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1.

Background

A number of studies on total hip arthroplasty have compared highly cross-linked polyethylene (HXLPE) with conventional polyethylene (CPE) liners beyond 10 years. However, the impact of HXLPE on the wear-related reoperation rate is unclear. The purpose of this study was to evaluate the clinical advantage of using a single manufacturer's HXLPE in terms of reducing the reoperation rate.

Methods

The study was a follow-up retrospective cohort study over a mean of 12 years that examined patients aged 45-70 years with cementless total hip arthroplasty using a 26-mm-diameter cobalt-chromium head. Sixty-seven patients (79 hips; HXLPE group = 41 hips, CPE group = 38 hips) were evaluated for a minimum 10-year follow-up. Kaplan-Meier survival analysis was performed, with wear-related reoperations and radiographic osteolysis serving as the end points. The polyethylene wear rate was also assessed.

Results

The mean 12-year follow-up rates of survivorship that were evaluated using wear-related reoperations as the end point were 100% and 91.4% in the HXLPE and CPE groups, respectively (P = .007), and the mean 12-year follow-up rates of survivorship with osteolysis as the end point were 100% and 36.2%, respectively (P < .001). Compared with the CPE group, the HXLPE group presented a significantly reduced wear rate (HXLPE group, 0.035 mm/y; CPE group, 0.118 mm/y).

Conclusion

A unique strength of this study is that we assessed a single manufacturer's HXLPE while keeping most other implant parameters uniform. This study reveals the clinical advantage of using a single manufacturer's HXLPE in terms of a reduced wear-related reoperation rate at a mean 12-year follow-up.  相似文献   

2.

Background

Polyethylene acetabular components are common in hip arthroplasty. Highly cross-linked polyethylene (HXLPE) has lower wear than ultra-high molecular weight polyethylene (UHMWPE). Evidence suggests that wear particles induce inflammation causing periprosthetic osteolysis contributing to implant loosening with wear rates of 0.05 mm/y were considered safe. We aimed to compare incidence and volume of periacetabular osteolysis between HXLPE and UHMWPE using computed tomography.

Methods

Initially, 54 hips in 53 patients were randomized to HXLPE or UHMWPE acetabular liner. At 10 years, 39 hips in 38 patients remained for the radiostereometric analysis' demonstrating significantly lower wear in the HXLPE group. At 12 years, 14 hips in 13 patients were lost to follow-up leaving 25 hips for computed tomography assessment. Images were reconstructed to detect osteolysis and where identified, areas were segmented and volumized.

Results

Osteolysis was observed in 8 patients, 7 from the UHMWPE group and only 1 from the HXLPE group (Fisher exact, P = .042). There was no correlation between the amount of polyethylene wear and osteolysis volume; however, the radiostereometric analysis-measured wear rate in patients with osteolysis from both groups was significantly higher than overall average wear rate.

Conclusion

This data demonstrates lower incidence of periacetabular osteolysis in the HXLPE group of a small cohort. Although numbers are too low to estimate causation, in the context of lower wear in the HXLPE group, this finding supports the hypothesis that HXLPE may not elevate osteolysis risk, and hence does not suggest that HXLPE wear particles are more biologically active than those generated by earlier generations of polyethylene.  相似文献   

3.

Background

There is a paucity of reports on osteolysis associated with tibial screw fixation in cementless total knee arthroplasty (TKA), and the pathophysiology is not clear. This study aimed to describe the pathology related to screw track osteolysis around the tibia in cementless TKA.

Methods

The study cohort comprised 100 revised cementless TKAs with tibial screw fixation. Screw track osteolysis and various screw angles were analyzed radiologically. Tissue samples from the joint capsule and the osteolytic cavity were investigated for metal/polyethylene wear. The type of tissue response was determined using immunohistochemistry. Retrieved tibial polyethylene inserts were analyzed for screw hole impression and mode of wear. Tissue metal content was measured by inductively coupled plasma optical emission spectrometry. Electrochemical reactions between the tibial tray and the cancellous screws were investigated.

