bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of diabetic foot ulcers based on pictorial material: an interobserver study
Authors: Jørgensen Tue Smith , Hellsten Ylva , Gottlieb Hans , Brorson Stig
Published: November 2020

Objective:

The frequent change in clinicians, and the emerging use of photographic documentation in wound management, could require a more diverse treatment of patients due to poor interobserver agreement. The aim of this study was to assess the interobserver agreement of a commonly used classification system for diabetic foot ulcers (DFUs), the Meggitt–Wagner classification, and to compare the agreement on classification with the agreement in treatment recommendations.

Method:

An interobserver study was conducted based on a questionnaire linked to 30 photographs of DFUs. Different groups of observers were tested to investigate whether there was a difference between professions or level of education: experienced orthopaedic wound care doctors (n=7); nurses specialised in wound care (n=8) and untrained nurses assigned to a diabetic wound care training course (n=23). Krippendorff's alpha was used to calculate interobserver agreement, and an agreement of >0.67 was defined as substantial.

Results:

The Krippendorff's alpha value for interobserver agreement on the Meggitt–Wagner classification was 0.52 for the doctors group, 0.67 for the specialised nurses and 0.61 for the untrained nurses. The corresponding values regarding agreement on recommendation of surgical revision of the wound were 0.35, 0.22 and 0.15, respectively. The choice of dressing type or antibiotic treatment had even lower interobserver agreement.

Conclusions:

The interobserver agreement on the Meggitt–Wagner classification was substantial in the specialised nurse group, but the evaluation and treatment of DFUs should not be exclusively based on pictorial materials.
Compensation for standing posture by whole-body sagittal alignment in relation to health-related quality of life
Authors: Hasegawa Kazuhiro , Okamoto Masashi , Hatsushikano Shun , Watanabe Kei , Ohashi Masayuki , Vital Jean-Marc , Dubousset Jean
Published: November 2020

Aims

The aim of this study is to test the hypothesis that three grades of sagittal compensation for standing posture (normal, compensated, and decompensated) correlate with health-related quality of life measurements (HRQOL).

Methods

A total of 50 healthy volunteers (normal), 100 patients with single-level lumbar degenerative spondylolisthesis (LDS), and 70 patients with adult to elderly spinal deformity (deformity) were enrolled. Following collection of demographic data and HRQOL measured by the Scoliosis Research Society-22r (SRS-22r), radiological measurement by the biplanar slot-scanning full body stereoradiography (EOS) system was performed simultaneously with force-plate measurements to obtain whole body sagittal alignment parameters. These parameters included the offset between the centre of the acoustic meatus and the gravity line (CAM-GL), saggital vertical axis (SVA), T1 pelvic angle (TPA), McGregor slope, C2-7 lordosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL, sacral slope (SS), pelvic tilt (PT), and knee flexion. Whole spine MRI examination was also performed. Cluster analysis of the SRS-22r scores in the pooled data was performed to classify the subjects into three groups according to the HRQOL, and alignment parameters were then compared among the three cluster groups.

Results

On the basis of cluster analysis of the SRS-22r subscores, the pooled subjects were divided into three HRQOL groups as follows: almost normal (mean 4.24 (SD 0.32)), mildly disabled (mean 3.32 (SD 0.24)), and severely disabled (mean 2.31 (SD 0.35)). Except for CAM-GL, all the alignment parameters differed significantly among the cluster groups. The threshold values of key alignment parameters for severe disability were TPA > 30°, C2-7 lordosis > 13°, PI-LL > 30°, PT > 28°, and knee flexion > 8°. Lumbar spinal stenosis was found to be associated with the symptom severity.

Conclusion

This study provides evidence that the three grades of sagittal compensation in whole body alignment correlate with HRQOL scores. The compensation grades depend on the clinical diagnosis, whole body sagittal alignment, and lumbar spinal stenosis. The threshold values of key alignment parameters may be an indication for treatment. Cite this article: Bone Joint J 2020;102-B(10):1359–1367.
Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty
Authors: Herregodts Stijn , Verhaeghe Mathijs , Paridaens Rico , Herregodts Jan , Vermue Hannes , Arnout Nele , De Baets Patrick , Victor Jan
Published: November 2020

Aims

Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon’s experience level.

Methods

A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB).

