Effectiveness of Applying Green Heart, a Smartphone-Based Self-management Intervention to Control Smoking: A Randomized Clinical Trial.

BACKGROUND: Cardiovascular diseases (CVDs) pose a significant global health concern and are the most common cause of death and disability, necessitating preventive interventions targeting modifiable risk factors. Recently, mobile-health technology has been developed to improve the delivery of cardiovascular prevention by risk factor modification. The "Green Heart" mobile application (app) was designed to aid in risk factor control among coronary artery disease (CAD) patients. METHODS: This parallel-group, single-blinded randomized controlled trial enrolled 1590 CAD patients, including 668 current smokers, randomly assigned to control (paper-based education) and intervention (application-based) groups. The app encompassed three modules targeting smoking cessation, dyslipidemia control, and blood pressure management. This study evaluated the impact of the smoking cessation module on behavioral change among current smokers. Green Heart assesses nicotine dependence, offering personalized quit plans, educational content, motivational messages, and automated progress tracking. The odds of smoking behavior changes during the 24-week follow-up underwent assessment. RESULTS: The intention-to-treat analysis highlighted significantly elevated rates of smoking cessation and reductions in the intervention group versus the control group. Adherence to the app (per-treatment analysis) also demonstrated significantly more favorable smoking behavior changes among the application users. Logistic regression emphasized higher odds of quitting and reduction in smoking in the application group, showing an odds ratio of 2.14 (95% CI: 1.16-3.97) compared to those not using the app (P=0.015). CONCLUSION: Our results confirmed that complete adherence to the app for at least 24 weeks was linked to alterations in cigarette smoking behavior among CAD patients. Trial Registration Number: IRCT20221016056204N1.

Simultaneous bilateral revision total knee arthroplasty following Abiotrophia defectiva infection.

A 65-year old man presented with 6-week history of bilateral knee pain and swelling, with difficulty mobilising. He had bilateral total knee arthroplasties in situ performed 5 years prior complicated by postoperative wound infection. Bilateral synovial fluid cultures were positive for Abiotrophia defectiva, and extensive investigations had not identified an extra-articular source of infection. Failing debridement antibiotic and implant retention procedure, the patient underwent a simultaneous bilateral 2-stage revision with articulated cement spacers impregnated with vancomycin and gentamycin. The patient received 6 weeks of intravenous antibiotics after each stage. A. defectiva is a nutritiously fastidious organism, posing a challenge for clinical laboratories to isolate and perform antimicrobial susceptibility testing, yet prosthetic joint infections caused by A. defectiva are scarce in literature and present atypically with subacute signs of chronic infection. This poses a diagnostic and therapeutic challenge, and two-stage revision is the only documented treatment that successfully eradicates the infection.

Bilateral snapping biceps femoris tendon: a case report and review of the literature.

Snapping biceps femoris tendon is an uncommon cause of lateral knee pain. We report the case of a 15-year-old athlete with bilateral snapping biceps femoris tendons, painful over his right lateral leg during exercise. He underwent elective exploration of the right knee which revealed an accessory biceps femoris tendon with attachment to the anterolateral tibia. The accessory tendon was released and reinserted onto the fibular head with a Krackow suture. There were no perioperative complications, and he returned to full sporting activities within 3 months. We describe the operative technique used and summarise the existing literature. Restoring the anatomy with release of the accessory tendon and reinsertion onto the fibular head is an effective technique in the management of knee pain due to snapping biceps femoris tendon. Other approaches include simple release of the anomalous tendon without reinsertion or partial resection of the fibular head. Partial resection of the fibular head is the only technique described in the literature with complication requiring a further operation on the same site. There remains a paucity of evidence in the literature regarding long-term outcomes required to inform the best operative approach. Further anatomical, intraoperative and radiological studies are required to delineate the true pathology of this condition.

Assessment of accuracy of robotically assisted unicompartmental arthroplasty.

PURPOSE: The purpose of this study was to analyse the accuracy of component placement during unicompartmental knee arthroplasty (UKA) using a robotic-assisted system. METHODS: Two hundred and six patients (232 knees) who underwent medial robotic-assisted UKA were retrospectively studied. Femoral and tibial sagittal and coronal alignments were measured in the post-operative radiographs and were compared with the equivalent measurements collected during the intra-operative period by the robotic system. Mismatch between pre-planning and post-operative radiography was assessed against accuracy of the prosthesis insertion. RESULTS: Robotic-assisted surgery for medial UKA resulted in an average difference of 2.2° ± 1.7° to 3.6° ± 3.3° depending on the component and radiographic view between the intra-operatively planned and post-operative measurements. Mismatch between pre-planning and post-operative radiography (inaccuracy) was related to improper cementing technique of the prosthesis in all measurements (except for tibial sagittal axis) rather than wrong bony cuts performed by the robotic arm. CONCLUSION: Robotic-assisted medial UKA results in accurate prosthesis position. Inaccuracy may be attributed to suboptimal cementing technique.

Association and impact of patellofemoral dysplasia on patellofemoral arthropathy and arthroplasty.

