Science method
Arthroplasty - Science method
Surgical reconstruction of a joint to relieve pain or restore motion.
Questions related to Arthroplasty
How many of us think that an academic society or organisation helps us, like AOTrauma helps us in professional growth, academic growth and helps us move up the ladder in our career. Does it really remove the obstacles. If yes please mention the name of such organization ( like Indian Orthopaedic association, AOTrauma, OTA, BOA, Arthroplasty, Arthroscopic or trauma societies of different countries states etc) which really help you. Please write your thoughts if you have a different point of view.
I am currently doing a meta-analysis on outcome of arthroplasty and come across different outcome measure across the literature. After discussion with a generic statistician, the suggestion is either perform Standard Mean Difference (SMD) or Ratio of Mean (RoM) for pooling the data of different outcome.
Cochrane has described the use of RoM; however, I am not able to find a way of performing the meta-analysis on Review Manager Softward.
Any idea how do we perform RoM meta-analysis?
What is the course of action in an arthroplasty which is infected clinically but is culture negative? I find this a difficult situation in many orthopaedic infections not only arthroplasty where the clinical features from a weeping wound to local signs cry infection and even the deeper swabs grow nothing. How does one tailor the antibiotics in such situations?
Incorporation of bone into the components of the non-cemented arthroplasty takes time, and it is difficult to know when the incorporation is sufficient enough to withstand full load.
Urethral catheters are frequently associated with urinary infections. This may set the arthroplasty at risk for early or late infections. Nevertheless many surgeons and anesthesiologists use urethral catheters for monitoring of diuresis in the perioperative period. Is it indispensable ?
Why VMO is the first muscle to undergo disuse atrophy following any knee joint pathological or traumatic condition?
Greetings.
How do you aply Spotorno score when facing a hip arthroplasty revision with severe bone defect in proximal femur, how do you rate Singh index in thse cases in the decision process of employing a cemented or non cemented stem?
Congratulations for this excellent review, in line with the 2012 consensus initiative I participated in.
The question rises directly from your last sentence "...needs to be prioritized is the investigation of potential systemic risks due to accumulation of metal ions". Do you think that european health authorities are ready to wait for this answer to take definite decision about MoM (whatsoever the head size ?) market retrieval, according to the "precaution principle" that currently governs political deciders in the health field ? What is the trend in Germany thus far ? In France, MoM THA use decreased from 7% of the market at its top (2010) to only 2% in 2013 ...
He has severe knee deformity and stiffness. Urging to regain knee movements (pain free!)
The incidence of Total knee replacement is on a rise. In another decade the incidence of revisions will rise too. Is there any way to predict the lifespan of implants nowadays so that we can prepare for the inevitable tomorrow
ORIF or Hemi Arthroplasty?
I am looking for an outpatient total joint arthroplasty risk assessment to use in my research and in my orthopedic practice. Specifically, I am looking for the Outpatient Arthroplasty Risk Assessment score developed by R. Michael Meneghini but I am open to other recommendations as well.
Interpositional arthroplasty has gained in success and popularity in non load bearing joints in recent years. All of the joints that have had great success have been sheer force joints and not in load bearing joints. Any thoughts or experience in performing this procedure in load bearing joints as to integration of graft or graft breakdown due to loads. Is there any graft that is more durable with load than others?
When should the weight bearing be allowed in these cases with uncemented arthroplasty?
The rationale of the new cruciate (ACL and PCL) sparing TKR seems feasible but I cannot find any clinical data on this.
Sometimes during the surgical procedure for TKR, one comes across hypertrophied synovium especially in suprapatellar pouch. I have only occasionally excised the synovium. Should it be excised as a routine or not, or what is the indication to remove it?
Intrawound use of vancomycin has been shown in several publications to reduce the incidence of infection following spine surgery.
However, there appears to be sparse, if any, data supporting the use of intrawound vancomycin in arthroplasty patients. Despite the lack of data, some arthroplasty surgeons have extrapolated the results from the spine literature and have begun placing vancomycin in the intra-capsular and sub-fascial spaces during closure following total knee and total hip arthroplasty procedures.
Is there any published data showing this practice reduces infection rates for total hip and total knee arthroplasty patients? Is there any data showing that vancomycin does not negatively affect the wear properties of highly cross-linked polyethylene or other bearing surfaces?
In a recent paper published in BMJ, the authors have condemned the arthroscipic surgery in degenerative knee reporting more harm than good even in patients around 40 years of age.
I have been doing this surgery for the last more than 20 years as a first choice in patients below fifties, and selectively in elderly patients who, due to economic/ social/ personal reasons do not want joint replacement. After this paper I compiled my data of last 10 years. Out of 40 knees, only 3 have converted into TKR. During surgery I use meniscal/ synovial debridement, osteophytectomy, microfractures etc depending upon pathologies. In some patients I also combined viscosupplementation at 4- 6 weeks post surgery.
Sometimes, It is difficult to differentiate between postoperative hematoma and imminent deep infection the first postoperative days after THA. Early debridement is reported to be very effective if it is done after 4-7 days of wound drainage. We need a biomarker to make the exact diagnosis and to act adequately.
Does the chronological age really matters in this decision making?
Every year a lot of studies are published on tourniquet time and blood loss and outcome after TKA. I do not use a tourniquet at any time of the TKA procedure. I am interested in conducting a study to assess quad muscle function and outcome of TKA without using a tourniquet.
In the last 10-15 years there is a certain trend to the appliaction of this type of hip replacement. In any case, I do not know if the long-term results are satisfactory. In the past, some 30-40 years age the Wagner cup has been very popular but the long- term results have not been satisfactory. What is the situation today based on your personal experience with resurfacing hip arthroplasty ?
