MOTION AND ITS EFFECTS ON THE CEMENT MANTLE – A BIOMECHANICAL ANALYSIS OF FEMORAL STEM DISPLACEMENT DURING IMPLANT CEMENTATION
Background: It is a common notion that motion of a femoral component during cementation should be avoided as it may weaken the cement mantle. We created an in vitro model of cemented femoral components and subjected them to varying rotational motion during the cement curing process, to measure the effect on the pullout strength of the stem. Methods: 21 sawbones femurs were separated into four groups. The first group served as control and was cemented in a standard fashion. The remainder of the stems were divided into groups and subjected to angular rotational displacement within the cement mantle during curing . Anteroposterior and lateral radiographs were obtained of each model to evaluate for cement defects. Pullout strength testing was performed. Results: Despite rotational displacement, no cement defects were noted on imaging. The control stems showed an average pullout strength of 3735.79N. The experimental groups showed a trend for lower failure loads but it was not statistically significant (P=0.063). Of the 21 stems tested, three encountered cement mantle failure and associated stem pullout and the remainder failed by peripros-thetic fracture. Conclusion: Despite conventional thinking that rotational displacement during the cementing process leading to disruption of the cement mantle integrity, this was not borne out in our study. This should give surgeons confidence that in the set-ting of unintended rotational displacement of a femoral stem, returning the stem to its original position does not significantly compromise the integrity of the cement mantle or the pullout strength of the femoral implant. Small displacement of the femoral stem with prompt correction during cement curing does not cause evident cement mantle defects or a loss of femoral stem pullout strength.
We report in the light of a literature review the results of 10 patients followed for anterior instability of the gleno-humeral joint treated by open Latarjet procedure between January 2017 and December 2020 with a view to a prospective study with longer following up and a greater number of patients.
SINGLE STAGE KNEE ARTHROPLASTY REVISION SURGERY, OUR EXPERIENCE WITH ELEVEN CASES AND REVIEW OF THE LITERATURE
Knee replacement is a widely performed and very successful procedure for the management of knee arthritis. Nevertheless, it is postulated that a total of 2-5% of primary and revision total knee arthroplasties (TKAs) is infected every year [1,2]. Despite the low incidence, the absolute numbers of prosthetic joint infections (PJIs) are growing, owing to an increased number of replacement surgeries, and are associated with significant morbidity and socioeconomic burden [3,4]. Although several definitions of PJI exist, Musculoskeletal Infection’s Society (MSIS) definition is based on strict criteria and is one of the most used . Patients with certain risk factors have an increased risk to develop PJI [6,7]. Risk factors include presence of systemic or local active infection in an arthritic knee; previous operative procedures in the same knee, diabetes mellitus, malnutrition, smoking, alcohol consumption, co-morbidities, and immunosuppression; end-stage renal disease on hemodialysis, liver disease, intravenous drug abuse, and low safety operative room environment. PJIs are classified according to the depth of infection, to superficial and deep infections. Superficial infections are limited to the incision and superficial tissues, while deep infections, that involve deep layers, may occur up to one year postoperatively, and influence surgical management strategy. Timing of infection is also an important factor in guiding treatment. PJIs are classified to acute postoperative, within a month of the index procedure, acute haematogenous, presenting with acute symptoms in a previously well – functioning joint, and late chronic, where infection develops later than one month postoperatively . Management of PJI’s is mainly surgical, reserving conservative treatment for patients unable to undergo surgery . Surgical options include debridement and retention of the prosthetic implants (DAIR), two – stage exchange revision, single – stage exchange revision, permanent resection arthroplasty, and finally amputation as the last measure . DAIR is a viable option in early…
Femoral neck fractures are common fractures in the elderly, especially in elderly women. There are many mature treatment methods for femoral neck fractures. However, which option is better is still controversial. In order to allow clinicians to better develop treatment plans for elderly patients with femoral neck fractures, this article summarizes the diagnosis and treatment status of elderly femoral neck fractures from the aspects of epidemiology, etiology and diagnosis, treatment methods and progress of elderly femoral neck fractures.
Background: Anterior talofibular ligament (ATFL) injuries are the most common in ankle torsional injuries. ATFL and peroneal tendons are both important stabilizers of lateral ankle joint. We aimed to evaluate peroneal tendons and ATFL. Methods: Fifteen nonpaired leg of fresh frozen cadavers were assessed in this study. After harvesting, ATFL diameters were measured at three points by calipers, these are fibular side, intermediate side and talar side. The mean of these three measurements were assessed and tissue a 15 lb load was applied to the peroneal tendons for 10 minutes, and the transverse diameters were measured by folding the thickest part of the tendon in a double-strand. Results: 5 single bundle, 8 double-bundle and 2 three bundles of ATFL were obtained after dissection. . There was no correlation between ATFL diameter, peroneus longus, peroneus brevis and total tendon diameters of peroneus longus and peroneus brevis in women (p> 0.05). A strong correlation was found between ATFL diameter, peroneus longus (r: 0.95), peroneus brevis (r: 0.81) and total tendon diameters of peroneus longus and peroneus brevis (r: 0.92) in men. Conclusion: Relationship between the diameter of the ATFL and peroneal tendons diameters were evaluated and a correlation was observed in males, while no correlation was observed in females.
