Robotic Surgical Procedures ; Robotics ; Orthopedic Procedures ; Orthopedics ; Surgery, Computer-Assisted

PURPOSE: Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary aim was to identify determinants of patients' satisfaction with their scars and evaluate current measurement scales. METHODS: The preferred reporting items for systematic reviews and meta-analyses checklist was followed. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. There were no constraints based on language or publication status. A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery. Determinants of patient satisfaction were identified along with the scales used to measure satisfaction. RESULTS: A total of 6059 records were screened in the initial search. Twenty-six articles satisfied the inclusion criteria, assessing 7130 patients. In the literature, six validated subjective scar scales were identified, including the Vancouver scar scale, patient and observer scar assessment scale, Manchester scar scale, Stony Brook scar evaluation scale, visual analogue scale, and Hollander wound evaluation scale. Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully. These were total hip arthroplasty, total knee arthroplasty, and limb reconstruction. The scales demonstrated satisfactory validity. Functional outcomes such as restoration of movement ranked among patients' highest concerns. Scar cosmesis was found to be amongst patients' lowest priorities. CONCLUSIONS Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery. However, these were able to appropriately assess scars in the studies identified in this review. Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.
Humans ; Cicatrix ; Orthopedic Procedures/adverse effects* ; Patient Satisfaction ; Pain Measurement

In the past decades,a dramatic development of navigation technology in orthopaedic surgery has been witnessed. By assisting the localization of surgical region,verification of target bony structure,preoperative planning of fixation,intraoperative identification of planned entry point and direction of instruments or even automated insertion of implants,its ability and potential to reduce operation time,intraoperative radiation,surgical trauma,and improve accuracy has been proved. However,in contrast to the widespread use of navigation technology in arthroplasty,orthopaedic tumor,and spine surgery,its application in orthopaedic trauma is relatively less. In this manuscript,the main purpose is to introduce the technical principles of navigation devices,outline the current clinical application of navigation systems in orthopaedic trauma,analyze the current challenges confronting its further application in clinical practice and its prospect in the future.
Humans ; Orthopedics ; Surgery, Computer-Assisted/methods* ; Orthopedic Procedures/methods* ; Operative Time

