Aims. Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as thromboprophylaxis. The secondary aim was to assess the non-inferiority of the reduction of blood loss of the short protocol versus the long protocol. Patients and Methods. A multicentre, prospective,
Radiostereometric analysis (RSA) studies of vitamin E-doped, highly crosslinked polyethylene (VEPE) liners show low head penetration rates in cementless acetabular components. There is, however, currently no data on cemented VEPE acetabular components in total hip arthroplasty (THA). The aim of this study was to evaluate the safety of a new cemented VEPE component, compared with a conventional polyethylene (PE) component regarding migration, head penetration, and clinical results. We enrolled 42 patients (21 male, 21 female) with osteoarthritis and a mean age of 67 years (Aims
Patients and Methods
Desmoid tumours are a rare fibroblastic proliferation of monoclonal origin, arising in deep soft-tissues. Histologically, they are characterized by locally aggressive behaviour and an inability to metastasize, and clinically by a heterogeneous and unpredictable course. Desmoid tumours can occur in any anatomical site, but commonly arise in the limbs. Despite their benign nature, they can be extremely disabling and sometimes life-threatening, causing severe pain and functional limitations. Their surgical management is complex and challenging, due to uncertainties surrounding the biological and clinical behaviour, rarity, and limited available literature. Resection has been the first-line approach for patients with a desmoid tumour but, during the last few decades, a shift towards a more conservative approach has occurred, with an initial ‘wait and see’ policy. Many medical and regional forms of treatment are also available for the management of this condition, and others have recently emerged with promising results. However, many areas of controversy remain, and further studies and global collaboration are needed to obtain prospective and randomized data, in order to develop an appropriate shared stepwise approach. Cite this article:
Aims. Arthroscopic microfracture is a conventional form of treatment for patients with osteochondritis of the talus, involving an area of < 1.5 cm. 2. However, some patients have persistent pain and limitation of movement in the early postoperative period. No studies have investigated the combined treatment of microfracture and shortwave treatment in these patients. The aim of this prospective single-centre,
Aims. The aim of the HIPGEN consortium is to develop the first cell therapy product for hip fracture patients using PLacental-eXpanded (PLX-PAD) stromal cells. Methods. HIPGEN is a multicentre, multinational,
Aims: To evaluate the inßuence of the type of anesthesia on the superior efþcacy of fondaparinux over enoxaparin in preventing venous thromboembolism (VTE) in orthopedic surgery (RRR >
50%; P<
0.0001). Methods: 4
Aims: The fondaparinux thromboprophylaxis phase III studies database including 7344 patients in orthopaedic surgery provides information regarding patient management according to country specificities. Methods: 4
Aims: Whether the use of elastic stockings (ES) on top of pharmacological thromboprophylaxis is beneficial remains debated. In a worldwide phase III program including 7344 patients in major orthopaedic surgery, fondaparinux, the first synthetic selective factor Xa inhibitor, demonstrated a substantial benefit over enoxaparin in preventing venous thromboembolism (VTE); risk reduction >
50% without increasing clinically relevant bleeding. The aim of this study was to evaluate the influence of ES on this superior efficacy of fondaparinux. Methods: In all four
Introduction: Rivaroxaban is a novel, oral, direct Factor Xa inhibitor in advanced clinical development for the prevention and treatment of thromboembolic disorders. In this phase III trial, the efficacy and safety of thromboprophylaxis with rivaroxaban was compared with enoxaparin in patients undergoing total knee replacement (TKR). Methods: In RECORD3 – a
Purpose: Rivaroxaban is a novel, oral, direct Factor Xa inhibitor in advanced clinical development for the prevention and treatment of thromboembolic disorders. RECORD3 was a phase III trial conducted to compare the efficacy and safety of oral rivaroxaban with subcutaneous enoxaparin for the prevention of venous thromboembolism (VTE) in patients undergoing total knee replacement (TKR). Method: In this
