Functional outcome and complication following THA through modified direct anterior approach correlated to cadaveric study: are there any differences in Asian hip?

BACKGROUND: Direct anterior approach (DAA) has several advantages including shorter length of hospital stay, faster recovery, and better functional outcome while this approach may cause damage to the lateral femoral cutaneous nerve (LFCN) as high as 81% in the works of literature. Not much data has identified the LFCN pattern in the Asian population. Therefore, the purpose of our study was to identify characteristics of the LFCN patterns representing an Asian hip, which would aid to provide the most appropriate incision of modified direct anterior approach (MDAA) for total hip arthroplasty (THA), and to identify the clinical outcome and complications following THA through MDAA correlated with cadaveric hip in the Asian population. METHODS: After IRB approval, a cadaveric study was done to identify pattern and course of the LFCN in Asian population. The MDAA defined as the incision 2 fingerbreadths posteriorly to anterior superior iliac spine to avoid injury to the LFCN. The clinical phase identified 32 patients who underwent THA because of late-stage osteoarthritis of the hip. The anterolateral skin numbness was measured along tensor fascia lata between 2 weeks until 2 years. The functional outcome assessed by Harris Hip Score (HHS) and complications were evaluated in all patients. RESULTS: The characteristics of the LFCN from cadaveric study (phase 1) was predominantly in sartorius type (60.0%) followed by posterior type (26.6%), fan type (6.7%), and variant type (6.7%). The clinical phase demonstrated that 23 patients (71.9%) had no numbness while 9 patients (28.1%) came with numbness after undergoing THA through the MDAA. Finally, a small area of skin numbness remained in only 3 patients (9.4%) at 2 years follow-up. Additionally, there was no significant difference in functional score at 2 years follow-up (89.0 vs 91.2, p = 0.422) between those with LFCN injury and those without LFCN injury. CONCLUSIONS: The LFCNs were divided into four types. Modified direct anterior approach, which is an alternative approach for THA, allowing for a lower rate of skin numbness and faster recovery without hip dislocation, abductor weakness, and serious nerve complication. Functional outcome was comparable with and without LFCN injury. LEVEL OF EVIDENCE: Level II, prospective observation study.

Precision of computed tomography and cartilage-reproducing image reconstruction method in generating digital model for potential use in 3D printing of patient-specific radial head prosthesis: a human cadaver study.

BACKGROUND: A prosthetic replacement is a standard treatment for an irreparable radial head fracture; however, the surface mismatch of the commercially available designs is concerned for the long-term cartilage wear. The patient-specific implant created from 3D printing technology could be favorable in replicating the normal anatomy and possibly reduce such sequela. Our study aimed to assess the precision of the computed tomography (CT) and cartilage-reproducing image reconstruction method (CIRM) in generating digital models for potentially use in manufacturing the patient-specific prosthesis from 3D printing. METHODS: Eight intact  elbows (3 right and 5 left) from 7 formalin-embalmed cadavers (4 males and 3 females) with mean age of 83 years (range, 79-94 years) were used for this study. Computerized 3D models were generated from CT, and CIRM. The cartilage-reproducing image reconstruction method has compensated the cartilage profile based on the distance between the subchondral surfaces of the radial head and surrounding bones in CT images. The models of actual radial head geometry used as the gold standard was generated from CT arthrography (CTA). All models of each specimen were matched by registering the surface area of radial neck along with the tuberosity. The difference of head diameter, head thickness, and articular disc depth among three models was evaluated and analyzed by Friedman ANOVA and multiple comparison test using Bonferroni method for statistical correction. A p-value of less than 0.01 was considered statistically  significant. The difference of overall 3D geometry was measured with the root mean square of adjacent point pairs. RESULTS: The analysis displayed the difference of diameter, thickness, and disc depth across the models (p< 0.01). Pairwise comparisons revealed statistically significant difference of all parameters between CTA models and CT models (p< 0.01) whereas no difference was found between CTA models and CIRM models. The mean difference of overall 3D geometry between CTA models and CT models was 0.51±0.24 mm, and between CTA models and CIRM models was 0.24±0.10 mm. CONCLUSIONS: CIRM demonstrated encouraging results in reestablish the normal anatomy and could be potentially used in production process of 3D printed patient-specific radial head prosthesis.

Anterior skin numbness after total knee arthroplasty: A prospective comparison study between diabetic and non-diabetic patients.

BACKGROUND: Anterior skin numbness from injury of the infrapatellar branch of saphenous nerve (IPBSN) and/or the anterior-inferior branch of the femoral cutaneous nerve (AIBFN) has been reported after TKA. A recent study has demonstrated no difference in skin numbness between minimally invasive and standard approach TKA. The purpose of our study was to compare the area of skin numbness following TKA in the diabetic and non-diabetic patient. MATERIAL AND METHODS: 120 patients (41 type II diabetic and 74 non-diabetic) undergoing TKA were evaluated. Five diabetic patients with preoperative skin numbness were excluded. Area of anterior skin numbness was periodically evaluated with a minimum 2-year follow-up (FU). RESULTS: Clinically, there was no difference in prevalence of skin numbness (73.2% vs 68.9%, p = 0.36) and warmness (97.6% vs 97.3%, p = 1.00) between diabetics and non-diabetics. Average area of numbness was comparable. However, duration of numbness recovery was significantly longer in diabetics (8.6 vs 5.3 months, p = 0.001). Diabetics had a higher rate of global anterior numbness (48.3% vs 22.9%, p = 0.045). Prevalence of supero-lateral skin numbness (2.6%, n = 3) correlated with the skin incision extended proximally above upper pole of patella at least 4.0 cm. CONCLUSION: The duration of numbness recovery following TKA was significantly longer in diabetic patients.

