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PubMed1993

Life satisfaction and health in cancer patients, orthopedic patients and healthy individuals.

Life satisfaction (LS) is one of a set of constructs defining quality of life. Previous studies showed that LS was sometimes related to health and sometimes not. The study was designed to examine the relation of LS as a general construct to satisfaction in specific domains. We assumed that there is a tendency to maintain an acceptable level of LS even under stressful and threatening conditions, that it is related to optimism and that the likelihood of attaining satisfaction in a particular domain affected the selection of domains on which LS is based. We expected that in cancer patients LS would be related to more domains but not to health. The study was done with 55 head-and-neck cancer patients, of all stages and grades of tumor; 51 orthopedic patients, victims of accidents with good recovery chances; and 55 healthy individuals. The healthy individuals and orthopedic patients were matched (in terms of group values) to the cancer patients in age, gender and education. Single-item measures of LS and optimism, and a questionnaire with 49 multiple-choice items assessing adjustment in 13 domains were administered to all subjects. The results showed that in cancer patients LS was related to most domains but not to health and not to optimism, whereas in the other groups it was related to few domains including health, and also to optimism. The findings support the tendency to maintain LS with the materials available to the individual, and show that health is related to LS only if its maintenance or attainment are realistic goals. Thus, both bottom-up and top-down theories of LS are supported.

Female↗
PubMed1996

Regulation of human osteoblast integrin expression by orthopedic implant materials.

Integrins are transmembrane proteins that mediate attachment to extracellular matrix (ECM) proteins. Integrins act as ECM receptors and are believed to play a role in signal transduction and gene regulation, potentially influencing several cellular functions, including differentiation, growth, and migration. Several integrins have previously been found in bone cells in vivo and in vitro. Because the biologic fixation of orthopedic implants depends on optimal cell interactions at the interface, we examined whether integrins are involved in the attachment of osteoblasts to implant materials. In this study, we have used immunohistochemistry to examine the expression of integrins in primary human osteoblasts cultured on tissue culture polystyrene (PS), and rough and polished disks of the orthopedic alloys titanium-aluminum-vanadium (Ti) and cobalt-chrome-molybdenum (CC). The integrin subunits, alpha 2, alpha 3, alpha 4, alpha 5, alpha v, alpha 6, beta 1 and beta 3, were expressed by primary human osteoblasts cultured on PS coated with various ECM molecules. However, alpha 5 and alpha 6 were notably absent in cells attached to the alloys. Also, alpha 3 was not present on rough Ti, polished CC, or rough CC, and beta 3 was not expressed by cells on rough CC. Thus, the nature of the metal alloy appeared to influence the expression of particular integrins. As a result, the ability of cells to adhere to and receive messages from the extracellular matrix may also be influenced by the substratum. These differences may explain previously observed differences in degree of cell attachment to these metals.

Alloys↗
PubMed2004

The effectiveness of video feedback in the acquisition of orthopedic technical skills.

BACKGROUND: The addition of video feedback to bench model training offers residents the opportunity to see themselves perform a surgical task. Videotaped feedback therefore promotes self-evaluation, a critical learning skill, and also has the potential to influence how a resident executes a skill once they have had the opportunity to see themselves perform the task. METHODS: Twenty-nine surgical residents were video recorded while performing three technical skills. They then were randomly assigned to receive either no feedback, video feedback alone, or video feedback with the help of an expert, an orthopedic surgeon. The surgical task was then repeated. Orthopedic surgeons evaluated the videotapes using the global rating scale and technical checklist form. RESULTS: One-way between-subject analysis of variance comparing the pretest and post-test difference scores on three different measures for each of the three tasks revealed no statistically significant differences. After controlling for rater variance, the global rating scores across the three surgical tasks did not reveal any statistically significant differences. CONCLUSIONS: This study failed to demonstrate an improvement in technical skills based on utilization of video feedback.

