What’s New in Hip Replacement- Recent Update and Guidelines

Hip replacement surgery has undergone tremendous changes from preoperative work up to post operative management. Now many studies are done on individual stages to assess which is the best method. Also, these are helping to fasten the recovery phase. Early and pain free mobilisation is the present motto in joint replacements so that patients can get back to their routine activities as soon as possible.

Solitary Plasmacytoma of The Sternal Stalk: A Case Report and Literature Review

Background: It has been reported that sternal neoplasms are a rare disease, accounting for about 1% of primary bone neoplasms, of which about 60% are malignancy, mostly occurring in the manubrium sternum. Case presentation: We reviewed a 77-year-old man with a solitary plasmacytoma of the sternal stalk presenting with pain in the anterior chest wall by examining a preoperative diagnosis of sternal manubrium malignant bone tumor. We performed extensive sternal manubrium tumor resection + bilateral partial costal cartilage resection + bilateral clavicular head resection + cervical lymph node dissection + thoracic reconstruction, and the postoperative recovery was perfect. Conclusion: We report a rare case of solitary plasmacytoma of the manubrium sternum successfully treated by extensive radical surgery for the manubrium tumor. Although rare, the disease should be identified, examined, and treated early to avoid serious complications.

Low-Cost, Low-Fidelity, Self-Made Arthroscopic Surgical Simulators: A Systematic Review

Purpose: To systematically review the literature regarding low-cost, low-fidelity, self-made arthroscopic surgical simulators and provide an overview of their use in the teaching of arthroscopic surgical skills. Methods: Systematic review of the literature following PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines. Results: A total of 10 studies met inclusion criteria. All studies utilized low-cost, low-fidelity, self-made arthroscopic simulators of varying designs. Five studies (50%) utilized low-cost, self-made arthroscopic cameras and three (30%) utilized commercial surgical arthroscopic cameras. One study (10%) demonstrated face validity, five (50%) demonstrated construct validity, and three (30%) demonstrated transfer validity. The assessed arthroscopic tasks varied, but generally consisted of a combination of triangulation, object grasping, and tissue manipulation. Seven (70%) studies evaluated total simulator construction costs, with six (60%) studies achieving total construction costs of < $80 US Dollars. Conclusions: A growing body of literature supports the use of low-cost, low-fidelity, self-made arthroscopic surgical simulators. The cost-effectiveness and practicality of these simulators remains a major benefit to their overall utility when compared to their commercially available and high-fidelity counterparts. Furthermore, studies utilizing low-fidelity arthroscopic simulators are beginning to place a large importance on the achievement of face, construct, and transfer validity. Evidence suggests that the true utility of low-cost, low-fidelity arthroscopic surgical simulators stem not from their ability to replicate operating room conditions, but rather from their ability to provide practical training in basic and essential arthroscopic skills that will then be further refined through possible additional simulation and future surgical training.

Hospital Mortality in Trauma Patients

Introduction: The study of mortality in a community makes it possible to define the axes of disease prevention and to readjust public health policies. The achieve of our study was to assess hospital mortality in trauma patients in an orthopedic department of a teaching hospital in sub-Saharan Africa. Patients and Method: We conducted a retrospective prognostic study evaluating hospital mortality during the period from March 1, 2013 to February 29, 2018. The results were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: Hospital mortality rate was 1.43%. The Circumstances of death were dominated by road accidents with 48.2%. Trauma to the lower limbs, the spine and polytrauma were the most frequently observed lesions on admission of patients with 40%, 27.3% and 28.2% respectively. Neurovegetative complications (29.51 %) and cardiopulmonary arrest (18.03 %) were the main causes of death at autopsy. Results: Hospital mortality rate was 1.43%. The Circumstances of death were dominated by road accidents with 48.2%. Trauma to the lower limbs, the spine and polytrauma were the most frequently observed lesions on admission of patients with 40%, 27.3% and 28.2% respectively. Neurovegetative complications (29.51 %) and cardiopulmonary arrest (18.03 %) were the main causes of death at autopsy. Conclusion: Traffic accidents are the most common cause of death from trauma. They can be avoided or limited by a good road safety policy.

