The purpose of this study was to develop a quality appraisal tool for the assessment of laboratory
We evaluated the top 13 journals in trauma and
orthopaedics by impact factor and looked at the longer-term effect regarding
citations of their papers. All 4951 papers published in these journals during 2007 and 2008
were reviewed and categorised by their type, subspecialty and super-specialty.
All citations indexed through Google Scholar were reviewed to establish
the rate of citation per paper at two, four and five years post-publication.
The top five journals published a total of 1986 papers. Only three
(0.15%) were on operative orthopaedic surgery and none were on trauma.
Most (n = 1084, 54.5%) were about experimental
Aim. The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff. Methods. A search of Medline, EMBASE, the Cochrane Library, World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) databases was performed encompassing a variety of terms including ‘coronavirus’, ‘covid-19’, ‘orthopaedic’, ‘personal protective environment’ and ‘PPE’. Online database searches identified 354 articles. Articles were included if they studied any of the other coronaviruses or if the
The contents of 3 orthopaedic journals [JBJS (Am), JBJS (Br) and CORR] during 2001 and 2011 were compared for publication bias. There were total of 2028 articles. After exclusion 1662 scientific articles were analysed for statistical results, clinical conclusion, sub-speciality topics studied, the geographical region the study been conducted and the statistical method used. The articles classified into 7 categories: THR, TKR,
Distal radius fractures (DRF) are the most common fracture type in all age groups combined. Unstable DRF may be surgically managed with volar or dorsal plate fixation. Dorsal plating has traditionally been associated with decreased range of motion (ROM). However, this assumption has not been recently assessed to determine whether functional ROM is achievable (approximately 54 degrees of flexion and 60 degrees of extension) with recent advances in lower profile dorsal plate design. The aim of this study was therefore to compare ROM and patient reported outcome measures between volar and dorsal plating methods for DRF. A meta-analysis was performed to directly compare ROM and Disabilities of Arm, Shoulder and Hand (DASH) scores between dorsal and volar plate fixation for DRF. Separate literature searches for each plating method were performed using MedLine and EMBase on January 28, 2018. Exclusion criteria consisted of non-English articles,
Distal radius fractures (DRF) are the most common fracture type in all age groups combined. Unstable DRF may be surgically managed with volar or dorsal plate fixation. Dorsal plating has traditionally been associated with decreased range of motion (ROM). However, this assumption has not been recently assessed to determine whether functional ROM is achievable (approximately 54o of flexion and 60o of extension) with recent advances in lower profile dorsal plate design. The aim of this study was therefore to compare ROM and patient reported outcome measures between volar and dorsal plating methods for DRF. A meta-analysis was performed to directly compare ROM and DASH scores between dorsal and volar plate fixation for DRF. Separate literature searches for each plating method were performed using MedLine and EMBase on January 28, 2018. Exclusion criteria consisted of non-English articles,
Nanotechnology is the study, production and controlled
manipulation of materials with a grain size <
100 nm. At this
level, the laws of classical mechanics fall away and those of quantum
mechanics take over, resulting in unique behaviour of matter in
terms of melting point, conductivity and reactivity. Additionally,
and likely more significant, as grain size decreases, the ratio
of surface area to volume drastically increases, allowing for greater interaction
between implants and the surrounding cellular environment. This
favourable increase in surface area plays an important role in mesenchymal
cell differentiation and ultimately bone–implant interactions.
Periprosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA). According to registry-based studies, some bearing couples are associated with an increased risk of PJI. The recent International Consensus on Periprosthetic Joint Infection stated that metal-on-metal (MOM) bearing surface appeared to be associated with a higher incidence of PJI. Based on emerging reports, the incidence of PJI appears to be different among different bearing surfaces. We conducted a multi-institutional study attempting to study this exact issue. The purpose of the study was to determine whether there was any difference in the incidence of PJI in two commonly used bearing couples (metal- on-polyethylene versus ceramic-on-polyethylene). Based on a retrospective multi-institutional query all patients who received primary THA with MOP or COP bearing surfaces performed during 2005–2009 in two high-volume arthroplasty centers were identified. Demographic factors, comorbidities, length of hospital stay, complications and other relevant information were extracted. PJI was defined based on the MSIS (International Consensus) criteria. Multivariate analysis was performed to determine whether bearing coupling was independently correlated with PJI. In our data, 25/2,921 (0.9%) patients with MOP and 11/2,643 (0.4%) patients with COP developed PJI. This difference was statistically significant (p=0.01). After the multivariate analysis, controlling for potential confounders (age, body mass index and length of hospital stay, Charlson comorbidity index), MOP bearing surface was found to be an independent factor correlating with higher incidence of PJI (odds ratio: 2.6, 95% confidence interval: 1.02–6.54, p=0.04). The finding of this study, and others from centers in Europe, suggest that the bearing surface may have an influence on the incidence of PJI. Although, we had originally thought that ceramic bearing surfaces may be used in younger and healthier patients, the multivariate analyses that controlled for all these variables confirms that use of metal femoral head is an independent risk factor for development of PJI. The finding of this study is compelling and begs for future
Hyaline articular cartilage has been known to
be a troublesome tissue to repair once damaged. Since the introduction
of autologous chondrocyte implantation (ACI) in 1994, a renewed
interest in the field of cartilage repair with new repair techniques
and the hope for products that are regenerative have blossomed.