Objective: To evaluate the short-term outcomes of non-contact low-frequency ultrasonic debridement in treating periprosthetic joint infections(PJI). Methods: The clinical data of patients with PJI who met the eligibility criteria and were treated with non-contact low-frequency ultrasonic debridement from August 2021 to January 2022 at the Department of Orthopaedics,the First Affiliated Hospital of Xinjiang Medical University were prospectively analyzed. PJI was defined according to the modified Musculoskeletal Infection Society criteria in 2016. After mechanical debridement,an 8-mm handheld non-contact low-frequency ultrasound probe was used for ultrasonic debridement in the whole surgical area at a frequency of (25±5)kHz and power of 90% for 5 minutes. Each ultrasound lasted 10 seconds with 3-second intervals. The probe was repeatedly sonicated among all soft tissue,bone interface and metal prosthesis surface(patients underwent debridement,antibiotics and implant retention (DAIR)) in the surgical area. The femoral canal of the hip joint,the distal femoral canal and the posterior capsule of the knee were fully sonicated with a special right-angle probe. Before and after ultrasonic debridement,20 ml of liquid was extracted from each operation area and injected into aerobic and anaerobic culture bottles,respectively,for pathogen culture. Harris hip score and Hospital for Special Surgery (HSS) score were used to evaluate clinical function. Treatment failure was defined as the recurrence of infection in the same joint. The patients were routinely followed up in the outpatient clinic at 1,3,and 6 months postoperatively and then annually with a deadline of August 2022. The paired t-test,rank sum,Mann-Whitney U or χ² test was used to compare the observed data,and rates among multiple groups were compared using the Bonferroni approach. Results: A total of 45 patients were included in the study,including 21 men and 24 women with age of (65.8±15.2)years(range: 20 to 80 years) and body mass index of (29.3±4.2)kg/m²(range: 20.2 to 38.5 kg/m²). Twenty-eight patients (18 hips and 10 knees) underwent one-stage revision,and 17 cases (5 hips and 12 knees) underwent DAIR. Three of the patients (6.7%) had recurrent infections during follow-up. There were no intraoperative complications related to ultrasonic debridement (neurovascular and muscle injury,poor wound healing and fat liquefaction). Seventeen patients who received DAIR were followed for a median(M(IQR)) of 9(3) months,and two relapsed 3 weeks and 3 months post-operation,respectively. In addition,28 patients who underwent one-stage revision were followed for a median of 9(2) months,and one of the patients (3.6%,1/28) had a recurrence 6 months post-operation. The culture-positive rate of preoperative aspiration was 47.6% (20/42). The data of intraoperative soft tissue culture was 86.7% (39/45). The culture-positive rate of wound liquid before ultrasonic debridement was 46.7% (21/45). And the culture-positive rate after ultrasonic debridement was (75.6% (34/45)). After sonication,the culture-positive rate of explanted prostheses was 88.9% (40/45). There was a significant difference in culture-positive rates among all five cultures (χ²=35.483,P<0.01). Further pairwise comparison showed that the culture-positive rate of wound liquid after ultrasonic debridement was higher than that before ultrasonic debridement (χ²=7.901,P=0.005) but was not significantly different from the positive rates of other cultures (all P>0.05). The median number of colonies 24 hours after ultrasonic debridement(2 240 (1 310) CFU/ml,range: 310 to 3 140 CFU/ml) was significantly higher than that before debridement(450 (550) CFU/ml,range: 10 to 910 CFU/ml) (U=43, P=0.017). The post-operative Harris ((78.6±4.2)points,range:70.5 to 85.3 points) and HSS scores((76.4±4.8)points,range: 68.5 to 84.3 points) were significantly higher than the preoperative scores((46.0±9.8)points,range: 27.5 to 64.3 points;and (45.5±10.3)points,range: 27.6 to 63.1 points) (t=-14.6,t=-12.7;both P<0.01). Conclusions: Non-contact low-frequency ultrasonic debridement can increase the culture-positive rate and lead to a favorable short-term outcome. In addition,no complications are associated with using this new technique to treat PJI.
Female ; Humans ; Male ; Anti-Bacterial Agents ; Debridement ; Knee Joint ; Orthopedic Procedures ; Prospective Studies ; Ultrasonics

