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1.
Artigo em Inglês | MEDLINE | ID: mdl-38908465

RESUMO

BACKGROUND: In patients with glenohumeral osteoarthritis and posteriorly eccentric wear patterns, the early to mid-term results of TSA using conservative glenoid reaming with no attempt at version correction have been favorable at early follow-up. The purpose of this study is to compare the clinical and radiographic outcomes of TSA using this technique for patients with and without eccentric wear patterns at a minimum 5-year follow-up. METHODS: Patients who underwent TSA with minimum 5-year follow-up were identified from an institutional registry. Preoperative and postoperative radiographs were used to determine humeroglenoid alignment (HGA-AP), humeroscapular alignment (HSA-AP), version, Walch classification and glenoid component seating. The outcome measures were the Simple Shoulder Test, glenoid component radiolucencies, and the occurrence of complications or revisions. RESULTS: Two hundred and ten patients were included in the study, of which 98 (47%) had posteriorly decentered humeral heads and 108 (51%) had centered humeral heads. There were 77 shoulders with Walch type A glenoids and 122 with Walch type B glenoids. At a mean 8-year follow-up, the final SST, change in SST and percentage of maximal improvement was not correlated with pre- and postoperative humeral head centering, Walch classification or glenoid version. There were no preoperative predictors of a low final SST. Two patients (1%) underwent open re-operations during the study period. In patients with Walch B1 and B2 glenoids (n=110), there were no differences in outcome measures between patients with postoperative retroversion of more and less than 15o. While 15 of 51 patients (29%) with minimum 5-year radiographs had glenoid radioluciences, these radiographic findings were not associated with inferior clinical outcomes. On multivariable analysis glenoid component radiolucencies were most strongly associated with incomplete component seating (OR 3.3, p = 0.082). CONCLUSION: The results of TSA with conservative glenoid reaming without attempt at version correction are favorable at minimum 5 year, mean 8-year follow-up. There were no differences in clinical and radiographic outcomes between patients with eccentric and concentric wear patterns. Incomplete glenoid component seating was the greatest predictor of glenoid component radiolucency, but these radiolucencies were not associated with inferior clinical outcomes.

2.
Int Orthop ; 48(5): 1277-1283, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38499713

RESUMO

PURPOSE: The objectives of this study were to: report minimum 5-year outcomes in patients undergoing TSA and determine characteristics predictive of patients achieving an excellent functional outcome. METHODS: Pre-operative demographic variables and Simple Shoulder Test (SST) scores were obtained pre-operatively and at a minimum of five years after surgery. A final SST ≥ 10 and percentage of maximal possible improvement (% MPI) of ≥ 66.7% were determined to be the thresholds for excellent outcomes. Univariate and multivariate analysis were performed to identify factors associated with excellent five year clinical outcomes. RESULTS: Of 233 eligible patients, 188 (81%) had adequate follow-up for inclusion in this study. Mean SST scores improved from 3.4 ± 2.4 to 9.7 ± 2.2 (p < 0.001). Male sex was an independent predictor of both SST ≥ 10 (OR 3.46, 95% CI 1.70-7.31; p < 0.001) and %MPI ≥ 66.7 (OR 2.27, 95% CI 1.11-4.81, p = 0.027). Workers' Compensation insurance was predictive of not obtaining SST ≥ 10 (OR 0.12, 95% 0.02-0.60; p = 0.016) or %MPI ≥ 66.7 (OR 0.16, 95% CI 0.03-0.77, p = 0.025). MCID was passed by the vast majority (95%) of patients undergoing TSA and did not necessarily indicate an excellent, satisfactory outcome. CONCLUSION: Male sex and commercial insurance coverage were significantly associated with these excellent outcomes, while Workers' Compensation insurance was associated with failure to achieve this result. Thresholds for excellent outcomes, such as final SST ≥ 10 and %MPI ≥ 66.7, may be useful in identifying the characteristics of patients who benefit most from TSA.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Humanos , Masculino , Articulação do Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Ombro/cirurgia , Resultado do Tratamento , Artroplastia , Estudos Retrospectivos , Amplitude de Movimento Articular
3.
J Shoulder Elbow Surg ; 33(3): e162-e174, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37473904