Results

Radiological analysis showed screw track osteolysis predominantly at the medial aspect of the tibial component, and the severity of osteolysis positively correlated with smaller medial proximal tibial screw angles. Osteolysis was associated with high titanium concentrations but not with polyethylene particles. An open circuit potential between the screw and the tibial base plate was measured. Necrosis, osteolytic cyst formation and macrophages, T and B cells, and dendritic cells were present.

Conclusion

The present study highlights the risk for screw track osteolysis in cementless TKA with screw fixation. Our data collectively suggest that titanium wear may contribute to screw track osteolysis in the cementless TKA design. The contribution of screw angles is difficult to prove.  相似文献   

4.

Background

Dislocation is a major complication following total hip arthroplasty, with risk factors such as surgical technique, implant positioning, and implant design. Literature has suggested the distance the femoral head must travel before dislocation to be a predictive factor of dislocation where smaller travel distance has increased dislocation risk. The purpose of this study was to compare 3 designs (hemispherical, metal-on-metal, and dual mobility [DM]) in terms of the dynamic dislocation distance and force required to dislocate.

Methods

This dynamic dislocation distance model used a material testing system that defined acetabular component inclination (30°, 45°, and 60°), anteversion angles (0°, 15°, and 30°), and pelvic tilt (5° [standing] and 26° [chair rise]). Testing groups included a hemispherical shell with a modular polyethylene liner and 32-mm head, a metal-on-metal hip resurfacing cup design with a 40-mm CoCr head, and a DM design with a 42-mm outside diameter articulating liner and an inner 28-mm articulating head.

Results

The dynamic dislocation distance of the DM hip was greater than that of the other designs for all inclination, anteversion, and pelvic tilt angles tested with the exception of 60° inclination/0° anteversion. At 26° pelvic tilt, it was observed that dislocation distance increased with greater anteversion and decreased with larger inclination.

Conclusion

Clinical results have shown the DM design may reduce dislocation. These data support those findings and suggest that if instability is a concern preoperatively or intraoperatively, using a DM implant increases the dynamic dislocation distance.  相似文献   

5.

Background

Due to anterior bone defects, high and/or posterior placement of an acetabular cup is often required to achieve sufficient coverage in patients with hip dysplasia. We examined whether posterior cup placement affected the postoperative range of motion (ROM) in primary total hip arthroplasty (THA).

Methods

Using computer software, bone coverage and ROM were examined in 32 patients with unilateral osteoarthritis of the hip with Crowe type II or III hip dysplasia. We determined the cup position to satisfy cup center-edge (Cup-CE) angle ≥0° and the required ROM. The cup was placed at the anatomic hip center and moved in 2-mm increments anteroposteriorly and 10-mm increments vertically.

Results

At vertical anatomic hip center, less than 68.8% hips fulfilled Cup-CE ≥0° regardless of anteroposterior position. Significantly more hips at higher hip center with posterior cup placement achieved Cup-CE ≥0° than hips at vertical anatomic hip center, and 10 mm higher hip center was the most suitable for achieving bone coverage. However, posterior and superior cup placement significantly decreased the flexion and IR due to early bone impingement, whereas ER and extension were not affected. A smoothing spline curve demonstrated that more posterior cup placement than 4.8 mm and 3.6 mm did not satisfy the required ROM at 10 mm and 20 mm higher hip center, respectively.

Conclusions

Posterosuperior cup placement gained more bone coverage but decreased the range of hip flexion and internal rotation. Consequently, posterosuperior cup placement did not satisfy the required ROM.  相似文献   

6.

Background

The short-term corrosion and micromechanical behavior of 32 unique head-neck taper design/material/assembly conditions was tested using an incremental cyclic fretting corrosion (ICFC) test method previously developed.

Methods

Seven materials, design, and simulated surgical parameters were evaluated, each being assigned 2 conditions for testing, using a 27-2 (7 factor, quarter factorial) design of experiments test matrix. The factors explored were (1) seating load, (2) head-neck offset, (3) material combination, (4) taper diameter, (5) taper roughness, (6) angular mismatch/engagement, and (7) taper length. Each sample underwent assembly, ICFC testing, pull off.

