Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 304
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-35013748

RESUMO

PURPOSE: No systematic review has compared the clinical outcome of anterior stabilized ultra-congruent and standard cruciate-retaining inserts in fixed-bearing primary total knee arthroplasty. This study aimed to compare the outcomes and establish the superiority or equivalence of these inserts. METHODS: Pubmed, EMBASE, Medline, AMED, ERIC, and Proquest databases were searched electronically. PRISMA guidelines were followed in the conduct of the study. The clinical outcomes compared in the meta-analysis were overall knee score, WOMAC, score for knee function, score for knee pain, SF-12 PCS, knee flexion, manipulation under anaesthesia for postoperative knee stiffness, revision total knee arthroplasty or change of polyethylene insert for post-operative instability (relative risk [RR]) and survivorship. Study quality was evaluated using the Newcastle Ottawa Scale and the Modified Jadad scale. RESULTS: Fourteen studies comprising 9989 knees (three RCTs and 11 comparative case-cohort studies) were included for qualitative and quantitative analysis. The pooled analysis of the ultracongruent insert and the standard cruciate retaining insert was based on a cohort of 2860 and 7129 TKA, respectively. Knee pain was significantly better in patients that had standard inserts (p = 0.02; 95% CI - 1.06 to - 0.10), and the physical component of health-related quality of life was also significantly better in patients that had standard inserts (p = 0.02; 95% CI - 6.43 to - 0.64). There was a 72% lesser chance of revision TKA or change of insert for postoperative instability in knees that had been implanted with ultracongruent inserts (RR = 0.28; p = 0.0002; 95% CI 0.15-0.55). There was no difference in the otheroutcome measures. There was no significant difference between the two inserts, considering the minimal clinically important difference or absolute ratio. CONCLUSION: Differences observed between the two types of inserts were not clinically significant. Therefore, based on current evidence, arthroplasty surgeons can use either of these inserts with cruciate-retaining knee prosthesis. LEVEL OF EVIDENCE: Therapeutic study, Level II.

2.
J Clin Orthop Trauma ; 24: 101691, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34820262

RESUMO

Background: Various joint preserving treatments are available for use in Avascular Necrosis of the femoral head. Most of these are effective in the pre-collapse stage of the disease. This review aimed to evaluate the effectiveness of core decompression and Bone Marrow Aspirate Concentrate in various stages of AVN, in modifying the progression of the disease and the need for hip replacement. Material and methods: The Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews reporting guidelines were followed. The literature search was conducted from inception till 2nd May 2021, on the PUBMED, SCOPUS, and Google Scholar search engines, using "bone marrow aspirate concentrate osteonecrosis femur" and "bmac osteonecrosis femur" as the keywords. In all these studies, Core Decompression with Bone marrow Aspirate concentrate was performed. The evaluation was done based on the progression of osteonecrosis, improvement in functional outcomes and the conversion to total hip arthroplasty. Results: We have analyzed 612 hips from11 studies, based on our inclusion and exclusion criteria. The mean age of the patients was 38.27 years. There was a predominance of males. The grade of AVN ranged from grade 1 to 4. The average follow-up period of the cases ranged from 2 to 12 years (average: 4.38 years). The functional scores were improved in the majority of cases. Radiographic progression occurred in 23.5% of hips, and the Total Hip Arthroplasty was performed in 14.9% of hips. Conclusions: Core decompression with Bone Marrow Aspirate Concentrate in pre-collapse stages of the disease is beneficial in improving the functions scores and for reducing the radiological progression of the disease and need for total hip arthroplasty, in the majority of cases.

3.
J Clin Orthop Trauma ; 24: 101707, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34853775

RESUMO

Osteoarticular Tuberculosis (TB) of the Sacroiliac (SI) joint is an uncommon site affected by Mycobacterium Tuberculosis infection. The SI joint is involved in approximately 5-10% of all cases of TB. Diagnosis of SI joint TB can be delayed in early stages due to its varied and hidden presentation and probability of being confused with other spinal diseases. Delay in diagnosis can lead to chronic pain, joint destruction, and a natural progression to symptomatic bony ankylosis. A focused clinical examination, complementary imaging, microbiological and histopathological confirmation of Mycobacterium tuberculosis can direct a targeted therapy. Anti-Tubercular Therapy (ATT) regime remains a cornerstone in the overall management of SI joint TB. Early diagnosis allows conservative or non-operative management. Surgical interventions like abscess drainage, debridement, and arthrodesis with or without bone grafting may be required to achieve an excellent functional outcome.

