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Background/Objectives: Periprosthetic joint infection (PJI) is a severe complication in total knee arthroplasty (TKA) with catastrophic outcomes. The relationship between prolonged operative times and PJI remains debated. This meta-analysis investigated the link between prolonged operative times and the risk of PJI in primary TKA. Methods: A comprehensive search of the MEDLINE/PubMed, Cochrane Library, and EMBASE databases was conducted to identify studies comparing the incidence of PJI in TKAs with prolonged versus short operative times, as well as those comparing operative times in TKAs with and without PJI. Pooled standardized mean differences (SMD) in operative times between groups with and without PJI or surgical site infections (SSI), including superficial SSIs and PJIs, were analyzed. Additionally, the pooled odds ratios (OR) for PJI in TKAs with operative times exceeding 90 or 120 min were examined. Results: Seventeen studies involving 427,361 patients were included. Significant differences in pooled mean operative times between the infected and non-infected TKA groups were observed (PJI, pooled SMD = 0.38, p < 0.01; SSI, pooled SMD = 0.72, p < 0.01). A higher risk of PJI was noted in surgeries lasting over 90 or 120 min compared to those of shorter duration (90 min, pooled OR = 1.50, p < 0.01; 120 min, pooled OR = 1.56, p < 0.01). Conclusions: An association between prolonged operative time and increased risk of PJI in primary TKA has been established. Strategies for infection prevention should encompass thorough preoperative planning aimed at minimizing factors that contribute to prolonged operative times.
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BACKGROUND: Antimicrobial resistance (AMR) is an important global public health concern in adults and children. Laryngotracheobronchitis (croup) is a common acute respiratory infection (ARI) among children, most often caused by a virus, and should not be treated with antibiotics. Reducing the usage of unnecessary antibiotics in ARI using an antimicrobial stewardship program (ASP) is an effective measure against AMR in children. This study investigates the antibiotic prescription pattern in pediatric patients with laryngotracheobronchitis in Korea. Our results will be useful to improve the ASP. METHODS: The data were obtained from the government agency Health Insurance Review and Assessment Service. We analyzed outpatient prescriptions issued to children ≤ 5 years of age with a first-listed diagnosis code for laryngotracheobronchitis, i.e., International Classification of Disease, 10th Revision, code J050 (croup), J040 (laryngitis), or J041 (tracheitis), during 2017-2020. For each prescription, demographic information and information about medical facilities visited (type of hospital, specialty of physician, location of hospital) were extracted. The overall antibiotic prescription rate was subsequently estimated, and multivariable analysis was conducted to determine the associated factors of antibiotic prescription. Prescribed antibiotics were described and classified into extended-spectrum penicillins, cephalosporin, and macrolides. RESULTS: Of 2,358,194 prescriptions reviewed, 829,172 (35.2%) contained antibiotics. In the multivariable analysis, management in a hospital was the strongest factor associated with antibiotic prescription (adjusted odds ratio [aOR], 22.33; 95% confidence interval [CI], 20.87-23.89; P < 0.001), followed by management in a clinic (aOR, 12.66; 95% CI, 11.83-13.54; P < 0.001) and management in a general hospital (aOR, 8.96; 95% CI, 8.37-9.59; P < 0.001). Antibiotic prescription was also significantly associated with patients who were ≤ 2 years of age, managed by a pediatric specialist, and treated at a hospital located in a non-metropolitan region. Overall, extended-spectrum penicillins were the most frequently prescribed (18.6%) antibiotics, followed by cephalosporins (9.4%) and macrolides (8.5%). CONCLUSION: The results of our study suggest that ASPs need to focus on physicians in hospitals, clinics, general hospitals, and pediatric specialties. Providing education programs to these groups to increase awareness of AMR and appropriate antibiotics use could be effective ASP policy and may help to reduce unnecessary prescriptions of antibiotics for laryngotracheobronchitis among pediatric patients and therefore potentially AMR in children in Korea.
