The latest medical research on Orthopaedic Surgery

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 orthopaedic surgery gathered by our medical AI research bot.

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Treatment patterns and achievement of the treat-to-target goals in a real-life rheumatoid arthritis patient cohort: data from 1317 patients.

Therapy Advances in Musculoskelet Disease

Data regarding the real-life predictors of low disease activity (LDA) in rheumatoid arthritis (RA) patients are limited. Our aim was to evaluate the rate and predictors of LDA and treatment patterns in RA.

This was a multicenter, prospective, RA cohort study where patients were evaluated in two different time points approximately 12 months apart. Statistical analysis was performed in order to identify predictors of LDA while patterns of disease-modifying anti-rheumatic drug [DMARDs; conventional synthetic (csDMARD) or biologic (bDMARD)] and glucocorticoid (GC) use were also recorded.

The total number of patients included was 1317 (79% females, mean age: 62.9 years, mean disease duration: 10.3 years). After 1 year, 57% had achieved LDA (DAS28ESR<3.2) while 43% did not (34%: moderate disease activity: DAS28ESR ⩾3.2 to <5.1, 9%: high disease activity, DAS28ESR ⩾5.1). By multivariate analysis, male sex was positively associated with LDA [odds ratio (OR) = 2.29 p < 0.001] whereas advanced age (OR = 0.98, p = 0.005), high Health Assessment Questionnaire (HAQ) score (OR = 0.57, p < 0.001), use of GCs (OR = 0.75, p = 0.037) or ⩾2 bDMARDs (OR = 0.61, p = 0.002), high co-morbidity index (OR = 0.86, p = 0.011) and obesity (OR = 0.62, p = 0.002) were negative predictors of LDA. During follow-up, among active patients (DAS28ESR >3.2), 21% initiated (among csDMARDs users) and 22% switched (among bDMARDs users) their bDMARDs.

In a real-life RA cohort, during 1 year of follow-up, 43% of patients do not reach treatment targets while only ~20% of those with active RA started or switched their bDMARDs. Male sex, younger age, lower HAQ, body mass index and co-morbidity index were independent factors associated with LDA while use of GCs or ⩾2 bDMARDs were negative predictors.

Real-world evidence of the impact of adalimumab on work productivity and sleep measures in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Therapy Advances in Musculoskelet Disease

Our aim was to evaluate the effect of adalimumab on work productivity measures, overall activity impairment, and sleep quality in patients with active moderate to severe rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) treated in routine care settings in Greece and determine factors associated with work impairment and sleep disturbance.

Patients with active moderate to severe RA (n = 184), PsA (n = 166), and AS (n = 150) were enrolled in this 24-month, prospective, observational study at 80 hospital outpatient clinics and private practices throughout Greece. Patients received adalimumab alone or in combination with standard antirheumatic therapies according to routine care. Work productivity and sleep were assessed through two patient-reported outcome measures: the Work Productivity and Activity Impairment-General Health questionnaire and the Medical Outcomes Study Sleep Scale (MOS-SS). Pearson correlation coefficients were estimated to assess the association of work impairment and sleep disturbances with disease activity scores.

In the overall population, adalimumab significantly lowered absenteeism [mean (95% confidence interval) reduction, 18.9% (13.3-24.5%); n = 100]; presenteeism [40.0% (33.8-46.3%); n = 98], overall work productivity impairment [46.8% (40.4-53.2%); n = 94], activity impairment [47.0% (44.3-49.6); n = 421], and the MOS-SS sleep problems index [31.6 (29.5-34.1); n = 421] after 24-month treatment (p < 0.001). Significant improvements were also noted across the RA, PsA, and AS subpopulations (p < 0.05). Improvements in overall work impairment and sleep disturbance positively correlated with improvements in disease activity measures.

Adalimumab improves work productivity and sleep problems while lowering disease activity in patients with moderate to severe RA, PsA, and AS managed in real-world settings.

Effects of Cyclic Compression on Intervertebral Disc Metabolism using a Whole-Organ Rat Tail Model.

Journal of Orthopaedic Research

Many factors contribute to the development and progression of intervertebral disc (IVD) degeneration. This study was designed to assess the effects...

Teamwork in hip preservation: the ISHA 2019 Annual Scientific Meeting.

Arthroscopy

Hip preservation surgery is now an established part of orthopedic surgery and sports medicine. This report describes the key findings of the 11th A...

Effect of intraoperative dexmedetomidine infusion during functional endoscopic sinus surgery: a prospective cohort study.

Patient Safety in Surgery

Dexmedetomidine, an α2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this study to evaluate the effect of intraoperative dexmedetomidine infusion on intra operative blood loss and postoperative pain in functional endoscopic sinus surgery.

