and 63 study patients met the inclusion criteria. The mean follow-up period was 12.88 months. No significant differences were observed in terms of age, sex, follow-up, or procedures performed. No gastrointestinal bleeding was observed. Radiographic findings of HO were present in 36 of 100 control patients with 17, 15, and 4 classified as having Brooker grades 1, 2, and 3, respectively. No patients in the study group presented with HO, and a significant difference in the HO rate between groups was observed (P < .0001). CONCLUSION: HO after hip arthroscopic surgery is a relatively common complication, with a rate of 19% for Brooker grade ≥2 in the patients who did not receive NSAID prophylaxis. No HO was found in the patients who received short-term COX-2 inhibitor prophylaxis. The short-term administration of 600 mg etodolac once daily for 2 weeks was found to be safe and effective in preventing HO in patients undergoing hip arthroscopic surgery. HO prophylaxis protocols based on short-term etodolac treatment may be considered after hip arthroscopic surgery.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroscopia/efeitos adversos , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Ossificação Heterotópica/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/etiologia , Dor/etiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Resultado do Tratamento , Adulto Jovem
16.
J Mech Behav Biomed Mater ; 54: 223-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26476965

RESUMO

BACKGROUND: Intramedullary nail fixation is the most accepted modality for stabilizing long bone midshaft fractures. The commercially used nails are fabricated from Stainless Steel or Titanium. Composite-materials (CM) mainly carbon-fiber reinforced polymers (CFRP) have been gaining more interest and popularity due to their properties, such as modulus of elasticity close to that of bone, increased fatigue strength, and radio-opacity to irradiation that permits a better visualization of the healing process. The use of CFRP instead of metals allows better control of different directional movements along a fracture site. The purpose of this analysis was to design a CM intramedullary nail to enable micromovements as depicted on a finite element analysis method. METHODS: We designed a three-dimentional femoral nail model. Three CFRP with different laminates arrangements, were included in the analysis. The finite element analysis involved applying vertical and horizontal loads on each of the designed and tested nails. RESULTS: The nails permitted a transverse micromovement of 0.75mm for the 45° lay-up and 1.5mm for the 90° lay-up for the CM, 1.38mm for the Titanium and 0.74mm for the Stainless Steel nails. The recorded axial movements were 0.53mm for the 45° lay-up, 0.87mm for the 90° lay-up, 0.46mm for the unsymmetrical lay-up CM, 0.046 for the Titanium and 0.02 for the Stainless Steel nails. Overall, the simulations showed that nail transverse micromovements can be reduced by using 45° carbon fiber orientations. Similar results were observed with each metal nails. INTERPRETATION: We found that nail micromovements can be controlled by changing the directional stiffness using different lay-up orientations. These results can be useful for predicting nail micromovements under specified loading conditions which are crucial for stimulating callus formation in the early stages of healing.


Assuntos
Pinos Ortopédicos , Carbono/química , Análise de Elementos Finitos , Movimento (Física) , Polímeros/química , Desenho de Prótese , Fêmur/lesões , Fêmur/cirurgia
17.
Clin Biomech (Bristol, Avon) ; 30(9): 889-94, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26330122

RESUMO

BACKGROUND: After unilateral total knee arthroplasty, frontal plane loading patterns on the operated knee remain pathological in the long term, but it is unclear how they change in the early postoperative period. Additionally, researchers have suggested that the non-operated knee bears greater frontal plane loads postoperatively, but this effect is unclear. The objective of the present study was to compare the preoperative and early postoperative frontal plane loading patterns of both knees after unilateral total knee arthroplasty. METHODS: Fifty patients with end-stage knee osteoarthritis were examined prior to and six weeks after surgery. Patients underwent a three-dimensional gait analysis that determined the frontal plane loading patterns of knee varus angle and knee adduction moment during gait, and completed self-evaluative questionnaires and functional tests. FINDINGS: There were no significant loading differences between limbs preoperatively. The operated knee showed large reductions in varus angle and adduction moment after surgery (all p<0.001). The non-operated knee showed no increases in varus angle or adduction moment, but did show a small reduction in the adduction moment (p<0.001). Both knees showed reduction in pain after surgery (p<0.001) and the operated Knee Society Score improved after surgery (p=0.01). INTERPRETATION: Total knee arthroplasty reduces frontal plane loading in the operated knee and does not worsen frontal plane loading in the non-operated knee. Therapy after surgery should focus on retaining the reduction in knee adduction moment in the operated knee and preventing further worsening loading patterns in the non-operated knee.


