The latest medical research on Hip & Knee Osteoarthritis
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about hip & knee osteoarthritis gathered by our medical AI research bot.
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Cement augmentation of suture anchors in the proximal humerus during rotator cuff repair improves pullout strength: a systematic review.j isakos
To evaluate the biomechanical benefits and fixation strength of cement-augmented versus non-augmented suture anchors in the proximal humerus during rotator cuff repair (RCR).
IV, systematic review.
After review of 105 abstracts, seven full manuscripts met inclusion criteria. Six of seven studies reported statistically significant differences in mean pullout force between augmented (three PMMAs, three composites, one PMMA vs composite) and non-augmented anchors. Of two studies evaluating cycles to failure, both found a significant increase in the augmented versus non-augmented anchors. Of two studies stratifying by anchor position, both investigations identified significant differences in mean pullout strength between augmented and non-augmented anchors at the posteromedial and anterolateral anchor positions.
Cement augmentation of suture anchors in cadaveric humeri for RCR improves pullout strength regardless of cement type used or anchor position. Cement augmentation may provide a viable option for future clinical application.
Return to sport after reverse total shoulder arthroplasty is highly frequent: a systematic review.j isakos
The aim of this systematic review was to determine the rate of return to sport after reverse total shoulder arthroplasty (RSA) and the subjective level of performance.
A total of six studies were included for a total of 457 patients. Mean age and average follow-up were, respectively, 74.7 years (range 33-88 years) and 3.6 years (range 1-9.4 years). The mean rate of return to sport ranged from 60% to 93%. The mean time for resuming sports was 5.3 months. The overall rate of return to sport after reverse shoulder arthroplasty was 79%. The mean level of sports at the time of the survey was worsened in 7.9%, improved in 39.6% and had no change in 55.2% of the cases.
Based on the current available data, return to sports after reverse shoulder arthroplasty is possible and highly frequent. The subjective level of practice undergoes no change or improves in most of the cases. More studies and better-designed trials are needed in order to enrich the evidence on specific sports recovery after the procedure.
Endoscopic cubital tunnel decompression: state of the art.j isakos
Cubital tunnel syndrome is a common compressive neuropathy of the upper limb. Surgical decompression is indicated for patients who failed conservat...
Venous thromboembolism complications in shoulder surgery: current concepts.j isakos
Venous thromboembolism (VTE) is a rare yet known complication of shoulder surgery. Concerning shoulder arthroplasty, reported rates of VTE range fr...
A lower Instability Severity Index score threshold may better predict recurrent anterior shoulder instability after arthroscopic Bankart repair: a systematic review.j isakos
The purpose of this systematic review was to evaluate the efficacy of the ISI score as a tool to predict postoperative recurrence among patients undergoing arthroscopic Bankart procedures.
Four studies concluded the ISI score was effective in predicting postoperative recurrence following arthroscopic Bankart repair; however, these studies found threshold values lower than the previously proposed score of >6 may be more predictive of recurrent instability. A pooled analysis of these studies found patients with an ISI score <4 to experience significantly lower recurrence rates when compared with patients with a score ≥4 (6.3% vs 26.0%, p<0.0001). The mean ISI score among patients who experienced recurrent instability was also significantly higher than those who did not.
The ISI score as constructed by Balg and Boileau may have clinical utility to help predict recurrent anterior shoulder instability following arthroscopic Bankart repair. However, this review found the threshold values published in their seminal article to be insufficient predictors of recurrent instability. Instead, a lower score threshold may provide as a better predictor of failure. The paucity of level I and II investigations limits the strength of these conclusions, suggesting a need for further large, prospective studies evaluating the predictive ability of the ISI score.
Differences in risk factors exist for the occurrence of bilateral versus unilateral distal biceps tendon ruptures: a systematic review.j isakos
This aims of this study were to determine risk factors for bilateral distal biceps rupture and to compare these to the known risk factors for unilateral rupture.
Systematic review; level III evidence.
