Objectives. Tendonitis and carpal tunnel syndrome are common cumulative trauma disorders that can occur with repetitive usage of pistol grip power tools. The role of reaction torque resulting in a ...forceful rotary displacement of the tool handle, as well as the role of applied grip force, is not clear in the development of these disorders. This study aimed to quantify the flexor tendon strains and median nerve pressure during a typical power tool operation securing a threaded fastener. Methods. Six fresh-frozen cadaver arms were made to grip a replica pistol grip power tool using static weights to apply muscle forces. A 5-Nm torque was applied to the replica power tool. The median nerve pressure and strains in the flexor digitorum profundus and superficialis tendons were measured using a catheter and strain gauges, at three wrist flexion angles. Results
. The peak tendon strains were between 1.5 and 2% and were predominantly due to the grip force more than the transmitted torque. Median nerve pressure significantly increased with the wrist flexed versus extended. Conclusion
. The results indicate that the contribution of the grip force to the tendon strain and median nerve pressure was greater than the contribution from the reaction torque.
ObjectivesThis study aimed to identify a threshold in annual surgeon volume associated with increased risk of revision (for any cause) and deep infection requiring surgery following primary elective ...total knee arthroplasty (TKA).DesignA propensity score matched cohort study.SettingOntario, Canada.Participants169 713 persons who received a primary TKA between 2002 and 2016, with 3-year postoperative follow-up.Main outcome measuresRevision arthroplasty (for any cause), and the occurrence of deep surgical infection requiring surgery.ResultsBased on restricted cubic spline analysis, the threshold for increased probability of revision and deep infection requiring surgery was <70 cases/year. After matching of 51 658 TKA recipients from surgeons performing <70 cases/year to TKA recipients from surgeons with greater than 70 cases/year, patients in the former group had a higher rate of revision (for any cause, 2.23% (95% Confidence Interval (CI) 1.39 to 3.07) vs 1.70% (95% CI 0.85 to 2.55); Hazard Ratio (HR) 1.33, 95% CI 1.21 to 1.47, p<0.0001) and deep infection requiring surgery (1.29% (95% CI 0.44 to 2.14) vs 1.09% (95% CI 0.24 to 1.94); HR 1.33, 95% CI 1.17 to 1.51, p<0.0001).ConclusionsFor primary TKA recipients, cases performed by surgeons who had performed fewer than 70 TKAs in the year prior to the index TKA were at 31% increased relative risk of revision (for any cause), and 18% increased relative risk for deep surgical infection requiring surgery, at 3-year follow-up.
How much is enough for total knee arthroplasty? Wek, Caesar; Okoro, Tosan; Tomescu, Sebastian ...
BMJ surgery, interventions, & health technologies,
10/2021, Letnik:
3, Številka:
1
Journal Article
Recenzirano
Odprti dostop
...we would argue that the true surgical volume is the most important factor when determining the risk of revision in TKA surgery, as demonstrated by our study.1 The findings in our study are echoed ...in the analysis by Yu et al, which concluded that from a number of outcomes evaluated, only surgical volume was associated with an increased risk of TKA 30-day readmission.2 While it is recognized that highly experienced orthopaedic surgeons may deliver excellent patient outcomes regardless of a minimum volume, evidence suggests that higher surgical volumes result in better patient outcomes.3 Data from Jeschke et al suggested that a minimum institutional threshold of 145 TKA procedures per annum would result in a reduction of revision rates.4 In the USA, reduced mortality rates were observed when surgeons performed greater than 15 cases per year and institutions performed greater than 85 cases.5 Further research by Wilson et al has sought to further define meaningful thresholds in the relationship between surgical volume and patient outcomes in TKA surgery.6 Their work reviewed various surgical procedure numbers among surgeons according to the revision rates from a database of 289 976 knee arthroplasties. In our study, the use of a spline also enabled the identification of a threshold of volume of 70 cases at which the greatest patient benefit is obtained.1 This RCSR method was also used by Chou et al in total hip arthroplasty and demonstrated that there was a minimum surgeon volume threshold of 15 cases per annum for reducing the 30-day unplanned readmission rates.8 As our paper concluded, surgeons who had performed less than 70 TKA procedures in the year prior to the patient’s index TKA had a 31% increased risk of revision and an 18% increased risk of deep surgical infection requiring further surgery at 3 years of follow-up.1 In terms of what institutional/structural changes that we suggest armed with this knowledge, we use an example from the UK. Optimal hospital and surgeon volume thresholds to improve 30-day readmission rates, costs, and length of stay for total hip replacement.
The purpose of this study was to investigate biomechanical differences of medial patellofemoral ligament (MPFL) reconstruction, medial quadriceps tendon femoral ligament (MQTFL) reconstruction, and a ...combination of these techniques to restore lateral patellar constraint and contact pressures.
