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Senders C.W.,Davis Medical Center | Tollefson T.T.,Davis Medical Center | Curtiss S.,Orthopedics | Wong-Foy A.,University of California at Davis | And 3 more authors.
Archives of Facial Plastic Surgery | Year: 2010

Objective: To determine the force requirements, optimal vector, and appropriate materials of a novel eyelid sling device that will be used to rehabilitate eyelid closure (blink) in congenital or acquired permanent facial paralysis with an artificial muscle. Methods: The force required to close the eyelids in human cadavers (n = 6) were measured using a load cell system. The eyelid sling using either expanded polytetrafluoroethylene (ePTFE) or temporalis muscle fascia was implanted. The ideal vector of force and placement within the eyelid for a natural eyelid closure were compared. Results: The eyelid sling concept was successful at creating eyelid closure in a cadaver model using an upper eyelid sling attached to the distal tarsal plate. Less force was necessary to create eyelid closure using a temporalis muscle fascia sling (627 ± 128 mN) than for the ePTFE eyelid sling (1347±318 mN). Conclusions: The force and stroke required to close an eyelid with the eyelid sling are well within the attainable range of the electroactive polymer artificial muscle (EPAM). This may allow the creation of a realistic and functional eyelid blink that is symmetric and synchronous with the contralateral, normally functioning blink. Future aims include consideration of different sling materials and development of both the EPAM device and an articulation between the EPAM and sling. The biocompatibility and durability studies of EPAM in a gerbil model are under way. The successful application of artificial muscle technology to create an eyelid blink would be the first of many potential applications.


Wiegant K.,Rheumatology and Clinical Immunology | Van Roermund P.M.,Orthopedics | Intema F.,Rheumatology and Clinical Immunology | Cotofana S.,Musculoskeletal Anatomy | And 3 more authors.
Osteoarthritis and Cartilage | Year: 2013

Background: Treatment of severe osteoarthritis (OA) in relatively young patients is challenging. Although successful, total knee prosthesis has a limited lifespan, with the risk of revision surgery, especially in active young patients. Knee joint distraction (KJD) provides clinical benefit and tissue structure modification at 1-year follow-up. The present study evaluates whether this benefit is preserved during the second year of follow-up. Methods: Patients included in this study presented with end-stage knee OA and an indication for total knee replacement (TKR); they were less than 60 years old with a VAS pain ≥60mm (n=20). KJD was applied for 2 months (range 54-64 days) and clinical parameters assessed using the WOMAC questionnaire and VAS pain score. Changes in cartilage structure were measured using quantitative MRI, radiography, and biochemical analyses of collagen type II turnover (ELISA). Results: Average follow-up was 24 (range 23-25) months. Clinical improvement compared with baseline (BL) was observed at 2-year follow-up: WOMAC improved by 74% (P<0.001) and VAS pain decreased by 61% (P<0.001). Cartilage thickness observed by MRI (2.35mm (95%CI, 2.06-2.65) at BL) was significantly greater at 2-year follow-up (2.78mm (2.50-3.09); P=0.03). Radiographic minimum joint space width (JSW) (1.1mm (0.5-1.7) at BL) was significantly increased at 2-year follow-up as well (1.7mm (1.1-2.3); P=0.03). The denuded area of subchondral bone visualized by MRI (22% (95%CI, 12.5-31.5) at BL) was significantly decreased at 2-year follow-up (8% (3.6-12.2); P=0.004). The ratio of collagen type II synthesis over breakdown was increased at 2-year follow-up (P=0.07). Conclusion: Clinical improvement by KJD treatment is sustained for at least 2 years. Cartilage repair is still present after 2 years (MRI) and the newly formed tissue continues to be mechanically resilient as shown by an increased JSW under weight-bearing conditions. © 2013 Osteoarthritis Research Society International.


Ehlinger M.,Orthopedics | Adamczewski B.,Orthopedics | Rahme M.,Orthopedics | Adam P.,Orthopedics | Bonnomet F.,Orthopedics
International Orthopaedics | Year: 2015

Purpose: Treatment of tibial plateau fractures is discussed. A retrospective comparative study of fractures treated with an anatomical locking plate of 4.5 mm or 3.5 mm. Our hypothesis is that the 3.5 mm plates give an equivalent hold of fractures with comparable results and better clinical tolerance. Methods: From May 2010 to October 2011, 18 patients were operated on using a 4.5-mm LCP™ anatomical plate (group A) and 20 patients received a3.5-mm LCP™ anatomical plate (group B). Groups were comparable. One fracture was open. Results: For the Group A, 14 patients had a follow up of 35.3 months and for the Group B, 16 patients had a follow up of 27 months. Mobility was comparable in both groups. The Hospital for Special Surgery (HSS) score was 86.4 versus 80.6, the Lysholm score was 83.6 versus 77 for groups A and B respectively. Consolidation was 3.25 months versus 3.35 months and mean axis was 183.1° versus 181.6° for groups A and B. Mechanical axes during revision were statistically different to the controlateral axes. One secondary displacement was noted in group A and one secondary displacement in group B. Group A had eight patients reporting discomfort with the material versus three in group B (p < 0.05). Conclusion: The hypothesis is proven. In regards to the results, there is no significant difference between the two groups but the clinical tolerance was better in group B. More time is needed in the long term to better evaluate these severe fractures. © 2015, SICOT aisbl.