4.
5.
BMJ Case Rep ; 14(11)2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789531

RESUMO

Charcot's joint is a type of neuro-arthropathy, where asymmetrical damage of the involved joint happens haphazardly, without following any described pattern. We present a rare case of Charcot's joint involving the knee joint in an adult male following spina bifida. His knee joint was successfully fused after two surgeries. Later, he sustained a fracture through the arthrodesis after a fall, which we managed surgically. The fracture through the knee arthrodesis was managed surgically by an open reduction and internal fixation, using a 14-hole broad low contact dynamic compression locking plate with bone grafting. Union was achieved at the knee arthrodesis site in 6 months. Fracture through a fused knee requires surgical management. Re-arthrodesis was done using a stable fixation. Postoperative rehabilitation should include protected weight bearing with braces and splints until a sound bony union is achieved.


Assuntos
Artropatia Neurogênica , Fraturas Ósseas , Adulto , Artrodese , Artropatia Neurogênica/diagnóstico por imagem , Artropatia Neurogênica/etiologia , Artropatia Neurogênica/cirurgia , Humanos , Joelho , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino
7.
J Clin Orthop Trauma ; 23: 101643, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34722150

RESUMO

Steroid induced osteonecrosis of the femoral head is commonly seen in clinical practice, but yet not fully understood. It is intriguing why only some cases develop and others escape from it. We did an extensive and up to date literature review on it, with the aim to identify its incidence, associated risk factor and pathogenesis. We found that the incidence ranged from 03 to 40%, and was more with associated risk factors. Several risk factors were identified, which included higher dose and prolonged duration of steroid consumption, and underlying disease for which the steroids were given. Pathogenesis of this disease is complex and not yet fully understood. Awareness about this condition and associated risk factors should help the clinicians in identifying the cases who are prone to develop osteonecrosis with the use of steroids.

8.
J Clin Orthop Trauma ; 22: 101605, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34631412

RESUMO

Innovations in computer technology and implant design have paved the way for the development of smart instruments and intelligent implants in trauma and orthopaedics to improve patient-related functional outcomes. Sensor technology uses embedded devices that detect physical, chemical and biological signals and provide a way for these signals to be measured and recorded. Sensor technology applications have been introduced in various fields of medicine in the diagnosis, treatment and monitoring of diseases. Intelligent 'Smart' implants are devices that can provide diagnostic capabilities along with therapeutic benefits. In trauma and orthopaedics, applications of sensors is increasing because of the advances in microchip technologies for implant devices and research designs. It offers real-time monitoring from the signals transmitted by the embedded sensors and thus provides early management solutions. Smart orthopaedic implants have applications in total knee arthroplasty, hip arthroplasty, spine surgery, fracture healing, early detection of infection and implant loosening. Here we have explored the role of Smart sensor implant technology in total knee arthroplasty. Smart sensor assisted can be used intraoperatively to provide objective assessment of ligament and soft tissue balancing whilst maintaining the sagittal and coronal alignment to achieve desired kinematic targets following total knee arthroplasty. It can also provide post-implantation data to monitor implant performance in natural conditions and patient's clinical recovery during rehabilitation. The use of Smart Sensor implant technology in total knee arthroplasty appears to provide superior patient satisfaction rates and improved functional outcomes.