This article reviews the
The incorporation of platelet rich plasma (PRP) in the treatment of various musculoskeletal conditions has increased exponentially over the past decade. While described most often as an augment or treatment for tendinopathies and acute tendon injuries, more recently, PRP has been described as an adjunct to arthroplasty procedures, mostly with respect to knee arthroplasty. In the shoulder, only a single study has been published, in which Zavadil and colleagues performed a randomised study of 40 patients undergoing total shoulder arthroplasty undergoing either treatment with autologous platelet gel and platelet poor plasma (n=20) or undergoing no biologic treatment (control group, n=20). The authors noted that the treatment group had significantly lower pain scores, less pain medication requirements, and improved internal rotation when compared to controls; in addition, there were no significant differences in post-operative (compared to pre-operative) hemoglobin levels or length of stay. The vast majority of arthroplasty studies discussing PRP analyze the impact of treatment on wound healing, post-operative pain, post-operative range of motion, and need for post-operative blood transfusions. Unfortunately, due to the substantial variability of methodology (not all PRP preparations are the same) in the available studies as well as the variability in outcomes reporting, direct comparison between different studies is not feasible. Here, we discuss the
In North America, and for the most part globally, a cementless acetabular component with adjuvant screw fixation is the preferred technique for revision total hip arthroplasty. However, there are situations that involve massive pelvic bone loss that preclude the use of a cementless cup alone. Options include:
. i). Enhanced fixation components and augments. ii). Specialised constructs (cup/cage). iii). Structural allografts. iv). Bone graft substitutes. Complex acetabular revisions present the arthroplasty surgeon with challenges that require an approach with more than one solution for all scenarios. While structural allografts have recently fallen out of favour with the increasing use of enhanced fixation components, there would still appear to be a role in the case in which bone stock restoration is a primary goal. The role of bone graft substitutes remains unclear, with supportive
There is no doubt that peri-prosthetic joint infection (PJI) is one the most terrible complications of joint arthroplasty. There has been a surge of interest in PJI in recent years as this problem moves to be the last frontier in joint arthroplasty. There are a number of strategies employed for prevention of PJI. Irrigation of the surgical site with various irrigation solutions is one such strategy as it helps reduce bioburden in the wound and reduce the potential for subsequent infection. Although the irrigation solution may work by dilution phenomenon alone, some believe that bactericidal or bacteriostatic agents may be added to the irrigation solution to increase its efficacy. Addition of antibiotics (Abx) to the irrigation solution stems from the same reasoning. There are a number of serious issues related to the addition of Abx to the irrigation solution or in fact, for pouring into the wound (like the vancomycin powder). Efficacy: There are no randomised prospective studies to demonstrate that addition of Abx to the irrigation solution improves “kill”. To do such a study would be logistically challenging.
