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New Frontiers in Orthopedic Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 December 2022) | Viewed by 35028

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Prof. Dr. Joseph Borrelli Jr.

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West Coast Musculoskeletal Institute and Department of Orthopedic and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
Interests: osteoarthritis; fractures; cartilage injury; joint reconstruction; orthopedic trauma
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine will explore several exciting new developments in musculoskeletal medicine in general and orthopaedic surgery in particular. Musculoskeletal medicine involves the care of a broad range of “conditions” involving many different anatomical areas of the body. These areas include the skeletal system itself, large and small joints of the body, and the ligaments and tendons that stabilise these joints and permit movement and locomotion. In the past, orthopaedic surgeons mostly concerned themselves with treating fractures, arthritis, and tendon and ligament injuries. More recently, orthopaedists have expanded their interest into the more traditional “medicine” side of things, including skeletal health (osteoporosis), anaesthesia as it relates to orthopaedic surgery, pain management, and regenerative medicine (supporting the body’s healing properties to more actively participate in the repair of injuries). Advances in these and other areas of orthopaedic medicine will be presented in this Special Issue to bring the reader up to date with advances in musculoskeletal medicine and to encourage additional advances in the care, treatment, and long-term outcomes of orthopaedic patients.

Prof. Dr. Joseph Borrelli Jr.
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

nanotechnology
multimodal anesthesia
osteoporosis
well-leg compartment syndrome
supra-patellar tibial nailing

Published Papers (11 papers)

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Research

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11 pages, 5104 KiB

Open AccessEditor’s ChoiceArticle

No Significant Differences in Clinical and Radiographic Outcomes between PCL Retained or Sacrificed Kinematic Aligned Medial Pivot Total Knee Arthroplasty in Varus Knee

by Fortunato Giustra, Francesco Bosco, Giorgio Cacciola, Salvatore Risitano, Marcello Capella, Alessandro Bistolfi, Alessandro Massè and Luigi Sabatini

J. Clin. Med. 2022, 11(21), 6569; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11216569 - 5 Nov 2022

Cited by 15 | Viewed by 1819

Abstract

In the last decades, several surgical techniques, such as medial pivot (MP) philosophy and kinematic alignment (KA), have been introduced in total knee arthroplasty (TKA) to improve patients’ outcomes. This retrospective study aims to evaluate the clinical, radiographic, and functional results of PCL preservation or sacrifice in KA MP-TKA. A consecutive series of 147 patients older than 60, with a minimum follow-up of two years, were treated with TKA for severe primary knee osteoarthritis (OA) at the Department of Orthopedics and Traumatology between 1 January 2019, and 1 July 2020. After excluding those not meeting the inclusion criteria, 64 patients were included in the study analysis. Regarding radiographic outcomes, no statistically significant difference was observed between patients with preserved or sacrificed PCL (p > 0.05). A slight improvement in Knee Society Score (KSS), knee and function score, and FJS was observed for the PCL-preserved group, although this superiority tendency was not statistically significant (p > 0.05). PCL-preserved MA MP-TKA reported a statistically significant result in only two questions on the FJS questionnaire (p < 0.05). A slight, non-statistically significant improvement in active ROM was found in the PCL-sacrificed group (p > 0.05). No interventions or revisions were reported in this case series for all treated patients at the final follow-up. No significant differences were described in clinical, radiographic, and functional outcomes in preserved or sacrificed PCL KA MP-TKA. Although not significant, a slight trend toward better clinical outcomes was reported in PCL-preserved KA MP-TKA. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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11 pages, 4507 KiB

Open AccessArticle

Radiographic Outcomes of Ganz versus Modified Triple Osteotomies in Femoral Head Medialization and Coverage in Acetabular Dysplasia

by Jui-Yo Hsu, Chia-Che Lee, Sheng-Chieh Lin, Ting-Ming Wang, Ken N. Kuo and Kuan-Wen Wu