Introduction. Early ambulation after total hip arthroplasty (THA) predicts early discharge. Spinal anesthesia is preferred but can delay ambulation, especially with bupivacaine. Mepivacaine, an intermediate-acting local anesthetic, could enable earlier ambulation than bupivacaine. We hypothesized that patients who received mepivacaine would ambulate earlier than those who received hyperbaric bupivacaine or isobaric bupivacaine for primary THA. Methods. This was a
Introduction. Postoperative nausea and vomiting (PONV) is a common occurrence following total joint arthroplasty, and can result in patient discomfort, delayed discharge, and decreased patient satisfaction. Carbohydrate loading as part of the Enhanced Recovery after Surgery (ERAS) protocol has gained popularity, and has been shown to minimize postoperative nausea, vomiting, pain, and lead to accelerated recovery and better overall outcome following abdominal surgery. This study aims to investigate the effects of preoperative carbohydrate-rich drinks on PONV following primary total knee arthroplasty (TKA). Methods. Patients undergoing primary TKA at one institution were enrolled randomly assigned to one of three groups: Group 1 received preoperative carbohydrate-rich drink, Group 2 received placebo water drink of similar appearance and taste, and Group 3 did not receive a drink (control). All healthcare personnel and patients (group 1 and 2) were blinded to group allocation. We compared rate of postoperative nausea, vomiting, length of stay (LOS), and opiate consumption (morphine equivalents, meq). We also reviewed visual analog scale (VAS) pain scores and serum glucose at 0–4 hours, 4–12 hours, and 12–24 hours postoperatively. Results. 229 eligible patients were enrolled and randomized. 79 patients were later excluded due to reasons precluding appropriate participation. 150 patients were included for final analysis, with 50 patients in Group 1, 48 patients in Group 2, and 52 patients in Group 3. The demographics and comorbid conditions known to increase risk of nausea and vomiting were similar between the groups. Rate of vomiting was not statistically significant across groups; group 1 (6%, 3/50), group 2 (13%, 6/48), group 3 (8%, 4/52), p=0.51. Rate of requiring antiemetic medication in group 1 (30%, 15/50) did not differ significantly from group 2 (27%, 13/48) and group 3 (40%, 21/52), p=0.32. Average LOS was not different in group 1 (32 hours) compared to group 2 (32.5 hours) and group 3 (32 hours), p=0.79. Average postoperative opiate consumption for group 1 (57.0 meq) was not statistically different from group 2 (61.3) or group 3 (61.0), p=0.91. Pain VAS scores and serum glucose measurements did not differ between groups for all three time periods (p>0.05). There was no difference in reported adverse events between groups. Conclusion. There appears to be no significant difference in PONV, antiemetic requirements, LOS, pain VAS scores, serum glucose measurements, and opiate consumption in patients receiving preoperative carbohydrate-rich drink prior to primary TKA. Preoperative carbohydrate-rich drinks are safe, however, their utility in the setting of arthroplasty does not yet demonstrate clinical benefit. Continued investigation is required. Summary. This is a prospective,
The April 2024 Foot & Ankle Roundup360 looks at: Safety of arthroscopy combined with radial extracorporeal shockwave therapy for osteochondritis of the talus; Bipolar allograft transplantation of the ankle; Identifying risk factors for osteonecrosis after talar fracture; Balancing act: immediate versus delayed weightbearing in ankle fracture recovery; Levelling the field: proximal supination osteotomy’s efficacy in severe and super-severe hallux valgus; Restoring balance: how adjusting the tibiotalar joint line influences movement after ankle surgery.
The October 2024 Research Roundup360 looks at: Fracture risk among stroke survivors according to post-stroke disability status and stroke type; Noise-induced hearing loss: should surgeons be wearing ear protection during primary total joint replacement?; Intravenous dexamethasone in hip arthroscopy can enhance recovery; Patient-reported outcomes following periprosthetic joint infection of the hip and knee: a longitudinal, prospective observational study; When should surgery take place after weight loss?; Which type of surgery is the hardest physically and mentally?