RESUMO

BACKGROUND: Disabling cuff tear arthropathy (CTA) is commonly managed with reverse shoulder arthroplasty (RSA). However, for patients with CTA having preserved active elevation, cuff tear arthropathy hemiarthroplasty (CTAH) may offer a cost-effective alternative that avoids the complications unique to RSA. We sought to determine the characteristics and outcomes of a series of patients with CTA managed with these procedures. MATERIALS AND METHODS: We retrospectively reviewed 103 patients with CTA treated with shoulder arthroplasty, the type of which was determined by the patient's ability to actively elevate the arm. Outcome measures included the change in the Simple Shoulder Test (SST), the percent maximum improvement in SST (%MPI), and the percentage of patients exceeding the minimal clinically important difference for the change in SST and %MPI. Postoperative x-rays were evaluated to assess the positions of the center of rotation and the greater tuberosity for each implant. RESULTS: Forty-four percent of the 103 patients were managed with CTAH while 56% were managed with RSA. Both arthroplasties resulted in clinically significant improvement. Patients having RSA improved from a mean preoperative SST score of 1.7 (interquartile range [IQR], 0.0-3.0) to a postoperative score of 6.3 (IQR, 2.3-10.0) (P < .01). Patients having CTAH improved from a preoperative SST score of 3.1 (IQR, 1.0-4.0) to a postoperative score of 7.6 (IQR, 5.0-10.) (P < .001). These improvements exceeded the minimal clinically important difference. Instability accounted for most of the RSA complications; however, it did not account for any CTAH complications. The postoperative position of the center of rotation and greater tuberosity on anteroposterior radiographs did not correlate with the clinical outcomes for either procedure. CONCLUSION: For 103 patients with CTA, clinically significant improvement was achieved with appropriately indicated CTAH and RSA. In view of the lower cost of the CTAH implant, it may provide a cost-effective alternative to RSA for patients with retained active elevation.


Assuntos
Artroplastia do Ombro , Hemiartroplastia , Lesões do Manguito Rotador , Artropatia de Ruptura do Manguito Rotador , Articulação do Ombro , Humanos , Artropatia de Ruptura do Manguito Rotador/cirurgia , Artropatia de Ruptura do Manguito Rotador/etiologia , Artroplastia do Ombro/efeitos adversos , Hemiartroplastia/efeitos adversos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Lesões do Manguito Rotador/etiologia , Amplitude de Movimento Articular
4.
Value Health ; 26(9): 1363-1371, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37236394

RESUMO

OBJECTIVES: The viability of specialty condition-based care via integrated practice units (IPUs) requires a comprehensive understanding of total costs of care. Our primary objective was to introduce a model to evaluate costs and potential costs savings using time-driven activity-based costing comparing IPU-based nonoperative management with traditional nonoperative management and IPU-based operative management with traditional operative management for hip and knee osteoarthritis (OA). Secondarily, we assess drivers of incremental cost differences between IPU-based care and traditional care. Finally, we model potential cost savings through diverting patients from traditional operative management to IPU-based nonoperative management. METHODS: We developed a model to evaluate costs using time-driven activity-based costing for hip and knee OA care pathways within a musculoskeletal IPU compared with traditional care. We identified differences in costs and drivers of cost differences and developed a model to demonstrate potential cost savings through diverting patients from operative intervention. RESULTS: Weighted average costs of IPU-based nonoperative management were lower than traditional nonoperative management and lower in IPU-based operative management than traditional operative management. Key drivers of incremental cost savings included care led by surgeons in partnership with associate providers, modified physical therapy programs with self-management, and judicious use of intra-articular injections. Substantial savings were modeled by diverting patients toward IPU-based nonoperative management. CONCLUSIONS: Costing models involving musculoskeletal IPUs demonstrate favorable costs and cost savings compared with traditional management of hip or knee OA. More effective team-based care and utilization of evidence-based nonoperative strategies can drive the financial viability of these innovative care models.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Humanos , Osteoartrite do Joelho/terapia , Osteoartrite do Quadril/terapia , Redução de Custos , Análise Custo-Benefício
5.
Arthroplast Today ; 16: 68-72, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35662993