Euler S.A.,Innsbruck Medical University | Spiegl U.J.,University of Leipzig | Millett P.J.,Orthopedics | Petri M.,Klinik fur Unfallchirurgie
Zeitschrift fur Orthopadie und Unfallchirurgie | Year: 2015

The ideal treatment for massive rotator cuff tears is influenced by the morphology and chronicity of the tear, tissue quality, the degree of concomitant osteoarthritis, and patient-specific factors. Traditionally, massive rotator cuff tears have wrongly been equated with irreparable tears. A variety of improvements in surgical technique and materials now permit successful arthroscopic management of many massive rotator cuff tears when non-operative management has failed. This study provides an overview of the current treatment options for large and massive rotator cuff tears, including their expected outcomes. Finally, a possible treatment algorithm is suggested. © Georg Thieme Verlag KG.


Brinkman J.-M.,Orthopedics | Bubra P.S.,Concord Repatriation and General Hospital | Walker P.,Orthopedics | Walsh W.R.,Prince of Wales Hospital | And 2 more authors.
ANZ Journal of Surgery | Year: 2014

Background: In order to emulate normal knee kinematics more closely, and thereby potentially improve wear characteristics and implant longevity, the medial pivot-type knee replacement geometry was designed. In the current study the outcome of 50 consecutive knee replacements using a medial pivot-type knee replacement was compared with the results in the Australian Orthopaedic Association National Joint Replacement Registry. Methods: Pre- and post-operatively at follow-up evaluation consisted of the Knee Society score system and the Western Ontario and McMaster Universities Arthritis Index Score. Patient satisfaction was documented using 5-point Likert-type scales. Standard radiographs were used to assess signs of radiographic failure. Revisions were subcategorized into major total, major partial and minor. Patient records were cross-referenced against the Australian Orthopaedic Associations National Joint Replacement Registry's and the outcome compared with the registry's subset of data on the medial pivot knee used. Results: According to the patients' Knee Society score system and Western Ontario and McMaster Universities Arthritis Index scores, there was good pain relief and functional improvement; none of the implants showed radiographic signs of failure. There was one minor revision. There was no statistically significant difference in revision rate compared with the registry results. Discussion: The medial pivot knee-type implant in this series provided pain relief, functional improvement and a revision rate, similar to what is reported in the literature after a longer follow-up period, which is reassuring for those who use this type of implant on a day-to-day basis. © 2013 Royal Australasian College of Surgeons.


Kharb S.,Orthopedics | Chaudhary S.,Orthopedics | Kundu Z.S.,Orthopedics
American Journal of Biochemistry and Molecular Biology | Year: 2014

Osteosarcoma along with other tumors like osteoma, osteoid osteoma and osteoblastoma are grouped as bone forming tumors. Several studies have shown link between serum concentrations of IGF-I and increased risk of common cancers namely breast, prostate, colorectal and lung cancer. Conflicting data are available regarding leptin effects on bone with both positive and negative effects being reported. No reports are available regarding leptin levels in osteosarcoma and its correlation with IGF-I. Hence, the present study is planned to study serum IGF-I and leptin levels in patients of osteosarcoma. Serum IGF-1 and leptin were analyzed in thirty cases of osteosarcoma and these patients were compared with thirty age and sex matched controls with musculoskeletal pain. Serum calcium and phosphorous levels were decreased in patients with osteosarcoma as compared to controls. Serum alkaline phosphatase levels were significantly raised in patients with osteosarcoma as compared to patients of musculoskeletal pain (p<0.001). Serum IGF-land leptin levels were significantly decreased in osteosarcoma patients (group-II) as compared to the patients of musculoskeletal pain (group-I), (p<0.001, p<0.05, respectively). Inverse correlation was observed between IGF-1 and calcium, IGF-1 and ALP, leptin and calcium leptin and ALP in group II as compared to group I. Lowered serum IGF-1 and leptin levels observed in osteosarcoma patients as compared to control in the present study and could be due to their possible utilization in tumor formation. The present study suggests that these parameters can serve as useful markers for diagnosis and follow up of disease. © 2014 Academic Journals Inc.