Results

Low seating load and high head offset correlated with increased fretting corrosion (P < .05). High head offset also contributed to a lower onset load for fretting current and higher micromotion (P < .05). Head subsidence measured over the ICFC test for samples seated at 100 N was significantly higher than samples seated at 4000 N. Micromotion for 12-mm head offsets was statistically higher than samples with a 1.5-mm head offset. A number of interactive effects were observed. For example, samples seated at 4000 N were less sensitive to head offset than samples seated at 100 N in terms of the resulting fretting current.

Conclusion

Taper locking position, material combination, taper engagement length, taper roughness, and taper dimensions all had weak or no correlation with fretting current and taper micromotion. This test method and experimental design is a versatile means of assessing potential new taper designs in the future.  相似文献   

7.

Background

There were few studies assessed the postoperative sarcopenia in patients with cancers. The objective of present study was to assess whether postoperative development of sarcopenia could predict a poor prognosis in patients with adenocarcinoma of esophagogastric junction, (AEG) and upper gastric cancer (UGC).

Methods

Patients with AEG and UGC who were judged as non-sarcopenic before surgery were reassessed the presence of postoperative development of sarcopenia 6 months after surgery. Patients were divided into the development group or non-development group, and clinicopathological factors and prognosis between these two groups were analyzed.

Results

The 5-year overall survival rates were significantly poorer in the development group than non-development group (68.0% vs. 92.6%, P?=?0.0118). Multivariate analyses showed that postoperative development of sarcopenia was an independent prognostic factor for poor overall survival (P?=?0.0237).

Conclusions

Postoperative development of sarcopenia was associated with a poor prognosis in patients with AEG and UGC.  相似文献   

8.

Introduction

The Affordable Care Act (ACA) mandated the expansion of Medicaid in order to increase access to health care services. We examined the effect of the ACA on breast cancer screening and diagnosis at a Los Angeles safety net hospital.

Methods

We performed a retrospective review of breast cancer patients treated at our institution. We compared two cohorts: patients diagnosed with breast cancer in the years 2011–2012 (pre-ACA) vs. 2015–2016 (post-ACA).

Results

There were no differences in number of screening mammograms performed, age at diagnosis, mammography-detected cancers, or clinical stage at diagnosis. There was a significant decrease in the number of patients who reported as self-pay (34% vs. 6%, p?<?0.0001).

Conclusion

In the 2-year period following ACA implementation, there was limited impact on breast cancer presentation at a safety-net hospital. Long-term follow-up across different healthcare systems is necessary to fully evaluate the global impact of the ACA on breast cancer care.  相似文献   

9.

Study Design

A within-subject research design was used in this study. The difference of the range of motion (ROM) with and without ulnar nerve block was analyzed.

Introduction

For the clinical evaluation of the functional effects of ulnar nerve palsy at the hand the relevance of clinical tests is in discussion.

Purpose of the Study

The aim of the study was to evaluate the predictive value of 2 clinical tests for a simulated ulnar nerve lesion by motion analysis with a sensor glove.

Methods

In 28 healthy subjects, dynamic measurements of the finger joints were performed by a sensor glove with and without ulnar nerve block at the wrist. In the 0° metacarpophalangeal (MCP) stabilization test, the subjects were asked to stabilize the MCP joints actively in 0° while moving the interphalangeal joints, whereas at the 90° MCP stabilization test, the subjects stabilized the MCP joints actively in the 90° position.

Results

In the 0° MCP stabilization test, no remarkable changes of the ROM were found at the MCP joints; at the proximal interphalangeal joints 2-5, the ROM decreased with ulnar nerve block, significantly at the index, middle, and ring fingers (P < .05). In the 90° MCP stabilization test, the average ROM of the MCP joints 2-5 significantly increased with ulnar nerve block (P < .05), whereas at the PIP joints, the average ROM decreased (P < .05).

Discussion

The 90° MCP stabilization test had a high predictive value for the discrimination between healthy subjects and subjects with a simulated peripheral ulnar nerve lesion.

Conclusions

The results could be relevant for the determination of the functional effect of ulnar nerve palsy and the quantification of clawing in hand rehabilitation.

Level of Evidence

II.  相似文献   

10.
11.

Study Design

Case report.