J. Clin. Med. 2022, 11(7), 1924; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11071924 - 30 Mar 2022

Cited by 2 | Viewed by 3977

Abstract

Variable techniques in periacetabular osteotomy have been formulated for the treatment of acetabular dysplasia. However, few studies have compared the radiographic outcomes between different osteotomy types. This study compared modified triple innominate (MTI) osteotomy and Ganz osteotomy with respect to radiographic outcomes. Patients receiving MTI osteotomies and Ganz osteotomies at any time between 2006 and 2018 in a tertiary medical centre were recruited. Only patients with unilateral osteotomies were recruited to eliminate potential influence from the contralateral hip following periacetabular osteotomy. Patients having hip-joint dislocation, receiving simultaneous proximal femoral osteotomy, or having fewer than 2 years of follow-up were excluded. The radiographic parameters of preoperative and postoperative anteroposterior radiographs of the pelvis were measured, and Sharp’s angle (SA), the lateral centre-edge angle (CE angle), the femoral head extrusion index (FHEI), and the centre-head distance discrepancy (CHDD) were included for comparison. Among 55 participants, 23 received MTI osteotomies and 32 received Ganz osteotomies. The mean age at which patients underwent surgery was 21.9 years in the Ganz osteotomy group and 21.1 years in the MTI group. The mean follow-up length was 2.5 years. The preoperative radiographic parameters between groups differed only slightly and nonsignificantly. Both groups exhibited significantly improved SA, LCEA, and FHEI after surgery. The Ganz osteotomy group exhibited more favourable postoperative FHEI (13.5 vs. 24.3, p < 0.0001), CHDD (3.7 vs. 11.5, p < 0.0001), Sharp angle (45.0 vs. 41.8, p = 0.0489) and CE angles (28.3 vs. 21.1, p = 0.029) compared with the MTI osteotomy group. Notably, CHDD became better and worse following Ganz and MTI osteotomies, respectively; this suggests that the femoral head is pushed laterally in modified triple osteotomy. With respect to femoral head coverage and the medialization of the femoral head, Ganz osteotomy exhibits more favourable corrections in postoperative radiographic parameters than does MTI osteotomy. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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9 pages, 1398 KiB

Open AccessArticle

The Application of an Allogenic Bone Screw for Stabilization of a Modified Chevron Osteotomy: A Prospective Analysis

by Thorsten Huber, Stefan G. Hofstätter, Rainer Fiala, Florian Hartenbach, Robert Breuer and Björn Rath

J. Clin. Med. 2022, 11(5), 1384; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11051384 - 3 Mar 2022

Cited by 6 | Viewed by 2475

Abstract

Background: Distal first metatarsal osteotomies are commonly performed operative procedures for hallux valgus deformity, and usually involve fixation with a metal screw. However, various bioabsorbable osteosynthesis materials have been in use for a number of years. One recent innovation is the Shark Screw^®, a human cortical bone allograft. This study aimed to evaluate the efficacy and safety of this allogeneic screw in the stabilization of Reversed L-Shaped osteotomy, a modified Chevron osteotomy. Methods: In a prospective study, 15 patients underwent a Reversed L-Shaped osteotomy stabilized with the allogenic bone screw Radiological data on osteointegration of the screw and correction of the intermetatarsal angle were recorded. Furthermore, each follow-up examination included the collection of clinical data, the American Orthopedic Foot and Ankle Society (AOFAS) score, evaluation of pain level, and patient’s overall satisfaction. Results: Full osseous fusion of the osteotomy was seen in all patients. The bone screws were radiographically integrated after approximately 6.5 (±2.6) months. Neither nonunion nor failure occurred in any of our cases. Furthermore, we did not find any potential graft reaction. The AOFAS score improved significantly from 51.6 (±15.2) points to 90.9 (±10.3) (p < 0.001). The preoperative hallux valgus angle and intermetatarsal angle decreased significantly from 24.8 (±4.9) degrees to 7.2 (±4.4) degrees (p < 0.001) and 12.6 (±3.2) degrees to 4.8 (±1.3) degrees (p < 0.001), respectively. Conclusions: With this study, we demonstrated the efficiency of the allogenic bone screw (Shark Screw^®) in regard to clinical and radiological short-term outcomes. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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10 pages, 462 KiB

Open AccessArticle

Less Fluctuation in Hemodynamics of the Wide-Awake Local Anesthesia No Tourniquet Technique Than General Anesthesia in Distal Radius Plating Surgery: A Prospective Case-Control Study

by Wen-Chih Liu, I-Cheng Lu, Chung-Chia Chang, Chih-Ting Chen, Chung-Hwan Chen, Chia-Lung Shih, Yin-Chih Fu and Jesse Bernard Jupiter

J. Clin. Med. 2022, 11(4), 1123; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11041123 - 21 Feb 2022

Cited by 7 | Viewed by 2003 | Correction

Abstract

This prospective case-control study aimed to compare the intraoperative hemodynamic changes between the wide-awake local anesthesia no tourniquet (WALANT) technique and general anesthesia (GA) in patients undergoing distal radius plating surgery. Forty adults with distal radius fractures underwent plating surgery via the WALANT technique (20 patients) or GA (20 patients). Mean arterial pressure (MAP) and heart rate were recorded. Intraoperative pain intensity was measured using the visual analog scale (VAS) for pain in the WALANT group. The measures of hemodynamics and VAS were recorded at seven-time points perioperatively. The VAS score decreased significantly compared with the preoperative status in the WALANT group for most of the intraoperative period except during injections of local anesthetics and fracture reduction. The intraoperative MAP in the WALANT group showed no significant change during the perioperative period. In addition, the WALANT group showed fewer perioperative MAP fluctuations than the GA group (p < 0.05). The reduction and plating quality were similar between the two groups. WALANT provided a feasible technique with less fluctuation in hemodynamic status. With gentle manipulation of the fracture reduction, distal radius plating surgery using the WALANT technique is a well-tolerated surgical procedure and shows similar reduction and plating quality to GA. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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Review

