Objectives/Hypothesis
Olfactory dysfunction is common among the general population, with chronic rhinosinusitis (CRS) as one of the leading causes. Patients affected by CRS often report changes in ...taste sensations; however, quantitative measurements have not been performed to date. Therefore, the present study aimed to investigate gustatory and olfactory function in CRS patients prior to and after multimodal treatment.
Study Design
Prospective cohort study.
Methods
Twenty‐one patients suffering from CRS with nasal polyps (14 male, seven female) with a mean age of 48 ± 15 years were included in the study. Chemosensory function was assessed prior to and approximately 190 days after multimodal treatment, which included endoscopic sinus surgery, oral antibiotics for 5 days, oral steroids for 12 days, and at least 6 weeks of topical nasal steroids. Olfactory function was tested with the Sniffin’ Sticks test battery, whereas gustatory function was measured with taste strips. A clinically relevant change in olfactory function was defined as a change of ≥5 points in the threshold, discrimination, and identification scores.
Results
Compared to normative data, patients baseline gustatory and olfactory function was impaired. After multimodal treatment, improvements were seen in olfactory function for eight patients (42%), remained stable in 10 patients (53%), and deteriorated in one patient (5%). Taste function remained unchanged following sinus surgery.
Conclusions
Patients suffering from CRS with polyps exhibit olfactory and taste dysfunctions. Multimodal treatment leads to an improvement in olfactory, but not gustatory functionality.
Level of Evidence
4. Laryngoscope, 128:E86–E90, 2018
Introduction
Fixed-bearing unicompartmental knee arthroplasty (UKA) closely replicates native knee kinematics. As few studies have assessed kinematics following mobile-bearing (MB) UKA, the current ...study aimed to investigate whether MB UKA preserves natural knee kinematics.
Materials and methods
Seven fresh-frozen full-leg cadaver specimens were prepared and mounted in a kinematic rig that allowed all degrees of freedom at the knee. Three motion patterns, passive flexion–extension (0°–110° flexion), open-chain extension (5°–70° flexion) and squatting (30°–100° flexion), were performed pre- and post-implantation of a medial MB UKA and compared in terms of rotational and translational knee joint kinematics in the different anatomical planes, respectively.
Results
In terms of frontal plane rotational kinematics, MB UKA specimens were in a more valgus orientation for all motion patterns. In the axial plane, internal rotation of the tibia before and after UKA was consistent, regardless of motion task, with no significant differences. In terms of frontal plane, i.e., inferior–superior, translations, the FMCC was significantly higher in UKA knees in all flexion angles and motor tasks, except in early flexion during passive motion. In terms of axial plane, i.e., anteroposterior (AP), translations, during open-chain activities, the femoral medial condyle center (FMCC) tended to be more posterior following UKA relative to the native knee in mid-flexion and above. AP excursions of the FMCC were small in all tested motions, however. There was substantial AP translation of the femoral lateral condyle center during passive motion before and after UKA, which was significantly different for flexion angles > 38°.
Conclusions
Our study data demonstrate that the kinematics of the unloaded knee following MB UKA closely resemble those of the native knee while relative medial overstuffing with UKA will result in the joint being more valgus. However, replacing the conforming and rigidly fixed medial meniscus with a mobile inlay may successfully prevent aberrant posterior translation of the medial femoral compartment during passive motion and squatting motion.
Purpose
Balancing mobile-bearing (MB) unicondylar knee arthroplasty (UKA) is challenging. If performed improperly, potential complications include pain, implant loosening, or progression of ...osteoarthritis in the preserved compartment. The purpose of this study was to document effects of improper balancing on knee kinematics and joint contact stress. It was hypothesized that over-stuffing would lead to more valgus and higher lateral contact force.
Methods
Seven fresh-frozen cadaver legs were mounted in a kinematic rig that applied three motion patterns to the specimens: passive flexion–extension, open chain extension, and squatting. During testing, an infrared camera system recorded the trajectories of markers rigidly attached to femur and tibia, while a pressure sensor measured contact pressure in the lateral compartment. Prior computer tomography scans allowed identification of coordinate frames of the bones and calculations of anatomical rotations and translations. Collateral ligament strains were calculated, and quadriceps forces recorded. Following testing on the native knee, a medial MB UKA was implanted in each specimen and all motion trials were repeated. Three inlay thicknesses were tested to simulate optimal balancing as well as under- (1 mm thinner) and over-stuffing (1 mm thicker) of the medial compartment relative to the optimal thickness.