Introduction

Development of extensor tendon adhesions is a common complication after intra-articular metacarpal head fracture. Whenever these adhesions cannot be mobilized by rehabilitation, tenolysis should be considered. However, the decision for tenolysis is often delayed. When the rehabilitation program comes to a plateau and clinical examination may not be sufficient to find out the cause, dynamic ultrasound (US) can show where the gliding mechanism is disrupted and help clinicians to give an accurate decision for determining the next steps.

Purpose of the Study

To determine the role of dynamic US during hand rehabilitation.

Methods

A 22-year-old woman presented with a fifth metacarpal intra-articular head fracture. Ten days after the surgery (open reduction and internal fixation) the hand rehabilitation program was commenced. After the third week, the metacarpophalangeal (MP) joint range of motion (ROM) gradually diminished. Dynamic US near the level of fifth MP joint revealed diminished extensor tendon excursion and capsular thickening.

Results

Considering physical and sonographic findings, surgical tenolysis and capsular release was planned. After surgery, the DIP, PIP and MP joints reached full passive ROM.

Conclusion(s)

Ultrasound is a quick and practical way to diagnose tendon adhesions. With this report, the authors suggest that clinicians may use dynamic US, especially in times when the patient comes to plateau during hand rehabilitation.

Level of Evidence

IV.  相似文献   

12.

Study Design

Two-group randomized controlled trial.

Introduction

Upper limb orthoses worn during functional tasks are commonly used in pediatric neurologic rehabilitation, despite a paucity of high-level evidence.

Purpose of the Study

The purpose of this study was to investigate if a customized functional wrist orthosis, when placed on the limb, leads to an immediate improvement in hand function for children with cerebral palsy or brain injury.

Methods

A 2-group randomized controlled trial involving 30 children was conducted. Participants were randomized to either receive a customized functional wrist orthosis (experimental, n = 15) or not receive an orthosis (control, n = 15). The box and blocks test was administered at baseline and repeated 1 hour after experimental intervention, with the orthosis on if randomized to the orthotic group.

Results

After intervention, there were no significant differences on the box and blocks test between the orthotic group (mean, 10.13; standard deviation, 11.476) and the no orthotic group (mean, 14.07; standard deviation, 11.106; t[28], ?0.954; P = .348; and 95% confidence interval, ?12.380 to 4.513).

Discussion

In contrast to the findings of previous studies, our results suggest that a functional wrist orthosis, when supporting the joint in a ‘typical’ position, may not lead to an immediate improvement in hand function.

Conclusions

Wearing a functional wrist orthosis did not lead to an immediate improvement in the ability of children with cerebral palsy or brain injury to grasp and release. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term.  相似文献   

13.

Background

Critical access hospitals (CAH) serve a key role in providing medical care to rural patients. The purpose of this study was to assess effectiveness of CAHs in initial care of trauma patients.

Methods

A 5-year retrospective review was conducted of all adult trauma patients who were transported directly to a level I trauma facility or were transported to a CAH then transferred to a level I trauma facility after initial resuscitation.

Results

Of 1478 patients studied, 1084 were transferred from a CAH with 394 transported directly to the level I facility. Patients transported directly to the level I hospital were younger and more severely injured. After controlling for injury severity score, age, GCS, and shock, the odds of mortality did not differ between CAH transfer patients and patients transported directly to a level I facility (OR 0.70, P?=?0.20). Transfer from CAH was associated with decreased ICU and hospital days, but not associated with increased ventilator days.

Conclusion

This study demonstrates that use of a CAH for initial trauma care in rural areas is effective.  相似文献   

14.

Study Design

Clinical measurement (reliability and validity) study.

Introduction

Forearm supination is important in many daily activities and is thus measured by therapists and researchers usually with a universal goniometer. DrGoniometer, a SmartPhone application, has been validated for other joint angles in the body.

Purpose of the Study

To establish the reliability and validity of DrGoniometer (CDM S.r.L, Cagliari, Italy) for measuring forearm supination in healthy populations and those with forearm fractures.