The 31 papers included a total of 2234 patients with 2366 ruptures. Patients with a bilateral rupture were younger than patients with unilateral ruptures (45.8 vs 48.8 years old). Women made up a larger percentage of patients with bilateral ruptures (6.8% vs 4.0%). Bilateral injuries occurred most commonly during heavy lifting or falls, whereas forced extension of the arm was the most frequently reported injury mechanism reported with unilateral ruptures. Tobacco used was more common in patients with bilateral ruptures (24.4% vs 6.8%). Labour-intensive occupations and anabolic steroid use did not appear to increase the risk of a bilateral rupture. Pooling of the data was not possible due to heterogeneity of the included studies.
While differences in risk factors between patients with unilateral and bilateral ruptures were observed, there was too great of a degree of heterogeneity among the studies to perform a meta-analysis of the data.
Knee registries: state of the art.j isakos
Sports injuries, trauma and the globally ageing and obese population require increasing levels of knee surgery. Shared decision making has replaced...
Outcomes of single bundle arthroscopic anterior cruciate ligament reconstruction in a limited resource setting.j isakos
Despite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in low-income and middle-income countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR) in the urban group and that of the rural group.
Level III, retrospective comparative study.
There was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of laxity and functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely abnormal in all parameters of functional outcomes was higher in the older female in the rural group. Graft failure occurred in 19 (17.6%) knees in the urban group and 17 (16.8%) knees in the rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections.
We advised similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the urban group than the rural group. The rate of deep infection was higher in the rural group as compared with the urban group.
Prioritised challenges in the management of acute knee dislocations are stiffness, obesity, treatment delays and associated limb-threatening injuries: a global consensus study.j isakos
Heterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD.
Ninety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management.
This consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines.
Pre-existing osteoarthritis remains a key feature of arthroscopy patients who convert to total hip arthroplasty.j isakos
To determine the rate of conversion to total hip arthroplasty following ipsilateral hip arthroscopy by a single surgeon in New Zealand and to describe patient-related and surgical characteristics of patients who converted.
Sixty-six out of 1856 (3.56%) primary hip arthroscopies were followed by an ipsilateral hip arthroplasty during the follow-up period (mean 87 ± 29 months). Most patients had pre-existing osteoarthritis and/or chondral lesions (n=51). Dysplasia and over-resection of the acetabulum were also identified as contributing factors.
Conversion rate by a high-volume surgeon in New Zealand was relatively low. Most patients had pre-existing osteoarthritis and/or chondral lesions that became apparent at arthroscopy. Dysplasia is also a factor to be cautious of when selecting patients for arthroscopy. Acetabular resection must be approached cautiously.
SLAP tears and return to sport and work: current concepts.j isakos
Superior labrum, anterior and posterior (SLAP) lesions are common and identified in up to 26% of shoulder arthroscopies, with the greatest risk fac...
Adequate return to sports and sports activities after treatment of Lisfranc injury: a meta-analysis.j isakos
The aim is to assess the RTS rates, times and the sports activity levels after different treatments of Lisfranc injuries.
Systematic review and meta-analysis.
Fifteen studies were included in this review. Methodological quality of the studies was poor. The treatments reported in the studies were conservative treatment, surgical fixation and primary partial arthrodesis. For conservative treatment, the RTS rate regardless of sports level was 93% (95% CI 81% to 98%; n=42) and for return to preinjury level of sports was 88% (95% CI 75% to 95%; n=42). The fixation group showed a RTS percentage of 94% (95% CI 91% to 97%; n=270) to each level of sports and for return to the level before injury was 86% (95% CI 80% to 90%; n=188). In the primary partial arthrodesis group, the return to any level of sports was 94% (95% CI 85% to 98%; n=65) and for return to preinjury level was 74% (95% CI 62% to 83%; n=65). Mean time to RTS ranged from 7 to 33 weeks across all treatment groups. No data pooling was possible for this outcome measure. From the different studies, a total of 43 different sports and 440 physical activities were reported before treatment. After treatment, patients participated in 37 different sports (88%) and 391 different physical activities (89%).
The different treatment options for Lisfranc injuries allow for good sport-specific outcomes with 93% to 94% of athletes returning to any level of sports, and 74% to 88% of athletes returning to their preinjury level of sport. These sport-specific outcomes can be used to inform patients about their expected sport-specific outcomes after different treatments of Lisfranc injuries.