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31 pages, 752 KiB

Open AccessReview

Advancement in the Treatment of Osteoporosis and the Effects on Bone Healing

by Yevgeniya Kushchayeva, Iryna Pestun, Sergiy Kushchayev, Nataliia Radzikhovska and E. Michael Lewiecki

J. Clin. Med. 2022, 11(24), 7477; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11247477 - 16 Dec 2022

Cited by 13 | Viewed by 4048

Abstract

Osteoporosis (OP) is a major global health concern, with aging being one of the most important risk factors. Osteoarthritis (OA) is also an age-related disorder. Patients with OP and/or OA may be treated surgically for fractures or when their quality of life is impaired. Poor bone quality due to OP can seriously complicate the stability of a bone fixation construct and/or surgical fracture treatment. This review summarizes the current knowledge on the pathophysiology of normal and osteoporotic bone healing, the effect of a bone fracture on bone turnover markers, the diagnosis of a low bone mineral density (BMD) before surgical intervention, and the effect of available anti-osteoporosis treatment. Interventions that improve bone health may enhance the probability of favorable surgical outcomes. Fracture healing and the treatment of atypical femoral fractures are also discussed. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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9 pages, 11581 KiB

Open AccessReview

Evidence for Local Antibiotics in the Prevention of Infection in Orthopaedic Trauma

by Michael J. Flores, Kelsey E. Brown, Saam Morshed and David W. Shearer

J. Clin. Med. 2022, 11(24), 7461; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11247461 - 16 Dec 2022

Cited by 9 | Viewed by 2263

Abstract

Prevention of fracture-related infection (FRI) remains a substantial challenge in orthopaedic trauma care. There is evolving evidence to support the use of local antibiotics for both the prevention and treatment of musculoskeletal infection. Local antibiotics can achieve higher local tissue concentrations with a lower risk of systemic complications compared to intravenously administered antibiotics. These antibiotics may be administered in powder or liquid form without carrier, or if sustained release is desired, using a carrier. Polymethylmethacrylate (PMMA), ceramics, and hydrogels are examples of antibiotic carriers. Unlike PMMA, ceramics and hydrogels have the advantage of not requiring a second surgery for removal. The VANCO trial supported the use of powdered vancomycin in high-risk fracture cases for the reduction of Gram-positive infections; although, data is limited. Future studies will evaluate the use of aminoglycoside antibiotics to address Gram-negative infection prevention. While theoretical concerns exist with the use of local antibiotics, available studies suggest local antibiotics are safe with a low-risk of adverse effects. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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14 pages, 304 KiB

Open AccessReview

The Evolution, Current Indications and Outcomes of Cementless Total Knee Arthroplasty

by Maria T. Schwabe and Charles P. Hannon

J. Clin. Med. 2022, 11(22), 6608; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11226608 - 8 Nov 2022

Cited by 8 | Viewed by 2619

Abstract

Total knee arthroplasty (TKA) has been performed by orthopedic surgeons for decades, but the cementless TKA has only recently gained much interest in the world of arthroplasty. Initially, early designs had multiple complications, particularly with aseptic loosening due to osteolysis and micromotion. However, modifications have shown good outcomes and excellent survivorship. Over the last several decades, changes in implant designs as well as implant materials/coatings have helped with bone in growth and stability. Furthermore, surgeons have been performing TKA in younger and more obese patients as these populations have been increasing. Good results from the cementless TKA compared to cemented TKA may be a better option in these more challenging populations, as several studies have shown greater survivorship in patients that are younger and have a greater BMI. Additionally, a cementless TKA may be more cost effective, which remains a concern in today’s healthcare environment. Overall, cemented and cementless TKA have great results in modern times and there is still a debate as to which implant is superior. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

10 pages, 1766 KiB

Open AccessReview

Well Leg Compartment Syndrome: Pathophysiology, Prevention, and Treatment

by Matthew Nester and Joseph Borrelli, Jr.

