Towards Consensus on the Reporting of Core Outcome Domains in Total Joint Replacement Clinical Trials

There is no consensus on how to report total joint replacement (TJR) trials. To our knowledge, core outcome domains for TJR clinical trials have not been defined.

Our objective was to develop data-driven, consensus-based, preliminary recommendations for core outcome domains for TJR clinical trials.

We surveyed two groups of experts/stakeholders, who rated potential core outcome domains (mapped to Outcome Measures in Rheumatology Trials filter 2.0 framework) for their relevance to TJR clinical trials during the 2014 American Academy of Orthopaedic Surgeons.

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Spondylodiscitis in a Geriatric Male

The incidence of Pyogenic Spondylodiscitis (PS) seems to be increasing in the last years as a result of the higher life expectancy of older patients with chronic debilitating diseases; also a number of co-morbidities have been found to increase the risk of disease such as diabetes (11-31%), immunosuppression, intravenous drug use, alcoholism, chronic debility disease with decubitus ulcers, malignancy, alcohol use and renal failure. 

Vertebral Fracture

The source of infection in the elderly has been related to the use of intravenous access devices and the asymptomatic urinary infections . A single organism is usually involved, although polymicrobial infections do occur in chronic and debility conditions. Staphylococcus aureus is the most common organism isolated implicated into 15- 84% of nontuberculosis cases of infection and frequently observed as complication of invasive spinal procedures (17-33%).  Read More>>>>

Rocuronium as Selective Local Musclerelaxant in Orthopedic Surgery

A variety of surgeries need profound muscular block solely in an exceedingly restricted surgical field. Recent accessibility of sugammadex, a cyclodextrin derivative antitoxic substance active on an amino steroid muscle relaxant, has offered the likelihood of maintaining a prolonged deep neuromuscular paralysis with a rapid reversal at the end of surgery.

As a consequence, complete post anesthesia recovery is often rapidly obtained under safe clinical conditions.

However, in selected patients, a muscle relaxant can be locally injected at low doses in one or more muscles concerned within the surgical technique without a systemic paralysis.

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Personalized Medicine for Metal on Metal Hip Resurfacing: Predictors for the 10 Years Success of the Birmingham Hip Resurfacing

Metal-on-metal hip resurfacing arthroplasty was introduced to preserve patients’ bone and facilitate revision surgery. This prospective cohort study aims to determine a prognostic model (OsBHR) to predict which patient and surgeon related factors predict better long term implant survival for the Birmingham Hip Resurfacing (BHR).

Between 1997 and 2002, details of 4490 patients (4945 hips) treated by hip resurfacing arthroplasty using the BHR prosthesis were entered in a prospective international registry and available for analysis. Implant survival was determined using the Kaplan-Meier estimator and a shared frailty proportional hazard model was used to determine predictors of implant revision.

prognostic equation suggested a minimum diameter of 50 mm should be used for male and 52 mm for female patients to ensure a minimum 10-year survival rate of 95% for in procedures performed by an average surgeon.

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Cementless Long Stem Total Hip Replacement for Revision of Failed Hemiarthroplasty

The total hip replacement after failure of hemiarthroplasty (unipolar or bipolar) has been associated with very high rates complications (intra- and postoperative).

Forty patients 24 males and 16 females with a mean age of 58 years (range: 48-68) had total hip arthroplasty (THA) revision of aseptic loosening of hip hemiarthroplasty.

The mean duration of the follow-up was 42 months (range: 30-72), and the cases lost in follow up were excluded from the study. Failure was defined as revision arthroplasty or radiographic evidence of stem loosening, indicated by an Engh fixation score ≤ 10. Vertical femoral migration of >5 mm was defined as subsidence.

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A Case of Crowned Dens Syndrome with Huge Calcifications

An 81-year-old woman presented to our hospital with a 1-month history of headache and neck pain. She had no neurological symptoms, articulation disorder, or swallowing disorder.

The plain radiograph showed calcification deposits around the atlantoaxial joint and anterior vertebral body. The computed tomography scan of her neck showed details of these calcifications.

Huge crownshaped deposits of hydroxyapatite or calcium pyrophosphate dihydrate were seen. The C-reactive protein level was slightly increased to 0.78 mg/dL. Oral non-steroidal anti-inflammatory drug therapy resulted in complete improvement of her symptoms.

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Evaluation of Humeral Head Cartilage Using the Magnetic Resonance Imaging T1ρ Relaxation Time Mapping Technique

To evaluate the difference in the age-related cartilage changes of the humeral head with T1ρ relaxation time mapping and assess the normal distribution of the proteoglycan content of the humeral head in healthy volunteers without any symptoms or structural disorders.

Twenty male volunteers (10 young subjects, 10 elderly subjects) for each generation group (mean age, young subjects: 30.2 ± 2.3 years; elderly subjects: 62.6 ± 6.2 years) participated in this study.

Spectral attenuated inversion recovery T2-weighted imaging and T1ρ relaxation time mapping were performed using 3.0-Tesla magnetic resonance imaging.

