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   Table of Contents - Current issue
October-December 2017
Volume 2 | Issue 4
Page Nos. 125-163

Online since Tuesday, December 5, 2017

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Predicting necrotic femoral head collapse using computed tomographic and X-ray imaging before hip arthroplasty: study protocol and results of a single-center, open-label, diagnostic trial p. 125
Di Qin, Wen-hui Ma, Wei-xia Bai, Yong-wei Shang, Hui-jie Li, Yong-tai Han
Background and objectives: Determining whether the femoral head collapses and the degree of collapse of the articular cartilage of the femoral head can help select the best surgical treatment plan for patients with osteonecrosis of the femoral head. Currently, articular cartilage collapse > 2 mm or < 2 mm supports palliative surgery and hip arthroplasty, respectively. However, the ideal method to preoperatively predict femoral head collapse remains controversial. We hypothesized that computed tomography (CT) and X-ray imaging can effectively predict collapse of the necrotic femoral head before hip arthroplasty. Our preoperative measurements highly matched measurements of the intraoperatively-resected femoral head specimens. Design: A single-center, open-label, diagnostic trial. Methods: We proposed, and subsequently conducted, a single-center, open-label, diagnostic trial at the Third Hospital, Hebei Medical University, China. Eighty-six patients with unilateral osteonecrosis of the femoral head who underwent total hip arthroplasty were randomized into three groups. In the X-ray group, changes in femoral head height were measured on anteroposterior X-ray images of the pelvis (healthy and affected sides of the hip) at preoperative week 1. In the CT group, changes in femoral head height were measured using bilateral hip CT scans (healthy side and affected side) at preoperative week 1. In the specimen group, the femoral head on the affected side was resected surgically and measured directly with a ruler and vernier caliper. The primary outcome of the trial was the sensitivity of the three methods to detect femoral head collapse. The secondary outcomes were specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic accuracy of the three methods to detect femoral head collapse; the consistency of X-ray and CT scans to diagnosis femoral head collapse; changes in the height of the middle, medial, and lateral femoral head measured by the three methods; and morphological changes in the femoral head observed by the three methods. Results: Changes in the height of the femoral head detected by different methods: The heights of the middle, medial and lateral femoral head were not significantly different on the affected side (P > 0.05). Discussion: This trial analyzed femoral head height using X-ray, CT, ruler and vernier caliper to precisely predict collapse of the necrotic femoral head, and provides imaging guidance for clinicians to select the best surgical management for osteonecrosis of the femoral head. Trial registration: ClinicalTrials.gov identifier: NCT03351153.
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Surgical site infections in orthopedic surgery: incidence and risk factors at an Iranian teaching hospital p. 132
Keykhosro Mardanpour, Mahtab Rahbar, Sourena Mardanpour, Nyousha Mardanpour
Background and objectives: Surgical site infection (SSI) is rare complication in orthopedic surgery and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, body mass index (BMI), prophylactic antibiotics, operation technique and duration, type of shaving, and length of hospitalization. This study aimed to determine the risk factors affecting orthopedic surgical site infections and their incidence at Imam Reza and Taleghani , two major referral teaching hospitals in west of Iran. Design: A prospective cohort study. Methods: A 36-month prospective cohort study, with 1 to 12 months of patient follow-up after surgery, was conducted at the teaching hospital in Iran. Patients (n = 1,900) who had undergone orthopedic surgery were studied between January 2012 and January 2015. Each patient was followed by pre- and post-operative examinations and telephone follow-ups. Results: Of the 1,900 patients, 73 suffered from SSI (3.84%). Methicillin Resistant Staphylococcus aureus (MRSA) 53% (n = 25) and Staphylococcus coagulase-negative 32% (n = 15) are the most common isolated germs. The smoking, high BMI, multiple fractures, increased operation time, increased bed stay, electivity of the operation, type of operation, using prosthetic implant and pre-operation of prophylactic antibiotic were all significantly associated with increased evidence of SSI (P < 0.04). Conclusion: Our study presented that stopping smoking, appropriate pre- and post-operational antibiotic prophylaxis regimens specially when using prosthetic implant, shortening duration of surgery and hospitalization and experience of the surgeon should be helpful to reduce rate of SSI.