Analysis of Variance↗
PubMed2004

Applying the ASRA guidelines to the use of low-molecular-weight heparin thromboprophylaxis in major orthopedic surgery.

Although low-molecular-weight heparin (LMWH) is a widely used form of thromboprophylaxis in orthopedic surgery, concerns remain over the concomitant use of regional anesthesia (RA)/postoperative regional analgesia (PRA) stemming from reports in the 1990s of spinal hematoma associated with this combination. One of the objectives of the Second American Society of Regional Anesthesia (ASRA) Consensus Conference was to address the safety of LMWH in combination with neuraxial anesthesia. The guidelines are designed in part to help orthopedic surgeons already using or contemplating the use of LMWH prophylaxis to avoid or minimize potential complications arising from its use with RA/PRA. Clinicians should consult the ASRA guidelines for recommendations on total daily dose, timing of the first postoperative dose, and dose schedule for anticoagulants used in conjunction with RA/PRA.

Analgesia↗
PubMed2006

Experimental and clinical performance of porous tantalum in orthopedic surgery.

Porous tantalum, a new low modulus metal with a characteristic appearance similar to cancellous bone, is currently available for use in several orthopedic applications (hip and knee arthroplasty, spine surgery, and bone graft substitute). The open-cell structure of repeating dodecahedrons is produced via carbon vapor deposition/infiltration of commercially pure tantalum onto a vitreous carbon scaffolding. This transition metal maintains several interesting biomaterial properties, including: a high volumetric porosity (70-80%), low modulus of elasticity (3MPa), and high frictional characteristics. Tantalum has excellent biocompatibility and is safe to use in vivo as evidenced by its historical and current use in pacemaker electrodes, cranioplasty plates and as radiopaque markers. The bioactivity and biocompatibility of porous tantalum stems from its ability to form a self-passivating surface oxide layer. This surface layer leads to the formation of a bone-like apatite coating in vivo and affords excellent bone and fibrous in-growth properties allowing for rapid and substantial bone and soft tissue attachment. Tantalum-chondrocyte composites have yielded successful early results in vitro and may afford an option for joint resurfacing in the future. The development of porous tantalum is in its early stages of evolution and the following represents a review of its biomaterial properties and applications in orthopedic surgery.

Animals↗
PubMed2003

Limiting loss to follow-up in a multicenter randomized trial in orthopedic surgery.

Even the best-designed, randomized controlled trials suffer when patients are lost to follow-up. Incomplete follow-up biases the results of a trial when patients who drop out are different from those who complete follow-up. This is exaggerated further when there are differential dropout rates between study groups. Previous randomized controlled trials in orthopedic trauma have reported up to 28% loss to follow-up. Only by striving to achieve a 0% loss to follow-up rate can we be certain that this type of bias does not affect our results. In our ongoing multicenter, randomized controlled trial comparing reamed and nonreamed intramedullary nailing of tibial shaft fractures, we have implemented several innovative strategies to minimize loss to follow-up. The exclusion criteria and consent process are designed to minimize losses. Study staff are carefully trained in communication and negotiation with patients. Additionally, a central methods center monitors all patient follow-up and aids in finding lost patients. Through these primary, secondary, and tertiary interventions, we have achieved 94% complete 1-year follow-up for the first 440 patients enrolled in the trial. Eleven patients withdrew consent, and we are unable to locate 17 patients. We have successfully minimized the loss to follow-up rate in our trial by incorporating innovative prevention and retention strategies into its design and conduct. Through planning, organization, and committing time and resources to minimizing loss to follow-up, other orthopedic trauma trials can hope to achieve the same high rates of follow-up.

Bias↗
PubMed2005

Orthopedic problems in geriatric dogs and cats.