Janus Kinase Inhibitors: Hope for Biotherapy in Sub-Saharan Africa?

Introduction: Tofacitinib is an oral Janus Kinase (JAK) inhibitor used in the treatment of rheumatoid arthritis (RA) and in many other conditions [1-3]. After promising results in clinical and preclinical trials, Tofacitinib was extensively evaluated in pivotal trials in 2012 and its efficacy on demonstrated structural damage [4]. Thus, Tofacitinib has been approved for the treatment of patients with RA who have an inadequate response to methotrexate [5]. Biologics are used routinely in many countries but remain difficult to access in sub-Saharan Africa [6]. The cost of biotherapies, their side effects, in particular infectious ones, and their presentation in injectable form constitute a brake on the use of these new treatments. The advent of a new therapy administered by bone would represent an excellent alternative for Africa. We thus report the case of a patient who failed conventional treatments and who has benefited from Tofacitinib (Xeljanz 5mg®).

Minimal Brain Dysfunction. Children and adults. Clinical and Psychological Symptoms. Examples of pathology. Rules of Therapy

In the paper there are presented observations from the years 1995-2021. Material content of 1355 children and youths in the ages between 2 and 18 years and adults 20-70 years old. In the article they are present the clinical symptoms of Minimal Brain Dysfunction [MBD]. Clinically there are: valgus deformity of the feet, hyperextension of the knees, anterior tilt of the pelvis, hyperlordosis of the lumbar spine. These symptoms are as result of spasticity or sub-spasticity of the muscles. At the same time, we observe in this group of patients “laxity of joints” and this is a result of the changes in the properties of collagen. In the MBD group of patients-there are very often also psychological disorders-similarly like in cases of Attention Deficit & Hyperactivity Disorder (ADHD). Children with MBD often present inclination to hyperactivity-frequent jumping-and it is the main cause of Perthes disease. There are also psychological changes in behavior in adults-and this is described in “Discussion”. It is also given information about physiotherapy of the diseases and disorders in movement system.

Hemispherical with Flattened Pole Dual-Mobility Acetabular Cup in Revision or Complex Hip Arthroplasty: Safety and Efficacy. The SYMCOR-2 study [NCT04209426]

Purpose: To Estimate the short-term clinical safety and efficacy of hemispherical with flattened pole chromium-cobalt metal back dual-mobility acetabular cups with porous outer coating and anchoring (HFPC-DMR-HA) or cement fixation (HFPCDM-CEM), in revision or complex THA. Methods: Single-centre retrospective observational cohort study (title: SYMCOR-2, clinicaltrials.gov: NCT04209426) of consecutively operated patients who underwent THA with an HFPC-DMR-HA or HFPC-DM-CEM cup 2 years prior to study start. Prospective 2-year follow-up with letter and phone questionnaires. Results: Sampling frame: 203 patients including 9.85% in the two cohorts with 15 HFPC-DMR-HA and 5 HFPC-DM-CEM. 30% lost to follow-up. Median follow-up (years): HFPC-DMR-HA: 2.3, HFPC-DM-CEM: 3.3. Indications: HFPC-DMR-HA 67% revision & 33% primary THAs, HFPC-DM-CEM 100% revision. Primary endpoint: 2-year implant survival rate: HFPC-DMR-HA 93% [59, 99], HFPC-DM-CEM 100%. Prosthetic dislocation: HFPC-DMR-HA: 1 (6.7%), HFPC-DM-CEM: 0%. Secondary endpoint: Modified HHS (pain & functional sub score) improved with HFPC-DMR-HA from baseline 26.8 [14.9, 38.7] to 82.2 [73.5, 90.9] at 2-year follow-up (p<0.0001), HFPC-DM-CEM from 41.6 [24.9, 58.3] to 80.7 [55.8, 100]. Conclusions: The short-term benefit-risk balance was deemed satisfactory

Dual-Mobility Progressive Press-Fit Hemispherical Acetabular Cup in Primary Hip Arthroplasty: Safety and Efficacy. The SYMCOR-1 study [NCT04209374]