This prospective cohort study included 90 patients planning to undergo endoscopic sinus surgery, who were randomly divided into three groups. 2 to 2.5 mg/kg of propofol was used in all groups to induce anesthesia. One group received dexmedetomidine 0.2 μg/kg per hour infusion whereas the other group received dexmedetomidine 0.5 μg/kg per hour infusion. The control group received normal saline infusion.

The mean age of patients was 41.02 ± 11.93. 33 patients in the dexmedetomidine 0.2 μg/kg/h group, 30 patients in the dexmedetomidine 0.5 μg/kg/h group and 27 patients in the placebo group. The lowest amount of bleeding was related to the dexmedetomidine 0.5 μg/kg/h group. The volume of bleeding between the three groups was significantly different (p = 0.012). The satisfaction of the surgeon in the dexmedetomidine 0.5 μg/kg/h group was more than other groups. There was a significant relationship between the satisfaction of the surgeon and the treatment groups (p < 0.001). The lowest duration of surgery was related to the dexmedetomidine 0.2 μg/kg/h group. The most Trinitroglycerin (TNG) consumption was in the placebo group and the highest dose of labetalol was in the dexmedetomidine 0.5 μg/kg/h group. There was no significant difference in the TNG and labetalol consumption between three groups. The lowest consumption of morphine and pethidine in the dexmedetomidine 0.5 μg/kg/h group.

Infusion of dexmedetomidine 0.5 μg/kg/h decreased blood loss and consumption of morphine and pethidine in patients who underwent endoscopic sinus surgery.

Pulsed electromagnetic fields improve the healing process of Achilles tendinopathy: a pilot study in a rat model.

Bone and Joint Research

In the context of tendon degenerative disorders, the need for innovative conservative treatments that can improve the intrinsic healing potential of tendon tissue is progressively increasing. In this study, the role of pulsed electromagnetic fields (PEMFs) in improving the tendon healing process was evaluated in a rat model of collagenase-induced Achilles tendinopathy.

A total of 68 Sprague Dawley rats received a single injection of type I collagenase in Achilles tendons to induce the tendinopathy and then were daily exposed to PEMFs (1.5 mT and 75 Hz) for up to 14 days - starting 1, 7, or 15 days after the injection - to identify the best treatment option with respect to the phase of the disease. Then, 7 and 14 days of PEMF exposure were compared to identify the most effective protocol.

The daily exposure to PEMFs generally provided an improvement in the fibre organization, a decrease in cell density, vascularity, and fat deposition, and a restoration of the physiological cell morphology compared to untreated tendons. These improvements were more evident when the tendons were exposed to PEMFs during the mid-acute phase of the pathology (7 days after induction) rather than during the early (1 day after induction) or the late acute phase (15 days after induction). Moreover, the exposure to PEMFs for 14 days during the mid-acute phase was more effective than for 7 days.

PEMFs exerted a positive role in the tendon healing process, thus representing a promising conservative treatment for tendinopathy, although further investigations regarding the clinical evaluation are needed.Cite this article: Bone Joint Res 2020;9(9):613-622.

Induced Hypothyroidism Alters Articular Cartilage in Skeletally Immature Miniature Swine.

Connective Tissue Research

Thyroid hormone has been implicated in the normal growth and development of articular cartilage; however, its effect on a disease state, such as hypothyroidism, is unknown. The purpose of this investigation was to compare normal articular cartilage from proximal femurs of immature miniature swine to proximal femurs from hypothyroid-induced immature miniature swine.

Two 11-week-old male Sinclair miniature swine were made hypothyroid by administration of 6-propyl-2-thiouracil (PTU) in their drinking water; two control animals did not receive PTU. At 25 weeks of age, the animals were euthanized and their proximal femurs were fixed and decalcified. Samples were sectioned and analyzed by histology to define extracellular matrix (ECM) structure, immunohistochemistry (IHC) to identify types II and X collagen, and histomorphometry to assess articular cartilage mean total and localized height and cell density. Statistics included nested mixed-effects ANOVA with p ≤ 0.05 considered statistically significant.

Compared to controls, hypothyroid articular cartilage demonstrated statistically significant quantitative differences in mean tissue height, mean cell density and type II collagen localized zone height. Qualitative differences in ECM proteoglycans and overall collagen types were also found. Type X collagen was not detected in either hypothyroid or control articular cartilage specimens.

Understanding articular cartilage development in immature animal models may provide insight into healing or repair of degenerative human articular cartilage.

3D Assessment in Posttraumatic Ankle Osteoarthritis.

Foot and Ankle International

Auto-generated 3-dimensional (3D) measurements based on weightbearing cone-beam computed tomography (CT) scan technology may allow for a more accurate hind- and midfoot assessment. The current study evaluated the reliability and clinical relevance of such measurements in patients with posttraumatic end-stage ankle osteoarthritis.