RESUMO

Background: Perioperative indwelling urinary catheterization remains common in patients undergoing total hip arthroplasty. This study sought to examine the effect of routine catheterization following total hip arthroplasty performed under spinal anesthesia on urinary complications. Methods: A total of 991 consecutive patients who underwent primary total hip arthroplasty under spinal anesthesia over a 4-year period were retrospectively reviewed. Major postoperative urinary retention (POUR) was defined as persistent retention following 2 straight catheterizations, which required postoperative indwelling catheter placement. Minor POUR was defined as retention that resolved following 1 or 2 straight catheterizations. Statistical analyses were used to compare outcomes between those who received a routine indwelling catheter and those who did not. Results: Of the 991 patients included, 498 (50.3%) underwent routine indwelling urinary catheter placement preoperatively. Routine indwelling catheterization was associated with a higher rate of urinary tract infection (1.4% vs 0.0%, P = .015), but a lower rate of minor POUR (5.0% vs 10.3%, P = .001). There was no difference with respect to the rate of major POUR or discharge with an indwelling catheter. Multivariate analyses demonstrated indwelling catheterization to be independently associated with a lower rate of minor POUR (P = .021), but there was no association with overall POUR, major POUR, or discharge with a urinary catheter. Conclusion: These data suggest that routine indwelling urinary catheterization is likely unnecessary for patients undergoing total hip arthroplasty in the setting of spinal anesthetic and may even lead to increased risk of complications such as urinary tract infection.

6.
Int Orthop ; 46(3): 555-562, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35031818

RESUMO

PURPOSE: Cutibacterium is the most common organism causing shoulder periprosthetic infection (PJI). While most shoulder PJIs are well treated by prosthesis exchange and antibiotics, in some cases this treatment fails to resolve the infection. The factors associated with these failures have not been previously identified. The aim of this study was to identify the characteristics of patients with failure of treatment for PJI. METHODS: Thirty-five patients suspected of having Cutibacterium PJI had revision arthroplasty with single-stage implant exchange followed by intravenous antibiotics. The characteristics of those with ≥ two positive cultures at revision surgery were compared to those who did not. The characteristics of those patients having a re-revision with ≥ two positive deep cultures (documented treatment failures) were compared to those who did not. RESULTS: The 17 patients that had ≥ two positive cultures at their index revision were more likely to be male, to have had ream and run procedures, and to have higher loads of Cutibacterium on pre-operative cultures of their unprepared skin. The five patients that had documented treatment failure had higher loads of Cutibacterium on their skin and in deep cultures obtained at their index revision. CONCLUSION: Patients harboring high loads of Cutibacterium on their unprepared skin prior to revision and high loads of Cutibacterium on deep cultures at the time of their index revision are at increased risk for failure of implant exchange and antibiotics to resolve a Cutibacterium PJI.


Assuntos
Artroplastia do Ombro , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Artroplastia do Ombro/efeitos adversos , Feminino , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação/efeitos adversos , Estudos Retrospectivos , Ombro/cirurgia
7.
ACS Appl Mater Interfaces ; 9(17): 14566-14575, 2017 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-28393518