9.
J Clin Orthop Trauma ; 22: 101608, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34608365

RESUMO

Background: The COVID-19 pandemic has resulted in an infodemic about the novel coronavirus SARS-CoV-2 outbreak to build knowledge and develop mitigation strategies. In addition, scientific journals across the world have studied the impact of COVID-19 on trauma and orthopaedics. Methods: A cross-sectional, bibliometric analysis of the literature was undertaken on COVID-19 related articles from three Pubmed and Scopus indexed orthopaedic journals from India, namely, Indian Journal of Orthopaedics(IJO),Journal of Clinical Orthopaedics and Trauma(JCOT), and Journal of Orthopaedics (JOO), in May 2021. All the article types and study designs were included for this review. The authors, institutions, countries, keywords, and co-authorship mapping were studied. Results: A total of 112 COVID-19 related documents were retrieved. Period of these publications was from 2nd April 2020 to 31st May 2021. Vaishya R. (n = 16) was the most cited author, and Indraprastha Apollo Hospitals (n = 16) was the most cited research Institution. India led the list of countries in academic publication output. On keyword mapping, telemedicine was the most prominent Medical Subject Headings (MeSH) search word. Conclusion: The Indian orthopedic journals have addressed the impact of COVID-19 on orthopaedic practice in India and aborad whilst continuing to publish knowledge about basic science and clinical orthopaedic research studies. The JCOT has outperformed and become the most leading orthopaedic journal from India during the pandemic. COVID -19 articles have been fast tracked, open accessed and attracted more citations in reduced duration of time compared to non-COVID-19 papers.

10.
Diabetes Metab Syndr ; 15(6): 102306, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34619430

RESUMO

BACKGROUND AND AIMS: During the COVID-19 vaccination program in India, the healthcare workers were given the first priority. There are concerns regarding the occurrence of breakthrough infections after vaccination. We aimed to investigate the effictiveness of COVID-19 vaccines in preventing and reducing the severity of post-vaccination infections. METHODS: This retrospective test-negative case-control study examined 28342 vaccinated healthcare workers for symptomatic SARS-CoV-2 infections between January 16 to June 15, 2021. They worked at 43 Apollo Group hospitals in 24 Indian cities. These cohorts received either ChAdOx nCOV-19 (Recombinant) or the whole virion inactivated Vero cell vaccines. Various demographic, vaccination related and clinical parameters were evaluated. RESULTS: Symptomatic symptomatic post-vaccination infections occurred in a small number of vaccinated cohorts (5.07%, p < 0.001), and these were predominantly mild and did not result in hospitalization (p < 0.0001), or death. Both vaccines provided similar protection, with symptomatic infections in 5.11% and 4.58%, following ChAdOx nCOV-19 (Recombinant) and the whole virion inactivated Vero cell vaccines, respectively (p < 0.001). Nursing and Clinical staff and cohorts >50 years contracted more infections (p < 0.001). Two-dose vaccination has significantly lower odds of developing symptomatic infection (0.83, 95%CI - 0.72 to 0.97). Maximum infections occurred during the peak of the second COVID-19 wave from mid-April to May 2021 (p < 0.001). No significant difference existed in the infection between sex, vaccine type, and the number of vaccine doses received (p ≥ 0.05). CONCLUSION: Symptomatic infections occurred in a small percentage of healthcare workers after COVID vaccination. Vaccination protected them from not only infection but also severe disease.

11.
BMJ Case Rep ; 14(10)2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34610956

RESUMO

A 23-year-old female-treated patient of osteomalacia and secondary hyperparathyroidism with hypophosphatemia presented with a 5-year history of bilateral groin pain and stiffness of both hips and difficulty in walking. Plain radiographs of the pelvis showed bilateral coxa vara deformity. She was managed surgically by a single-stage bilateral subtrochanteric corrective osteotomy with the internal fixation. After the osteotomy healing at 3 months, the patient was pain free and walked comfortably with an increased range of hip motion.


