Adoption of blockchain as a step forward in orthopedic practice.

Blockchain technology has gained popularity since the invention of Bitcoin in 2008. It offers a decentralized and secure system for managing and protecting data. In the healthcare sector, where data protection and patient privacy are crucial, blockchain has the potential to revolutionize various aspects, including patient data management, orthopedic registries, medical imaging, research data, and the integration of Internet of Things (IoT) devices. This manuscript explores the applications of blockchain in orthopedics and highlights its benefits. Furthermore, the combination of blockchain with artificial intelligence (AI), machine learning, and deep learning can enable more accurate diagnoses and treatment recommendations. AI algorithms can learn from large datasets stored on the blockchain, leading to advancements in automated clinical decision-making. Overall, blockchain technology has the potential to enhance data security, interoperability, and collaboration in orthopedics. While there are challenges to overcome, such as adoption barriers and data sharing willingness, the benefits offered by blockchain make it a promising innovation for the field.

Endoscopic Repair of Hip Abductor Tendon Tears: A Case Report.

Introduction: Greater trochanteric pain syndrome is a common incapacitating hip condition characterized by chronic lateral hip pain. This condition includes a range of pathologies ranging from trochanteric bursitis, hip abductor pathology involving the gluteus medius and minimum, external coxa saltans (snapping hip syndrome), or combinations of these. Hip abductor tendon tears have gained recognition as a main contributor to this condition. This pathology is often misdiagnosed and left untreated because of the frequency of partial-thickness undersurface tears. Once this challenging diagnosis is confirmed, non-operative treatments are considered the first therapeutic approach. Despite the availability and effectiveness of multiple non-operative therapies, a considerable percentage of patients will present with chronic disabling pain and refractory symptoms. Many health-care providers are unaware of accessible advanced surgical techniques that benefit patients unresponsive to conservative management. Case Report: We present the case of a 51-year-old female patient with chronic lateral hip pain refractory to conservative treatment for more than two years, treated successfully with endoscopic abductor tendon repair. The patient returned to the desired activities six months following surgery without any reported complications. Patient's pre-operative reported outcomes utilizing the MHOT-14 and Vail hip scores improved from 27 to 79 points (on a scale of 0-100) and from 30 to 56 points (on a scale of 0-100), respectively, at eight months follow-up. Conclusion: This case report is illustrative of endoscopic surgical repair of the hip abductor tendons in the setting of a chronic full-thickness abductor tendon tear in a female patient after failure of conservative management. The multiple advantages of the technique include performance in an ambulatory day surgery center, soft-tissue preservation, and fewer complications compared to other open techniques. Knowledge of this pathology and its state-of-the-art available treatments is relevant for orthopedic surgeons and a wide range of health providers who encounter patients with chronic lateral hip pain.

Bilateral Bennett's fracture: A case report.

Bennet's fracture represents one of the most common injuries of the hand district, involving the base of the thumb, and it is affects children and elderly patients the most. The fracture is caused by direct axial trauma to a partially flexed first metacarpal and it is always intra-articular: the fracture line separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal. The fracture pattern is such that the first metacarpal shaft moves dorsally, proximally, and radially due to the pull of the abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, and the adductor pollicis brevis, which remain attached to the fracture fragment. The surgical treatment consists of closed reduction with percutaneous pinning or open reduction with either pins or interfragmentary screws. The decision to treat these fractures with either open reduction or closed reduction is still a matter of debate. To the best of our knowledge, there are no cases of bilateral Bennett's fracture reported in literature. The aim of this paper is to present a rare case of bilateral Bennet's fracture, the decision of two different treatments, and the good clinical outcomes.

Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years.

