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1.
BMC Musculoskelet Disord ; 20(1): 419, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506075

RESUMO

BACKGROUND: Proximal humeral fractures can be treated non-operatively or operatively with open reduction and internal fixation (ORIF) and arthroplasty. Our objective was to assess practice patterns for operative and non-operative treatment of proximal humeral fractures. We also report on complications, readmissions, in-hospital mortality, and need for surgery after initial treatment of proximal humeral fractures in California, Florida, and New York. METHODS: The State Inpatient Databases and State Emergency Department Databases from the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, were used for the states of California (2005-2011), Florida (2005-2014), and New York (2008-2014). Data on patients with proximal humeral fractures was extracted. Patients underwent non-operative or operative (ORIF or arthroplasty) treatment at baseline and were followed for at least 4 years from the index presentation. If the patient needed subsequent surgery, time to event was calculated in days, and Kaplan-Meier survival curves were plotted. RESULTS: At the index visit, 90.3% of patients with proximal humeral fractures had non-operative treatment, 6.7% had ORIF, and 3.0% had arthroplasty. 7.6% of patients initially treated non-operatively, 6.6% initially treated with ORIF, and 7.2% initially treated with arthroplasty needed surgery during follow-up. Device complications were the primary reason for readmission in 5.3% of ORIF patients and 6.7% of arthroplasty patients (p < 0.0001). All-cause in-hospital mortality was 9.8% for patients managed non-operatively, 8.8% for ORIF, and 10.0% for arthroplasty (p = 0.003). CONCLUSIONS: A majority of patients with proximal humeral fractures underwent non-operative treatment. There was a relatively high all-cause in-hospital mortality irrespective of treatment. Given the recent debate on operative versus non-operative treatment for proximal humeral fractures, our study provides valuable information on the need for revision surgery after initial treatment. The differences in rates of revision surgery between patients treated non-operatively, with ORIF, and with arthroplasty were small in magnitude. At nine years of follow-up, ORIF had the lowest probability of needing follow-up surgery, and arthroplasty had the highest.


Assuntos
Artroplastia/efeitos adversos , Fixação de Fratura/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fraturas do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia/métodos , Artroplastia/estatística & dados numéricos , California/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Florida/epidemiologia , Seguimentos , Fixação de Fratura/métodos , Fixação de Fratura/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Úmero/lesões , Úmero/cirurgia , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Fraturas do Ombro/mortalidade , Resultado do Tratamento
3.
Knee ; 26(5): 962-968, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31431338

RESUMO

BACKGROUND: To assess the risk of tunnel collision in combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstructions. METHODS: Three-dimensional (3D) CT reconstructions of 32 knees after transtibial (TT) (N = 16) or anteromedial portal (AMP) (N = 16) ACL reconstruction were used to simulate potential tunnel collision of the femoral ACL tunnel if combined with a virtual ALL reconstruction. The minimal distance between tunnels, the ALL tunnel length, and the lateral femoral condyle (LFC) width were measured. Moreover, the relationship between the ALL tunnel and the intercondylar notch, trochlear groove and posterior femoral cortex was determined. RESULTS: The highest rate of tunnel collision (81%) was observed when the ALL tunnel was aimed at 20° in the coronal plane and 0° in the axial plane. However, by aiming the ALL tunnel at 0° coronal and 40° axial angulation, collision was avoided in all patients and no violation of the trochlea was observed. Tunnel collision rate was significantly higher (P = 0.002) when the ACL tunnel was drilled by the AMP technique. CONCLUSIONS: Risk of tunnel collision was significantly increased when the tunnel was drilled at 0° in the axial plane. Tunnel collision was avoided by aiming the ALL tunnel 40° anteriorly and perpendicular to the anatomical axis of the femur. A more horizontal orientation of the ACL with the AMP technique is a risk factor for tunnel conflicts. CLINICAL RELEVANCE: ALL tunnel orientation needs to be adjusted to avoid tunnel conflicts in combined ACL-ALL reconstructions.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Fêmur/cirurgia , Ligamentos Articulares/cirurgia , Adulto , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroplastia/efeitos adversos , Artroplastia/métodos , Cadáver , Epífises , Feminino , Fêmur/diagnóstico por imagem , Humanos , Imagem Tridimensional , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Ligamentos Articulares/lesões , Masculino , Orientação Espacial , Medição de Risco , Fatores de Risco , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
4.
J Shoulder Elbow Surg ; 28(10): 2031-2038, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350107