For modeling hand and forearm and upperarm, I supposed 7 degrees of freedom: 3 degrees for rotations for shoulder, 1 degree for elbow and 3 degrees for wrist. But I know that I can rotate my forearm about its axis from wrist place while I supposed the seventh degree of freedom for rotating the hand about its axis. Should I import the effect of angular velocity of this degree for computing angular velocity of forearm? (Dynamic model of this degree is somehow complicated for me and I appreciate your help)
Currently several landmarks are used to identify the joint line level in revision knee arthroplasty. However, I wonder which one is a suitable method? Does anyone have an idea? Thank you for your contributions.
I am conducting a meta-analysis on the efficacy of MRSA decolonization in total joint arthroplasty (total hip replacement and total knee replacement) patients as part of a class project. Has anyone conducting research on this area which has not yet been published? Specifically, I am looking for the number of surgical site infections or periprosthetic joint infections and the number of patients in both the study group and control group. I am particularly interested in finding studies which have not been published to date -- but would welcome any data that you are willing to share on the topic. Thanks!
It's also a very tricky scenario when deal with a moderate deficient acetabulum as for choosing the proper bone coverage and abduction of the cup in THA., in case of avoiding bone graf, does anyone have a practical technique and surgic philosophy in this aspect to share with me?
This is a very unhappy situation and presents a serious intraoperative and postoperative challenge. Unfortunately, it happens sometimes in cases with poor bone quality and deficient bone stock. On the one hand one should have to treat the deep infection, while on the other hand the femur should be stabilized (wiring, bands, plates, IM, new implant - all of them are foreign bodies).
Urethral catheters are associated with urinary infections which could set an arthroplastry at risk for early or late infection. Nevertheless, some surgeons and anesthesilogists use urethral catheter for control of diuresis in the perioperative period. Is it really necessary?
I want to analyze a hip implant in Ansys 14. so i want to know which type of element i should use to support torque and bending moments besides i cant use this software help very well. furthermore where can i enter yield and ultimate strength?
I am an arthroplasty surgeon with a lot of revision reconstruction and complex hip surgery under my belt and I have done a few of DDH in my career achieving lengthening of 4-5cm. After my first complication following a Crowe IV hip in a patient of short stature (sciatic nerve palsy), I am questioning if the given "safe" length is just a number or if this has to follow a 'relative to the height of the patient' equation. As mentioned the present patient is of short stature and all my previous experiences were on taller patients. Anybody with any knowledge to this specific problem?
I doubt if new implants really improve results, making surgery more expensive and increasing the number of complications (dislocations, infections...)
Dear friends
A 24, year old male was sent by our nephrologists today. He is a case of renal failure on dialysis. He has undergone live donor transplant and the graft was rejected. Now he has graft rejection and reaction. Hematuria and is likely to undergo graft nephrectomy. To compound his woes, he has been unable to walk since 6 months. He has bilateral steroid induced osteonecrosis of hips. He is severely painful.
He has a related donor ready and is in queue for a transplant also.
No doubt he needs a total hip bilaterally
My queries after a detailed discussion with the senior transplant nephrologist who referred me this case, one of many we will need to tackle in the future.
1. Timing-- Do we do the hips before or after the transplant. Nephrologist feels preoperative management is easier before . afterwards he will be on multiple immune suppressants and steroids. They do not plan a steroid sparing regimen.
If the hips are not done first he will remain severely handicapped following the transplant for an extended period of time till he gets fit for surgery and the risks are higher following the transplant
2. Cemented or uncemented
I would go uncemented as I want to save time. The difference with cemented hips is that i end up spending longer in component implantation.
3. Risks-- Is the risk of infection higher-- As far as knees go we have excellent data from the scottish registry which says the risk is higher with patients with renal failure. (BJJ- published somewhere in the last two years). What other significant risks exist?
Do we change antibiotic prophylaxis? What happens if he does get infected, it will screw up his chances for a replacement as well as a transplant.
4. One side or both at a time. Honestly, we don't have the set up for one sitting bilateral hips. But here my advantage is that preoperatively the nephrologists will take over.
5. Cannot use alendronate and head conserving surgeries. I believe THA is the least invasive and best option here. All subject to how my anaesthetists view the patient.
Requesting experiences and opinions
Murali Poduval
Pondicherry
India
Statistically LLD is one of the most often complications that is underestimated by surgeons and exaggerated by patients. In the USA it is one of the most often reasons for legal problems to the surgeons after THR.
After several years of experience with THR I found some patients (several % of patients) with an elongation of operated leg 2cm. Currently, I perform THR with an additional tool for measuring distance between pelvis and femur during surgery and it improved a lot the results. I wonder what are the others opinions to this problem?
We get neglected cases of OA knee with badly stretched LCL. Weight bearing Xrays show even medial subluxation of tibia with posteromedial bone loss on tibia. The options at surgery include use of metallic wedges/ bone grafting to reconstruct the bone loss combined with intramedullary extension rods in tibia. The option of use of a larger tibial post to provide stability against subluxation is another option. What should be the algorithm of treating such cases?
In one of my recent surgeries on an obese female, the extension and flexion gaps (after the releases) were just sufficient enough for the largest insert (17.5) I had available. I was wondering what the options to tackle this situation would be if the gap was bigger.
Some surgeons do so in the attempt to diminish blood loss. It is very controversial. Some do not use any drains at all.
I am doing a meta analysis on TKR. There are so many outcomes measures (WOMAC, TUG,quadriceps lag etc) available. Which outcome measures will be the best predictor of the functional improvement?
Can you explain the definition of the patellofemoral offset for me?
Failure rate of ASR XL is approximately 22% at 5 years and ASR Resurfacing is 14% at 5 years