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Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Traqueítis , Humanos , Antibacterianos/uso terapéutico , República de Corea , Preescolar , Lactante , Masculino , Femenino , Traqueítis/tratamiento farmacológico , Laringitis/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Bronquitis/tratamiento farmacológico , Recién Nacido , Prescripciones de Medicamentos/estadística & datos numéricos , Crup/tratamiento farmacológicoRESUMEN
This study aimed to compare functional outcomes sequentially up to 1 year after combined anterior cruciate ligament reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) and isolated ACLR. Fifty patients who underwent ACLR with versus without ALLR were analyzed at four different time points (preoperatively and 3, 6, and 12 months postoperatively). For the functional outcomes, muscle strength and acceleration time (AT) were measured using an isokinetic dynamometer. Proprioception was evaluated using joint position sense and dynamic postural stability. Patient-reported outcomes were measured using the Tampa Scale for Kinesiophobia (TSK-11) scores. Functional performance was assessed using single-leg hop distance (SLHD) and Limb Symmetry Index. In the operated knees, quadriceps (at 6 months postoperatively, p = 0.003) and hamstring (at 6 and 12 months postoperatively, p < 0.001) strength were significantly higher in the combined ACLR and ALLR group than the isolated ACLR group. The TSK-11 (at 6 and 12 months postoperatively, p < 0.001) was significantly lower in the combined ACLR and ALLR group than the isolated ACLR group. SLHD was significantly higher in the combined ACLR and ALLR group than the isolated ACLR group (at 6 months, p = 0.022 and at 12 months, p = 0.024). The addition of ALLR to primary ACLR yielded better muscle performance, fear of movement, and functional performance than isolated ACLR.
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Reconstrucción del Ligamento Cruzado Anterior , Fuerza Muscular , Recuperación de la Función , Humanos , Reconstrucción del Ligamento Cruzado Anterior/métodos , Masculino , Femenino , Adulto , Fuerza Muscular/fisiología , Lesiones del Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Adulto Joven , Resultado del Tratamiento , Ligamento Cruzado Anterior/cirugía , Ligamento Cruzado Anterior/fisiopatología , Propiocepción/fisiología , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/fisiopatología , Medición de Resultados Informados por el Paciente , AdolescenteRESUMEN
This study aimed to compare functional outcomes including knee muscle strength in the quadriceps and hamstrings, and proprioception, assessed through dynamic postural stability (overall stability index [OSI]) and self-reported outcomes in the operated and non-operated knees between anterior cruciate ligament reconstruction (ACLR) with meniscal repair for unstable (root and radial tears) and stable (longitudinal, horizontal, and bucket handle tears) meniscal tears. A total of 76 patients were randomly selected (41 with ACLR with meniscal repair for unstable meniscal tears and 35 with ACLR with meniscal repair for stable meniscal tears) at three different time points (preoperative, 6 months, and 12 months). Repeated measures analysis of variance was used to investigate the differences in outcomes for between-subject and within-subject factors. In the operated knees, there were no significant differences for functional outcomes between the two groups (all p > 0.05). In the non-operated knees, a significant difference was observed for the OSI between the two groups, which was significantly higher in ACLR with meniscal repair for unstable meniscal tears than for stable meniscal tears at 6 months (p < 0.001). Multiple linear regression analysis showed that age (p = 0.027), preoperative OSI in the operated knees (p = 0.005), and postoperative OSI in the operated knees at 6 months (p = 0.002) were significant and independent predictors for OSI in the non-operated knees at 6 months postoperatively. Therefore, while no differences were observed in functional outcomes between the two groups in the operated knees, dynamic postural stability was poorer at 6 months postoperatively in the non-operated knees of patients with ACLR with meniscal repair for unstable meniscal tears. Furthermore, a significant correlation was observed between preoperative/postoperative dynamic postural stability in the operated knees and postoperative dynamic postural stability in the non-operated knees. Hence, we recommend incorporating balance exercises for both knees in post-surgical rehabilitation, particularly for patients with unstable meniscal tears.
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BACKGROUND: Acute bronchiolitis, the most common lower respiratory tract infection in infants, is mostly caused by respiratory viruses. However, antibiotics are prescribed to about 25% of children with acute bronchiolitis. This inappropriate use of antibiotics for viral infections induces antibiotic resistance. This study aimed to determine the antibiotic prescription rate and the factors associated with antibiotic use in children with acute bronchiolitis in Korea, where antibiotic use and resistance rates are high. METHODS: Healthcare data of children aged < 24 months who were diagnosed with acute bronchiolitis between 2016 and 2019 were acquired from the National Health Insurance system reimbursement claims data. Antibiotic prescription rates and associated factors were evaluated. RESULTS: A total of 3,638,424 visits were analyzed. The antibiotic prescription rate was 51.8%, which decreased over time (P < 0.001). In the multivariate analysis, toddlers (vs. infants), non-capital areas (vs. capital areas), primary clinics and non-tertiary hospitals (vs. tertiary hospitals), inpatients (vs. outpatients), and non-pediatricians (vs. pediatricians) showed a significant association with antibiotic prescription (P < 0.001). Fourteen cities and provinces in the non-capital area exhibited a wide range of antibiotic prescription rates ranging from 41.2% to 65.4%, and five (35.7%) of them showed lower antibiotic prescription rates than that of the capital area. CONCLUSION: In Korea, the high antibiotic prescription rates for acute bronchiolitis varied by patient age, region, medical facility type, clinical setting, and physician specialty. These factors should be considered when establishing strategies to promote appropriate antibiotic use.