RESUMO

BACKGROUND: To date, no gold-standard technique exists for the treatment of chronic acromioclavicular joint (ACJ) instability. We systematically reviewed the clinical results of 3 main categories of ACJ reconstruction for high-grade chronic instability. METHODS: A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The inclusion criteria were clinical studies involving patients with ACJ instability (Rockwood grades III-VI) for at least 6 weeks, managed with ACJ stabilization, with a minimum 1-year follow-up. Depending on the surgical technique, patients were divided into 1 of 3 groups: nonbiological fixation between the coracoid and clavicle, for example, suture loops and synthetic ligaments (group 1); biological reconstruction of the coracoclavicular ligaments, for example, allograft or autograft ligament reconstruction (group 2); and ligament and/or tendon transfer, for example, the Weaver-Dunn procedure (group 3). Patient demographic characteristics, functional scores, radiographic outcomes, and complications were compared. RESULTS: Two independent investigators reviewed 960 articles. A total of 27 studies met the inclusion criteria, comprising 590 patients divided into 1 of 3 groups. The complication rates were similar among the 3 groups: 15% for nonbiological fixation, 15% for biological reconstruction, and 17% for ligament and/or tendon transfer, with failure rates of 8%, 7%, and 5%, respectively. In terms of functional results, the mean Constant score was 87.2 points for nonbiological fixation (n = 89), 92.4 points for biological reconstruction (n = 86), and 87.4 points for ligament and/or tendon transfer (n = 49). CONCLUSION: On comparison of the results of 3 different ACJ reconstruction methods, all techniques showed similar complication rates. Among the level II studies, ACJ reconstruction with a tendon graft showed superior results.


Assuntos
Articulação Acromioclavicular/cirurgia , Artroplastia/métodos , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Articulação Acromioclavicular/fisiopatologia , Artroplastia/efeitos adversos , Doença Crônica , Humanos , Ligamentos Articulares/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Técnicas de Sutura , Suturas , Transferência Tendinosa
5.
J Orthop Surg Res ; 14(1): 180, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208432

RESUMO

BACKGROUND: Although arthroplasty has been proved to be a safe and effective procedure, data regarding inpatient mortality rates associated with arthroplasty in China is unclear. We aimed to investigate the inpatient mortality rate after arthroplasty and the determinants of mortality at our center to ensure improved perioperative management. METHODS: This retrospective study included all patients who underwent arthroplasty at our center. Clinical data of mortality patients were collected. The incidence and the causes of inpatient mortality after arthroplasty were analyzed. RESULTS: A total of 4176 total knee arthroplasties, 2164 total hip arthroplasties, and 1031 femoral head replacements were performed. A rapid growth in surgery volume was observed, and more than 50% of the surgeries were performed in the last 5 years. The overall inpatient mortality rate is 0.3%; however, the mortality rate even decreased in the last 5 years. The cause of death changed over time. Pneumonia has become the leading cause of death in the past 5 years instead of cardiovascular complications. CONCLUSIONS: Arthroplasty is a safe and effective procedure associated with a relatively low inpatient mortality in China. And inpatient mortality does not increase as the growing surgery volume due to improvement of perioperative management. However, patients presenting with risk factors and those undergoing non-elective procedures demonstrated a relatively high incidence of postoperative complications, particularly pneumonia.


Assuntos
Artroplastia/mortalidade , Mortalidade Hospitalar , Idoso , Idoso de 80 Anos ou mais , Artroplastia/efeitos adversos , Artroplastia de Quadril/mortalidade , Artroplastia do Joelho/mortalidade , Doenças Cardiovasculares/mortalidade , Causas de Morte , China/epidemiologia , Feminino , Prótese de Quadril , Humanos , Masculino , Pneumonia/mortalidade , Estudos Retrospectivos , Fatores de Risco
6.
J Shoulder Elbow Surg ; 28(7): e226-e231, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31085033

RESUMO

BACKGROUND: The Latarjet procedure is the preferred method to treat recurrent anterior shoulder instability with glenoid deficiency. An iatrogenic fracture of the transferred coracoid process is one possible intraoperative complication. METHODS: We propose a rescue technique using double-row suture bridge fixation. Double-loaded 4.5-mm suture anchors were placed medially in the scapular neck. These sutures were then brought over the top of the coracoid fragment, placed around the bony fragment, and fixated to the glenoid face with knotless suture anchors. RESULTS: Radiologic evidence of bone graft healing was observed in the desired position. CONCLUSIONS: We present a salvage procedure that will assist surgeons if an intraoperative fracture of the coracoid bone graft occurs during fixation when performing the Latarjet procedure.