PURPOSE: The purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with 'personalised alignment' would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on off-the-shelf (OTS) TKA. METHODS: Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and five refused participation, leaving 140 patients for analysis. Patients completed pre- and post-operative PROMs (Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster osteoarthritis index (WOMAC)) as well as overall level of satisfaction. Proportions that attained a patient acceptable symptom state (PASS) were calculated for OKS and FJS. Clinical findings were compared to the average scores reported for PROMs in recent systematic reviews and/or meta-analyses on OTS TKA. Descriptive statistics were used to summarise the clinical findings as means, standard deviations (SD) and ranges, or numbers and percentages. RESULTS: At mean follow-up 33.5 ± 4.5 months, 94% (135/143) were either satisfied or very satisfied. Proportions that achieved PASS were 89% for OKS (120/135), and 85% for FJS (118/139). Median OKS, WOMAC and KOOS Symptoms and Pain scores were all within the 4th quartile of medians reported in systematic reviews and/or meta-analyses. CONCLUSIONS: At a minimum follow-up of two years following custom TKA combined with 'personalised alignment', 94% of patients were either satisfied or very satisfied, and the PASS criteria were achieved in 89% for OKS and 85% for FJS, all of which compare favourably to published outcomes of OTS TKA. Direct comparisons to the literature may not be appropriate, however, considering the heterogeneity of patient demographics and alignment techniques. Randomised controlled trials with sufficient statistical power are needed to corroborate these findings and generalise them to unselected TKA patients. LEVEL OF EVIDENCE: IV, retrospective cohort study.

Custom TKA enables adequate realignment with minimal ligament release and grants satisfactory outcomes in knees that had prior osteotomies or extra-articular fracture sequelae.

PURPOSE: To report the early clinical and radiographic outcomes of custom total knee arthroplasty (TKA) in knees that had prior osteotomies and/or extra-articular fracture sequelae. METHODS: The authors retrospectively analysed a consecutive series of 444 knees that received custom TKA between 2016 and 2019 and identified 41 knees that had prior extra-articular events (osteotomies or fracture sequelae). Patients responded to pre- and post-operative (> 12 months) questionnaires, including Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Net improvements were calculated by subtracting pre- from post-operative scores. In addition to a preoperative CT scan, pre- and post-operative long-leg weight-bearing radiographs were obtained, on which the hip-knee-ankle (HKA) angle, femoral mechanical angle (FMA, between femoral mechanical axis and joint line) and tibial mechanical angle (TMA, between tibial mechanical axis and joint line) angles were measured, and alignment was planned within a 'target zone' of FMA and TMA within 85°-95° and HKA angle within 175°-183°. Agreements between preoperative, planned and post-operative angles were calculated using intra-class correlation coefficients (ICC). RESULTS: From the initial 41 knees, 3 had incomplete post-operative data and 1 was revised for painful stiffness due to uncorrected rotational malunion, leaving 37 knees for analysis. Twenty had prior osteotomies (tibia, n = 18, femur, n = 2), 8 had isolated fractures (tibial, n = 3; femoral, n = 5), and 9 had both osteotomies and fractures. Postoperative coronal alignments were 90.4° ± 2.4° for FMA, 89.3° ± 2.6° for TMA and 179.9° ± 3.0° for HKA angle. Agreements between planned and achieved alignments were fair to excellent, and 29 (78%) knees were within the 'target zone'. At a mean follow-up of 15 ± 5 months, all clinical scores had improved significantly (p < 0.001). CONCLUSIONS: Custom TKA granted satisfactory clinical outcomes and a low complication rate in knees that had prior osteotomies and/or extra-articular fracture sequelae. Using custom implants and strategies for coronal alignment, 29 (78%) of the 37 knees were successfully aligned within the 'target zone', and 35 (95%) of the 41 knees did not require ligament release. LEVEL OF EVIDENCE: IV.

Considerable inter-individual variability of tibial geometric ratios renders bone-implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis.