Results
Under-stuffing of the medial compartment leads to kinematics closest to the native knee. Subjectively balanced and over-stuffed MB UKA knees were in more valgus. Lateral peak contact stress was higher from mid- to deep flexion following UKA in all three tested states; however, these results were not significant. Peak strain in the superficial medial collateral ligament (sMCL) was significantly higher in MB UKA, regardless of the inlay thickness mainly in mid-flexion. Inlay thickness had no significant impact on measured quadriceps force during squatting.
Conclusion
The results underline the importance of optimal balancing. Over-stuffing should be avoided as it results in the largest kinematic changes relative to the native condition and induces higher strains in the sMCL. Based on the kinematic findings, it is advisable to use thinner inlays, as long as this is not compromising stability or risking inlay luxation.
Abstract Objective Recent studies have suggested that patients with obstructive sleep apnea (OSA) might be affected by olfactory impairment. However, more evidence is needed on the effect that OSA ...has on the chemical senses (olfaction and gustatory) of these patients, and whether continuous positive airway pressure (CPAP) treatment might help to reverse possible impairment. Methods A prospective study was conducted with 44 OSA patients (17 female and 27 male, mean age 54 ± 9.9 years) who were diagnosed via polysomnography and eligible for CPAP treatment. Orthonasal olfactory and gustatory function was measured with the extended Sniffin' Sticks test battery and "taste strips," respectively, before and after CPAP treatment. Results Baseline olfaction was decreased in OSA patients and after CPAP therapy olfactory scores (TDI: baseline 29.4 ± 4.11 after CPAP 32.3 ± 4.82; p = 0.001; THR: baseline 5.28 ± 1.69 after CPAP 6.78 ± 2.61; p = 0.000; ID: baseline 12.9 ± 1.95 after CPAP 13.6 ± 1.33; p = 0.013) improved significantly. In contrast, neither baseline taste function in OSA patients nor gustatory function after treatment seemed to be affected. Conclusion Orthonasal olfactory function in patients with OSA improves under CPAP therapy; however, gustatory function is not impaired in OSA patients.
Kinematics of a bicruciate-retaining total knee arthroplasty Heyse, Thomas J.; Slane, Joshua; Peersman, Geert ...
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA,
06/2017, Letnik:
25, Številka:
6
Journal Article
Recenzirano
Purpose
The recently reintroduced bicruciate-retaining Total Knee Arthroplasty (BCR TKA) is an interesting approach in the quest for close replication of knee joint biomechanics and kinematics closer ...to the native knee. Therefore, this study aimed at providing a detailed biomechanical view on the functional resemblance of BCR TKA to the native knee joint.
Methods
Seven fresh-frozen full leg cadaver specimens (76 ± 10 year) were mounted in a 6 degrees-of-freedom kinematic rig that applied a dynamic squatting motion knee flexion. Two motion patterns were performed pre- and post-implantation of a fixed bearing BCR TKA: passive flexion–extension and squatting while an infrared camera system tracked the location of reflective markers attached to the tibia and femur. Additionally, specimen laxity was assessed using Lachman tests and varus/valgus stress tests in triplicate.
Results
Overall, differences in tibiofemoral kinematics between native knee and BCR TKA were small. Some minor differences appeared under the load of a squat: less internal tibial rotation and some minor paradoxical anterior translation of the medial femoral condyle during mid-flexion. BCR TKA may slightly elevate the joint line. Knee laxity as measured by the Lachman and varus/valgus tests was not significantly influenced by BCR TKA implantation.
Conclusion
As both cruciate ligaments are preserved with BCR TKA the unloaded knee closely resembles native knee kinematics including preserving the rollback mechanism. The loss of the conforming anatomy of menisci and tibial cartilage and replacement via a relatively flat polyethylene inlay may account for the loss of tibial internal rotation and the slight paradoxical AP motion of the medial femoral condyle with BCR TKA. This phenomenon reproduces findings made earlier with fixed bearing unicondylar knee arthroplasty.
Eustachian tube dysfunction (ETD) affects approximately 1% of adults in the general population. Non treated Eustachian tube dysfunction can result in chronic middle ear diseases, which have been ...shown to significantly affect taste sensitivity. A promising treatment is balloon dilatation of the Eustachian tube. The primary aim of the present study was to investigate whether individuals with ETD had impairment in chemosensory functions, and the changes of the chemosensory function after balloon dilatation of the Eustachian tube.
26 patients (17 female, 9 male) (=56 ears) suffering from ETD with a mean age of 39±15years were included in the present study. 20 patients (76%) returned to be evaluated at the follow up (=40 ears) 51±22days after balloon dilatation. For pre- and post operation, gustatory function was measured with a lateralized gustatory test with the taste strips and olfactory function was tested by means of the Sniffin’ Sticks test battery (threshold, discrimination and identification (ID)).