Assuntos
Processo Coracoide/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Complicações Intraoperatórias/cirurgia , Instabilidade Articular/cirurgia , Articulação do Ombro , Adulto , Artroplastia/efeitos adversos , Transplante Ósseo/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Âncoras de Sutura , Tomografia Computadorizada por Raios X
7.
Acta Orthop Traumatol Turc ; 53(4): 266-271, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31047773

RESUMO

OBJECTIVE: The aim of this study was to compare the complication rates and clinical results of labral repair with two suture anchors and capsular plication, and labral repair with three suture anchor fixation in artroscopic Bankart surgery. METHODS: Sixty-nine patients (60 males, 9 females; mean age: 28.2 ± 7.8 years (range: 16-50)) who had undergone arthroscopic repair of a labral Bankart lesion were evaluated. Group A underwent an arthroscopic Bankart repair with three knotless suture anchors, while group B underwent a modified arthroscopic Bankart repair with two knotless suture anchors and an additional capsular plication procedure. The mean follow-up was 52.5 months. Constant Shoulder Score (CSS), Rowe Score (RS), modified UCLA Shoulder Score (mUSS) and range of motion (ROM) were used as outcome measures. RESULTS: In both groups, a significant improvement was detected in functional outcomes at postoperative last follow-up compared to the preoperative period. No statistically significant difference was found (p > 0.05) in clinical scores (CSS; Group A: 89.7, Group B: 80.2) (RS; Group A: 88.2, Group B: 80.2) (mUSS; Group A: 26.3, Group B: 25.7) external rotation loss (At neutral; Group A: 4.5°, Group B: 5.2°. At abduction; Group A: 4.3°, Group B: 5.7°) and recurrence rates (Group A: 13.3%, Group B: 20.8%). Although the difference was not statistically significant, the recurrence rate was higher in group B (20.8%), compared to group A (13.3%), despite the shorter average follow-up time of group B (p = 0.417). CONCLUSIONS: Arthroscopic repair of labral Bankart lesions with both techniques showed good functional outcomes and stability at the latest follow-up. Higher recurrence rate despite the shorter average follow-up of group B suggests that two anchor usage might not be sufficient for Bankart repair in terms of better stability and less recurrence risk. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Artroplastia , Lesões de Bankart , Instabilidade Articular , Complicações Pós-Operatórias , Luxação do Ombro , Articulação do Ombro , Âncoras de Sutura , Adulto , Artroplastia/efeitos adversos , Artroplastia/métodos , Artroscopia/efeitos adversos , Artroscopia/métodos , Lesões de Bankart/diagnóstico , Lesões de Bankart/cirurgia , Feminino , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Recidiva , Luxação do Ombro/diagnóstico , Luxação do Ombro/etiologia , Articulação do Ombro/lesões , Articulação do Ombro/cirurgia , Âncoras de Sutura/efeitos adversos , Âncoras de Sutura/classificação , Resultado do Tratamento
8.
J Shoulder Elbow Surg ; 28(9): e304-e312, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31043350

RESUMO

BACKGROUND: The Latarjet procedure is often used to treat shoulder instability in younger patients. Little is reported on the outcomes of this procedure in older (≥40 years) populations. The purpose of this study was to evaluate the clinical and radiographic outcomes of patients aged 40 years or older with recurrent anterior shoulder instability who underwent open Latarjet stabilization. METHODS: A total of 168 patients aged 40 years or older were treated surgically for recurrent anterior shoulder instability with an open Latarjet procedure between 1988 and 2014. Bankart lesions or anteroinferior glenoid fractures were confirmed preoperatively with a computed tomography arthrogram. Outcomes were assessed with preoperative and postoperative physical examinations, clinical outcome scoring, and radiographic examinations. RESULTS: Ninety-nine patients with complete data were available with a mean follow-up period of 13 years (range, 3-23 years). At the time of final follow-up, 94% of patients did not have recurrence of instability. Of the patients, 90% were satisfied or very satisfied with their outcomes and 54% returned to their preinjury level of activity. The overall complication rate was 21% (the most common complications being subjective apprehension [9%] and recurrent instability [6%]), with 9% of patients requiring reoperation. A full-thickness rotator cuff requiring repair was identified in 22% of patients. CONCLUSIONS: The Latarjet procedure is an effective treatment option for older patients (aged ≥ 40 years) with recurrent anterior shoulder instability in the setting of an anteroinferior capsulolabral and/or bony injury.


Assuntos
Lesões de Bankart/cirurgia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Adulto , Idoso , Artroplastia/efeitos adversos , Artroplastia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Recidiva , Reoperação , Estudos Retrospectivos , Escápula/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Clin Appl Thromb Hemost ; 25: 1076029619838066, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30939898

RESUMO

Appropriate chemoprophylaxis choice following arthroplasty requires accurate patient risk assessment. We compared the results of our prospective department protocol to the Caprini risk assessment model (RAM) retrospectively in this study group. Our goal was to determine whether the department protocol or the Caprini score would identify venous thromboembolism (VTE) events after total joint replacement. A secondary purpose was to validate the 2013 Caprini RAM in joint arthroplasty and determine whether patients with VTE would be accurately identified using the Caprini score. A total of 1078 patients met inclusion criteria. A Caprini score of 10 or greater is considered high risk and a score of 9 or less is considered low risk. The 2013 version of the Caprini RAM retrospectively stratified 7 of the 8 VTE events correctly, while only 1 VTE was identified with the prospective department protocol. This tool provided a consistent, accurate, and efficacious method for risk stratification and selection of chemoprophylaxis.