The February 2024 Shoulder & Elbow Roundup360 looks at: Does indomethacin prevent heterotopic ossification following elbow fracture fixation?; Arthroscopic capsular shift in atraumatic shoulder joint instability; Ultrasound-guided lavage with corticosteroid injection versus sham; Combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis; Are vascularized fibula autografts a long-lasting reconstruction after intercalary resection of the humerus for primary bone tumours?; Anatomical versus reverse total shoulder arthroplasty with limited forward elevation; Tension band or plate fixation for simple displaced olecranon fractures?; Is long-term follow-up and monitoring in shoulder and elbow arthroplasty needed?
The December 2024 Shoulder & Elbow Roundup360 looks at: Predicting recurrence of instability after a primary traumatic anterior shoulder dislocation; Predictors of surgery and long-term outcomes in nonoperative management of full-thickness rotator cuff tears; Reverse shoulder arthroplasty viable despite acquired acromial compromise, but higher infection risk noted; LP-PRP reduces retear rates in rotator cuff repair but shows no functional outcome advantage; Long-term clinical outcomes of arthroscopic supraspinatus tendon repair using the single anchor tension band technique – minimum five-year follow-up; Arthroscopic stabilization for anterior shoulder dislocation shows low recurrence rates regardless of prior dislocations; ORIF outperforms arthroplasty for complex radial head fractures: mid-term outcomes; Routine use of surgical helmet systems may not reduce infection risk in shoulder arthroplasty.
The aim of this study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment. The type and extent of disc herniation at the time of presentation in 108 patients who underwent anterior discectomy for cervical radiculopathy were analyzed on MRI, using a four-point scale. These were dichotomized into disc bulge and disc herniation groups. Clinical outcomes were evaluated using the Neck Disability Index (NDI), 36-Item Short Form Survey (SF-36), and a visual analogue scale (VAS) for pain in the neck and arm at baseline and two years postoperatively. The perceived recovery was also assessed at this time.Aims
Methods
Implants are highly susceptible to infection [. 1. ]. The infection rate is 0.5–2% after hip or knee arthroplasty [. 2. ]. Periprosthetic joint infections are hard to eradicate. Until recently, two-stage exchange or life-long antibiotic suppression therapy has been the rule. However, novel treatment concepts evolved. Whereas no controlled trials on the surgical management of prosthetic-joint associated infection are available, much is known about the optimal antimicrobial therapy. Modern treatment concepts are based on animal studies, in vitro data, observational studies and one single controlled trial comparing two different antimicrobial regimens in patients with orthopaedic device-associated infections [. 2. ]. The tissue-cage guinea pig model is especially suitable to analyse the role of antibiotics in device-related infections [. 3. ]. In this model, different aspects of implant-associated infections have been studied, namely. host-defense mechanisms around implants [. 1. ],. risk of hematogeneous infection of extravascular devices [. 4. ],. efficacy of prevention or antibiotic treatment [. 5. –. 12. ],. correlation between efficacy of treatment in vivo and in vitro [. 11. ,. 12. ], and the role of biofilm formation on the activity of antibiotics [. 11. ]. Taken together, these experiments showed that an agent acting on slow-growing and adhering microorganism is needed to eradicate device-associated infection. This requirement is only fulfilled by rifamycins in staphylococcal infection and by fluoroquinolones in infections caused by gram-negative bacilli [. 5. –. 12. ]. We could show that even new drugs against methicillin-resistant staphylococci (MRSA), such as linezolid and daptomycin, were not able to eradicate experimental foreign-body infections, when used as single agents. In contrast, in combination with rifampin linezolid cured 60%, and daptomycin 67% of the implant-associated MRSA-infections [. 9. ,. 10. ]. Based on these in vitro and animal data, observational studies were performed in patients with staphylococcal infections associated to orthopedic devices. We developed an algorithm allowing to choose the optimal therapeutic option for each patient [. 2. ]. This algorithm has been validated in cohort studies [. 13. ,. 14. ]. Finally, in a
Background: Clinical studies of Collagen Hydrolysate have suggested efficacy in decreasing symptoms and increasing joint function. Therefore a large multi-center,