J. Clin. Med. 2022, 11(21), 6448; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11216448 - 31 Oct 2022

Cited by 5 | Viewed by 4506

Abstract

The development of compartment syndrome involving the lower limb is a potentially devastating complication of prolonged surgery in patients held in the lithotomy position. Well leg compartment syndrome (WLCS) was recognized in 1953. The incidence of this condition has been reported to range from 0.20% to 0.03%. The mechanism of WLCS development in the absence of trauma appears to be related to prolonged hypoperfusion of the limb, pressure on the muscle compartments, and in some cases, reperfusion of the ischemic limb. This grave complication develops either during or immediately after prolonged surgery in which the patient was held in the Lloyd-Davies lithotomy or hemi-lithotomy position. Surgeons must be aware of the potential for WLCS development during prolonged surgery. Signs of developing WLCS include swelling, increased firmness of the muscle compartments, discoloration, and cooling of the limb. Preventive measures can be taken without contaminating the surgical field by returning the limb to the right atrium level. Once the diagnosis has been made, failure to prevent the development of WLCS requires extensile fasciotomy of each leg compartment to restore perfusion and relieve elevated intra-compartment pressures. This article reviews the pathophysiology, prevention, and treatment of WLCS. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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13 pages, 886 KiB

Open AccessReview

Multimodal Pain Management in Orthopedic Surgery

by Aparna Chunduri and Amit Kumar Aggarwal

J. Clin. Med. 2022, 11(21), 6386; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11216386 - 28 Oct 2022

Cited by 6 | Viewed by 5280

Abstract

Background: Orthopedic surgery typically results in moderate to severe pain in a majority of patients. Opioids were traditionally the primary medication to target mechanisms of pain transmission. Multimodal analgesia has become a preferred method of pain management in orthopedic practice. Utilizing more than one mode to address post-surgical pain by recruiting multiple receptors through different medications accelerates the recovery process and decreases the need for opioids. By implementing effective analgesic techniques and interventions, this practice, in turn, decreases the usage of perioperative opioids, and in the long term, prevents addiction to pain medications and risk of opioid overdose. In orthopedic surgeries, previous studies have found that multimodal analgesia has reduced early opioid usage in the postoperative course. Pain is the result of direct injury to the nervous system, with a wide variety of chemicals directly stimulating or sensitizing the peripheral nociceptors. The pathophysiology behind the mechanism of post-surgical pain, along with the importance of preoperative, perioperative, and postoperative pain regimens are emphasized. A brief overview of pain medications and their properties is provided. These medications are further categorized, with information on special considerations and typical dosage requirements. Pain management should address both neuropathic and subjective types of pain. Effective pain control requires constant reassessment with individualized strategies. Conclusion: By focusing on multimodal analgesia, anesthesiologists can now utilize newer techniques for postoperative pain relief from orthopedic surgery, with better short-term and long-term outcomes for the patient. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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16 pages, 1626 KiB

Open AccessReview

The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population

by Gabriel Larose and Mandeep S. Virk

J. Clin. Med. 2022, 11(19), 5832; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195832 - 30 Sep 2022

Cited by 4 | Viewed by 2738

Abstract

Proximal humerus fracture (PHF) is a common injury in the older population. While the majority of these fractures are treated non-operatively, a small subset of patients may benefit from surgical treatment. However, there continues to be an ongoing debate regarding the indications and ideal surgical treatment strategy. The use of reverse total shoulder arthroplasty (RTSA) has resulted in a paradigm shift in the treatment of PHFs in the older population. Unique biomechanical principles and design features of RTSA make it a suitable treatment option for PHFs in the older population. RTSA has distinct advantages over hemiarthroplasty and internal fixation and provides good pain relief and a reliable and reproducible improvement in functional outcomes. As a result, there has been an exponential increase in the volume of RTSA in the older population in last decade. The aim of this paper is to review the current concepts, outcomes and controversies regarding the use of RTSA for the treatment of PHFs in the older population. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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Other

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9 pages, 4852 KiB

Open AccessTechnical Note

Suprapatellar Tibial Nailing: Future or Fad?

by Matthew Ciminero, Hannah Elsevier, Justin Solarczyk and Amir Matityahu

J. Clin. Med. 2023, 12(5), 1796; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12051796 - 23 Feb 2023

Cited by 1 | Viewed by 2191

Abstract

Over the last hundred years, there have been significant advancements in the way the Orthopaedic community treats tibial fractures. More recently, the focus of Orthopaedic trauma surgeons has been comparing the different techniques of insertion for tibial nails, specifically suprapatellar (SPTN) versus infrapatellar. The existing literature is convincing that there does not appear to be any clinically significant differences between suprapatellar and infrapatellar tibial nailing, with some apparent benefits of SPTN. Based on the current body of literature and our personal experience with SPTN, we believe the suprapatellar tibial nail will become the future for most tibial nailing procedures, regardless of fracture pattern. We have seen evidence of improved alignment in both proximal and distal fracture patterns, decreased radiation exposure and operative time, relaxation of the deforming forces, ease of imaging, and static positioning of the leg, which would be helpful for the unassisted surgeon, as well as no difference in anterior knee pain or articular damage within the knee between the two techniques. Full article

(This article belongs to the Special Issue New Frontiers in Orthopedic Surgery)

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