Objective: To quantitatively evaluate the clinical effect of platelet-rich plasma(PRP) intra-articular injection for early and middle stage knee osteoarthritis(KOA) treatment by 3.0T MRI T2 mapping sequence. Methods: Clinical data of 26 patients with early or middle stage KOA who received treatment from April to December 2021 at Department of Orthopaedic Surgery,the Second Affiliated Hospital,Zhengzhou University were retrospectively analyzed. In total, 8 patients were male and 18 were female,with age of (66.4±12.0)years(range:51 to 94 years). Four patients were bilateral KOA and 22 patients were unilateral KOA.All patients received PRP intra-articular injection. Patients underwent 3.0T MRI T2 mapping sequence scanning pre-treatment,3-month-after and 6-month-after treatment respectively. Those were used to measure and compare T2 values of medial and lateral femoral articular surface and patellofemoral articular surface. Visual analogue scale(VAS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) score were recorded and evaluated. The results were analyzed using repeated measure ANOVA followed by Bonferroni multiple comparison test.The correlation between WOMAC scores and T2 values at pre-treatment and 6 months post-treatment was analyzed using Pearson correlation test. Results: After treatment, the patients' International Cartilage Regeneration＆Joint Preservation Society(ICRS) classification were partly improved(one case improved from grade Ⅲ to grade Ⅱ, one case improved from grade Ⅱ to grade Ⅰ),and all patients generally improved after treatment in clinical symptoms. Compared with pre-treatment,VAS and WOMAC scores of grade Ⅰ,Ⅱ,and Ⅲ of 6-month after treatment were declined significantly(all P<0.05).The T2 values of articular cartilage declined to varying degrees(the decrease in T2 values was about 2.06 ms in grade Ⅰ, 2.66 ms in grade Ⅱ, and 3.72 ms in grade Ⅲ).Three-month (VAS:4.8±1.3,WOMAC:21.5±4.0) and 6-month (VAS:4.2±1.4,WOMAC:17.2±2.9) after treatment, the VAS and WOMAC score were significantly higher than those before treatment (VAS:6.0±1.2, WOMAC:29.0±2.3) (F=48.846, F=346.746;both P<0.01). Multiple comparisons showed a statistically significant difference between pre-treatment and post-treatment VAS (P<0.01) and it also was significantly different between 3-month and 6-month post-treatment (P<0.01).At 3- and 6-month after treatment,WOMAC scores were significantly different from before treatment.And it also was significantly different between 3-month and 6-month post-treatment (P<0.01).There was a statistically significant improvement in T2 values of patellofemoral articular surface, medial and lateral femoral articular surface at pre-treatment((44.64±4.02)ms,(44.17±3.64)ms and(43.53±3.91)ms) and 3-month ((43.19±3.91)ms,(43.24±3.34)ms and (42.47±3.80)ms), 6-month ((41.49±3.64)ms,(41.83±3.15)ms and (41.10±3.42)ms) after treatment(F=148.845,F=73.657,F=86.268;all P<0.01).The results of the multiple comparisons showed a statistically significant difference in the T2 values of medial and lateral femoral articular surface and patellofemoral articular surface at each time point(all P<0.01).The Pearson correlation analysis suggested that the WOMAC score at pre-treatment was positively correlated with the medial condyle (r=0.856,P<0.01) and the patellofemoral joint surface T2 values (r=0.840,P<0.01);The WOMAC score at 6-month post-treatment was positively correlated with the medial condyle (r=0.731,P<0.01) and the patellofemoral joint surface T2 values (r=0.691,P<0.01). Conclusions: In the treatment of early and mid-stage KOA,MRI T2 mapping sequences are able to indicate the integrity of cartilage morphology and quantitatively evaluate cartilage repair. PRP has a good therapeutic effect on cartilage repair and reconstruction.
Humans ; Female ; Male ; Osteoarthritis, Knee/therapy* ; Retrospective Studies ; Orthopedic Procedures ; Platelet-Rich Plasma ; Magnetic Resonance Imaging

