Archives of Bone and Joint Surgery
Volume:8 Issue: 4, July 2020

EDITORIAL Table 1 summarizes recommendations based on the presented papers. To prevent infection, it is critical to identify high-risk patients and control those risks prior to surgery. Action must be taken at every step of the surgical process, from preoperative to postoperative protocols, including intraoperative measures. In this Editorial some recent issues that surgeons should explore to try to prevent infection after TKA have been reviewed. Our goal must be to lower the current rate of infection following TKA.

Total knee arthroplasty is considered as the treatment of choice for those with end stage hemophilic arthropathy.Compared to other patients undergoing TKA, these patients have specific features such as bleeding tendency, youngerage, pre-operative restricted range of motion (ROM), altered anatomy, and increased complications. This narrativereview of literature is going to investigate several issues regarding the TKA in hemophilic patients including indications,perioperative factor replacement, surgical challenges, postoperative rehabilitation, outcomes, and complications.Level of evidence: I

This systematic review aimed to investigate the effectiveness of proprioceptive neuromuscular facilitation(PNF) training on back pain intensity and functional disability in people with low back pain (LBP).

Totally, five electronic databases, including PubMed/Medline (NLM), Scopus, Google Scholar, PEDro, andCochrane Central Register of Controlled Clinical Trials were searched up to October 31, 2018. Clinical trials with aconcurrent comparison group (s) that compared the effectiveness of PNF training with any other physical therapyintervention were selected. Publication language was restricted to English language articles. Methodologic quality wasassessed using the PEDro scale. The measures of continuous variables were summarized as Hedges’s g.

In total, 20 eligible trials were identified with 965 LBP patients. A large effect size (standardized mean difference[SMD]=-2.14, 95% confidence interval [CI]=3.23 to -1.05) and significant effect were observed favoring the use of PNFtraining to alleviate back pain intensity in patients with LBP. Moreover, large effect size and the significant result werealso determined for the effect of PNF training on functional disability improvement (SMD=-2.68, 95% CI=-3.36 to -2.00)in population with LBP. A qualitative synthesis of results indicated that PNF training can significantly improve sagittalspine ROM. Statistical heterogeneity analysis showed that there was considerable statistical heterogeneity among theselected trials for the primary outcomes (I2 ≥ 86.6%).

There is a low quality of evidence and weak strength of recommendation that PNF training has positiveeffects on back pain and disability in LBP people. Further high-quality randomized clinical trials regarding long-termeffects of PNF training versus validated control intervention in a clinical setting is recommendable.Level of evidence: I

Polymethylmethacrylate antibiotic impregnated beads can be an effective treatment for chronicosteomyelitis or an adjuvant in the treatment of open fractures. It remains unclear however whether the beads causelong-term adverse events if not removed. The purpose of this study was to determine if removal of antibiotic beads wasrequired in order to avoid long term complications. A retrospective chart review was conducted on patients with an extremity or pelvis fracture that hadimplantation of polymethylmethacrylate (PMMA) antibiotic beads over a five-year period. Fifty-one patients met inclusion criteria for this study; thirty-seven patients (73%) did not have complicationsafter surgical debridement and placement of PMMA antibiotic beads necessitating removal. Our findings suggest that polymethylmethacrylate antibiotic beads can be utilized as a means of deliveringhigh-dose concentrations of local antibiotics and do not have to be removed in all patients.Level of evidence: III