Eight fresh frozen cadaver knees were mounted to a custom jig with physiological quadriceps tendon loading. Flexion angles and contact pressure (CP) were dynamically measured using Tekscan® pressure sensors and Polhemus® Liberty 6 degree of freedom (6DOF) positioning sensors in the following conditions: 1) intact 2) MPFL and MQTFL deficient, 3) MPFL reconstructed, 4) Combined MPFL + MQTFL reconstructed, and 5) MQTFL reconstructed. Lateral patellar translation was tested using horizontally directed 30 N force applied at 30° of knee flexion. The knees were flexed in dynamic fashion, and CP values were recorded for 10°, 20°, 30°, 50°, 70°, and 90° degrees of flexion. Group differences were assessed with ANOVA’s followed by pairwise comparisons with Bonferroni correction.
MPFL (P = .002) and combined MPFL/MQTFL (P = .034) reconstruction significantly reduced patellar lateralization from +19.28% (9.78%, 28.78%) in the deficient condition to −17.57% (−27.84%, −7.29%) and −15.56% (−33.61%, 2.30%), respectively. MPFL reconstruction was most restrictive and MQTFL reconstruction the least −7.29% (−22.01%, 7.45%). No significant differences were found between the three reconstruction techniques. Differences in CP between the three reconstruction techniques were not significant (<.02 MPa) at all flexion angles.
The present study found no significant difference for patellar lateralization and patellofemoral CP between MPFL, combined MPFL/MQTFL, and MQTFL reconstruction. All 3 techniques resulted in stronger lateral patellar constraint compared to the native state, while the MQTFL reconstruction emulated the intact state the closest.
Various surgical techniques for medial patellofemoral complex reconstruction can restore patellar stability with similar patellofemoral articular pressures.
Background:
There is increasing evidence that a significant proportion of randomized trials in medicine, and recently in orthopaedics, do not go on to publication.
Purpose:
The objectives of this ...study were (1) to determine publication rates of randomized controlled trials in sports medicine that have been registered with ClinicalTrials.gov (CTG) and (2) to compare the registration summaries of randomized trials on CTG with final published manuscripts on pertinent methodological variables.
Study Design:
Systematic review.
Methods:
Two independent investigators searched ClinicalTrials.gov for all closed and completed trials related to sports medicine until June 2009 using a text search strategy. The authors then searched for publications resulting from these registered trials in peer-reviewed journals that are indexed with MEDLINE and/or EMBASE as of February 2012 based on study authors and key words provided in the study protocol. Details of primary outcomes and secondary outcomes, study sponsors, and sample size were extracted and compared between registrations and publications.
Results:
Of 34 closed and completed trials registered on CTG, there were 20 resultant publications in peer-reviewed journals (58.8%). There was no significant relationship between source of funding and rate of publication (P > .05). The authors found a discrepancy between the CTG registration summary and the manuscript in at least one methodological variable (primary/secondary outcomes, inclusion/exclusion criteria, sample size) in 16 of 20 (80.0%) articles and a discrepancy in the primary outcome in 8 of 20 (40.0%) published trials.
Conclusion:
Although registration of sports medicine trials in CTG does not consistently result in publication or disclosure of results at 32 months from the time of study completion, observed publication rates are higher than in other orthopaedic subspecialties. Changes are also frequently made to the final presentation of eligibility criteria and primary and secondary outcomes that are not reflected in the registered trial data.
Introduction:
Although differential outcomes based on sex are widespread in medicine and surgery, evaluation of sex-specific differences in the field of orthopaedic surgery in general – and ...arthroplasty in particular – are lacking. We hypothesised that morbidly obese male and female patients would have differing risks of surgical complications following primary total hip replacement.
Methods:
We reviewed data contained within the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database from 2015 through 2018, inclusive. A multivariable binary logistic regression model was used to determine the adjusted odds ratios (OR) of relevant variables on primary and secondary outcomes.
Results:
A total of 86,684 patients undergoing THR were identified, of whom 9972 patients (4095 male and 5877 female) were morbidly obese. Among morbidly obese patients, odds of surgical site infection were higher in females than males within 30 days of surgery (adjusted OR 1.40; 95% CI, 1.10–1.79; p = 0.007). This comprised the odds of both superficial infection (1.8% vs. 1.1%, adjusted OR 1.67; 95% CI, 1.16–2.40; p = 0.006) and deep infection (1.9% vs. 1.4%, adjusted OR 1.22; 95% CI, 0.88–1.68; p = 0.24). Unexpected return to the operating room (i.e., reoperation) within 30 days of the surgical procedure was also higher among females than males (4.2% vs. 3.1%, adjusted OR 1.38, 95% CI, 1.10–1.71, p = 0.005). There were no differences between male and female patients in the non-obese cohort.
Conclusions:
Among patients with morbid obesity, the risk of surgical site infection and reoperation within the first 30 days is greater in women as compared to men. Future research must address whether this early increased risk among morbidly obese women persists in the longer term, and whether it results in compromised function or quality of life.