Senior dogs and cats with orthopedic injuries and diseases often require a treatment plan that differs from that of younger patients. Injured bone and soft tissues tend to heal more slowly in the geriatric patient. The older animal is likely to have a less competent immune system and may have compromised metabolic and endocrine function. Pre-existing musculoskeletal problems may make ambulation difficult for an animal convalescing from a new orthopedic problem. Special attention is often needed when treating these patients for fractures, joint instability, infection, and neoplasia. In general, issues that should be addressed in the geriatric patient include reducing intraoperative and anesthesia time, enhancing bone and soft tissue healing, return to early function, control of postoperative pain, physical therapy, and proper nutrition.

Aging↗
PubMed2006

Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware.

Multi-detector CT imaging (MDCT) becomes routine imaging modality in the assessment of the postoperative orthopedic patients with metallic instrumentation that degrades image quality at MR imaging. This article reviews the physical basis and CT appearance of such metal-related artifacts. It also addresses the clinical value of MDCT in postoperative orthopedic patients with emphasis on fracture healing, spinal fusion or arthrodesis, and joint replacement. MDCT imaging shows limitations in the assessment of the bone marrow cavity and of the soft tissues for which MR imaging remains the imaging modality of choice despite metal-related anatomic distortions and signal alteration.

Artifacts↗
PubMed2005

Prevalence of cna, fnbA and fnbB adhesin genes among Staphylococcus aureus isolates from orthopedic infections associated to different types of implant.

Here are reported data on virulence determinants of Staphylococcus aureus from orthopedic surgical infections, emphasizing on the genes encoding fibronectin (fnbA, fnbB) and collagen (cna) adhesins. 191 S. aureus strains from orthopedic infections (53 from internal fixation devices, 29 external fixation devices, 15 knee arthroprostheses, 30 hip arthroprostheses, 45 surgical reconstruction and 19 non-associated to medical devices) were investigated for the presence of the genes of the collagen-binding protein Cna and of the two fibronectin-binding proteins, FnbA and FnbB. 87 (46%) strains were found to be cna+ without significant variations across the different surgical categories considered. Conversely, the fnbA and the fnbB genes were almost always present in all surgical categories. The finding that, among the investigated adhesins, fibronectin-adhesins are present in the majority of the implant associated S. aureus clinical isolates encourages the development of strategies to specifically block the interaction of bacteria with matrix fibronectin by antagonist ligands.

Adhesins, Bacterial↗
PubMed2005

Antibiotic prophylaxis in orthopedic prosthetic surgery.

The problem of prophylaxis in orthopedic implant surgery will become increasingly important and complex as the population ages and requires more arthroplasty procedures, and the prevalence of antimicrobial-resistant bacteria meanwhile also continues to rise. Energy spent preventing prosthetic joint infection is more effective than that expended in treating the infection of a prosthetic joint, once established. Preventive measures encompass a wide array of variables related to host response, wound environment, and microorganisms. Prophylaxis should address these areas in the preoperative, intraoperative, and postoperative periods. Antimicrobial prophylaxis remains the single most effective method of reducing the prevalence of infection after total joint arthroplasty. In the postoperative period, prophylaxis aims to protect the prosthetic joint against hematogenous seeding from oral, urologic, skin, or gastrointestinal sources. Currently, dental and urologic advisory statements provide recommendations for antimicrobial prophylaxis for high-risk patients with total joint arthroplasty undergoing high-risk procedures. Close collaboration between the orthopedic surgeon, urologist, or dentist and the infectious disease specialist is crucial for providing recommendations regarding prophylaxis in special circumstances. In these particular circumstances, individual decisions should be made based on clinical judgment.

Anti-Bacterial Agents↗
PubMed2006

Antibiotics in trauma and orthopedic surgery -- a primer of evidence-based recommendations.

Systematic reviews and meta-analyses published in recent years have allowed drafting of evidence-based guidelines for antibiotic prophylaxis in orthopedic and trauma surgery. It is important to recognize the limitations of the recommendations derived from the available body of evidence. Since some of the most relevant randomized controlled clinical trials were performed more than 20 years ago, it is sometimes difficult to apply the data to today's clinical practice. In establishing consensus guidelines, it could prove difficult to identify areas for improvement through further research and better compliance. Although recommendations for optimized treatment of orthopedic implant infections are not currently based on first-class evidence, there are very promising new concepts emerging in this field, and we are awaiting more data and decisive conclusions from larger clinical trials.