Given high rates of positive Cutibacterium acnes (C. acnes) cultures in cases of both primary and revisionshoulder surgery, the ramifications of positive C. acnes cultures remain uncertain. Next generation sequencing (NGS)is a molecular tool that sequences the whole bacterial genome and is capable of identifying pathogens and the relativepercent abundance in which they appear within a sample. The purpose of this study was to report the false positiveculture rate in negative control specimens and to determine whether NGS has potential value in reducing the rate offalse positive results. Between April 2017 and May 2017 swabs were taken during primary shoulder arthroplasty. After surgicaltime out, using sterile gloves, a sterile swab was opened and exposed to the air for 5 seconds, returned to its contained,and sealed. One swab was sent to our institution’s microbiology laboratory for aerobic and anaerobic culture and heldfor 13 days. The other sample was sent for NGS (MicroGen Dx, Lubbock, TX), where samples were amplified forpyrosequencing using a forward and reverse fusion primer and matched against a DNA library for species identification. For 40 consecutive cases, swabs were sent for culture and NGS. C. acnes was identified by culture in 6/40(15%) swabs and coagulase negative staphylococcus (CNS) was identified in 3/40 (7.5%). Both cases with positiveNGS sequencing reported polymicrobial results with one sample (2.5%), including a relative abundance of 3% C.acnes. At 90 days after surgery, there were no cases of clinical infection in any of the 40 cases. We demonstrate that the two most commonly cultured organisms (C. acnes and CNS) during revisionshoulder arthroplasty are also the two most commonly cultured organisms from negative control specimens.Contamination can come from air in the operating room or laboratory contamination.Level of evidence: III

Conventional fixation methods of posterior wall acetabular fractures feature the use of plating and lagscrews. However, fixation of posterior wall fractures with buttress plating alone offers potential advantages by avoidingthe hardware complications related to hardware placement through the wall fragment. The purpose of this study wasto examine if buttress plating alone, without screw fixation through the wall would be a viable method of treating thesefractures. Our hypothesis was that this technique would not result in loss of reduction. Consecutive series of patients with isolated posterior wall acetabular fractures treated by two independentsurgeons at two Level I Trauma centers without screw fixation across the fracture (Boston Medical Center/HarborviewMedical Center). All 72 fractures treated without a screw through the posterior wall fragment maintained reduction at anaverage of 1.6 years post-operatively. For fractures fixed with buttress plating alone, 92 % were reduced within 2 mmof being anatomic compared to 94 % of fractures that had screws cross the fracture. The described buttress plating technique without screw fixation in the wall is an acceptable form offixation for posterior wall acetabular fractures without the theoretical risk of intra-wall screw fixation.Level of evidence: III

The purpose of this prospective study was to determine the accuracy of pedicular screw insertion withoutthe use of fluoroscopy. This study was conducted on patients with spinal diseases in need of pedicular screw fixation and fusion.The included patients suffered from such conditions as vertebral fracture, spinal stenosis, kyphosis, tumor, and pelvicfractures and were managed with triangular osteosynthesis fixation. However, those with scoliosis deformity wereexcluded from the study. A total of 760 pedicular screws were inserted in C7 to S1 vertebrae without using fluoroscopy.The locations of the screws were assessed by means of computed tomography scan after the surgery. The data wereanalyzed in SPSS software (version 22) using the Chi-square test. Out of 387 thoracic screws and 373 lumbar screws, 65 (16.8%) and 34 (9.1%) screws perforated the pediclewall or vertebral body, respectively. The most frequent locations of perforation in the thoracic and lumbar spine werethe anterior cortex of the vertebral body and medial wall of the pedicle, respectively. Except for the perforation of theanterior vertebral body (P=0.0001), there was no difference between the left and right sides or between thoracic andlumbar sites in terms of the preformation of the screw. No complication was observed due to screw perforation. Our findings revealed the unnecessity of using fluoroscopy in spine surgeries for the insertion of pediculatescrews. In this regard, the use of fluoroscopy for the placement of pedicular screw resulted in similar accuracy andcomplications, as compared to the free hand procedure.Level of evidence: I

The ultimate goal of the treatment of infectious knee arthritis is to protect the articular cartilage fromadverse effects of infection. Treatment, however, is not always hundred percent successful and has a 12% failurerate. Persistent infection is more likely to happen in elderly patients and those with underlying joint diseases,particularly osteoarthritis. Eradication of infection and restoration of function in the involved joint usually arenot possible by conventional treatment strategies. There are few case series reporting two-stage primary kneearthroplasty as the salvage treatment of the septic degenerative knee joint; however, the treatment protocol remainsto be elucidated.

Based on a proposed approach, patients with failure of common interventions for treatment of septic kneearthritis and underlying joint degeneration were treated by two-stage TKA and intervening antibiotic loaded staticcement spacer. Suppressive antibiotic therapy was not prescribed after the second stage.

Complete infection eradication was achieved with mean follow up of 26 months. All cases were balanced withprimary total knee prosthesis. The knee scores and final range of motions were comparable to other studies.