Methods

Participants had sustained a distal radius fracture that was treated non-surgically. Forearm supination of the participant’s fractured (n = 30) and healthy forearm (n = 30) was measured using DrGoniometer and the universal goniometer by two assessors. The assessors were blinded to each other’s measurements and their own previous measurements. Reliability was established by calculating Intra-class Correlation Coefficients, standard error of measurement and minimal detectable change. The validity of DrGoniometer was established against the universal goniometer using Pearson’s correlation co-efficient.

Results

Intra-rater reliability of both DrGoniometer and the universal goniometer was high for both fractured and healthy forearms (ICCs ranged from 0.74-0.88). Inter-rater reliability of both DrGoniometer and the universal goniometer was also high in the fractured forearm group (0.76 and 0.72 respectively), but low in the healthy forearm group (0.34 and 0.42 respectively). Correlation between the tools was excellent across the fractured and healthy forearm groups (0.94 and 0.93 respectively).

Discussion

Both goniometers demonstrated good-to-excellent intrarater and iner-rater reliability except in the healthy forearm group where both goniometers demonstrated poor inter-rater reliability which could be due to assessor instructions. The speed the photo can be taken and the digital record obtained are valuable aspects of DrGoniometer.

Conclusion

DrGoniometer is a valid, alternate tool for measuring forearm supination.  相似文献   

15.

Background

This study examines the alignment of quantitative and qualitative assessment data in end-of-rotation evaluations using longitudinal cohorts of residents progressing throughout the five-year general surgery residency.

Methods

Rotation evaluation data were extracted for 171 residents who trained between July 2011 and July 2016. Data included 6069 rotation evaluations forms completed by 38 faculty members and 164 peer-residents. Qualitative comments mapped to general surgery milestones were coded for positive/negative feedback and relevance.

Results

Quantitative evaluation scores were significantly correlated with positive/negative feedback, r?=?0.52 and relevance, r?=??0.20, p?<?.001. Themes included feedback on leadership, teaching contribution, medical knowledge, work ethic, patient-care, and ability to work in a team-based setting. Faculty comments focused on technical and clinical abilities; comments from peers focused on professionalism and interpersonal relationships.

Conclusions

We found differences in themes emphasized as residents progressed. These findings underscore improving our understanding of how faculty synthesize assessment data.  相似文献   

16.

Study Design

Basic research (biomechanics).

Introduction

The high degree of motion that occurs at the thumb metacarpophalangeal (MCP) joint must be taken into account when immobilizing a partially torn or repaired thumb ulnar collateral ligament.

Purpose of the Study

To determine the efficacy of a radial-based thumb MCP-stabilizing orthosis in resisting abduction across the thumb ulnar collateral ligament.

Methods

Ten fresh cadaveric hands were mounted to a custom board. An anteroposterior radiograph of the thumb was obtained with a 2 N preload valgus force applied to the thumb, and the angle between the Kirschner wires was measured as a baseline. Subsequently, 20, 40, 60, 80, and 100 N valgus forces were applied 15 mm distal to the MCP joint. Anteroposterior radiographs of the thumb were obtained after each force was applied. The angle of displacement between the wires was measured and compared with the baseline angle. The angles were measured with an imaging processing tool. A custom radial-based thumb MCP-stabilizing orthosis was fashioned for each cadaveric thumb by a certified hand therapist. The aforementioned loading protocol was then repeated.

Results

The radial-based thumb MCP-stabilizing orthosis significantly reduced mean abduction angles at each applied load.

Discussion

We found that our orthosis, despite being hand-based and leaving the thumb IP and CMC joints free, significantly reduced mean abduction angles at each applied load.

Conclusions

This investigation provides objective evidence that our radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction that occurs at the thumb MCP joint up to at least 100 N.

Level of Evidence

n/a (cadaveric).  相似文献   

17.

Study Design

Case series.

Introduction

A salvaged limb is one that has undergone a major traumatic injury, followed by repeated surgical attempts in order to avoid amputation. Psychological recovery for individuals with lower extremity limb salvage has been examined in a number of studies. However, psychosocial reactions for individuals with upper extremity (UE) limb salvage are understudied in the literature.

Purpose of the Study

The purpose of this study was to explore the process of psychosocial adaptation for 3 trauma cases after UE limb salvage.