Anti-Bacterial Agents↗
PubMed2005

Virtual reality simulators in orthopedic surgery: what do the surgeons think?

BACKGROUND: There is increasing pressure to develop virtual reality surgical simulation that can be used in surgical training. However, little is known of the attitudes of the surgical community toward such simulation, and which aspects of simulation are most important. MATERIALS AND METHODS: A postal survey on attitudes to surgical simulation was sent to all New Zealand orthopedic surgeons and advanced trainees. This comprised of 44 questions in 10 sections, using either a visual analogue scale (0 to 10) or free text box replies. Results were analyzed for two sub-groups; surgeons qualified before 1990 and those qualified in or after 1990 or still in training. RESULTS: Of the 208 possible responses, 142 were received, a response rate of 68%. Only four respondents had tried a surgical based simulator. Earlier qualified surgeons were more likely to agree that simulation was an effective way to practice surgical procedures, median score 7.7 versus 5.6 (P = 0.03). Both groups thought the most important task for simulation was practicing angulation/spatial orientation (median score 8.4/10), while a realistic view of the operation was the most important requirement (median score 9/10). Both groups were unconvinced that simulation would impact on their practice in the next 5 years, with this statement being scored lower by later qualified surgeons, median score 2.4 versus 4.1 (P = 0.04). CONCLUSIONS: Orthopedic surgeons in New Zealand are supportive of surgical simulation but do not expect simulation to have an impact in the near future. Intriguingly, later qualified surgeons and trainees are more skeptical than their earlier qualified colleagues.

Adult↗
PubMed2006

Orthopedic trauma: office management of major joint injury.

Orthopedic injuries are common reasons for visits to primary care physicians. Careful history and physical examination with intelligent use of imaging technology will arrive at the correct diagnosis in most patients. Many conditions may be definitively managed by the office internist. Others maybe initially stabilized and referred to orthopedic surgeons for definitive care. Nondisplaced fractures, tendon injuries, sprains, and overuse syndromes are entities within the purview of the primary care physician. Familiarity and confidence with diagnosis and management of these conditions in the office is optimal for the care of the adult patient.

Acute Disease↗
PubMed2005

Orthopedic personnel roles in the OR for computer assisted total knee arthroplasty.

The methods and problems associated with traditional total knee arthroplasty surgery and the development and advantages of computer-assisted surgery (CAS) are discussed in this article. In the next decade, CAS products have the potential to transform as many as 25% of all orthopedic surgical procedures from techniques that largely depend on line of sight and traditional instruments to techniques that use integrated surgical instruments and computer technology. This technology could revolutionize orthopedic surgery, the lives of patients, and the work of perioperative staff members during the next decade.

Anthropometry↗
PubMed1996

Use of recombinant human erythropoietin in the perioperative period of orthopedic surgery.

In a double-blind, multicenter study, 200 patients who could not or would not donate autologous blood before major orthopedic surgery requiring transfusion of at least 2 units of whole blood were randomized to receive placebo (n = 69) or recombinant human erythropoietin (Epoetin alfa) in daily doses of 300 U/kg (n = 60) or 100 U/kg (n = 71) for 15 consecutive days, starting 10 days before surgery and extending through the fourth postoperative day. Of these, 185 patients who received active medication or placebo and underwent surgery were qualified for evaluation of efficacy (n = 67, n = 54, and n = 64, respectively). All patients received concomitant oral iron supplementation. Compared with placebo-treated patients, a significantly lower proportion of patients who received either dose of Epoetin alfa required allogeneic blood transfusions (54% for placebo, 17% for 300 U/kg, 25% for 100 U/kg; p < 0.01), as well as fewer mean units of blood (1.42 units for placebo, 0.37 units for 300 U/kg, 0.58 units for 100 U/kg; p < 0.01). The differences between the Epoetin alfa treatment groups were not statistically significant. On the basis of these results, perioperative Epoetin alfa therapy in conjunction with iron supplementation may have a place as an adjunct to elective orthopedic surgery, particularly if dosing regimens less frequent than once daily can be established.