BACKGROUND: The association of patellar and trochlear anomalies resulting in isolated patellofemoral osteoarthritis has often been postulated but rarely studied. The purpose of this study was to examine the association of patellofemoral dysplasia, specifically trochlear anomalies, which are a cause for degenerative disease and may result in a worse outcome after arthroplasty for isolated patellofemoral arthritis. METHODS: Eighteen consecutive patients who underwent robotic image-based patellofemoral arthroplasty were compared with an age and sex-matched group of patients who underwent medial unicompartmental arthroplasty using the same image-based navigation system and had no patellofemoral, lateral disease or malalignment. The compared parameters were the patellofemoral-trochlear angle and Dejour score in the preoperative radiographs and patellofemoral-trochlear angle and internal rotation of the trochlea compared to the intercondylar line in the proximal, middle and distal trochlea. RESULTS: Significantly higher rates of patella alta (T=5, P=0.0001) and trochlear dysplasia (6% vs. 55%) were found, as manifested by an increase in the trochlear angle and Dejour score. Furthermore, the trochlea was found to have a higher degree of internal rotation in patients with isolated patellofemoral arthritis compared to the control group. CONCLUSIONS: In conclusion, patellofemoral anomalies such as patella alta and trochlear dysplasia are present in association with isolated patellofemoral arthritis. Isolated patellofemoral arthritis is also associated with higher rates of trochlear internal rotation. Correction of this internal rotation is essential in the success of arthroplasty in patients with patellofemoral disease. LEVEL OF EVIDENCE: Level III study, It is a case control study.

Effect of arthritis in other compartment after unicompartmental arthroplasty.

The purpose of this study is to evaluate the outcome of robotic-assisted (MAKO Surgical Corp.) unicondylar replacement in the treatment for knee osteoarthritis after the initial surgical insult is worn off to evaluate the impact of residual patellofemoral and lateral osteoarthritis on the outcome of medial unicompartmental knee replacement. One hundred and thirty-four patients who underwent uncomplicated 144 robotic-assisted medial unicondylar replacements for knee arthritis were identified and studied. Original radiographs were used to classify severity of patellofemoral and lateral compartmental osteoarthritis in these patients. Severity of patellofemoral and lateral compartmental osteoarthritis was analyzed against Oxford and Knee Society scores and amount of ipsilateral residual knee symptoms at 6 months postoperative period. Preoperative Oxford and Knee Society scores, other comorbidities and long-term disability were studied as confounding variables. We found significant improvement in symptoms and scores in spite of other compartment diseases. Poorer outcome was seen in association with comorbidities and long-term disability but not when radiographic signs of arthritis in the other compartments were present. Six patients required revision of which three had (lateral facet) patellofemoral disease in the original X-rays. In conclusion, there is a higher amount of postoperative retained symptoms, but similar outcome when there is radiographic disease in the other compartments. However, when symptoms are severe enough to necessitate revision, this is due to the lateral facet of patellofemoral compartment and not lateral compartment disease.

Achieving accurate ligament balancing using robotic-assisted unicompartmental knee arthroplasty.

Unicompartmental knee arthroplasty (UKA) allows replacement of a single compartment in patients with limited disease. However, UKA is technically challenging and relies on accurate component positioning and restoration of natural knee kinematics. This study examined the accuracy of dynamic, real-time ligament balancing using a robotic-assisted UKA system. Surgical data obtained from the computer system were prospectively collected from 51 patients (52 knees) undergoing robotic-assisted medial UKA by a single surgeon. Dynamic ligament balancing of the knee was obtained under valgus stress prior to component implantation and then compared to final ligament balance with the components in place. Ligament balancing was accurate up to 0.53 mm compared to the preoperative plan, with 83% of cases within 1 mm at 0°, 30°, 60°, 90°, and 110° of flexion. Ligamentous laxity of 1.31 ± 0.13 mm at 30° of flexion was corrected successfully to 0.78 ± 0.17 mm (P < 0.05). Robotic-assisted UKA allows accurate and precise reproduction of a surgical balance plan using dynamic, real-time soft-tissue balancing to help restore natural knee kinematics, potentially improving implant survival and functional outcomes.

Use of intraoperative computed tomography scanning in determining the magnitude of arthroscopic osteochondroplasty.

Femoroacetabular impingement has recently become a recognized cause of disability and hip arthritis. Hip arthroscopy and femoroacetabular reshaping have been performed to treat this condition. Quantification of the excess femoral and acetabular bone requiring resection has been challenging with the less invasive arthroscopic technique. We describe the use of intraoperative computed tomography assessing osteochondroplasty during arthroscopic surgery to treat cam- and pincer-type femoroacetabular impingement. We also describe the technical steps and present the important radiologic findings we have been able to visualize. We found intraoperative computed tomography scanning to be a reliable and reproducible method of assessing the quality of femoroacetabular impingement surgery. We believe that femoroacetabular impingement surgery can be assessed intraoperatively by use of computed tomography scanning where corrections can be made if necessary.

Does a plastic drape reduce incidence of heterotopic ossification after hip resurfacing?