PURPOSE: The purpose of this systematic review and meta-analysis was to investigate the variability in tibial geometric ratios among knees of different sexes and races to determine whether commercially-available tibial baseplates accommodate the morphologic diversity. The hypothesis was that anthropometric studies report considerable variability of tibial geometric ratios among sexes and races. METHODS: This systematic review and meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 28 January 2021 for clinical studies reporting on tibial geometric ratios. Tibial geometric ratios, as reported by the clinical studies, were represented by plotting their means and two standard deviations for comparison to two symmetric and two asymmetric commercially-available tibial baseplates. RESULTS: A total of 27 articles that reported on a combined total of 20,944 knees were eligible for data extraction. Variation in tibial aspect ratios was equal among sexes. The greatest variation in aspect ratio was observed among East Asians, followed by Caucasians, African-Americans, Indian and Middle Easterns. The variation in tibial asymmetry ratio was larger among men compared to women. The greatest variation in asymmetry ratio was observed among African-Americans, followed by Caucasians, East Asians, Indian and Middle Easterns. Bone-implant mismatch of > 3 mm overhang or > 4 mm under-coverage with four commercially-available tibial baseplates occurred in large proportions of knees due to variations in aspect ratio (in 17-100% of knees) and asymmetry ratio (in 7-100% of knees). CONCLUSION: Anthropometric studies reported considerable inter-individual variability of tibial geometric ratios, which exceeded effects of sexual dimorphism and racial diversity. Bone-implant mismatch may be unavoidable in a large proportion of knees, when considering that a surgeon generally only uses one or a few TKA brands. These findings support the drive towards patient-specific implants to potentially achieve accurate bone-implant fit by implant customisation. LEVEL OF EVIDENCE: IV.

Tibial tubercle osteotomy: effect of different osteotomy planes on contact surface area and tubercle anteriorization.

In 1983, Fulkerson introduced a technique of tibial tubercle osteotomy performed according to an inclined plane with respect to frontal plane. Due to obliquity of the osteotomy plane, this procedure allows both anterior and medial transfer of the tibial tubercle. The purpose of the study was to investigate the influence of the different degrees of the oblique plane of osteotomy on anterior displacement and the contact surface area of tibial tubercle. Synthetic bones were used for the study. An osteotomy of the tibial tubercle (TT) was performed in each specimen. Specifically, 3 different degrees of osteotomy planes relative to the reference frontal plane were examined: 20°, 30° and 40°. On each sample, tibial tubercle medial transposition of 5 mm, 10 mm and 15 mm was performed. Anterior displacement was measured with a caliper. Further, the bone contact surface was calculated for each sample and each transposition. Finally, the measured data were statistically compared with a geometric model. At 5 mm of medial TT transposition, the anterior displacement (AD) was 0.1 mm when the osteotomy was performed at 20°. It increased of 1.5 mm and 2.7 mm, respectively at 30° and 40°. At 15 mm of TT transposition, the AD was 3.4 mm at 20°, 7.6 mm at 30° and 10.0 mm at 40°. Concerning the amount of medialization, it was observed a decrease in the overall contact surface passing from 5 to 15 mm of TT transposition. In addition, regarding the oblique plane of the osteotomy, it was observed an increase in the contact surface area passing from 20° to 40°. The main result of the present study is that the amount of anteriorization and medialization of the tibial tubercle could be predicted by the degrees of oblique plane of osteotomy. An increase in medialization significantly reduces the contact surface area at low degrees of osteotomy plane, potentially increasing the risk of non-union.

Effects of the Percutaneous Carbon Dioxide Therapy on Post-surgical and Post-traumatic Hematoma, Edema and Pain.

Introduction: Carbon dioxide therapy (CDT) has been used since the Roman Empire to improve the microcirculation and oxygenation of tissues altered. The classical indications are vasculopathies and ischemic diseases. Hypothesis: The CDT could be effective in favoring joint mobility recovery and pain reduction in patients with post-surgical or post-traumatic hematoma, edema, and pain. Study Design: Case report. Material and Methods: Eight patients were treated once a day for 5-10 days; a single session lasted 50 min. For post-surgical cases, the treatment began the day or the day after they were discharged from the hospital. Result: For all patients in this series, the CDT has brought clinical benefits in terms of decreasing pain and improving of joint mobility. Conclusion: The CDT is a safe and effective treatment to provide a greater amount of oxygen to the injured tissues. It favors the healing of post-surgical and post-traumatic hematoma and edema, promoting the mobility recovery of patients.