This systematic review of randomized controlled trials (RCTs) aims to compare important clinical, functional, and radiological outcomes between robotic-assisted total hip arthroplasty (RATHA) and ...conventional total hip arthroplasty (COTHA) in patients with hip osteoarthritis. We identified published RCTs comparing RATHA with COTHA in Ovid MEDLINE, EMBASE, Scopus, and Cochrane Library. Two reviewers independently performed study screening, risk of bias assessment and data extraction. Main outcomes were major complications, revision, patient-reported outcome measures (PROMs), and radiological outcomes. We included 8 RCTs involving 1014 patients and 977 hips. There was no difference in major complication rate (Relative Risk (RR) 0.78; 95% Confidence Interval (CI) 0.22 to 2.74), revision rate (RR 1.33; 95%CI 0.08 to 22.74), and PROMs (standardized mean difference 0.01; 95%CI − 0.27 to 0.30) between RATHA and COTHA. RATHA resulted in little to no effects on femoral stem alignment (mean difference (MD) − 0.57 degree; 95%CI − 1.16 to 0.03) but yielded overall lower leg length discrepancy (MD − 4.04 mm; 95%CI − 7.08 to − 1.0) compared to COTHA. Most combined estimates had low certainty of evidence mainly due to risk of bias, inconsistency, and imprecision. Based on the current evidence, there is no important difference in clinical and functional outcomes between RATHA and COTHA. The trivial higher radiological accuracy was also unlikely to be clinically meaningful. Regardless, more robust evidence is needed to improve the quality and strength of the current evidence.
PROSPERO registration:
the protocol was registered in the PROSPERO database (CRD42023453294). All methods were carried out in accordance with relevant guidelines and regulations.
Purpose
The effectiveness of ACL functional knee braces to reduce meniscal and ACL strain after ACL injury or reconstruction is not well understood. A new dynamic knee tensioning brace system has ...been designed to apply an active stabilizing force to the knee. The ability of this system to reduce tissue strains is unknown. The purpose of this study was to test the ability of the dynamically tensioned brace to reduce strain in both the ACL and meniscus during rehabilitation activities.
Methods
A combined in vivo/in silico/in vitro method was used to study three activities: gait, double leg squat, and single leg squat. Muscle forces and kinematics for each activity were derived through in vivo motion capture and applied to seven cadaveric knee specimens fitted with custom braces. Medial meniscal strain and ACL strain were measured in ACL intact, deficient and reconstructed conditions.
Results
The brace lowered peak and average meniscal strain in ACL deficient knees (
P
< 0.05) by an average of 1.7%. The brace was also found to lower meniscal strain in reconstructed knees (1.1%) and lower ACL strain in ACL intact (1.3%) and reconstructed knees (1.4%) (
P
< 0.05).
Conclusions
This study supports the use of a brace equipped with a dynamic tensioning system to lower meniscal strain in ACL-deficient knees. Its use may help decrease the risk of subsequent meniscal tears in chronic ACL deficiency or delayed reconstruction. In ACL-intact and reconstructed knees, the brace may be beneficial in injury prophylaxis or in protecting the ACL graft following reconstruction. These results will aid clinicians make informed recommendations for functional brace use in patients with unstable knees.
Level of evidence
II.
The goal of this study was to determine what visual information is used to navigate around barriers in a cluttered terrain. Twelve traffic pylons were arranged randomly in a 4.55 × 3.15 m travel ...area: there were 20 different arrangements. For each arrangement, individuals (N = 6) were positioned in 1 of 3 locations on the outside border with their eyes closed: on verbal command they were instructed to open their eyes and quickly go to 1 of 2 specified goals (2 vertical posts defining a door) located on one edge of the travel area. The movement of the body was tracked using the OPTOTRAK system, with the IREDS placed on a collar worn by the subjects. Experimental data of travel path chosen were compared with those predicted by models that incorporated different types of visual information to control path trajectory. The 6 models basically use 2 different strategies for route selection: reactive control based on visual input about the obstacle encountered in the line-of-sight travel path (Model # 1) and path planning based on different visual information (Model # 2, 3, 4, 5, and 6). The models that involve path planning are grouped into 2 categories: models 2, 3, 4, and 5 need detailed geometrical configuration of the obstacles to plan a route while model 6 plans a route based on identifying and avoiding a cluster of obstacles in the travel path. Two measures were used to compare model performance with the actual travel path: the difference in area between predicted and actual travel path and the number of trials that accurately predicted the number of turns during travel. The results suggest that route selection is not based on reactive control, but does involve path planning. The model that best predicts the travel paths taken by the individuals uses visual information about cluster of obstacles and identification of safe corridors to plan a route.Key words: navigation, obstacle avoidance, vision, path planning.
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