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Efficacy and safety of a digital navigation template combined with cervical pedicle screw implantation: study protocol for a prospective, single-center, self-controlled, clinical trial p. 138
Wei Wei, Long-yan Xing, Jia-xun Jiao, Lei Zhao, Ai-qing Lu
Background and objectives: Cervical pedicle screw fixation is a reliable method for the treatment of traumatic and non-traumatic cervical instability and cervical disc removal and fixation; however, the operation risks and the failure rate of screw insertion are still high. At present, the digital navigation template with digital computer technology, used in the department of orthopedics, has the advantages of accurate screw insertion and a small error in the screw insertion depth. This trial aims to observe the clinical efficacy and safety of the digital navigation template combined with cervical pedicle screw implantation. Design: This is a prospective, single-center, self-controlled, clinical trial. Methods: Thirty-two patients with cervical spondylosis will be recruited from the Harrison International Peace Hospital, Hebei Province, China. Before surgery, a three-dimensional (3D) navigation model of the cervical vertebrae will be designed by 3D reconstruction. The navigation template will be generated by 3D printing. The cervical pedicle screws will be implanted according to preoperatively designed models and the screw positions will be observed by computerized tomography (CT) after surgery. The patients will be followed up for 40 months. Outcome measures: The primary outcome measure is the excellent and good rate of screw position 40 months after implantation. The secondary outcome measures include the Visual Analog Scale score, American Spinal Injury Association classification, cervical X-ray and CT images before implantation and 40 months after implantation, and the incidence of adverse reactions 40 months after implantation. Discussion: We will verify a high success rate of cervical pedicle screw implantation using the digital navigation template. The operation is simple and quick, with good efficacy and safety. Ethics and dissemination: The protocols have been approved by the Ethics Committee of the Harrison International Peace Hospital in China (approval number: 20120630). The study protocol has been conducted in accordance with the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be obtained from all participants. The recruitment of subjects will begin in December 2017. Samples and data will be collected from December 2017 to April 2019. Outcome measures will be analyzed in October 2020. This trial will be completed in November 2020. The results of the trial will be reported in a scientific conference or disseminated in a peer-reviewed journal. Trial registration: This trial has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-ONC-17013481).
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Preemptive analgesia in orthopedic surgery: a literature review Highly accessed article p. 144
Juan Lopez Valencia, Anapaola Koch Leopo
Pain after surgery is a maladaptive response. Acute postoperative pain is an important predictive factor for chronic post-surgical pain, which is observed in 10–65% of patients after surgery. Therefore controlling pain after surgery is very important. Reducing postoperative pain will result in more patient satisfaction, less complications due to immobility and decreased hospitalization periods. In this review, the use of preemptive analgesia in orthopedic surgery with a great variety of medications and interventions is examined. A search with the key words of “preemptive analgesia”, “orthopedic surgery” and “post-surgical pain” was conducted in online database PubMed, EBSCO, Elsevier (ClinicalKey), SpringerLink and OVID. Then selected articles from 5 years relevant with the application of preemptive analgesia in orthopedic surgery were analyzed. Finally we show some interventions with the outcomes and the challenges and new investigations suggested. The results showed that preemptive analgesia can be from regional blockade and local wound infiltration before incision to application of oral or intravenous medication before beginning surgery (NSAIDs, Gabapentin, Pregabalin, Dextromethorphan, Melatonin, Multimodal and Opioids) and the new approaches like transcutaneous electrical nerve stimulation (TENS). Preemptive analgesia has an important role in diminishing the pain rate in the post-surgical state, lowering pain medication intake and improving the patient satisfaction and early mobilization.
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Use of incisional negative pressure wound therapy in orthopedics p. 153
Supriya Singh, Jennifer C Urquhart, Christopher S Bailey, Parham Rasoulinejad
This review article summarizes the results of currently available literature on use of incisional negative pressure wound therapy for primary closure of orthopedic incisions. Post-operative wound complications place a heavy toll on patients and the health care system. Patients with post-operative wound complications often require readmission, repeat surgery, prolonged hospitalization, and diminished outcomes. The financial burden on the health care system for surgical site infection, the most common post-operative wound complication, varies from $27,969 to over $100,000 per patient, representing a nearly 300% increase in health care costs.The role of incisional negative pressure wound therapy is currently being investigated in reducing post-operative wound complications. However, the subject is still novel and based on our literature search, only 11 papers discuss the role of incisional negative pressure wound therapy in orthopedic surgery, with only one paper providing level 1 evidence. However, despite the paucity of sufficient clinical trials, it appears that most reports suggest positive outcomes with use of negative pressure wound therapy.
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Exercises interventions in people with rheumatoid arthritis p. 160
Amal Elramli
This review will examine publications which have investigated exercise intervention to promote physical activity in people with rheumatoid arthritis. Literature was searched using PubMed, Medline, Google Scholar, Cochrane Library and Web of Science. Overall, the studies demonstrated the promotion of physical activity in people with rheumatoid arthritis. Although there were aerobic, strengthening, stretching or combined exercise interventions, the majority of studies evaluated used combined exercise. There were no specific physical activity guidelines for people with rheumatoid arthritis and, additionally, a lack of data regarding the type, frequency and intensity of appropriate exercise in people with rheumatoid arthritis, therefore further studies are recommended.
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Correction: VTI InterFuse® S vs. InterFuse® T for the treatment of scoliosis and degenerative disc disease: protocol for a multicenter post-market study p. 163
William F Lavelle, Richard Tallarico, Jeffrey C Felt
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