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Antibacterianos , Bronquiolitis , Humanos , Antibacterianos/uso terapéutico , Lactante , República de Corea , Bronquiolitis/tratamiento farmacológico , Bronquiolitis/diagnóstico , Femenino , Masculino , Enfermedad Aguda , Programas Nacionales de Salud , Recién Nacido , Preescolar , Pautas de la Práctica en Medicina , Reembolso de Seguro de SaludRESUMEN
Background: Proximal-distal mismatch has emerged as a prominent concern in Dorr type A femoral morphology, prompting the exploration of short stems as promising alternatives to conventional stems. This study aimed to evaluate clinical and radiographic outcomes of total hip arthroplasty (THA) using short femoral stems in Dorr type A proximal femoral morphology with a minimum follow-up of 5 years. Methods: Patients with short femoral stems in Dorr type A between 2011 and 2017 were included. Patients with the Short Modular Femoral (SMF) stem and Metha stem were recruited and patients with a shortened tapered stem (Tri-Lock BPS) were matched by propensity score matching based on age, sex, body mass index, calcar to canal ratio, and diagnosis. Patient-reported outcomes and the presence of thigh pain were assessed at 5 years postoperatively. Revision rate, complication rate, and radiographic outcomes were also assessed and compared. Results: Twenty-two cases (81%) in the SMF stem and 43 cases (65%) in the Metha stem had more than 5 years of follow-up data available. The SMF stem showed a higher failure rate than the other 2 groups, with 18% requiring revision surgery in the SMF stem compared to 4.6% in the Metha stem, and 2.3% in the Tri-Lock BPS. The SMF stem showed considerable complications such as stem position change and lateral cortical hypertrophy with inferior clinical outcomes than the other 2 stem groups. When the Metha stem and the Tri-Lock BPS groups were compared, more intraoperative fractures were observed in the Metha stem, whereas stress shielding and anterior thigh pain were significantly more prevalent in the Tri-Lock BPS. Conclusions: The SMF stem might be less reliable than previously reported, showing a high failure rate and increased radiologic complications. Thus, its use for THA in Dorr Type A femurs needs caution. On the other hand, the Metha stem showed comparable outcomes to the shortened tapered Tri-Lock BPS.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Humanos , Supervivencia , Diseño de Prótesis , Fémur/diagnóstico por imagen , Fémur/cirugía , Reoperación , Dolor/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Estudios de SeguimientoRESUMEN
BACKGROUND: Delamination of cuff tendons has a negative impact on outcomes following arthroscopic rotator cuff repair (RCR). The purpose of this study is to compare en masse repair (EMR) and separate double-layer repair (SDLR) for delaminated rotator cuff tears. METHODS: A systematic literature search was conducted on major databases (MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus) until 1 June 2023. Comparative studies with a minimum 24-month follow-up of patients undergoing arthroscopic RCR for delaminated tears were included. The outcomes assessed retear rates and functional outcomes. RESULTS: Five eligible studies involving 325 cases were analyzed. The meta-analysis showed no significant difference in retear rates between SDLR and EMR for delaminated tears (OR = 0.73, 95% CI: 0.35-1.49). However, the meta-analysis demonstrated a significant intergroup difference in favor of the SDLR for the total Constant score (SMD = 0.68, 95% CI: 0.35 to 1.02), SST score (SMD = 0.37, 95% CI: 0.02 to 0.71), and postoperative range of abduction (SMD = 0.34, 95% CI: 0.03 to 0.64). CONCLUSION: The evidence suggests that the SDLR in arthroscopic RCR for delaminated rotator cuff tears leads to improved short-term functional outcomes and range of motion compared to EMR. However, there is no significant difference in retear risk between the two approaches.