Matching precision of the reverse contralateral radial head in generating of the individualized prosthesis from the surface registration in tuberosity-neck and in tuberosity-diaphysis.

PURPOSE: Following the radial head replacement, the surface mismatches between the implants and the morphological characteristics of the original proximal radius decreased contact areas and increased contact forces which is potential for the long-term articulating cartilage wear. Several studies demonstrated that the individualized prosthesis, created from computed tomographic (CT) images of the contralateral side with the reverse engineering technology, may reduce the mismatch. The aim of this study is to demonstrate the matching precision of the reverse contralateral head between the surface registration in tuberosity-neck (TN) area and in tuberosity-diaphysis (TD) area. MATERIALS AND METHODS: High-resolution CT scan of 11 pairs of the cadaveric arms was performed. Utilizing advanced image processing techniques, three-dimensional (3-D) models of each specimen was generated. The model of the left side was reversed and matched with the model of the right side in the same cadaver by registering in the area of radial neck along with tuberosity (TN) and in the area of radial tuberosity combined with 2 cm of proximal diaphysis (TD). The alteration of the head diameter, dish diameter, articular depth, head thickness, end-plane angle, offset, and head volume were evaluated and analyzed by paired t-test. RESULTS: No statistically significant difference was found in all parameters from both TN and TD registrations ( p < 0.05). CONCLUSION: The surface registration in either TN or TD area can generate the statistically symmetrical 3-D model with the original head. The registration in these areas may possibly be used in creating the individualized radial head prosthesis.

Variation of the Great Auricular Nerve and Prediction of the Facial Nerve Trunk Size.

BACKGROUND: This study aimed to reveal the anatomical variation in the great auricular nerve (GAN) and the correlation between the size of the GAN and the facial nerve trunk (FNT), so as to aid surgeons to perform safe facelift surgery and parotidectomy. METHODS: Sixteen human cadavers were studied on 16 left and 15 right facial sides. The GAN's branching patterns, location, and the mean width of the GAN and FNT were measured. RESULTS: The average distance where the nerve emerged from under the sternocleidomastoid muscle was 87.61 ± 12.13 mm when measured perpendicular to the Frankfort horizontal plane. The branching pattern of the GAN could be classified into 5 types of which the most common was type 3 (30.77%), where the GAN divided into the anterior (superficial) and posterior branches, and then the deep branch originated from the posterior branch of the GAN. The mean width of the GAN and FNT from all the dissections was 3.26 ± 0.67 mm and 3.36 ± 0.71 mm, respectively. There was a significant correlation between the width of the nerves on both facial sides (right: r =0.740, P =0.002; left: r = 0.839, P < 0.001). CONCLUSIONS: This study revealed the anatomical variation and the width of the GAN, which can strongly predict the width of the FNT. This should be taken into consideration during facelift surgery and parotidectomy, especially in patients with a small GAN to prevent iatrogenic injury to the small FNT.

Effect of curcumin in the amelioration of pancreatic islets in streptozotocin-induced diabetic mice.

OBJECTIVE: To evaluate the antidiabetic effect of curcumin and its potential in amelioration of pancreatic islets against damage under diabetic condition. MATERIAL AND METHOD: Diabetic mice were induced by injection of STZ (60 mg/kg body weight). Male mice were divided into 3 groups: group I was normal mice, group II was diabetic mice and group III diabetic mice were treated with curcumin (200 mg/kg body weight). The blood glucose levels and body weights were recorded every two weeks. After 4 weeks, 8 weeks and 12 weeks, the animals in each group were sacrificed. Histopathology of pancreatic tissues, pancreatic islets areas and numbers were observed under light microscope. RESULTS: The weight loss and the elevation of blood glucose levels were observed in diabetic mice and diabetic mice treated with curcumin at 4 weeks, 8 weeks and 12 weeks. The reduction of pancreatic islets areas and numbers were presented in diabetic mice and diabetic mice fed with curcumin at 4 weeks. At 8 weeks of diabetic mice, the numbers of pancreatic islets were decreased however the pancreatic islets hyperplasia was prominently investigated, whereas the noticeable increase in numbers of small pancreatic islets were observed in diabetic mice fed with curcumin. Histopathological observation at 12 weeks revealed the accumulation of lymphocytes in the shrunken pancreatic islets of diabetic mice, while an absent lymphocytes infiltration in the pancreatic islets and the increase in numbers of small islets of Langerhans appeared nearly the ducts in the pancreas of diabetic mice treated with curcumin at 12 weeks. CONCLUSION: Curcumin treatment at 12 week can exert beneficial effect in diabetes mellitus, regarding the improvement of pancreatic islets. The islets of Langerhans neogenesis is characterize by the presentation of small islets increase in numbers nearly the ducts and no insulitis.