Objective: To evaluate the efficacy and prognosis of orthopedic surgical resection surgery in patients with newly diagnosed multiple myeloma (NDMM). Methods: This retrospective cohort study collected clinical data of patients with NDMM who underwent surgery due to spinal cord compression or pathological long-bone fractures at the Peking Union Medical College Hospital from 1 January 2003 to 31 December 2021. Patients who received biopsy or vertebroplasty/kyphoplasty were excluded and patients with the same degree of bone disease and who did not undergo any surgical intervention were selected as controls. Visual analogue scale (VAS) and physical status (ECOG) scores, progression-free survival (PFS), and overall survival (OS) were compared. Statistical analysis included the χ²-test, t-test, and Kaplan-Meier methods. Results: Baseline data were compared between the surgical group (n=40 with 43 interventions) and the non-surgical group (n=80), and included sex, age, paraprotein type, International Staging System (ISS), number of lytic lesions, cytogenetic abnormalities, first-line treatment, and the proportion of patients receiving autologous stem cell transplantation (ASCT) (all P>0.05). Serum M protein levels in the surgical group were significantly lower than those of the non-surgical group [(21.95±16.44) g/L vs. (36.18±20.85) g/L, P=0.005]. The surgical lesions involved the axial skeleton (79.1%, 34/43) or the extremities (20.9%, 9/43). VAS and ECOG scores improved significantly after surgery (VAS: 2.30±0.80 vs. 6.60±1.50, P<0.001; ECOG: 2.09±0.59 vs. 3.09±0.73, P<0.001). The median follow-up time was 51 months. Kaplan-Meier survival analysis suggested that the median PFS (25 vs. 29 months) and OS (46 vs. 60 months) were comparable between the surgical and non-surgical intervention groups (both P>0.05). Subgroup analysis showed that among patients with ISS Ⅰ or those who had received ASCT, PFS in the surgical group was similar to that of the non-surgical intervention group (both P>0.05), while OS was worse (P=0.005, 0.017). Patients with ISS Ⅱ/Ⅲ scores or without ASCT had similar PFS and OS between the surgical and non-surgical intervention groups (all P>0.05). Cox multivariate analysis suggested that ISS and ASCT were independent prognostic factors for OS (ISS: HR=0.42, 95%CI 0.19-0.93, P=0.031; ASCT: HR=0.41, 95%CI 0.18-0.97, P=0.041), while orthopedic surgery did not influence survival (P=0.233). Conclusion: For patients with NDMM, orthopedic surgical resection decreased bone-related complications and improved quality of life, but did not affect survival.
Humans ; Prognosis ; Multiple Myeloma/diagnosis* ; Hematopoietic Stem Cell Transplantation/methods* ; Retrospective Studies ; Quality of Life ; Transplantation, Autologous ; Orthopedic Procedures ; Treatment Outcome

OBJECTIVE: To explore the effectiveness of a new point contact pedicle navigation template (referred to as "new navigation template" for simplicity) in assisting screw implantation in scoliosis correction surgery. METHODS: Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. RESULTS: Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups ( P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group ( P<0.05). There was no complications related to screws implantation during or after operation in the two groups. CONCLUSION The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.
Humans ; Orthopedic Procedures ; Pedicle Screws ; Retrospective Studies ; Scoliosis/surgery* ; Spinal Fusion/methods* ; Spine ; Surgery, Computer-Assisted/methods*

OBJECTIVE: To explore the effect of Chinese massage on the rehabilitation of scoliosis patients undergoing 3D printing orthopedics. METHODS: A retrospective selection of 262 patients with adolescent idiopathic scoliosis(AIS) who underwent 3D printing technology orthopedics admitted to the Department of Orthopedics in our hospital from January 2013 to January 2019 were selected for clinical research. According to the rehabilitation treatment methods adopted by the patients after the operation, the patients were divided into control group and observation group, there were 131 cases in each group. The observation group was treated with traditional Chinese acupuncture and massage after operation, and the control group was treated with conventional rehabilitation. The torso rotation angle and the maximum Cobb angle before and after intervention were measured and compared between two groups, Oswestry Disability Index(ODI) was used for functional evaluation, and the visual analogue scale(VAS) was used to evaluate the changes in pain before and after rehabilitation intervention. RESULTS: After the intervention, the trunk rotation angle and maximum Cobb angle of the observation group were significantly better than those of the control group, the VAS score of the observation group was significantly lower than that of the control group, ODI in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). CONCLUSION After scoliosis patients undergo preoperative 3D printing correction, the scientific and reasonable implementation of TCM acupuncture and massage can effectively improve the patient's vertebral rotation angle, maximum Cobb angle, and improve the patient's spinal function.
Adolescent ; Humans ; Lumbar Vertebrae/surgery* ; Massage ; Medicine, Chinese Traditional ; Orthopedic Procedures ; Orthopedics ; Printing, Three-Dimensional ; Retrospective Studies ; Scoliosis/surgery* ; Spinal Fusion ; Treatment Outcome

Humans ; COVID-19/epidemiology* ; Pandemics ; Orthopedics ; Orthopedic Procedures ; Telemedicine

Humans ; Hallux Valgus/surgery* ; Orthopedic Procedures ; Bunion/surgery* ; Joint Diseases/surgery* ; Treatment Outcome