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In Situ Tarsal Metatarsal Dowel Arthrodesis with Trephine Reamers and Cancellous Bone Plugs: A Technique Guide and Case Report

Tarsalmetatarsal (TMT) osteoarthritis is encountered frequently. Pathology at the TMT joints play a role in continued foot fatigue and further compensation of gait laterally to avoid discomfort over the medial and central columns of the midfoot.

Sequeula and further pathology to the central TMT joints are multifactorial. Recalcitrant pain, subtle instability, and arthrosis are commonly observed.

Patients who fail nonoperative treatment are subjective to reconstructive surgical treatment. We present a straightforward stepwise technique for an in situ arthrodesis of the central TMT joints.

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Primary Cutaneous Squamous Cell Carcinoma of Thigh A Case Report and Review of Literature

The Change of Bone Erosion using Denosumab to Rheumatoid Artiritis

A 49-year-old woman presented to our hospital for treatment of rheumatoid arthritis (RA). Although she was taking methotrexate (8 mg/week), her symptoms had not resolved.

SDAI was 26.2 at the first visit. We recommended biological agents, but she refused. Therefore, methotrexate was increased to 16 mg/week over a 1-year period, resulting in improvement of SDAI to 3.4.

Bone mineral density (BMD) was measured during treatment, revealing low BMD at L2-L4 (0.834 g/cm2), so alendronate was started (35 mg/week).

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Treatment by Quacks Still An Issue of Concern

It was not all about writing a research paper or a case report. This time it was writing our experience regarding mismanagement of simple injuries or fractures by quacks.Lots of patients frequently come to our orthopaedic OPD with complaints of deformities, stiffness of joint, non union of fractures or an ugly swelling.

It is not uncommon to see patient left handicapped by a quack after a simple fracture. Not only do these quacks treat injuries but they also put their hands on other orthopaedic ailments like rheumatoid arthritis.

Most of time history is same.History of trauma sustaining injury to limbs and often injury is of 5 to 6 months old.

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Intra-articular Injections for Osteoarthritis: From Bench to Bedside, can we Teach Old Drugs New Tricks?

The two articles in this month’s press of The Journal of Arthritis, one by Ekinci et al. titled ‘A New Treatment Option in Osteoarthritis: Prolotherapy Injections’ and the other by Senatorov et al. titled ‘Clinical Outcome of Hylan G-F 20 Injections in Shoulder and Hip Osteoarthritis: A Retrospective Review’ raise several important points surrounding the topic of intra-articular injections.

Firstly that there is a paucity of high quality literature in the field that often leads to inconclusive or misrepresented conclusions on drug efficacy in established treatments. The articles also highlight the heterogeneity in injection procedure, site, concentration, preparation and outcome measurements.

This editorial will, therefore, provide a concise review on some of the current injection therapies and suggest possible improvements to methodological structure to inspire readers strive for high quality data. Further, through an example of a possible novel therapy, Actovegin, this editorial will hopefully challenge readers’ way of thinking to consider the reapplication of established drugs; posing the question can you teach an old drug new tricks?

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How to Control the Calamities and Protect the Earth

Now a day the calamities are more destructive element in the world. It destroys the life, crops, houses, trees, and many other things. The Area which is affected by it goes not less than 20 years back.

The pollution of the Air, Water, Soils, Replacement of minerals, occupies the land, Day by day less number of birds, Animals and aquatic creatures, Manufacture of synthetic items, Chemicals and management of plants (trees) are reason behind it.

God has given us every things to clean the environment for example we can take birds Vulture, Eagle, Kite, Wood Peker, Ravan, crow and many others birds. Now we cannot find many kinds of birds.

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Can Metal Levels be Measured at a Community Laboratory?

There remain concerns about the ability of community laboratories to accurately measure blood metal levels as one piece of the monitoring and treatment algorithms for patients with a metal-on-metal total hip arthroplasty (THA).

The purpose of this study is to compare serum cobalt and chromium levels obtained from one group of patients at a single reference laboratory to levels from a different group of patients measured at multiple community laboratories.

We compare serum metal levels performed prospectively at a single reference laboratory on 57 patients to levels performed retrospectively on 160 patients in community laboratories. All patients had unilateral metal-on-metal bearing hips.

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Plantar Fasciitis: What Does the Evidence Show?

Plantar Fasciitis (PF) is caused by repetitive and excessive tensile stress applied to the PF, which leads to fibrosis and inflammatory and degenerative changes.

The PF is a membrane that connects the heel bone and the toes, and has a thick structure with bonding strength.

PF plays a complex role in the protection and support of the foot itself, and is also important for support of body weight.

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Intra-articular Injections for Osteoarthritis: From Bench to Bedside, can we Teach Old Drugs New Tricks?

The two articles in this month’s press of The Journal of Arthritis, one by Ekinci et al. titled ‘A New Treatment Option in Osteoarthritis: Prolotherapy Injections’ and the other by Senatorov et al.

Titled ‘Clinical Outcome of Hylan G-F 20 Injections in Shoulder and Hip Osteoarthritis: A Retrospective Review’ raise several important points surrounding the topic of intra-articular injections.

Firstly that there is a paucity of high quality literature in the field that often leads to inconclusive or misrepresented conclusions on drug efficacy in established treatments.

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