RESUMO

Using delivery systems to control the in vivo release of growth factors (GFs) for tissue engineering applications is extremely desirable as the clinical use of GFs is limited by their fast in vivo turnover. Hence, the development of effective platforms that are able to finely control the release of GFs in vivo remains a challenge. Herein, we investigated the ability of multiscale microspheres, composed by a nanostructured silicon multistage vector (MSV) core and a poly(dl-lactide-co-glycolide) acid (PLGA) forming outer shell (PLGA-MSV), to release functional platelet-derived growth factor-BB (PDGF-BB) to induce in vivo localized neovascularization. The in vitro release of PDGF-BB was assessed by enzyme-linked immunosorbent assay (ELISA) over 2 weeks and showed a sustained, zero-order release kinetics. The ability to promote in vivo localized neovascularization was investigated in a subcutaneous injection model in BALB/c mice and followed by intravital microscopy up to 2 weeks. Fully functional newly formed vessels were found within the area where PLGA-MSVs were localized and covered 3.0 ± 0.9 and 19 ± 5.1% at 7 and 14 days, respectively, showing a 6-fold increase in 1 week. The distribution of CD31+ and α-SMA+ cells was detected by immunofluorescence on harvested tissues. CD31 was significantly more expressed (4-fold increase) compared to the untreated control. Finally, the level of up-regulation of angiogenesis-associated genes (Vegfa, Vwf, and Col3a1) was assessed by q-PCR, resulting in a significantly higher expression where PLGA-MSVs were localized (Vegfa: 2.32 ± 0.50 at 7 days and 4.37 ± 0.75 at 14 days; Vwf: 4.13 ± 0.82 and 7.74 ± 0.91; Col3a1: 5.43 ± 0.37 and 6.66 ± 0.89). Altogether, our data supported the conclusion that the localized delivery of PDGF-BB from PLGA-MSVs induced the localized de novo formation of fully functional vessels in vivo. With this study, we demonstrated that PLGA-MSV holds promise for accomplishing the controlled localized in vivo release of GFs for the design of innovative tissue engineering strategies.


Assuntos
Preparações de Ação Retardada/química , Animais , Camundongos , Camundongos Endogâmicos BALB C , Microesferas , Ácido Poliglicólico , Proteínas Proto-Oncogênicas c-sis
8.
J Zoo Wildl Med ; 45(3): 719-22, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25314852

RESUMO

Severe splenomegaly was found during routine examination of a clinically normal 7-yr-old male Asian small clawed otter. The spleen and three enlarged splenic lymph nodes were immediately removed. The spleen weighed 310 g (approximately 8% of body weight). The spleen and resected lymph nodes were diffusely infiltrated by coalescing sheets of neoplastic lymphocytes that occasionally surrounded remnants of preexisting lymphoid follicles. Immunohistochemical confirmation of B lymphocyte origin and microscopic pattern were consistent with primary splenic marginal zone lymphoma (MZL) with metastasis to the splenic lymph nodes. The otter received no additional treatment and survived for 16 mo following splenectomy. Necropsy confirmed metastasis to multiple abdominal and extra-abdominal lymph nodes, liver, and kidney, and renal failure related to glomerulosclerosis. The prolonged survival in this otter is typical for MZL, an indolent form of B-cell lymphosarcoma that spreads slowly to the abdominal and extra-abdominal lymph nodes.


Assuntos
Linfoma de Zona Marginal Tipo Células B/veterinária , Lontras , Neoplasias Esplênicas/veterinária , Animais , Linfoma de Zona Marginal Tipo Células B/patologia , Linfoma de Zona Marginal Tipo Células B/cirurgia , Masculino , Esplenectomia/veterinária , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/cirurgia
9.
Trends Biotechnol ; 31(7): 426-34, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23755997

RESUMO

Fluids are involved in practically all physiological activities of living organisms. However, biological and biorelated flows are hard to analyze due to the inherent combination of interdependent effects and processes that occur on a multitude of spatial and temporal scales. Recent advances in mesoscale simulations enable researchers to tackle problems that are central for the understanding of such flows. Furthermore, computational modeling effectively facilitates the development of novel therapeutic approaches. Among other methods, dissipative particle dynamics and the lattice Boltzmann method have become increasingly popular during recent years due to their ability to solve a large variety of problems. In this review, we discuss recent applications of these mesoscale methods to several fluid-related problems in medicine, bioengineering, and biotechnology.