Assuntos
Anticoagulantes/administração & dosagem , Artroplastia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Tromboembolia Venosa/etiologia , Trombose Venosa/etiologia
10.
Acta Orthop ; 90(4): 389-393, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30931687

RESUMO

Background and purpose - Revision surgery after trapeziometacarpal arthroplasty is sometimes required. Varying revision rates and outcomes have been reported in rather small patient series. Data on risk factors for revision surgery, on the final outcome of revision, and possible factors affecting the outcome of revision are also limited. We evaluated these factors in 50 patients. Patients and methods - From 1,142 trapeziometacarpal arthroplasties performed during a 10-year period, 50 patients with 65 revision surgeries were retrospectively identified and invited to participate in a follow-up study involving subjective, objective, and radiologic evaluation. The revision rate, risk factors for revision, and factors affecting the outcome of revision were analyzed. Results - The revision rate was 5%. Scaphometacarpal impingement was the most common reason for revision surgery. Patient age ≤ 55 years was a risk factor with a revision rate of 9% in this age group, whereas an operation on both thumbs during the follow-up period was a negative risk factor for revision surgery. There was no difference in revision risk between ligament reconstruction and tendon interposition with or without a bone tunnel. 9 patients had multiple revision procedures and their final outcome did not differ significantly from patients revised only once. Most of the patients felt subjectively that they had benefited from revision surgery and the subjective outcome measures (QuickDash and pain VAS) and the Conolly score were in the same range as previously described for revision trapeziometacarpal arthroplasty. Interpretation - Age ≤ 55 years is a risk factor for revision surgery. The type of primary surgery does not affect the risk of revision surgery and multiple revision procedures do not result in worse outcomes than cases revised only once. Mechanical pain caused by contact between the metacarpal and scaphoid is the most common indication for revision surgery. In general, patients seem to benefit from revision surgery for trapeziometacarpal osteoarthritis.


Assuntos
Artroplastia/efeitos adversos , Articulações dos Dedos/cirurgia , Ossos Metacarpais/cirurgia , Trapézio/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Gestão de Riscos , Polegar
11.
J Shoulder Elbow Surg ; 28(5): 819-827, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30928396

RESUMO

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) provides excellent clinical outcomes but is often associated with significant postoperative pain. The use of intraoperative anesthesia in conjunction with multimodal pharmacologic strategies is a widely accepted approach for managing surgical pain and reducing opiate use. The purpose of this study was to determine whether using a combined field and suprascapular nerve block with liposomal bupivacaine (LB) in addition to an interscalene block would provide greater pain relief and a reduction in opiate consumption compared with an interscalene block alone. METHODS: The study enrolled 50 patients with full-thickness rotator cuff tears undergoing primary ARCR surgery. Patients were randomized to receive intraoperative LB (n = 25) or not (n = 25) and given postoperative "pain journals" to document visual analog scale pain scores and to track their daily opioid consumption during the first 5 postoperative days. RESULTS: Patients in the LB group reported statistically and clinically lower pain scores during postoperative days 1 and 2 (P < .0001 and P = .03, respectively). In addition, patients in the LB group consumed significantly fewer narcotics than the control group during the 5-day period, demonstrating a 64% reduction in total narcotic consumption (P = .002). CONCLUSION: The findings of this study suggest that the addition of LB to multimodal anesthetic protocols significantly reduces the acute perioperative pain experienced following rotator cuff repair and the number of narcotic pills consumed in the first 5 days after ARCR. Furthermore, the findings provide guidelines for postoperative narcotic prescribing to reduce the quantity of opiates prescribed.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroplastia/efeitos adversos , Bupivacaína/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Lesões do Manguito Rotador/cirurgia , Artroplastia/métodos , Artroscopia/efeitos adversos , Artroscopia/métodos , Feminino , Humanos , Injeções Intra-Articulares , Lipossomos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Alcaloides Opiáceos/administração & dosagem , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Manguito Rotador/cirurgia , Método Simples-Cego
12.
Arch Orthop Trauma Surg ; 139(9): 1193-1201, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30874896