A desmoid tumor (DT) was first described by MacFarlane in 1832. DTs are rare tumors, corresponding to only 0.03% of all neoplasia and less than 3% of all soft tissue tumors. Most of the tumors occur in the abdomen and presentation in the extremities is uncommon. Here, we present a review of the literature and the 27th case of DT of the foot.
SEMI-RIGID LUMBAR SPINE FIXATION WITH PEEK RODS AS A TREATMENT OPTION FOR MONO-SEGMENTAL DEGENERATIVE DISK DISEASE
Long lasting back pain due to degenerative disc disease is one of the major reasons for reduced quality of life and work incapacity. In some of these patients conservative treatment will not improve back pain significantly. Therefore fusion surgery as a surgical option is offered to these patients. The main aim of this kind of treatment is the reduction of segmental motion leading to an improvement in pain. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Therefore a semi-rigid stabilization with PEEK rods may be an option because it is associated with less implant related rigidity and is a less invasive procedure. The aim of this retrospective study was to evaluate the improvement in back pain after minimally invasive semi-rigid lumbar stabilization with screws and PEEK rods in 45 patients and to identify potential implant failures during a follow up of two years. Six weeks after surgery the patients showed a significant improvement in their back pain, which persisted during the whole observation time of two years (p
Osteoporosis is a common metabolic disease of the bones that increases bone fragility due to decreased bone mass and bad quality of bone, leading to an increased risk of bone fracture. This disease affects all the bones, including femurs/pelvis, spine, forearms, ribs, mandible, and maxillary bone. Periodontitis is an inflammation of the tissue around the teeth that results from infections and leads to tooth loss due to attachment loss and destruction of the alveolar bones around the teeth. Apart from Periodontitis, does Osteoporosis also lead to tooth loss? The purpose of this article is to answer this question. An electronic search of English language literature was conducted through PubMed, Medline, and Google scholar. The articles were selected through their topics and contents regarding osteoporosis, periodontitis, and tooth loss. The selected articles included cross-sectional, cohort, and review studies. Osteoporosis and periodontitis are multifactorial diseases and recent studies revealed a positive relation between periodontal disease and osteoporosis. In summary, as well as osteoporosis has an indirect correlation with tooth loss by periodontitis, it also has a direct relationship with tooth loss by decreasing mandibular and maxillary alveolar bone density. Not only Tooth loss could occur due to periodontitis, but also it has many other reasons, which with nowadays researches osteoporosis counts as one of them. Due to the effect of osteoporosis in the reduction of BMD and its relationship with periodontitis, it can both directly and indirectly result in tooth loss. Further well-controlled researches are required to clarify the inter-relationship between osteoporosis and tooth loss.
RESULTS OF OPEN REDUCTION INTERNAL FIXATION OF DISPLACED INTRAARTICULAR CALCANEUS FRACTURE WITH LOCKING PLATE
Introduction: One of the most common foot fractures, fracture calcaneum, whenever has displacement of articular surface, is treated operatively. Various modes of treatment are used for the same. Non operative treatment in severe cases has been associated with poor result. Material and methods: The study included 43 prospective and retrospective cases in 38 patients of intra-articular calcaneal fractures treated operatively with open reduction and internal fixation with locking plate using the standard lateral approach. The patients were assessed radiologically and for functional outcome as per AOFAS (American Orthopedic Foot and Ankle Score) score. Results: 43 fractures in 38 patients were included in our study between19 to 62 years of age with mean age in our study between 38.53±11.17. 79% patients were males and 21% were females. Sander’s type of fracture pattern affected the complications following surgery. There was no influence of complications following surgery over final AOFAS score. Conclusion: Careful patient selection, preoperative planning, appropriate timing for surgery, proper approach for raising full thickness flaps and accurate anatomic reduction gives a good functional outcome.
Osteoarthritis (OA) has long been considered as a degenerative disease, but growing evidence suggests that inflammation plays a vital role in its pathogenesis. Unlike rheumatoid arthritis and other autoimmune diseases, inflammation in OA is chronic and in relatively low-grade, mainly mediated by the innate immune system, especially macrophages. However, due to its low abundance, there is a lack of systematic studies on macrophages in the OA condition. Here, we have used single-cell RNA sequencing analysis to gain insight into the heterogeneity and functional specialization of human knee macrophages. We also compared the gene expression profiles of macrophages in healthy people and OA patients, and found the characteristic changes of special macrophages in the OA knee. We believe that this in-depth understanding of the basis of OA inflammation will bring hope for the development of new therapies.