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(1) Background: Addressing large to massive rotator cuff tears (LMRCTs) poses complex challenges. This systematic review investigated outcomes of superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) compared to conventional rotator cuff repair (RCR) for LMRCTs. (2) Methods: A systematic search across the MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus databases until 1 October 2023 identified studies that directly compared SCR with LHBT with conventional RCR in patients with LMRCTs and included a minimum of a 12-month follow-up period. The assessed outcome measures encompassed retear rates, functional outcomes, range of motion (ROM), and acromiohumeral interval (AHI). Risk of bias assessment was conducted via the Robins-I tool. (3) Results: In six studies with 456 cases (210 SCR using LHBT and 246 using RCR), SCR with LHBT significantly reduced retear rates (OR = 0.21; 95% CI, 0.12-0.36; p < 0.01; I2 = 0%). Furthermore, SCR with LHBT showed significant improvement in range of forward flexion (SMD 0.32, 95% CI: 0.09-0.55, p < 0.01, I2 = 39%) and AHI (SMD 0.61, 95% CI: 0.31-0.92, p < 0.01, I2 = 0%) postoperatively. (4) Conclusion: SCR with LHBT is a safe and effective treatment for LMRCTs, reducing retear rates, maintaining greater postoperative AHI, and improving ROM compared to conventional RCR. Additional high-quality interventional studies are needed to confirm these results.
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BACKGROUND: The treatment of pediatric patients with latent tuberculosis infection (LTBI) is a crucial TB control strategy. LTBI is not a reportable communicable disease, and data regarding LTBI treatment in pediatric patients in Korea are scarce. This study aimed to investigate the prescription patterns and treatment completion rates among pediatric patients with LTBI in Korea by analyzing National Health reimbursement claims data. METHODS: We retrospectively analyzed outpatient prescription records for pediatric patients aged 18 or younger with LTBI-related diagnostic codes from 2016 to 2020. We compared the frequency of prescriptions for the standard treatment regimen (9 months of isoniazid [9H]) and an alternative treatment regimen (3 months of isoniazid plus rifampicin [3HR]). We also assessed the treatment incompletion rates by age group, treatment regimen, treatment duration, the level of medical facility, physician's specialty, and hospital location. We performed multivariable analysis to identify factors influencing treatment incompletion. RESULTS: Among the 11,362 patients who received LTBI treatment, 6,463 (56.9%) were prescribed the 9H regimen, while 4,899 (43.1%) received the 3HR regimen. Patients in the 3HR group were generally older than those in the 9H group. The proportion of 3HR regimen prescriptions significantly greater in the later period (2018-2020), in primary hospitals, under the management of non-pediatric specialists, and in metropolitan regions. The overall treatment incompletion rate was 39.7% (9H group: 46.9%, 3HR group: 30.3%). In the multivariable analysis, 9H regimen prescription was the strongest factor associated with treatment incompletion (adjusted odds ratio, 2.42; 95% confidence interval, 2.20-2.66; P < 0.001). Additionally, management in a primary hospital, a hospital's location in a non-metropolitan region, and management by a non-pediatric specialist were also significant risk factors for treatment incompletion. CONCLUSION: Our study results suggest that promoting the use of 3HR regimen prescriptions could be an effective strategy to enhance treatment completion. Physicians in primary hospitals, hospitals located in non-metropolitan regions, and physicians without a pediatric specialty require increased attention when administering LTBI treatment to pediatric patients to ensure treatment completion.
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Isoniazida , Tuberculosis Latente , Humanos , Niño , Isoniazida/uso terapéutico , Antituberculosos/uso terapéutico , Estudios Retrospectivos , Tuberculosis Latente/tratamiento farmacológico , Tuberculosis Latente/diagnóstico , Rifampin/uso terapéutico , Pacientes Ambulatorios , República de CoreaRESUMEN
BACKGROUND: Although routine changing of central venous catheters (CVCs) is commonly performed in patients with severe burns, information on pathogen colonization of the CVC tip and associated bloodstream infections (BSIs) is limited in those patients. METHODS: The medical records of 214 patients with severe burns who underwent routine CVC changing at 7-day intervals and their results of 686 pairs of CVC tips and concurrent blood cultures were retrospectively reviewed to evaluate the CVC colonization rate and associated BSI pathogens. RESULTS: Of the 686 CVCs, 137 (20.0%) were colonized by pathogens, and 81 (59.1%) of them had BSIs caused by the same pathogen. Nonflame burn (P = .002), total body surface area burn ≥30% (P = .004), femoral catheterization (P = .001), CVC changing during pre-existing BSI (P < .001), and renal replacement therapy (P = .017) were associated with catheter-related BSI in the multivariate analysis. Most BSIs were caused by Gram-negative bacteria (most commonly Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa). CONCLUSIONS: The CVC colonization rate in patients with severe burns and routine CVC changing was not high. Lengthening the CVC duration might be attempted in patients at a lower risk of catheter-related BSI although further prospective studies are necessary.