Background. A cell-based tissue-engineered construct can be employed for treating meniscal lesions occurring in the non-vascularized inner two-thirds. The objective of this study was to test the hypothesis that both pre-differentiation of human bone marrow derived stromal cells (hBMSCs) into chondrogenic lineage before cell seeding and platelet-rich plasma (PRP) pretreatment on a PLGA mesh scaffold enhances the healing capacity of the meniscus with hBMSCs-seeded scaffolds in vivo. Methods. PRP of 5 donors was mixed and used for the experiments. The woven PLGA mesh scaffold (VicrylTM, Ethicon) measuring 20×8 mm (thickness, 0.2 mm) was prepared. The scaffolds were immersed into 1,000 μl of PRP and were centrifuged at 150g for 10 min. Then, the scaffold was flipped 180° and the same procedure was done for the other side. After washing, the scaffolds were soaked into 1,000 μl of DMEM media. hBMSCs from an iliac crest of 10 patients after informed consent and approval of our IRB were induced into chondrogenic differentiation with chondrogenic media containing 10 ng/ml rhTGF-ß3 in 1.2% alginate bead culture system for 7 days. Then, 2×10. 5. hBMSCs were recovered, seeded onto the scaffold, and cultured under dynamic condition. Based on the presence of pre-differentiation into chondrogenic lineage and the PRP pretreatment, 4 study groups were prepared. (no differentiation without PRP, no differentiation with PRP, chondrogenic differentiation without PRP, chondrogenic differentiation with PRP) Cell number for each cell-seeded scaffold was determined at 24 hours after seeding. Then, scaffolds were placed between human meniscal discs and were implanted subcutaneously in nude mice for 6 weeks (n=10 per group). Results. Cell attachment analysis revealed no significant difference among groups (p>0.05). The average cell number attached on the scaffold was ranged 1.1×10. 5. to 1.2×10. 5. among groups after 24 hours, so the initial cell seeding efficiency was ranged 55 to 60%. Histologic results from the 10 constructs containing hBMSCs undifferentiated and seeded onto non-PRP treated scaffolds revealed none had healed at all. Of the constructs containing hBMSCs undifferentiated and seeded onto PRP-pretreated scaffolds, three menisci healed and seven did not heal. Of the constructs containing hBMSCs pre-differentiated into chondrogenic lineage and seeded onto non-PRP treated scaffolds, six menisci healed and four did not heal. Of the constructs containing hBMSCs pre-differentiated into chondrogenic lineage and seeded onto PRP-pretreated scaffolds, seven menisci healed and three did not heal. Histological evaluation demonstrated a continuous hypercellular new fibrous tissue integrating into the native devitalized meniscus disc tissue in healed samples. The histological outcome between the groups was significant (p<0.05) (Table 1) (Figure 1). Conclusion. hBMSCs, which were differentiated into chondrogenic lineage before cell seeding and attached PRP-pretreated PLGA mesh scaffolds, demonstrated enhanced healing capacity of human meniscus in a meniscal repair mouse model. These findings demonstrate that both pre-differentiation of hBMSCs into chondogenesis and the PLGA scaffold modified by PRP pretreatment provides more biomimetic and biocompatible strategy for cell-mediated meniscal repair. Acknowledgements. This study was supported by
Hip impingement causes clinical problems for both the native hip, where labral or chondral damage can cause severe pain, and in the replaced hip, where subluxation can cause squeaking/metallosis through edge loading, or can cause dislocation. There is much research into bony/prosthetic hard impingements showing that anatomical variation/component mal-positioning can increase the risk of impingement. However, there is a lack of
Background. The focus on evidence-based medicine has led to calls for increased levels of evidence in surgical journals. The purpose of the present study was to review the levels of evidence in articles published in the foot and ankle literature and to assess changes in the level of evidence over a decade. Methods. All articles from the years 2000 and 2010 in Foot and Ankle International, Foot and Ankle Surgery, and all foot and ankle articles from JBJS A and JBJS B were analysed. Animal, cadaveric,
Background. There is no consensus on which glenoid plane should be used in total shoulder arthroplasty. Nevertheless, anatomical reconstruction of this plane is imperative for the success of a total shoulder arthroplasty. Methods. Three-dimensional reconstruction CT-scans were performed on 152 healthy shoulders. Four different glenoid planes, each determined by three surgical accessible bony reference points, are determined. The first two are triangular planes, defined by the most anterior and posterior point of the glenoid and respectively the most inferior point for the Saller's Inferior plane and the most superior point for the Saller's Superior plane. The third plane is formed by the best fitting circle of the superior tubercle and the most anterior and posterior point at the distal third of the glenoid (Circular Max). The fourth plane is formed by the best fitting circle of three points at the rim of the inferior quadrants of the glenoid (Circular Inferior). We hypothesized that the plane with normally distributed parameters, narrowest variability and best reproducibility would be the most suitable surgical glenoid plane. Results. No difference in position of the mean humeral center of rotation is found between the Circular Max and Circular Inferior plane (X=91.71degrees/X=91.66degrees p=0.907 and Y=90.83degrees /Y=91.7degrees p=0.054 respectively), while clear deviations are found for the Saller's Inferior and Saller's Superior plane (p < 0.001). The Circular Inferior plane has the lowest variability to the coronal scapular plane (p<0.001). Conclusion. This study provides arguments to use the Circular Inferior glenoid plane as preferred surgical plane of the glenoid. Level of evidence: Level II,