Purpose: To Estimate the short-term clinical safety and efficacy of hemispherical with flattened pole chromium-cobalt metal back dual-mobility acetabular cup with porous outer coating (HFPC-DM-HA), in primary THA. Methods: Single-center retrospective observational cohort study of consecutive patients undergoing THA with a HFPC-DMHA cup 2 years prior to study start. Prospective 2-year follow-up with letter and phone questionnaires. Results: Sampling frame: 361 patients including 59 patients (16.3%) in the cohort. 6 patients (10%) lost to follow-up. Median age 77.5 years (67, 92), 32% female, median BMI 25.2 kg.m-2 (18.4 to 56.8). Primary osteoarthritis in 80%. Median follow-up 3.0 years (2.7 to 4.1) Primary Endpoint: 2-year implant survival rate: 97% [87, 99]. Prosthetic dislocation: 0%. Secondary Endpoint: Modified HHS (pain & functional sub score) improved from baseline 39.7 [34.6, 44.7] to 75.8 [72.1, 79.6] at 1-year and to 86.7 [83.7, 89.7] at 2-year (p<0.0001). Conclusions: The short-term benefit-risk balance was deemed satisfactory

Management of Tibial Metaphyseal Fractures Using JESS Fixator

Introduction: The management of proximal and distal tibia fractures remains challenging due to associated soft tissue injuries. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a simple wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 30 consecutive patients (20 patients of proximal tibial metaphyseal fractures and 10 of distal tibial metaphyseal fractures). Results: In our study, the most common mode of injury was road traffic accidents (21 cases), fall from height (6 cases) and slip injury (3 cases). The patients were operated at a mean interval of 3.2 days (range 1-6 days) due to associated poor soft tissue conditions. The patients were followed up for 24 weeks. Full weight bearing was allowed at 10 to 14 weeks. JESS frame was removed at mean duration of 13 weeks (range 12-16 weeks). According to knee society score (KSS), excellent result (score 80- 100) was seen in 12 patients (60%), good result (score 70-79) was seen in 4 patients (20%), fair result (score 60-69) in 3 patients (15%) and poor result (score <60) in 1 patient (5%) of proximal tibial metaphyseal fracture. According to Olerud and Molander score (OAMS), excellent result (score 91-100) was seen in 5 patients (50%), good result (score 61-90) in 3 patients (30%) and fair result (score 31-60) in 2 patients (20%) of distal tibial metaphyseal fracture. The complication seen was superficial pin tract infection in 4 patients, which was managed by regular pin tract dressing and oral antibiotics. Delayed union (mean at 15.3 weeks) was seen in 2 patients with Schatzker type VI fracture and 1 patient with severe comminuted distal metaphyseal fracture. Conclusion: JESS is a simple, light, effective and cheap method and can be used as a definitive procedure to treat these fractures even with soft tissue compromise.

Incidental Dural Tear in Lumbar Spine Surgery: A Prospective Study

Introduction: Incidental dual tear is a complication of spinal surgery characterized by an accidental nick of the spinal dural sheath during operative procedures. The worldwide incidence of dural tear according to previous literature varies widely (1- 17%) and in general depends on the type and complexity of the procedure. The present was carried to evaluate the incidence of dural tear in lumbar spine surgery, and to study clinical outcomes in terms of VAS score ODI score and length of hospital stay. Methods: This was a prospective, observational and case control study conducted on 40 patients who underwent elective Lumbosacral spine surgery. The incidence of dural tear was evaluated and the patients were divided into with dural tear and without dural tear. The clinical outcome such as visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score and length of hospital stay were evaluated. Results: The incidence of Dural tear in our study population was found to be 7.5%. The ODI score was significantly higher in dural tear as compared to without dual tear at various postoperative periods. Further, there was no significant difference in the VAS scores with and without dural tear patients. The length of hospital stay was significantly higher in patients with dural tear as compared to without dural tear (11.63±6.19 vs 3.06±1.02 days; p=0.004). Conclusion: Incidental Dural tears if detected and managed accordingly, adverse clinical and postoperative outcomes can be reduced effectively and also increases the quality of life in patients.