RESUMO

BACKGROUND: Total joint arthroplasty (TJA) is a major orthopedic procedure associated with substantial morbidity and mortality. Never events (NEs) are harmful hospital-acquired conditions (HACs) that are preventable. METHODS: Information on hospital admissions with TJA was collected from the National Inpatient Sample (NIS) from 2003 to 2012. NIS was queried to identify NE applicable to TJA patients based on the HAC definition listed by the Centers for Medicare and Medicaid Services (CMS). NEs were further compared before and after 2008 to evaluate the effect of the new CMS non-reimbursement policy on their incidence. RESULTS: A total of 8,176,774 patients were admitted with TJA from 2003 to 2012. 108,668 patients of these (1.33%) had ≥ 1 NE. The most prevalent NE was fall and trauma (0.7%). Significant multivariable predictors with higher odds of developing at least one NE included weekend admission [odds ratio (99.9% CI), 4.3 (3.1, 5.8), p < 0.001] and weight loss [odds ratio (99.9% CI), 2.8 (2.2, 3.5), p < 0.001]. A temporal comparison of NE before and after 2008 revealed a decrease in total NE occurrence after 2008 when the CMS announced discontinuing payment for NE (1.39% vs. 1.25%, p < 0.001). After adjustment for potential confounding risk factors, NE after TJA was significantly associated with an increased mortality (p < 0.001), a longer hospital stay (p < 0.001), and higher total hospitalization charges (p < 0.001). CONCLUSIONS: These data demonstrated that NE in TJA patients was predictive of an increased mortality, length of hospital stay, and hospitalization costs. This study established baseline NE rates in the TJA patient population to use as benchmarks and identified target areas for quality improvement in US.


Assuntos
Artroplastia , Doença Iatrogênica/epidemiologia , Erros Médicos/estatística & dados numéricos , Artroplastia/efeitos adversos , Artroplastia/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Humanos , Prevalência , Estados Unidos/epidemiologia
13.
Acta Orthop Traumatol Turc ; 53(5): 356-359, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30853399

RESUMO

OBJECTIVE: The aim of this study was to evaluate which specific factors influence the improvement in function and to estimate the time to obtain pain relief following arthroscopic rotator cuff repair. METHODS: A total of 97 patients (57 men and 40 women; mean age: 55.5 ± 9.3 years) who had arthroscopic rotator cuff repair between 2013 and 2016 were included into the study. Multivariable stepwise analysis included preoperative variables (age, gender, body mass index, comorbidities, occupation and participation in sports, Oxford shoulder score at baseline, preceding injury and duration of preoperative symptoms) and arthroscopic findings (size of rotator cuff tear, pathology of the long head of the biceps and cartilage lesions). The change in the Oxford shoulder score at the last follow-up was modeled as a function of the above predictor variables. The time to regain a visual analogue scale (VAS) under two points following surgery was considered the time to regain substantial pain relief. RESULTS: The mean follow-up time was 33.2 ± 14.4 months. Twenty three patients had partial thickness and seventy four had full thickness supraspinatus tears. In third of the patients the tears were defined as large full thickness. At the last follow-up the mean Oxford shoulder score improved from 13.8 ± 4.8 to 42.1 ± 7.2 points (P < 0.001). The mean VAS improved from a preoperative score of 6.7 ± 1.3 points to 1.5 ± 0.6 points postoperatively (P < 0.001) and 80 (83%) patients declared they were satisfied to have had the operation. The mean time interval for substantial pain relief was 4.9 ± 3.6 months. Patients with higher preoperative Oxford shoulder score and larger tear size were correlated with lesser improvement in Oxford shoulder score (R = 0.5, P = 0.001). CONCLUSION: Arthroscopic rotator cuff repair improved pain and function at an average follow-up of three years. A substantial pain relief was regained within five months from surgery. Larger rotator cuff tear size and more favorable preoperative function were predictors of worse postoperative function. LEVEL OF EVIDENCE: Level IV, Therapeutic study.


Assuntos
Artroplastia/efeitos adversos , Dor Pós-Operatória/diagnóstico , Lesões do Manguito Rotador , Manguito Rotador , Dor de Ombro , Artroplastia/métodos , Artroscopia/efeitos adversos , Artroscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Prognóstico , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/patologia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Resultado do Tratamento , Escala Visual Analógica
14.
Acupunct Med ; 37(1): 72-76, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30843420

RESUMO

OBJECTIVE: There are multiple treatment options for hiccups, including non-pharmacological therapies, but little evidence of superiority of one treatment over another. The aim of this study was to investigate the effects of acupuncture on persistent hiccups after arthroplasty. METHODS: From April 2010 to December 2015, 15 patients with primary unilateral total hip/knee arthroplasty were diagnosed with persistent hiccups and given acupuncture at PC6, CV12 and ST36. Each acupuncture session lasted 30 min. The total number of treatment sessions was determined by the persistence of symptoms, but acupuncture was administered no more than three times over the course of a week. The hiccups assessment instrument (HAI) was used to assess the severity of hiccups pre-treatment and post-treatment. Adverse events were also recorded. RESULTS: Absolute resolution was observed in all 15 patients after less than three acupuncture sessions. Of these, 10 patients required only one acupuncture session, 3 patients required two sessions and 2 patients required three sessions. The HAI score improved after each round of acupuncture treatment (P<0.05). The average HAI score improved significantly post-acupuncture compared to baseline values pre-treatment (P<0.05). Symptoms accompanying the hiccups included pain in the diaphragmatic area (five patients), mild dyspnoea (three patients), dysphagia (two patients) and nausea/vomiting (one patient). All these accompanying symptoms disappeared at the point of resolution of the hiccups. There were no adverse effects related to acupuncture during the study period. CONCLUSION: Based on our results, acupuncture may represent a potential treatment option for hiccups after arthroplasty. Caution must be exercised, however, given the lack of a control group. Accordingly, randomised controlled trials will be required to verify the efficacy and effectiveness of acupuncture for the treatment of hiccups.