Patients’ baseline taste function (summed taste score 9.8±3.5 (mean±SD)) was significantly impaired compared to normative data (summed taste score 12.4±2.3; p=0.002). After balloon dilatation of the Eustachian tube, the taste function remained stable (summed taste score 9.4±4.3; p=0.814). Olfactory function (odor ID, summed score (TDI)) improved postoperatively (TDI 32.4±3.6) compared to pre-operative scores (TDI 33.6±4.0; p=0.012), but not to a clinically relevant extent.
This study suggests, that patients suffering from ETD exhibit reduced taste scores. Balloon dilatation of the Eustachian tube does not seem to influence gustatory function, but olfactory function showed improvement.
Abstract Background The recently reintroduced bicruciate retaining Total Knee Arthroplasty (BCR TKA) is an effort to reproduce kinematics closer to the native knee. However, there is no data on ...appropriate balancing with this implant. Balancing is crucial and challenging as medial and lateral polyethylene (PE) inlays are modular, which allows for placement of different thicknesses in the medial and lateral compartments. This study aimed at providing a detailed kinematic view on balancing BCR TKA. Methods Seven fresh frozen cadaver legs were mounted in a kinematic rig that applied squatting under application of physiologic quadriceps and hamstring forces. Additionally, specimen laxity was assessed using Lachman tests and varus/valgus stress tests. Following testing on the native knee, a BCR TKA was implanted in each specimen and all trials were repeated. Using 1 mm increments, five inlay thicknesses were tested to simulate optimal balancing, symmetric under-, and overstuffing, valgus constellation, and varus constellation. Results Overall, knee kinematics following BCR TKA seem to be very close to the native knee. The changes as introduced to tibiofemoral kinematics through over- or understuffing the polyethylene inserts are affecting the system only to a minor degree and generally lack statistical significance. Reproduction of the tibial varus via PE-Inlays did not lead to kinematics much closer to the native knee. Conclusions The changes introduced to tibiofemoral kinematics by removal of the conforming meniscus and cartilage and replacement with a flat PE insert and femoral component are of more impact than different inlay sizes and their combinations for a BCR TKA.
Studies using conventional radiographical signs and computerized tomography (CT) for retroversion of the acetabulum have reported a prevalence of up to 25%. The purpose of this study was to provide a ...detailed report on acetabular version, gender, age and side differences in a large cohort.
A total of 404 patients receiving a whole-body CT scan, aged between 16 and 40 years, have been included in the study. The measurement was performed in the transversal plane on three levels: cranial, central and caudal.
The retroverted acetabulum on all three levels had a prevalence of 0.25% (95% confidence interval 0–0.7%). The average central anteversion in men was 16.46° (±4.42) and that in women was 19.31° (±5.04) (p < 0.001). Version increases with age, but a cluster analysis showed this to be a trend (p = 0.068).
Women have a higher average acetabular version than men. Retroversion in a young adult population has a low prevalence when measured with conventional CT. About a tenth of the population has a significantly different contralateral acetabular version.
Global acetabular retroversion has a much lower prevalence than previously reported.
A relevant proportion of patients undergoing joint replacement surgery for the treatment of osteoarthritis exhibit COPD. This coincidence may result from an increased prevalence of both the diseases ...in elderly patients. In this study, COPD, which is known to be associated with a variety of comorbidities, and its potential interactions, eg, mediated via systemic inflammation, are discussed. The purpose of the present study was to identify the role of COPD as an independent risk factor for complications after total knee and hip arthroplasty.
In a monocentric patient cohort of 2,760 arthoplasties, propensity score matching was done using the following factors: sex, age, replaced joint, American Society of Anesthesiologists' score, body mass index, hypertension, chronic heart disease, anticoagulation, diabetes mellitus, chronic renal deficiency, and actual smoking status to create 224 pairs. Both the pre-matched differences and the results after propensity score matching were statistically analyzed with
≤0.05 being defined as statistically significant.
All confounders were eliminated after matching. Preoperatively measured C-reactive protein and leukocytes were higher in the COPD group (
<0.001;
=0.01, respectively). Intensive care unit admission was higher for COPD patients (
=0.023). Pneumonia occurred in patients with COPD only (
=0.024). There was a trend (not significant) toward a higher rate of wound infections, increased transfusion of red blood cells, and a prolonged hospital stay in patients with COPD.
COPD was associated with an increased length of hospital stay, a higher risk of pneumonia and wound infection, higher general complications, and an increased need for red blood cell transfusion. It is thus recommended to enhance the implementation of pneumonia prevention programs on surgical wards.
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