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Quemaduras , Infecciones Relacionadas con Catéteres , Catéteres Venosos Centrales , Humanos , Quemaduras/complicaciones , Quemaduras/microbiología , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Catéteres Venosos Centrales/efectos adversos , Catéteres Venosos Centrales/microbiología , Adulto , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/epidemiología , Anciano , Adulto Joven , Bacteriemia/microbiología , Bacteriemia/epidemiología , Bacteriemia/etiología , Adolescente , Anciano de 80 o más Años , Bacterias/aislamiento & purificación , Bacterias/clasificación , Cateterismo Venoso Central/efectos adversosRESUMEN
OBJECTIVES: To evaluate initial fracture morphology influences on outcomes in simple 2-part pertrochanteric fracture, with a focus on the basicervical component and its initial impaction. DESIGN: A retrospective cohort series. SETTING: Single Level I Trauma Center. PATIENTS SELECTION CRITERIA: Patients older than 60 years with intertrochanteric fractures between 2011 and 2022 were retrospectively reviewed. Inclusion criteria comprised simple 2-part pertrochanteric fractures (Orthopaedic Trauma Association [OTA]/Arbetisgemeinschaftfur Osteosynthesefragen [AO] 31-A1.2) with a basicervical component who underwent cephalomedullary nailing and had a minimum follow-up of 6 months. Patients were divided whether the basicervical component was impacted into the medullary canal (intramedullary impaction [II] group) or displaced beyond the medullary canal (extramedullary [E] group). Exclusion criteria encompassed pathologic fractures, nondisplaced fractures, and basicervical neck fractures (OTA/AO 31-B3). OUTCOME MEASUREMENTS AND COMPARISONS: Reduction status was assessed as unacceptable if the head and neck (proximal) fragment was positioned intramedullary with respect to the distal fragment in either the anterior posterior or cross-lateral x-ray and acceptable otherwise. In addition, the degree of impaction on x-ray and CT scans (coronal, sagittal, axial) at injury was analyzed as a risk factor for failure. Revision rates and lag screw sliding over 15 mm were compared between the II and E groups. RESULTS: Hundred fifteen patients (95 female, average age 80 years) were included. The II group (n = 58) compared with E group (n = 57) showed more acceptable postoperative reductions (57% vs. 81%, P = 0.001), but significantly higher fixation failure (16% vs. 3.5%, P = 0.048) and fracture collapse (28% vs. 7%, P = 0.01). II was identified as a significant independent predictor for failure (odds ratio 5.64, 95% confidence interval, 2.14-16.9, P < 0.001) with more than 19.5-mm impaction in sagittal CT scan as the threshold linked to increased failure risk. CONCLUSIONS: This study highlights the significance of specific intertrochanteric fracture patterns, particularly II of a basicervical component and impaction severity (≥19.5 mm), as drivers of fixation failure. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Fracturas del Fémur , Fijación Intramedular de Fracturas , Fracturas de Cadera , Humanos , Femenino , Anciano de 80 o más Años , Estudios Retrospectivos , Clavos Ortopédicos , Fracturas de Cadera/cirugía , Tornillos Óseos , Fijación Intramedular de Fracturas/métodos , Resultado del TratamientoRESUMEN
Background: Arthroscopic rotator cuff repair (RCR) is a common orthopaedic procedure, but it has a high rate of retears that can negatively affect the functional outcomes. Bone marrow stimulation (BMS) has been suggested as an additional treatment to improve the outcomes of RCR. Purpose: To compare the effectiveness of the BMS procedure during RCR with conventional RCR. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic literature search was conducted in MEDLINE/PubMed, Embase, Cochrane Library, and Scopus, on March 1, 2023, for studies comparing postoperative retear rates and functional outcomes between patients who underwent primary arthroscopic RCR with and without the BMS procedure. Only level 1 and 2 randomized controlled trials with a minimum 12-month follow-up were included. The primary outcomes were retear rates and functional outcomes as measured by the Constant; American Shoulder and Elbow Surgeons (ASES); and University of California, Los Angeles (UCLA) scores and by postoperative range of motion. Subgroup analyses were performed based on repair technique (single-row repair vs double-row or suture-bridge repair). The standardized mean difference (SMD) and odds ratio (OR) were utilized to synthesize continuous and dichotomous outcomes, respectively. Homogeneity was evaluated using the chi-square test and I2 statistic. Results: The literature search yielded 661 articles, of which 6 studies (522 patients; 261 with BMS, 261 without BMS) met the eligibility criteria. The combined analysis showed no significant decrease in retear rates with the utilization of the BMS procedure during RCR (OR, 0.60; 95% CI, 0.35 to 1.03; P = .07; I2 = 24%). There was no significant intergroup difference in functional outcomes (Constant score: SMD, 0.13; 95% CI, -0.04 to 0.31; P = .13; I2 = 0%; ASES score: SMD, 0.04; 95% CI, -0.20 to 0.28; P = .73; I2 = 0%; UCLA score: SMD, -0.13; 95% CI, -0.50 to 0.23; P = .47; I2 = 0%). Subgroup analyses revealed no significant differences in postoperative retear risk or total Constant score according to the repair technique. Conclusion: Based on the available evidence, this systematic review did not find a significant benefit of the BMS procedure at the footprint during arthroscopic RCR compared with conventional RCR in terms of retear rates and functional outcomes at short-term follow-up.