Assuntos
Coxa Vara , Adulto , Coxa Vara/diagnóstico por imagem , Feminino , Fixação Interna de Fraturas , Humanos , Osteotomia , Radiografia , Caminhada , Adulto Jovem
12.
J Clin Orthop Trauma ; 22: 101569, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34513587

RESUMO

Osteoarthritis (OA) is a debilitating disease generally of old age manifested as degeneration of articular cartilage. With no definitive treatment available, ongoing research aims at early detection and use specific noninvasive imaging markers to monitor therapeutic efficacy of disease modifying osteoarthritic drug (DMOAD) to reverse or/and arrest the disease process. Articular cartilage degradation and loss, as well as bone remodelling, are typical biomarkers of OA. As a result, an ideal imaging technique for early detection of OA is required, which must be sensitive to both soft tissue and bone health. PET/MRI is emerging as an imaging tool which can be used to study the underlying pathogenesis of OA as it enables us to assess molecular activity with PET markers while also linking them to qualitative and quantitative MRI indices of OA. In this regard recent work was exploring the role of 18F-Na Fluoride which is a marker of bone remodelling together with MRI in early detection of OA on simultaneous PET/MRI. In this article we intend to present different patterns of OA (mild to severe stages of OA) that we had observed on 18F-Sodium Fluoride (18F-NaF) PET/MRI.

13.
J Clin Orthop Trauma ; 22: 101590, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34567972

RESUMO

Background: The Journal of Clinical Orthopaedics and Trauma (JCOT) is one of the top three orthopaedic journals from India. We set out to analyse the top 50 cited articles from JCOT since indexing in PubMed and Scopus. Methods: We looked into the bibliometrics of the top 50 cited articles and compared citations from PubMed and Scopus, and depicted outputs from VOS viewer analysis on co-authorship and keywords. Results: Total citations for top-cited articles were 1076 in numbers, with a maximum of 103.2016 and 2018 were the most productive years. The major contribution was from India with 74%, followed by the USA. New Delhi published maximally at 72%. Clinical topics and narrative reviews were the most common types of studies. Trauma and Adult reconstruction was the most common sub-specialities, and Level 4 was the most frequent level of study. The basic science and COVID-19 related articles received the maximum citations. The authors from Indraprastha Apollo Hospitals published the maximum number of top-50 cited articles in the JCOT. Conclusions: There is a steady increase in the number of publications in the JCOT, with an increasing number of citation counts. Both the Indian and foreign authors have been publishing in this journal at a comparative rate. Although the citation counts in Scopus are more than those in PubMed for given articles, more than 80% of articles are listed in both databases as top 50 cited articles. The majority of top-cited articles belonged to trauma and adult reconstruction, level III studies, and narrative reviews.

17.
Nature ; 599(7883): 114-119, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34488225

RESUMO

The B.1.617.2 (Delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in the state of Maharashtra in late 2020 and spread throughout India, outcompeting pre-existing lineages including B.1.617.1 (Kappa) and B.1.1.7 (Alpha)1. In vitro, B.1.617.2 is sixfold less sensitive to serum neutralizing antibodies from recovered individuals, and eightfold less sensitive to vaccine-elicited antibodies, compared with wild-type Wuhan-1 bearing D614G. Serum neutralizing titres against B.1.617.2 were lower in ChAdOx1 vaccinees than in BNT162b2 vaccinees. B.1.617.2 spike pseudotyped viruses exhibited compromised sensitivity to monoclonal antibodies to the receptor-binding domain and the amino-terminal domain. B.1.617.2 demonstrated higher replication efficiency than B.1.1.7 in both airway organoid and human airway epithelial systems, associated with B.1.617.2 spike being in a predominantly cleaved state compared with B.1.1.7 spike. The B.1.617.2 spike protein was able to mediate highly efficient syncytium formation that was less sensitive to inhibition by neutralizing antibody, compared with that of wild-type spike. We also observed that B.1.617.2 had higher replication and spike-mediated entry than B.1.617.1, potentially explaining the B.1.617.2 dominance. In an analysis of more than 130 SARS-CoV-2-infected health care workers across three centres in India during a period of mixed lineage circulation, we observed reduced ChAdOx1 vaccine effectiveness against B.1.617.2 relative to non-B.1.617.2, with the caveat of possible residual confounding. Compromised vaccine efficacy against the highly fit and immune-evasive B.1.617.2 Delta variant warrants continued infection control measures in the post-vaccination era.