Assuntos
Biologia/métodos , Biotecnologia/métodos , Hidrodinâmica , Simulação por Computador
10.
J R Soc Interface ; 9(77): 3208-18, 2012 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-22904256

RESUMO

In cold wet weather, mammals face hypothermia if they cannot dry themselves. By rapidly oscillating their bodies, through a process similar to shivering, furry mammals can dry themselves within seconds. We use high-speed videography and fur particle tracking to characterize the shakes of 33 animals (16 animals species and five dog breeds), ranging over four orders of magnitude in mass from mice to bears. We here report the power law relationship between shaking frequency f and body mass M to be f ∼ M(-0.22), which is close to our prediction of f ∼ M(-0.19) based upon the balance of centrifugal and capillary forces. We also observe a novel role for loose mammalian dermal tissue: by whipping around the body, it increases the speed of drops leaving the animal and the ensuing dryness relative to tight dermal tissue.


Assuntos
Mamíferos/fisiologia , Atividade Motora/fisiologia , Água , Animais , Fenômenos Biomecânicos , Tamanho Corporal , Cães , Metabolismo Energético , Mamíferos/anatomia & histologia , Camundongos , Modelos Teóricos , Estremecimento , Gravação em Vídeo
11.
IEEE Trans Biomed Eng ; 59(4): 1187-93, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22333977

RESUMO

In this paper, we designed, built, and tested a novel single-port access laparoscopic surgery (SPA) specific camera system. This device (magnet camera) integrates a light source and video camera into a small, inexpensive, portable package that does not compete for space with the surgical tools during SPA. The device is inserted through a 26-mm incision in the umbilicus, followed by the SPA port, which is used to maintain an insufflation seal and support the insertion of additional tools. The camera, now in vivo, remains separate from the SPA port, thereby removing the need for a dedicated laparoscope, and, thus, allowing for an overall reduction in SPA port size or the use of a third tool through the insertion port regularly reserved for the traditional laparoscope. The SPA camera is mounted to the abdominal ceiling using one of the two methods: fixation to the SPA port through the use of a rigid ring and cantilever bar, or by an external magnetic handle. The purpose of the magnet camera system is to improve SPA by: 1) eliminating the laparoscope SPA channel; 2) increasing the field of view through enhanced camera system mobility; and 3) reducing interference between the camera system and the surgical tools at the port, both in vivo and ex vivo.


Assuntos
Laparoscópios , Imãs , Sistemas Homem-Máquina , Fotografação/instrumentação , Robótica/instrumentação , Cirurgia Assistida por Computador/instrumentação , Gravação em Vídeo/instrumentação , Desenho de Equipamento , Análise de Falha de Equipamento
12.
Surg Innov ; 19(2): 123-9, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21914703

RESUMO

In this work, the authors designed, built, and tested a novel port camera system for single port access (SPA) laparoscopic surgery. This SPA Port Camera device integrates the monitor, laparoscopic camera, and light source into an inexpensive, portable cannula port. The device uses a 2-channel SPA port inserted through an umbilical incision, similar to traditional SPA. After insertion into a channel, the device deploys a small camera module and LED lamp in vivo. An integrated, on-patient LCD provides the view of the surgical site. The design intent of the port camera is to enhance SPA by (a) reducing the size of the SPA port through the elimination of the dedicated laparoscope channel; (b) reducing equipment cost by integrating an inexpensive CMOS sensor and LED lamp at the port tip; (c) eliminating the need for an assistant who operates the laparoscope; and (d) mechanically coupling the camera, tool port, and on-patient LCD screen. The effectiveness of the device was evaluated by comparing the video performance with a leading industry laparoscope and by performing a user evaluation study and live porcine surgery with the device. Effectiveness of the device was mixed. Overall video system performance of the device is better than an industry standard high-definition laparoscope, implying that significant cost savings over a traditional system are possible. Participant study results suggest that simulated laparoscopic tasks are as efficient with the SPA Port Camera as they are with a typical SPA configuration. However, live surgery revealed several shortcomings of the SPA Port Camera.


Assuntos
Laparoscópios , Laparoscopia/instrumentação , Laparoscopia/métodos , Gravação em Vídeo/instrumentação , Análise de Variância , Animais , Colecistectomia/instrumentação , Colecistectomia/métodos , Desenho de Equipamento , Suínos
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