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Background: This study aimed to evaluate the annual trends of transfusion rates and utilization of blood management agents in total knee arthroplasty (TKA) based on the operation type and to analyze the risk factors of transfusion after TKA. Methods: Using the Korean National Insurance claims database of 797,106 primary and revision TKAs between January 2008 and October 2019, data on the patients' characteristics, comorbidities, utilization of transfusion, and blood management agents were collected. The patients were categorized into three groups based on the operation type: primary, revision, and simultaneous bilateral TKA. The transfusion rate and utilization of blood management agents (intraoperative tranexamic acid [TXA] and preoperative iron supplements) were compared, and the risk factors for transfusion were evaluated. Results: After excluding the inaccurate data, 730,554 arthroplasties (636,292 primary, 10,540 revision, and 41,861 simultaneous bilateral TKAs) were identified. The transfusion rates of primary, revision, and simultaneous bilateral TKAs in 2019 were 64.0%, 67.7%, and 68.9%, respectively, which were significantly decreased compared with 83.2%, 88.0%, and 92.5% in 2008, respectively (p < 0.001). Conversely, the utilization of intraoperative TXA and preoperative iron supplements was significantly increased from 4.6% and 13.8%, respectively, in 2008 to 52.4% and 27.0%, respectively, in 2019 (p < 0.001). The utilization of intraoperative TXA and preoperative iron supplements significantly lowered the risk of transfusion after TKA (odds ratio [OR], 0.20; p < 0.001 and OR, 0.71; p < 0.001). Conclusions: The transfusion rate after TKA decreased gradually from 83.5% to 64.5% between 2008 and 2019 in South Korea corresponding with the increased utilization of blood management agents. Therefore, consistent attention to patient blood management should be emphasized to reduce the transfusion rate after TKA.
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Antifibrinolíticos , Artroplastia de Reemplazo de Rodilla , Ácido Tranexámico , Humanos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Antifibrinolíticos/uso terapéutico , Ácido Tranexámico/uso terapéutico , Transfusión Sanguínea , Pérdida de Sangre Quirúrgica , HierroRESUMEN
Subchondral insufficiency fracture of the knee (SIFK) causes acute knee pain in adults and often requires surgical management. Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are the two most common surgical treatments for SIFK. While both UKA and TKA have their advantages, there is no consensus for SIFK localized on the medial compartment. We hypothesized that patients with SIFK treated with UKA would show superior patient-reported outcomes compared to those who underwent TKA. A total of 90 patients with SIFK located medially were included in the TKA (n = 45) and UKA (n = 45) groups. Size of SIFK lesions were measured on MR images. Patient reported outcomes in the form of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital Special Surgery (HSS) scores, and Knee Society Scores (KSS) were assessed preoperatively, postoperative 6, 12 months, and at the final follow-up. There were no differences in the size of the SIFK lesion between two groups. At 6 months, WOMAC score was better in the UKA group than the TKA group (p < .01). Both groups had a significant improvement in WOMAC, HSS, and KSS scores at the final follow-up compared to preoperative scores. The UKA group had better range of motion of the knee preoperatively and postoperatively than the TKA group (p < .01 and p < .01). UKA group showed a higher relative risk than the TKA group in terms of complications (RR = 3.0) but with no statistical significance (P = 0.31). Unicompartmental arthroplasty and total joint arthroplasty can produce successful outcomes in patients with SIFK with proper patient selection, regardless of the size of SIFK lesion.