Double-Blind Method↗
PubMed2005

[Prevalence and risk factors for postoperative infection in pediatric orthopedic surgery: a study of 458 children].

PURPOSE OF THE STUDY: The incidence of postoperative infection in pediatric surgery has been studied little in the literature. It would be lower than in adults. In the present work, we attempted to define the incidence of postoperative infection in orthopedic pediatric surgery and identify risk factors. MATERIAL AND METHODS: This was a retrospective analysis of 458 children who underwent surgery between 1998 and 1999 for the following conditions: talipes equinus, congenital hip dislocation, supracondylar fracture of the elbow, and femur shaft fracture. We noted the prevalence of infection of the surgical site, the type of infection and its course as well as the principal risk factors incriminated: age, condition, surgical modalities (emergency setting, hour, bleeding) and use of antibiotic prophylaxis. RESULTS: Mean age at surgery was 5.4+/-3.5 years. The sex ratio was 1.6 boys/1 girl. Forty-two patients developed an infection of the surgical site, giving an incidence of 9.2% of the patients and 8.3% of the surgical sites. Postoperative infection was more frequent in the talipes equinus group (19.4% versus 5.8% for supracondylar fractures of the elbow, 2% for femur shaft fractures, and 0% for congenital hip displacement). In 78.6% of the cases, the infection was superficial. The analysis of risk factors showed that talipes equinus is an independent risk factor. The absence of antibiotic prophylaxis increased the risk of infection of the surgical site significantly only in the talipes equinus group (40.7% versus 14%). DISCUSSION: The incidence of infection of the surgical site in pediatric orthopedic surgery was high in our series, 8.3% versus 0.4% and 5.6% reported in the literature. Talipes equinus surgery exposes the child to a significant risk of infection. The principal risk factors related to surgery would be: ischemia, inflammation of cutaneous and subcutaneous tissue due to detachment, the tourniquet, and the absence of antibiotic prophylaxis.

Child↗
PubMed1999

A new era in orthopedic trauma care.

The previous 20 years have truly opened a new era of orthopedic trauma care. Rapid advances in the development of systems for internal and external fixation have been made. Improvements in technology and surgical technique have allowed fracture reduction and fixation to be achieved with less-invasive surgical approaches. This has reduced postoperative morbidity, decreased hospitalization, and expedited the recovery of function. A new understanding of processes at the cellular and molecular levels offers the possibility, for the first time, of directly influencing the biology of fracture union and soft-tissue healing. Transitional research has introduced new therapies that are moving rapidly from the laboratory to biotech industry and the clinical arena. Given the present state of scientific acceleration, orthopedic trauma care in the new millennium will be shaped by important developments that physicians can now only imagine.

Forecasting↗
PubMed2000

Synthetic biodegradable polymers as orthopedic devices.

Polymer scientists, working closely with those in the device and medical fields, have made tremendous advances over the past 30 years in the use of synthetic materials in the body. In this article we will focus on properties of biodegradable polymers which make them ideally suited for orthopedic applications where a permanent implant is not desired. The materials with the greatest history of use are the poly(lactides) and poly(glycolides), and these will be covered in specific detail. The chemistry of the polymers, including synthesis and degradation, the tailoring of properties by proper synthetic controls such as copolymer composition, special requirements for processing and handling, and mechanisms of biodegradation will be covered. An overview of biocompatibility and approved devices of particular interest in orthopedics are also covered.

Biocompatible Materials↗