Assuntos
Terapia por Acupuntura , Artroplastia/efeitos adversos , Soluço/terapia , Complicações Pós-Operatórias/terapia , Pontos de Acupuntura , Idoso , Feminino , Soluço/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
15.
J Orthop Res ; 37(4): 981-990, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30737817

RESUMO

Despite being a relatively safe surgery, total joint replacement is often associated with two major complications-severe post-operative pain and periprosthetic joint infection. Local sustained delivery of therapeutics to the surgical site has a potential to address these complications more effectively than current clinical approaches. Given that several analgesics were shown to possess antibacterial activity, we propose here to use analgesic-loaded ultra-high molecular weight polyethylene (UHMWPE) as a delivery vehicle to provide antimicrobial effect after an arthroplasty. Three commonly used anesthetics, lidocaine, bupivacaine, and ropivacaine, were analyzed in order to reveal the drug with the highest antibacterial activity against methicillin-sensitive Staphylococcus aureus. Having shown highest antibacterial activity in the bacterial susceptibility tests, bupivacaine was chosen to be incorporated into UHMWPE to provide antibacterial properties. Bupivacaine-loaded UHMWPE possessed moderate dose-dependent antimicrobial properties, decreasing the S. aureus proliferation rate by up to 70%. Biofilm formation was also substanitally inhibited during the first 9 h of culture as quantified by bacterial counts and SEM. This proof-of-concept study is first of its kind to demonstrate that analgesic-loaded UHMWPE can be used as part of a multimodal antimicrobial therapy. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.


Assuntos
Anestésicos Locais/administração & dosagem , Antibioticoprofilaxia/métodos , Artrite Infecciosa/prevenção & controle , Bupivacaína/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Infecções Relacionadas à Prótese/prevenção & controle , Artrite Infecciosa/etiologia , Artroplastia/efeitos adversos , Staphylococcus aureus Resistente à Meticilina , Testes de Sensibilidade Microbiana , Dor Pós-Operatória/etiologia , Polietilenos , Estudo de Prova de Conceito
16.
Am J Sports Med ; 47(1): 123-130, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30781991

RESUMO

BACKGROUND: Appropriate patient selection is critical when hip arthroscopy is considered in the setting of borderline dysplasia (BD). It is presumable that excessive femoral anteversion (EFA) and BD may contraindicate arthroscopy. HYPOTHESIS: Patients with combined EFA and BD (EFABD) demonstrate significantly inferior short-term outcomes after arthroscopic labral preservation and capsular closure when compared with a similar control group with normal lateral coverage and femoral anteversion. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were prospectively collected and retrospectively reviewed on patients undergoing hip arthroscopy between April 2010 and November 2014. The EFABD group's inclusion criteria were BD (lateral center-edge angle, 18°-25°), labral tear, capsular closure, and femoral version ≥20°, as well as preoperative modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale. Exclusion criteria were workers' compensation, preoperative Tönnis grade >1, microfracture, abductor pathology, or previous ipsilateral hip surgery or conditions. Patients in the EFABD group were matched 1:2 to a similar control group with normal coverage and femoral anteversion by age at surgery ± 6 years, sex, body mass index ± 5, acetabular Outerbridge grade (0, 1 vs 2, 3, 4), and iliopsoas fractional lengthening. RESULTS: Sixteen EFABD cases were eligible for inclusion, and 100% follow-up was obtained at ≥2 years postoperatively. Twelve EFABD cases were matched to 24 control cases. Mean femoral version was 22.4° in the EFABD group and 10.2° in the control group ( P = .01). Mean lateral center-edge angle was 22.1° in the EFABD group and 31.5° in the control group ( P < .0001). Acetabuloplasty was performed significantly more frequently in the control group ( P = .0006). No other significant differences were found regarding demographics, findings, procedures, or preoperative scores. At latest follow-up, the EFABD group demonstrated significantly lower mean modified Harris Hip Score (76.1 vs 85.9; P = .005), Nonarthritic Hip Score (74.8 vs 88.5; P < .0001), Hip Outcome Score-Sports Specific Subscale (58.3 vs 78.4; P = .02), and patient satisfaction (7.1 vs 8.3; P = .005). There were 4 secondary surgical procedures (33.3%) in the EFABD group and 1 (4.2%) in the control group ( P = .03). One patient in each group required arthroplasty. CONCLUSION: Patients treated with arthroscopic labral preservation and capsular closure in the setting of EFABD demonstrated significant improvements from presurgery to latest follow-up. However, their results are significantly inferior when compared with a matched-controlled group. Consideration of periacetabular osteotomy or femoral osteotomy may be warranted in the setting of EFABD to achieve optimal benefit.