The two-stage total knee replacement technique is a good option for management of failure of previoussurgical treatment in patients with septic arthritis and concomitant joint degeneration. Our proposed approach enabledus to use primary prosthesis in all of our patients with no need for suppressive antibiotic therapy.Level of evidence: IV

Trunk muscles play an important role in providing both mobility and stability during dynamic tasks in athletes.The purpose of this study was to evaluate the within-day and between-day reliability of ultrasound (US) in measuringabdominal and lumbar multifidus muscle (MF) thickness in athletes with and without hamstring strain injury (HSI).

Fifteen male soccer players (18-30 years old) with and without HSI were evaluated using two US probes (50mm linear 7.5 MHZ and 70 mm curvilinear 5 MHz). The abdominal muscle thickness as well as the cross sectional area(CSA) of the MF was measured. To determine within and between days reliabilities, the second and third measurementswere repeated with two hours and one week intervals, respectively.

Intraclass correlation coefficients for athletes with and without HSI demonstrated good to high reliabilityfor the abdominal muscle thickness (0.82 and 0.93) and CSA of the MF muscle (0.84 and 0.89, respectively).

Our results indicated that US seemed to be a reliable instrument to measure abdominal and lumbarmultifidus muscle thickness in soccer players with and without HSI. However, further studies are recommended tosupport the present study findings in other athletes.Level of evidence: III

Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effectivesurgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varusdeformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoralosteotomy in ACL-deficient knees with femoral varus deformity and medial osteoarthritis till now. This prospectivestudy presents the technique and clinical outcome of a consecutive series of simultaneous lateral closed-wedge distalfemoral osteotomy and ACL reconstruction. Nineteen patients with confirmed ACL rupture and femoral varus deformity (mechanical lateral distal femoralangle ≥ 93°) associated with medial osteoarthritis (± lateral thrust) were included the study. The patients underwentsimultaneous lateral closed-wedge distal femoral osteotomy and ACL reconstruction. At the end of one year followup, the final range of motion and stability of the knees and the last alignment of extremities were recorded. Surgicaloutcomes were assessed on 2000 IKDS subjective scores and KOOS subscales. The mean preoperative varus knee was 10.6° (±2.2°) mostly from the femoral side. The mean union timewas 3.2 (±0.4) months. Regarding the radiological evaluation, the alignment of extremity and mLDFA were correctedsignificantly compared to the pre-operative findings. At the end of one year follow up, all patients were free of kneeinstability. Subjective assessment based on questionnaires showed a significant improvement in all aspects of kneefunction after surgery, however there was no considerable change in the knees range of motion. Simultaneous lateral closed- wedge distal femoral osteotomy and ACL reconstruction is a valuableprocedure in femoral varus knees with medial osteoarthritis and anterior knee instability. After one year follow up allaspects of knee function were improved without serious complications.Level of evidence: IV

Surgical reattachment of medial meniscus posterior root tear (MMPRT) with transtibial sutures can delay the presenceof medial knee joint compartment osteoarthritis. Most suture configurations are placed five mm away from the tornmargin in the meniscal substance which is already degenerated and may decrease the pull out strengths of repairconstruct. The number of meniscus penetration may also be important considering meniscus tissue damage with morecomplex suture techniques impose the risk of suture cut out through the meniscus substance.We introduce our loop postsuture construct technique which is simple, cheap and reproducible.Level of evidence: V

We have conducted a retrospective study to know the impact of a didactic sitting on the Ponseti method of clubfoot management. We have compared the outcome of patients managed by orthopaedic residents who attended such a session with that of patients treated by residents who didn’t get this additional training. The results revealed that the frequency of PTA tenotomy was significantly higher in the additionally-trained group compared to the classically-trained group, which emphasises the role of regular such meetings.

It is necessary to have a greater understanding of COVID-19, and studies with an adequate design must be performed to be able to make treatment and rehabilitation recommendations with a sufficient degree of evidence. However, for patients discharged from the hospital who have been cured of the infection and who have significant functional impairment, Blood flow restriction (BFR) strengthening might be an effective option to aid the strengthening and functional recovery process.