Assuntos
Evasão da Resposta Imune , SARS-CoV-2/crescimento & desenvolvimento , SARS-CoV-2/imunologia , Replicação Viral/imunologia , Anticorpos Neutralizantes/imunologia , Vacinas contra COVID-19/imunologia , Fusão Celular , Linhagem Celular , Feminino , Pessoal de Saúde , Humanos , Índia , Cinética , Masculino , Glicoproteína da Espícula de Coronavírus/metabolismo , Vacinação
19.
Indian J Med Res ; 153(5&6): 550-554, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34341227

RESUMO

Background & objectives: COVID-19 pandemic has taken a significant toll on the health of the people across the globe, including India, and is still continuing with its rapidly evolving second wave. Although the COVID-19 vaccines effectively prevent infection, yet some cases of infections have been reported post-vaccination, raising concerns about their efficacy and safety. This study was aimed to investigate the occurrence of SARS-CoV-2 infection among the symptomatic-vaccinated healthcare workers (HCWs) and to analyze the severity of their disease. Methods: This retrospective study was done at a single multispecialty hospital, on the HCWs who have had COVID-19 vaccination, during the initial period of the vaccination drive (January 16 to April 24, 2021). The symptomatic post-vaccination infections in these HCWs were evaluated. Results: Eighty five of 3235 (2.63%) vaccinated HCWs acquired the SARS-CoV-2 infection after vaccination, during the study period. Of these, 65 (76.5%) were fully vaccinated (FV), and 20 (23.5%) were partially vaccinated (PV) and the protection rate of vaccination was 97.4 per cent [95 % confidence interval (CI)=96.8-97.9]. The odds ratio of acquiring infection among females was higher at 1.84 (95% CI=1.17-2.88; P=0.008) mainly because of their greater involvement in the patient care as nursing personnel. The chances of infections were the highest in the medical and nursing personnel, as compared to paramedical, administrative and supporting staff (P<0.001). Among the HCWs studied, only two required hospitalization (0.06%), none needed an intensive care unit (ICU) admission and there were no deaths. Interpretation & conclusions: The COVID-19 infection after vaccination occurred in a smaller subset (2.63%) of HCWs, in both PV and the FV groups. These infections were primarily minor and did not lead to severe disease. Overall, the vaccination with ChAdOx1 nCoV-19 vaccine (recombinant) prevented SARS-CoV-2 severe infection in the HCWs, leading to ICU admission and deaths.


Assuntos
COVID-19 , SARS-CoV-2 , Vacinas contra COVID-19 , Feminino , Pessoal de Saúde , Humanos , Pandemias , Projetos Piloto , Estudos Retrospectivos , Vacinação
20.
J Clin Orthop Trauma ; 21: 101505, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34367911

RESUMO

As we step into a technology powered era, where information is available everywhere, managing data forms an important part of professional and everyday life. With developments like online databases, high definition videos and images, social media, robotics, explosion of academic publications, telecommunication, artificial intelligence and internet of things, there is a variable amount of data that the orthopaedic surgeon is exposed to and has to deal with on a regular basis. It is imperative that the surgeon has a basic working knowledge on data and its applications in relation to the field of orthopaedic surgery. This review introduces the surgeon to data and its types, its sources, collection, Electronic Medical Records (EMR), management after collection, Big data and legal issues related to data. Data generators from megabytes to yottabytes are discussed along with options for their storage and analysis. Knowledge on the types of data is important to decide on the type of statistical tests that may be used on them, for the options available for storage, analysis and legal issues. We discuss the different types of data, computer and cloud-based systems of Electronic Medical Records (EMRs) with their advantages and disadvantages as well as the differences between conventional and EMRs. Management of data after collection is discussed including storage and backup, archiving and sharing, organizing, tracking changes and analysis. High resolution images, videos, robotics and analytics are powering demand and production of data in Trauma and Orthopaedics. Issues like copyright, Privacy, security, encryption and legal issues related to data are highlighted as these are important as more and more data is being used online and involve issues of privacy and security. We also take a look into the future of data in orthopaedics as digitization of the world is occurring at a rapid pace.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...