Methods

The Reactions to Impairment and Disability Inventory was used to assess psychosocial adaptation. Physical function outcomes (pain, range of motion, edema, sensation, and dexterity) are presented. The Disabilities of the Arm, Shoulder, and Hand measure was used to assess perceived disability. Medical and rehabilitation history are discussed for each case, in order to provide in-depth understanding of the impact of these injuries.

Results

Reactions to injury varied across the cases; however, outcomes suggest that psychosocial adaptation may be influenced by the experience of pain, the ability to participate in valued roles and activities, and having a supportive social network.

Discussion

For this population, therapists may consider emphasizing pain management, focusing on client-centered goals and interventions, and facilitating peer support. Providers should closely monitor patients for signs of poor adaptation, such as hand-hiding behaviors.

Conclusions

This study is among the first to examine psychological outcomes for the UE limb salvage population. Future research would be beneficial to provide deeper understanding of the psychosocial challenges for these individuals.  相似文献   

18.

Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) usually affects both sensory and motor function of hands and feet, resulting in impaired skilled hand function (e.g., typing a keyboard). However, quantitative and objective evaluations for this condition have not been established.

Purpose of the Study

We evaluated skilled hand function using a kinematic analysis and investigated relationships among hand kinematic function and the clinical sensory and motor features of CIPN.

Study Designs

Clinical measurement.

Methods

Twelve CIPN patients and 12 age-matched control participants were enrolled. We recorded their reach and grasp movements using a three-dimensional measurement system, and calculated the normalized jerk of these movements as quantitative indexes of skilled hand function. Additionally, we used the number of sequential hand grip–release cycles in 10 seconds as an evaluation of clinical motor function.

Results

Our kinematic analyses revealed significant difference in normalized jerk of grasp movement (CIPN: 3.7 ± 0.2, control: 3.4 ± 0.1; P = .005), but this was not the case for reach movement (CIPN: 2.5 ± 0.1, control: 2.5 ± 0.2; P = .43), indicating that the distal part of the forearm is particularly affected in CIPN. Such disturbed grasp movement was directly correlated with poor scores on the hand grip–release test and the sensory tests.

Discussion

We revealed deficit impaired hand function objectively and quantitatively in CIPN patients using a kinematic analysis. Further, the hand grip test could represent such kinematic abnormality and could be useful for evaluating skilled hand function of CIPN patients.

Conclusions

Our kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with CIPN in clinical settings.

Level of Evidence

Cross-sectional observational study.  相似文献   

19.
20.

Background

Developmental hip dysplasia is the most common cause of secondary hip osteoarthritis. Due to severe acetabular bone deficiency, cup positioning in total hip arthroplasty (THA) of dysplastic hips remains a surgical challenge. The aim was to analyze the functional outcome of far proximal cup positions in primary THA.

Methods

Fifty patients (61 hips) with THA for severe dysplastic osteoarthritis and a far proximal cup position were included. Patients were divided according to the heights of the implanted cups with increasing vertical distance from the interteardrop line (group A: 55-65 mm, group B: 65-75 mm, group C: >75 mm). Functional outcome was assessed at latest follow-up (38 ± 16 months) by Lower Extremity Functional Score, Tegner Activity Score, and Harris Hip Score (HHS). Patients answered a Patient Satisfaction Questionnaire. Leg length discrepancy was estimated radiographically.

Results

The Lower Extremity Functional Score significantly decreased in C (45.3 ± 25) compared to A (66.7 ± 15.3) and B (67.9 ± 9.9). The Tegner Activity Score significantly increased in all subgroups from preoperative to postoperative (2.2 ± 1.3 to 4.1 ± 1.4; P < .05). The mean overall HHS was 89.3 ± 14.7 (A: 89.5 ± 14.3, B: 94.3 ± 6.5, C: 78.3 ± 22.1). The HHS domains of activity of daily life and gait were significantly reduced in C (P < .05). Patients described a high satisfaction level with the surgery. No significant differences were found with regard to preoperative and postoperative leg lengthening (P = .881). Neither dislocations, impingement problems nor neurologic complications were observed.

Conclusion

Primary THA without any concomitant surgical interventions with a far proximal cup position offers a safe and effective treatment option in severe dysplastic hip osteoarthritis.  相似文献   

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