Custom TKA combined with personalised coronal alignment yield improvements that exceed KSS substantial clinical benefits.

PURPOSE: The purpose of this study was to report Knee Society Scores (KSS) at 12-month follow-up in a series of 266 knees that received custom TKA. The hypothesis was that custom TKA combined with personalised alignment would yield improvements greater than substantial clinical benefits (SCB) of KSS Knee and Function. METHODS: From a consecutive series of 905 patients (918 knees) that received primary TKAs, 261 (29%) patients (266 knees) received computed tomography (CT)-based posterior-stabilised cemented custom TKA. Knees were aligned aiming to preserve or restore constitutional alignment within predetermined limits of 85°-95° for femoral mechanical angle (FMA) and tibial mechanical angle (TMA), and 175°-183° for hip knee ankle (HKA) angle. The KSS Knee and Function were collected preoperatively and 12 months postoperatively, to determine if patients achieved SCB. Uni- and multivariable analyses were performed to determine associations between KSS scores (Knee and Function) and patient demographics as well as pre- and postoperative radiographic alignments. RESULTS: Of the initial cohort of 261 patients, 4 (1.8%) were reoperated for patellar resurfacing, 1 (0.4%) for lavage to treat infection, and 1 (0.4%) had arthroscopy to treat a stiff knee with < 90° range of motion. Complete clinical records were available for 227 patients (232 knees, 87%) that comprised 102 men (5 bilateral) and 125 women. At 12-month follow-up, mean improvements in KSS Knee and Function scores were, respectively, 61.0 ± 13.0 and 42.7 ± 16.7, which exceeded the SCB of KSS. Comparison of knees inside versus outside the target zone revealed no differences in KSS Knee (94.1 ± 9.1 versus 94.3 ± 9.0, n.s.) and Function (96.1 ± 9.2 versus 96.3 ± 8.9, n.s.). Multivariable analysis revealed worse KSS Knee in knees with preoperative FMA > 95° (ß = - 6.21; p = 0.023), but no association between KSS Function and patient demographics or pre- and postoperative radiographic alignments. CONCLUSIONS: Custom TKA combined with personalised alignment yielded improvements that exceeded substantial clinical benefits of KSS Knee and Function scores. These findings demonstrate the feasibility of custom TKA with 'personalised alignment' and encourage further investigations using comparative studies at longer follow-up. LEVEL OF EVIDENCE: IV, case series.

Cement augmentation for trochanteric fracture in elderly: A systematic review.

BACKGROUND: Cement augmentation of internal fixation of hip fracture has reported to improve fracture stability in osteoporotic hip fractures, reducing the risk of cut-out of the sliding screw through the femoral head. The purpose of present study was to perform a systematic literature review on the effects of augmentation technique in patients with osteoporotic hip fractures. MATERIAL AND METHODS: A comprehensive literature search was systematically performed to evaluate all papers published in English language included in the literature between January 2010 and July 2020, according to the PRISMA 2009 guidelines. In vivo and in vitro studies, case reports, review articles, cadaveric studies, biomechanical studies, histological studies, oncological studies, technical notes, studies dealing with radiological classifications and studies on revision surgery were excluded. RESULTS: A total of 5 studies involving 301 patients were included. Patients had a mean age of 84.6 years and were followed up for a mean period of 11 months. The proximal femoral fractures were stabilized with implantation of the PFNA or Gamma nail and augmentation was performed with two different cements: polymethylmethacrylate (PMMA) in 4 studies and calcium phosphate (CP) in one study. Overall, 57.5% of patients reached the same or greater preoperative mobility, and postoperative Parker Mobility Score and Harris Hip Score were acceptable. No significantly complications were observed, and no additional surgery related to the implant was required. CONCLUSION: The results of this systematic review show that cement augmentation is a safe and effectiveness method of fixation to treat trochanteric fractures.