Seventy-two patients treated at our institution for posttraumatic end-stage ankle osteoarthritis, with available weightbearing conventional radiographs and a cone-beam CT scan, were analyzed. Twenty healthy individuals aged between 40 and 70 years served as controls. Seven variables were measured on weightbearing conventional radiographs (2D) and compared to 3D measurements that were based on reconstructions from weightbearing cone-beam CT scans. The reliability of each measurement was calculated and subgroups formed according to commonly observed deformities.

Inter- and intraobserver reliability was superior for 3D compared to 2D measurements. The accuracy of 3D measurements performed on osteoarthritic ankles was similar to 3D measurements performed on healthy individuals. Thirty-three of the 72 included patients (46%) evidenced an inframalleolar compensation of a supramalleolar/intra-articular ankle deformity (78% = varus compensation; 22% = valgus compensation), whereas 24 of those 72 patients (33%) showed no compensation or a further increase of a supramalleolar/intra-articular ankle deformity (67% = varus deformity; 33% = valgus deformity).

Auto-generated 3D measurements of the hind- and midfoot were found to be reliable in both healthy individuals and patients with posttraumatic end-stage ankle osteoarthritis. Such measurements may be crucial for a detailed understanding of the location and extent of hindfoot deformities, possibly impacting decision making in the treatment of end-stage ankle osteoarthritis.

Level III, comparative study.

Intradural extramedullary spinal metastasis of renal cell carcinoma: illustrative case report and comprehensive review of the literature.

European Spine Journal

Case report and literature review.

Intradural metastasis of renal cell carcinoma (RCC) has rarely been reported. We describe a case of an intradural extramedullary spinal metastasis to the cervical spine in a 68-year-old male treated for RCC 22 years prior. Additionally, we review the known reports of both intradural extramedullary and intramedullary of RCC.

A 68-year-old male with a history of right-sided nephrectomy for RCC preformed 22 years prior now presents with a MRI of the cervical spine showing a 1.5 cm contrast enhancing intradural extramedullary lesion at the level of C3-C4. Surgical resection of the lesion was performed. The tumor's histological and immunohistochemical profile was consistent with metastatic RCC. There are 18 reported cases of intradural extramedullary metastases of sporadic RCC. The average age at diagnosis was 61.6 ± 14.3 years. The interval from diagnosis of primary RCC to diagnosis metastasis ranged from 0 to 264 months (mean 46.8 ± 74.0 months). Sixteen cases of intramedullary renal cell carcinoma metastasis are reported. The average age at time of diagnosis was 53.6 ± 10.2 years. The interval from diagnosis of primary RCC to diagnosis of metastasis ranged from 0 to 180 months (mean 20.9 ± 53.4 months).

The 22-year interval from diagnosis of primary RCC to intradural metastasis is the longest latency reported in the literature. Intramedullary metastases tend to have a younger age at diagnosis and shorter interval from diagnosis of primary RCC compared to extramedullary lesions.

Cancer cachexia and skeletal muscle atrophy in clinical studies: what do we really know?

Journal of Cachexia, Sarcopenia and Muscle

Research investigators have shown a growing interest in investigating alterations underlying skeletal muscle wasting in patients with cancer. Howev...

Letter to the Editor concerning "Impact of spinal alignment and stiffness on impingement after total hip arthroplasty: a radiographic study of pre‑ and post‑operative spinopelvic alignment" by Hagiwara S, et al. (Eur Spine J. 2020; doi.org/10.1007/s00586-020-06589-z).

European Spine Journal

Dislocation is one of the remaining challenges after total hip arthroplasty. The spinopelvic mobility is considered to be the key to solve this problem and is of interest both to arthroplasty and spine surgeons. The purpose of this letter is to discuss the spinopelvic mobility and spinal stiffness described in the paper titled "Impact of spinal alignment and stiffness on impingement after total hip arthroplasty: a radiographic study of pre‑ and post‑operative spinopelvic alignment." by Hagiwara S, et al. METHODS: Examining the consistency between this paper and previously published papers on spinopelvic mobility.

In this article, radiographic clearance of anterior impingement was defined as adding of femoral shaft angle and sacral slope (SS), and that of posterior impingement as adding SS and femoral shaft angle subtracting 90º in the sitting position. The impingement itself and other factors for dislocation including implant design, implant orientation, extra-prosthetic impingement and their mobilities are not considered in this parameter, and it is better if the validity of this parameter is shown. The term "rigid spine" and "spinal stiffness" are used in the manuscript. When THA candidates are evaluated, they are categorized according to the flexibility and/or sagittal balance. It would be better if the definition was described in the text and the clearance for impingement was shown to be affected by spinal stiffness.

The conclusions and titles are overstated from the results, but this paper is highly valuable in reminding spinal surgeons of the importance of spinopelvic alignment and mobility in THA.