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Artroplastia de Reemplazo de Rodilla , Fracturas por Estrés , Osteoartritis de la Rodilla , Adulto , Humanos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/métodos , Resultado del Tratamiento , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: The Omicron variant has been the predominant severe acute respiratory syndrome coronavirus 2 variant circulating in Korea since January 2022. This study evaluated and compared the clinical characteristics of children with coronavirus disease 2019 (COVID-19) between the Delta and Omicron periods. METHODS: The medical records of children aged < 12 years diagnosed with acute COVID-19 (<2 weeks of symptom onset) at seven university-affiliated hospitals were retrospectively reviewed. Children with a previous history of COVID-19 or vaccination were excluded. The clinical characteristics of the included children during the Delta (1 August 2021 to 15 January 2022) and Omicron (16 January to 30 June 2022) periods were compared. RESULTS: Among the 515 children included in the study, 36 (7.0%) and 479 (93.0%) were diagnosed with COVID-19 during the Delta and Omicron periods, respectively. A total of 142 (27.6%) were hospitalized, and the hospitalization rate was higher during the Delta period than the Omicron period (91.7% vs. 22.8%, p < 0.001). The incidence of fever (p = 0.009), vomiting (p = 0.031), and seizures (p = 0.007) was higher during the Omicron period, whereas the incidence of rhinorrhea (p = 0.027) was higher during the Delta period. Clinical severity and outcomes were comparable between the two periods. During the Omicron period, 6.4% of the hospitalized children received oxygen therapy and 1.8% received intensive care. CONCLUSION: The incidence of fever and seizures was higher during the Omicron period in pediatric patients without a history of vaccination or previous COVID-19. However, the clinical severity was similar during both periods.
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Background: While the pandemic of coronavirus disease 2019 (COVID-19) is ongoing, the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been dominant recently. The Omicron variant causes more seizures in pediatric patients compared with previously circulated variants. This study aimed to investigate the incidence and clinical features of febrile seizure (FS) in pediatric patients with COVID-19 during the Omicron era. Methods: The medical records of pediatric patients (≤18 years of age) diagnosed with COVID-19, who presented with FS between February 2020 and June 2022, were reviewed retrospectively to analyze clinical characteristics of FS in seven university-affiliated hospitals of Korea. Results: Of 664 pediatric patients with COVID-19 during the study period, 46 during the pre-Omicron period and 589 during the Omicron period were included in the study analysis; 29 patients during the transition period were excluded. Among the included patients, 81 (12.8%) had concomitant FS, and most (76.5%) experienced simple FS. All FS episodes occurred during the Omicron period and none of them during pre-Omicron period (P=0.016). Sixty-five (80.2%) and 16 (19.8%) patients were categorized as FS (patient age ≤60 months) and late-onset FS (patient age >60 months), respectively. Underlying neurologic disease (P=0.013) and focal onset seizure (P=0.012) were more common in the late-onset FS group than in the FS group; however, overall clinical manifestations and outcomes including seizures consistent with characteristics of complex FS and subsequent epilepsy were similar between the two groups. Conclusions: As the COVID-19 pandemic persists, the incidence of FS has increased with the emergence of the Omicron variant. About one-fifth of the patients experiencing FS due to infection by the Omicron variant of SARS-CoV-2 were aged >60 months; however, clinical characteristics and outcomes were favorable. More information and long-term prognoses in patients with FS due to COVID-19 should be acquired.
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Background: Viral infections of the upper respiratory tract are one of the most common causes of febrile seizures (FSs). During the coronavirus disease-2019 (COVID-19) pandemic, mitigation measures have contributed to changes in the incidence of respiratory viral infections. Therefore, we aimed to evaluate the impact of the COVID-19 pandemic on the incidence of respiratory viral infections and clinical characteristics of FSs. Methods: We retrospectively reviewed the medical records of 988 episodes of FS (865 before the pandemic and 123 during the pandemic) between March 2016 and February 2022. Seizure characteristics and their outcomes, along with the distribution of identified respiratory viruses were compared before and during the pandemic. Results: The occurrence of FSs decreased during the COVID-19 pandemic compared to that before the pandemic. A substantial reduction in the incidence of influenza virus infections was observed (P<0.001) during the pandemic, while the incidence of rhinovirus infection was not significantly changed (P=0.811). Interestingly, a significantly high incidence of parainfluenza virus (P=0.001) infections was observed during the pandemic. No statistically significant between-group differences were observed in the clinical presentation and outcomes of FSs before and during the pandemic. Conclusions: Despite epidemiological changes in respiratory viral infections, the clinical characteristics and outcomes of FSs before and during the COVID-19 pandemic were comparable.