Background. Author credibility and creativity is often gauged by the number of scientific papers published, with the frequency of citations for particular articles reflecting the impact of published data on the area of practice. Aims. The objective of this study was to identify and analyse the qualities of the top one hundred cited articles in Orthopaedic surgery. Methods. We used the database of the Science Citation Index of the Institute for Scientific Information (1945-1995) in addition to Scopus, Medline and Pubmed search engines. Results. 1490 articles were cited in excess of 100 times with the top 100 being subjected for further analysis. The 100 articles discussed were published between 1945 and 2005. The mean number of citations per articles was 446.5 (range 334 - 1786). The majority of published articles originated in the United States (68) with the United Kingdom and Canada closely behind (12 and 5 respectively). The 100 articles were published in 7 Orthopaedic journals led by the Journal of Bone and Joint Surgery American edition (JBJS Am) (n=55) followed by Spine (n=16), Clinical Orthopaedic Related Research (n=14), JBJS Britain (n=7), Journal of Orthopaedic Research (n=5), Acta Orthopaedica Scandinavia (n=2) and Foot and Ankle International (n=1). 80 of the most cited articles reported clinical experiences, 7 were clinical review articles and 13 dealt with
Introduction. Fractures of the proximal humerus represent a major osteoporotic burden. Recent developments in CT imaging have emphasized the importance of cortical bone thickness distribution in the prevention and management of fragility fractures. We aimed to experimentally define the CT density of cortical bone in the proximal humerus for building cortical geometry maps. Methods. With ethical approval we used ten fresh frozen human proximal humeri. These were stripped of all soft tissue and high resolution CT images were then taken. The humeral heads were then subsequently resected to allow access to the metaphyseal area. Using curettes, cancellous bone was removed down to hard cortical bone. Another set of CT images of the reamed specimen was then taken. Using CT imaging software and a CAD interface we then compared cortical contours at different CT density thresholds to the reference inner cortical contour of our reamed specimens. Working with 3D model representations of these cortical maps, we were able to accurately make distance comparison analyses based on different CT thresholds. Results. We could compute a single closest value at 700HU. There was no difference found in the HU based contours generated along the 500HU–900HU pixels (p=1.000). The contours were significantly different to those generated at 300HU, 400HU, 1000HU and 1100HU. Discussion/conclusion: A Hounsfield range of 500 to 900 HU can accurately depict cortical bone geometry in the proximal humerus. Thresholding outside this range leads to statistically significant inaccuracies. Our results concur with a similar range reported in the literature for the proximal femur. Knowledge of regional variations in cortical bone thickness has direct implications for
Background. Presentations at national meetings provide an important forum to relay research findings in all areas of Orthopaedic surgery. Orthopaedic surgical trainees are encouraged throughout the training process to participate, present and ultimately publish their research. Indeed the well known mantra ‘Publish or Perish’ signifies the pressure trainees are sometimes placed under in order to achieve professional success. The number of original published papers is often the yardstick by which professional appointments are made. We aimed to determine the overall publication rates of presentations from the 2001 and 2002 Irish Orthopaedic Association meetings and to determine whether publication rates differed among other national Orthopaedic meetings and amongst the subspecialties. Methods. A comprehensive literature review was conducted using the proceedings of the 2002 & 2003 IOA meetings using Pubmed and Medline. Time to publication, orthopaedic subspecialty and journal was analysed. Rates were compared to other similar studies documenting rates of publication in the AAOS and data compared using Pearsons chi square test. Results. In 2002 and 2003 there were 63 and 49 presentations respectively. The overall publication rate was 26.98% for 2003 and 24.4% for 2002. All 29 presentations were published in a selection of 20 journals, the most common being the JBJS (Br) and Injury. The most published topics were
Purpose. In recent years, it has become increasingly common to publish the level of evidence of orthopaedic research in journal publications. Our primary research question is: is there an improvement in the levels of evidence of articles published in paediatric orthopaedic journals over time? In addition, what is the current status of levels of evidence in paediatric orthopaedic journals?. Methods. All articles in the Journal of Paediatric Orthopaedics-A and Journal of Paediatric Orthopaedics-B for 2001, 2002, 2007 and 2008, and in the Journal of Children's Orthopaedics for 2007 and 2008, were collected. Animal, cadaveric and