Assuntos
Artroplastia , Artroscopia , Fêmur/patologia , Fêmur/cirurgia , Luxação do Quadril/patologia , Luxação do Quadril/cirurgia , Acetabuloplastia/efeitos adversos , Acetábulo/patologia , Acetábulo/cirurgia , Adolescente , Adulto , Artroplastia/efeitos adversos , Artroscopia/efeitos adversos , Estudos de Casos e Controles , Contraindicações de Procedimentos , Feminino , Quadril/patologia , Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
17.
BMC Musculoskelet Disord ; 20(1): 87, 2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782150

RESUMO

BACKGROUND: This study aimed to clarify the characteristics associated with postoperative floating of the lesser toes, especially focusing on the medial and lateral lessor toes, after arthrodesis of the first metatarsophalangeal joint and resection arthroplasty of the lessor toes in rheumatoid forefoot deformity. METHODS: Fourty-seven feet of 43 people who underwent resection arthroplasty of the metatarsal head of the lesser toes for rheumatoid arthritis of the metatarsophalangeal joints were included. We retrospectively evaluated the preoperative radiographic findings and clinical characteristics of the patients, and the occurrence of postoperative floating of the lesser toes. The mean duration of follow-up was 36.5 (range 12 to 114) months. RESULTS: Preoperative dislocation grades of the second and third toes that demonstrated postoperative floating were significantly higher than those of toes that did not experience postoperative floating. The hallux valgus deformity before surgery was significantly more severe in toes with postoperative floating of the second and third lessor toes than those with no floating (p < 0.05). In addition, the Japanese Society for Surgery of the Foot (JSSF) hallux scale scores before surgery in toes with postoperative floating of the fourth and fifth lessor toes were significantly worse than those in non-dislocating toes (p < 0.05). CONCLUSIONS: The preoperative condition of the first metatarsophalangeal joint, including hallux valgus deformity, pain, range of motion, activity of daily living, and function is significantly different between postoperative floating of the lesser toes and non-floating of them after resection arthroplasty for rheumatoid forefoot deformity.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/cirurgia , Artroplastia/tendências , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Cuidados Pré-Operatórios , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/epidemiologia , Artroplastia/efeitos adversos , Feminino , Seguimentos , Deformidades do Pé/diagnóstico por imagem , Deformidades do Pé/epidemiologia , Deformidades do Pé/cirurgia , Hallux Valgus/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos
18.
BMC Musculoskelet Disord ; 20(1): 49, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704444

RESUMO

BACKGROUND: Moderately increased motion at the intermediate segment (IS) after skip-level fusion may accelerate disc degeneration. However, limited biomechanical data are available that examine the effects on the IS following cervical disc arthroplasty (CDA). The purpose of this study is to investigate the biomechanical changes in the IS of the cervical spine after skip-level fusion or skip-level arthroplasty. METHODS: A finite element model of a healthy cervical spine (C2-C7) was constructed. Two surgical models were developed: (1) skip-level fusion at C3/4 and C5/6 and (2) skip-level arthroplasty at C3/4 and C5/6. A 75-N follower load and 1.0-N·m moments were applied to the top of the C2 vertebra to produce flexion, extension, lateral bending and axial rotation in the intact model. The end-points in each direction corresponding to the intact model were applied to the surgical models under displacement-control protocols. RESULTS: The ranges of motion (ROMs) of the fusion model were markedly decreased at the operated levels, while the corresponding ROMs of the arthroplasty model were similar to those of the intact spine in all directions. In the fusion model, the ROMs of the IS (C4/5) were markedly increased in all directions. The ROMs in the arthroplasty model were similar to those in the intact spine, and the ROMs of untreated segments were evenly increased. In the fusion model, the intradiscal pressure and facet contact force at were C4/5 remarkably increased and unevenly distributed among the unfused segments. In the arthroplasty model, the IS did not experience additive stress. CONCLUSION: The IS does not experience additive ROM or stress in the intervertebral disc or facet joints after skip-level arthroplasty, which has fewer biomechanical effects on the IS than does skip-level fusion. This study provides a biomechanical rationale for arthroplasty in treating patients with skip-level cervical degenerative disc disease.