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Background and Objectives: The medial collateral ligament (MCL) is one of the major supporting ligaments of the knee joint, and MCL injuries are common where excessive valgus loading is applied to the knee joint. Although most MCL injuries can be treated conservatively, healing of the MCL can take several weeks to months. Furthermore, once injured, the biomechanical properties of the healed MCL differ from those of the native MCL, resulting in an increased risk of re-injury and chronic remnant symptoms. Mesenchymal stem cells (MSCs), owing to their therapeutic potential, have been investigated in various musculoskeletal injuries, and some preclinical studies regarding MSC-based approaches in MCL injuries have shown promising results. Despite satisfactory results in preclinical studies, there is still a lack of clinical studies in the orthopedic literature. This article describes the basic knowledge of the MCL, standard treatments for MCL injuries, and recent studies regarding the application of MSCs for enhanced healing of the MCL. MSC-based approaches are expected to be a potential therapeutic option for enhanced healing of the MCL in the future.
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Lesiones del Ligamento Cruzado Anterior , Ligamentos Colaterales , Células Madre Mesenquimatosas , Humanos , Articulación de la Rodilla/cirugía , Cicatrización de HeridasRESUMEN
OBJECTIVE: Many studies have described nosocomial outbreaks of influenza in specialized wards. We evaluated nosocomial transmission of influenza in a pediatric general ward. DESIGN: Retrospective observational study. SETTING: Single secondary hospital. PATIENTS: The study included 814 hospitalized children with influenza between September 2015 and August 2020. METHODS: The medical records of the included children were retrospectively reviewed, and clinical characteristics of children with community-acquired (CA) influenza and hospital-acquired (HA) influenza were determined. The room of each included child during hospitalization was traced to identify the children exposed to them. RESULTS: CA influenza and HA influenza were diagnosed in 789 (96.9%) and 25 (3.1%) children, respectively. Among children with CA influenza, 691 (87.6%) were isolated or place in a cohort on admission. In total, 98 children (12.4%) admitted to multibed rooms exposed 307 children with noninfluenza diseases to influenza during 772 patient days; 3 exposed children (1.0%) were diagnosed with HA influenza. Including these 3 children, 25 children (19 without definite in-hospital exposure to influenza and 3 exposed to other children with HA influenza) were diagnosed with HA influenza, and 11 (44.0%) exposed 31 children with noninfluenza diseases to influenza for 85 patient days. Also, 3 exposed children (9.7%) were diagnosed with HA influenza, a significantly higher rate than that for CA influenza (P = .005). The clinical characteristics were comparable between children with HA influenza and those with CA influenza. CONCLUSIONS: Cohort placement of children with influenza in a pediatric general ward can be effective in controlling nosocomial transmission of influenza. However, control measures for children with HA influenza should be emphasized.
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Infección Hospitalaria , Gripe Humana , Niño , Humanos , Gripe Humana/prevención & control , Infección Hospitalaria/prevención & control , Estudios Retrospectivos , Habitaciones de Pacientes , HospitalesRESUMEN
Background: Comorbid chronic obstructive pulmonary disease (COPD) is increasingly common and may have an adverse impact on outcomes in patients undergoing total joint arthroplasty (TJA) of lower extremity. The purpose of this meta-analysis is to compare the postoperative complications between COPD and non-COPD patients undergoing primary TJA including total hip and knee arthroplasty. Methods: PubMed, EMBASE, and Cochrane Library were systematically searched for relevant studies published before December 2021. Postoperative outcomes were compared between patients with COPD versus those without COPD as controls. The outcomes were mortality, re-admission, pulmonary, cardiac, renal, thromboembolic complications, surgical site infection (SSI), periprosthetic joint infection (PJI), and sepsis. Results: A total of 1,002,779 patients from nine studies were finally included in this meta-analysis. Patients with COPD had an increased risk of mortality (OR [odds ratio] = 1.69, 95% confidence interval [CI] 1.42-2.02), re-admission (OR = 1.54, 95% CI 1.38-1.71), pulmonary complications (OR = 2.73, 95% CI 2.26-3.30), cardiac complications (OR = 1.40, 95% CI 1.15-1.69), thromboembolic complications (OR = 1.21, 95% CI 1.15-1.28), renal complications (OR = 1.50, 95% CI 1.14-1.26), SSI (OR = 1.23, 95% CI 1.18-1.30), PJI (OR = 1.26, 95% CI 1.15-1.38), and sepsis (OR = 1.36, 95% CI 1.22-1.52). Conclusion: Patients with comorbid COPD showed an increased risk of mortality and postoperative complications following TJA compared with patients without COPD. Therefore, orthopedic surgeons can use the study to adequately educate these potential complications when obtaining informed consent. Furthermore, preoperative evaluation and medical optimization are crucial to minimizing postoperative complications from arising in this difficult-to-treat population. Level of evidence: Level III. Registration: None. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00794-2.