PubMed | Orthopedics and Urology
Type: | Journal: Urology case reports | Year: 2016

TURP is a widespread urologic procedure that is performed by many urologists. This report describes a rare complication that causes serious morbidity because it is not recognized in time. This is also the first report of a prostatosymphyseal fistula treated without major surgery. Eventually diagnosis is made by a MRI 5months after surgery. Decompressive surgery was necessary to treat pubic ostetis with invalidating pain. Culture results revealed Escherichia coli but eventually the diagnosis was made by fistulography. Treatment consisted of bladder drainage and long-term antibiotic treatment and these could eventually heal the fistula.


PubMed | Orthopedics
Type: Comparative Study | Journal: International orthopaedics | Year: 2015

Treatment of tibial plateau fractures is discussed. A retrospective comparative study of fractures treated with an anatomical locking plate of 4.5 mm or 3.5 mm. Our hypothesis is that the 3.5 mm plates give an equivalent hold of fractures with comparable results and better clinical tolerance.From May 2010 to October 2011, 18 patients were operated on using a 4.5-mm LCP anatomical plate (group A) and 20 patients received a3.5-mm LCP anatomical plate (group B). Groups were comparable. One fracture was open.For the Group A, 14 patients had a follow up of 35.3 months and for the Group B, 16 patients had a follow up of 27 months. Mobility was comparable in both groups. The Hospital for Special Surgery (HSS) score was 86.4 versus 80.6, the Lysholm score was 83.6 versus 77 for groups A and B respectively. Consolidation was 3.25 months versus 3.35 months and mean axis was 183.1 versus 181.6 for groups A and B. Mechanical axes during revision were statistically different to the controlateral axes. One secondary displacement was noted in group A and one secondary displacement in group B. Group A had eight patients reporting discomfort with the material versus three in group B (p < 0.05).The hypothesis is proven. In regards to the results, there is no significant difference between the two groups but the clinical tolerance was better in group B. More time is needed in the long term to better evaluate these severe fractures.


PubMed | Orthopedics
Type: Evaluation Studies | Journal: International orthopaedics | Year: 2012

Smartphones have gained widespread use in the healthcare field to fulfill a variety of tasks. We developed a small iPhone application to take advantage of the built-in position sensor to measure angles in a variety of spinal deformities. We present a reliability study of this tool in measuring kyphotic angles.Radiographs taken from 20 different patients charts were presented to a panel of six operators at two different times. Radiographs were measured with the protractor and the iPhone application and statistical analysis was applied to measure intraclass correlation coefficients between both measurement methods, and to measure intra- and interobserver reliabilityThe intraclass correlation coefficient calculated between methods (i.e. CobbMeter application on the iPhone versus standard method with the protractor) was 0.963 for all measures, indicating excellent correlation was obtained between the CobbMeter application and the standard method. The interobserver correlation coefficient was 0.965. The intraobserver ICC was 0.977, indicating excellent reproductibility of measurements at different times for all operators. The interobserver ICC between fellowship trained senior surgeons and general orthopaedic residents was 0.989. Consistently, the ICC for intraobserver and interobserver correlations was higher with the CobbMeter application than with the regular protractor method. This difference was not statistically significant.Measuring kyphotic angles with the iPhone application appears to be a valid procedure and is in no way inferior to the standard way of measuring the Cobb angle in kyphotic deformities.


PubMed | Seth GS Medical College & KEM Hospital, Orthopedics and KEM Hospital
Type: Journal Article | Journal: Cureus | Year: 2016

Polyarthritis is a challenging condition that an orthopedic surgeon faces in day-to-day practice. Some of the conditions where multiple joints are affected are rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Multiple joint afflictions can cause severe impairment in the quality of life, which leads to a significant socioeconomic burden on the family and society. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by conservative management. Total joint arthroplasty remains one of the most commonly performed and universally accepted operative interventions for such patients.Fifty patients were invited into the study. All patients included in the study were 18 years of age and olderand had undergone two or more joint replacements with a minimum of six months duration from the last surgery. The data was collected during the preoperative and postoperative periods through patient records and questionnaires. The Short Form 36 Health Survey Questionnaire (SF-36) scores were generated from an online application that is readily available on the official website SF-36 scoring system. The results were compared, analyzed, and tested for significance using the Wilcoxon signed rank test.The highest incidence of multiple joint replacements appears to be in the age-group of 51 - 70 years (52%), the mean age of patients being 51.7 +/- 14.4 years. The ratio of female to male patients was 1.6:1. On comparison of preoperative and postoperative (six months)physical componentand mental component scores, the differences were found to be significant (p-value: < 0.01). This finding is irrespective of the diagnosis, gender, or age of the patient.In the study conducted on 50 patients, we found out that multiple joint arthroplasties are fruitful surgeries. The procedures are efficient in reducing the disabilities seen in patients with polyarthritis of various causes and improving the overall quality of life. We strongly recommend multiple joint arthroplasties to patients with severe disability. However, adequate medical management plays an equally important role to improve the overall results. Well-designed and larger studies are required to establish the treatment protocols and order of surgeries in patients with differing causes of polyarthritis.

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