Assuntos
Artroplastia/efeitos adversos , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Modelos Biológicos , Fusão Vertebral/efeitos adversos , Adulto , Vértebras Cervicais/diagnóstico por imagem , Análise de Elementos Finitos , Humanos , Imagem Tridimensional , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pescoço/fisiologia , Amplitude de Movimento Articular , Espondilose/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Arthroscopy ; 35(3): 763-769, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30704888

RESUMO

PURPOSE: To examine any association between perioperative serum 25-hydroxyvitamin D levels and failure of arthroscopic rotator cuff repair (RCR) requiring revision surgery. METHODS: Using a private-payer national insurance database, patients who underwent arthroscopic RCR with perioperative serum 25-hydroxyvitamin D levels recorded were included. Patients were stratified into groups of (1) serum 25-hydroxyvitamin D deficiency (<20 ng/mL), (2) insufficiency (20-30 ng/mL), or (3) sufficient (>30-<150 ng/mL). The primary outcome measure was ipsilateral revision rotator cuff surgery, including revision repair, debridement, or reverse shoulder arthroplasty. A multivariable logistic regression analysis was used to control for patient demographics and comorbidities during comparisons. RESULTS: A total of 982 patients were included in the study. The rate of revision rotator cuff surgery was significantly higher in patients in the serum 25-hydroxyvitamin D-deficient group (5.88%) compared with the serum 25-hydroxyvitamin D-sufficient control group (3.7%) (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.6-5.8; P = .007). Patients with serum 25-hydroxyvitamin D deficiency (5.88%) also had a significantly higher incidence of revision surgery compared with patients with serum 25-hydroxyvitamin D insufficiency (OR, 2.4; 95% CI, 1.5-3.9; P = .011). There was no significant difference in the incidence of revision surgery in the serum 25-hydroxyvitamin D-insufficient group (4.97%) compared with the serum 25-hydroxyvitamin D-sufficient control group (3.7%) (OR, 1.4; 95% CI, 0.8-2.3; P = .250). The absolute risk reduction of revision surgery for 25-hydroxyvitamin D-deficient patients compared with controls was 2.2%, corresponding to a number needed to treat to avoid 1 revision surgery of 46 patients, relative risk reduction = 0.59. CONCLUSIONS: Although the present study found a significant statistical association between serum 25-hydroxyvitamin D deficiency and insufficiency and the rate of revision rotator cuff surgery after primary arthroscopic RCR, the absolute differences of these revision rates are minimal and are accompanied with overlapping confidence intervals limiting the clinical significance of these findings. LEVEL OF EVIDENCE: Level III, retrospective cohort study.


Assuntos
Artroscopia/efeitos adversos , Lesões do Manguito Rotador/cirurgia , Deficiência de Vitamina D/complicações , Vitamina D/análogos & derivados , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia/efeitos adversos , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Manguito Rotador/cirurgia , Resultado do Tratamento , Vitamina D/sangue
20.
Am J Sports Med ; 47(4): 915-921, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30758977

RESUMO

BACKGROUND: Corticosteroid injections are sometimes used in the postoperative period after shoulder arthroscopy; however, a well-defined safety profile has not been established. PURPOSE: To examine the association between the timing of postoperative corticosteroid injections and rates of infection after shoulder arthroscopy. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Private payer and Medicare national insurance databases were queried for patients who underwent arthroscopic rotator cuff repair, debridement, or subacromial decompression. Patients who underwent corticosteroid injections within 1, 2, 3, or 4 months postoperatively were identified and compared with a matched control group that underwent the same procedures without a postoperative steroid injection. International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes were used to identify rates of postoperative infection within 90 days after injection for the study groups and controls. Multivariate binomial logistic regression analysis was used to compare groups, and adjusted odds ratios (ORs) and 95% CIs were calculated, with P < .05 considered significant. RESULTS: A total of 3946 patients were identified, including 264 patients who received an injection within 1 month after surgery, 471 within 2 months, 1037 within 3 months, 1874 within 4 months, and 2640 matched controls. When compared with controls, patients who underwent a corticosteroid injection within 1 month postoperatively had a significantly higher rate of infection (private payer: OR, 2.63; P = .014; Medicare: OR, 11.2; P < .0001). There were no differences in infection rates at all other time points ( P = .264-.835). CONCLUSION: This study adds to the evidence suggesting caution when administering injections in the immediate postoperative period after shoulder arthroscopy. Although causality cannot be determined on the basis of this database review, the authors found a significant association between intra-articular corticosteroid injections administered 1 month postoperatively and an increased rate of postoperative infection in Medicare and private payer patient cohorts as compared with a control group.


Assuntos
Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Ombro/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia/efeitos adversos , Artroscopia/métodos , Desbridamento , Descompressão Cirúrgica , Esquema de Medicação , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Razão de Chances , Período Pós-Operatório , Estudos Retrospectivos
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