Assuntos
Artroplastia do Joelho , Marcha/fisiologia , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Dor/prevenção & controle , Período Pós-Operatório , Inquéritos e Questionários
18.
Arch Orthop Trauma Surg ; 135(11): 1571-7, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26298561

RESUMO

BACKGROUND: The medial collateral ligament (MCL) is the most frequently injured ligament of the knee. Platelet-rich plasma (PRP) is a relatively new treatment option developed to enhance the healing response after injury to different tissue types. This study aimed at investigating whether the addition of PRP to MCL tears in rats would alter healing both biomechanically and histologically. METHODS: Bilateral full-thickness tears of the MCL were surgically induced in the knees of 32 rats. Right ligament was saturated with PRP (n = 32, study group), and the left ligament was saturated with saline (n = 32, control group). The animals were killed 3 weeks later and the surgical sites were evaluated by gross inspection, biomechanically and histologically. RESULTS: There was no gross difference in the mass of granulation tissue, load to failure, stiffness and displacement between the study and control groups. Histological examination by means of maturity score revealed no significant differences between the study and control groups. CONCLUSION: The addition of PRP to a healing MCL did not improve any of the outcome measures in this model.


Assuntos
Ligamentos Colaterais/lesões , Plasma Rico em Plaquetas , Cicatrização/fisiologia , Animais , Ratos
19.
Isr Med Assoc J ; 17(6): 341-5, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26233991

RESUMO

BACKGROUND: The surgical treatment of hip fractures remains controversial especially when considering age. OBJECTIVES: To investigate the long-term functional outcomes of displaced subcapital hip fractures that were reduced and surgically fixed using parallel cannulated screws in patients aged 60 years and younger. METHODS: During the period 1996-2005, 27 patients under age 60 with displaced subcapital hip fractures classified as Garden III or IV were treated with fracture reduction and surgical internal fixation using cannulated screws. Patient outcomes were assessed using the Harris Hip Score (HHS) and physical examination. RESULTS: During a follow-up period of 8-17 years 4 of the 27 patients (14.8%) developed non-union/femoral head avascular necrosis and had undergone hip arthroplasty. All reoperations were performed within the first year after fracture fixation, all in the 50-60 year old age group. The revision rate among patients 50-60 years old was significantly higher than that of patients 50 years and younger (40% vs. 0%, P = 0.037). Mean HHS was higher for patients not requiring revision surgery (85.4) than for patients with revision surgery (75.5), but this difference was not significant. CONCLUSIONS: Internal fixation using fracture reduction and cannulated screw fixation is a successful treatment modality for displaced subcapital hip fractures in patients under 50 years old. Patients aged 50-60 may have a higher risk of avascular necrosis or non-union and require arthroplasty, often within the first year after fracture fixation. The long-term outcome following these fractures is good when excluding patients who had early complications.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Adulto , Fatores Etários , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Resultado do Tratamento , Adulto Jovem
20.
Clin Rheumatol ; 34(11): 1955-60, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25604319

RESUMO

UNLABELLED: This study aims to evaluate the correlations between common clinical osteoarthritis (OA) diagnostic tools in order to determine the value of each. A secondary goal was to investigate the influence of gender differences on the findings. Five hundred and eighteen patients with knee OA were evaluated using the Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire, short form 36 (SF-36) Health Survey, and plain radiographs. Analysis of variance (ANOVA) was used to compare the different domains of the WOMAC and SF-36 questionnaires between genders and the radiographic scale. Higher knee OA x-ray grade were associated with worse clinical outcome: for women, higher scores for the WOMAC pain, function and final scores and lower scores in the SF-36 final score; in men, lower SF-36 overall and physical domains scores. Gender differences were found in all clinical scores that were tested, with women having worse clinical scores for similar radiographic grading (p values <0.001). Knee radiographs for OA have an important role in the clinical evaluation of the patient. Patients with higher levels of knee OA in x-ray have a higher probability of having a worse clinical score in the WOMAC and SF-36 scores. The gender differences suggest that for similar knee OA x-ray grade, women's clinical scores are lower. TRIAL REGISTRATION: NCT00767780.


Assuntos
Avaliação da Deficiência , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/classificação , Osteoartrite do Joelho/diagnóstico por imagem , Fatores Sexuais , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários
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