BACKGROUND: High rates of heterotopic ossification have been associated with hip resurfacing as compared to THA. Bone debris from femoral head reamings is cited as one of the risk factors linked to increased rates of heterotopic ossification. QUESTIONS/PURPOSES: We therefore asked whether (1) the incidence of heterotopic ossification differed with and without the use of a plastic drape used to collect bone debris and (2) any of a number of variables (age, gender, diagnosis, previous hip surgery, operative time, and blood loss) related to the occurrence of HO. METHODS: We retrospectively reviewed 136 hip resurfacings performed using one of two techniques: Group 1 contained 64 hip resurfacings performed using a sterile drape around the femoral neck while reaming the femoral head to collect bone debris; Group 2 contained 72 hip resurfacings carried out with manually removing bone debris and utilizing a pulse lavage. Data were collected with respect to diagnosis, gender, previous surgery, postoperative complications, operative time, and blood loss to rule out confounding variables. The amount of heterotopic ossification was measured radiographically in hips after undergoing resurfacing arthroplasty. The minimum followup was 6 months (mean, 15 months; range, 6-27 months). RESULTS: No patient had heterotopic ossification of clinical importance and none had resection of the heterotopic ossification. Group 1 had a lower overall incidence of minor heterotopic ossification (32%) than Group 2 (58%). Risk factors linked to heterotopic ossification include male gender and operative time. CONCLUSIONS: The use of a plastic drape to collect bone debris from femoral head reamings decreased the incidence of heterotopic ossification in resurfacing arthroplasty of the hip.

Stress fracture of the fifth metatarsal base caused by tension band wiring: an isolated case report.

Tension band technique has been described as a successful method of treatment for the fractures of the proximal part of the fifth metatarsal bone. A high rate of union and a low rate of complications have made this mode of treatment popular, especially in patients with nonunion and high-level athletes with stress fracture of the proximal fifth metatarsal bone. The authors report a case of an avulsion fracture of the base of the fifth metatarsal bone treated with tension band wiring fixation, which resulted in a stress fracture 1 year after the tension band wiring. The authors recommend a K-wire perforation and tension band drill hole distal to the watershed area of the fifth metatarsal bone and removal of metalwork 6 to 12 months after fracture union to avoid this complication.

Cervical spondylolysis, radiologic pointers of stability and acute traumatic as opposed to chronic spondylolysis.

STUDY DESIGN: Case report and literature review. OBJECTIVES AND METHODS: We report a case of subaxial cervical spondylolysis and review 142 reports of this anomaly in the English language literature to determine the cause, the distribution, the stability, and the prognosis of cervical spondylolysis. RESULTS: Cervical spondylolysis may affect any level of the lower cervical spine with the C6 isthmus being the most commonly affected region (48%). In 40% of cases, there were radiologic features consistent with congenital cervical spondylolysis and in 74% of cases there was a history of acute trauma. The radiographic features of congenital cervical spondylolysis are quite specific and can exclude trauma as a cause for the spondylolysis. Although instability was not commonly assessed, 30% of cases assessed with flexion-extension views were found to be unstable. These included 27 cases of myelopathy of which 26 were attributable to instability. Many treatment modalities have been employed to treat ranging from early mobilization to decompression and fusion. Three patients with radiologic signs of instability and no neurologic deficit were treated conservatively, whereas 1 patient with no neurologic deficit or instability was treated with spinal fusion. CONCLUSIONS: We found a direct relationship between spinal instability and the presence of neurologic deficit (P < 0.001). On the basis of this systematic review of case reports of lower cervical spondylolysis, we can recommend that spondylolysis of the lower cervical spine can be treated nonoperatively except in those with radiologically documented cervical instability.

Is high level of disability an indication for spinal fusion? Analysis of long-term outcome after posterior lumbar interbody fusion using carbon fiber cages.

OBJECTIVE: Posterior lumbar interbody fusion is a recognized procedure for the treatment of back pain associated with degenerative disc disease and segmental instability. It allows decompression of the spinal canal and circumferential fusion through a single posterior incision. METHODS: Sixty-five consecutive patients who underwent posterior lumbar interbody fusion using carbon cages and pedicle fixation between 1993 and 2000 were recruited and contacted with a postal survey. Clinical outcome was assessed by the postoperative clinical findings and complications and the fusion rate, which was assessed using the scoring system described by Brantigan and Steffee. Functional outcome was measured by using improvement in the Oswestry Disability Index, return to work, and satisfaction with the surgical outcome. The determinants of functional relief were analyzed against the improvement in disability using multiple regression analysis. RESULTS: The mean postoperative duration at the time of the study was 4.4 years. Overall radiologic fusion rate was 98%. There was a significant improvement in Oswestry Disability Index (P < 0.01). There was 84% satisfaction with the surgical procedure and 61% return to predisease activity level and full employment. We found preoperative level of disability to be the best determinant of functional recovery irrespective of age or the degree of psychological morbidity and litigation (P < 0.01). CONCLUSION: The combination of posterior lumbar interbody fusion and posterior instrumented fusion is a safe and effective method of achieving circumferential segmental fusion. A direct relationship between preoperative level of disability and functional recovery suggests that disability should be measured preoperatively and spinal fusion should be performed to alleviate disability caused by degenerative spine.