Results

The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents.

Conclusion

This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324–1330.
Vitamin E-doped total hip arthroplasty liners show similar head penetration to highly cross-linked polyethylene at five years: a multi-arm randomized controlled trial
Authors: Kjærgaard Kristian , Ding Ming , Jensen Carsten , Bragdon Charles , Malchau Henrik , Andreasen Christina M. , Ovesen Ole , Hofbauer Christian , Overgaard Søren
Published: November 2020

Aims

The most frequent indication for revision surgery in total hip arthroplasty (THA) is aseptic loosening. Aseptic loosening is associated with polyethylene liner wear, and wear may be reduced by using vitamin E-doped liners. The primary objective of this study was to compare proximal femoral head penetration into the liner between a) two cross-linked polyethylene (XLPE) liners (vitamin E-doped (vE-PE)) versus standard XLPE liners, and b) two modular femoral head diameters (32 mm and 36 mm).

Methods

Patients scheduled for a THA were randomized to receive a vE-PE or XLPE liner with a 32 mm or 36 mm metal head (four intervention groups in a 2 × 2 factorial design). Head penetration and acetabular component migration were measured using radiostereometric analysis at baseline, three, 12, 24, and 60 months postoperatively. The Harris Hip Score, University of California, Los Angeles (UCLA) Activity Score, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey questionnaire (SF-36) were assessed at baseline, three, 12, 36, and 60 months.

Results

Of 220 screened patients, 127 were included in this study. In all, 116 received the allocated intervention, and 94 had their results analyzed at five years. Head penetration was similar between liner materials and head sizes at five years, vE-PE versus XLPE was -0.084 mm (95% confidence interval (CI) -0.173 to 0.005; p = 0.064), and 32 mm versus 36 mm was -0.020 mm (95% CI -0.110 to 0.071; p = 0.671), respectively. No differences were found in acetabular component migration or in the patient-reported outcome measures.

Conclusion

No significant difference in head penetration was found at five years between vE-PE and XLPE liners, nor between 32 mm and 36 mm heads. Cite this article: Bone Joint J 2020;102-B(10):1303–1310.
What are the results of revised hip resurfacing arthroplasties?
Authors: Amstutz Harlan C. , Le Duff Michel
Published: November 2020

Aims

Hip resurfacing arthroplasty (HRA) is typically indicated for young and active patients. Due to the longevity of arthroplasty, these patients are likely to undergo revision surgery during their lifetime. There is a paucity of information on the long-term outcome of revision surgeries performed after failed HRA. The aim of our study was to provide survivorship data as well as clinical scores after HRA revisions.

Methods

A total of 42 patients (43 hips) were revised after HRA at our centre to a variety of devices, including four HRA and 39 total hip arthroplasties (THAs). In addition to perioperative complications, University of California, Los Angeles (UCLA) hip scores and 12-Item Short-Form Health Survey questionnaire (SF-12) quality of life scores were collected at follow-up visits after the primary HRA and after revision surgery.

Results

The mean follow-up time after revision surgery was 8.3 years (0.3 to 19.1). The mean UCLA pain and function scores post-revision were comparable with the best scores achieved by the patients after the index HRA, but UCLA activity scores were lower after revision. SF-12 physical component scores were comparable between timepoints, but the mental component score decreased after revision. Six patients underwent unilateral re-revision surgery at a mean follow-up time of 7.8 years (0.3 to 13.7). Using the time to any re-revision as endpoint, the Kaplan-Meier survivorship was 85.3% at 13 years.

Conclusion

Patients undergoing revision after HRA can expect to achieve function and quality of life similar to their best after their primary surgery, while the risk of re-revision is low. Cite this article: Bone Joint J 2020;102-B(10):1289–1296.
Two-stage anterior and posterior fusion versus one-stage posterior fusion in patients with Scheuermann’s kyphosis
Authors: McDonnell Jake M. , Ahern Daniel P. , Lui Darren F. , Yu Haiming , Lehovsky Jan , Noordeen Hilali , Molloy Sean , Butler Joseph S. , Gibson Alexander
Published: November 2020

Aims

Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann’s kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion.

Methods

A retrospective review of patients treated surgically for Scheuermann’s kyphosis between 2006 and 2014 was performed. A total of 62 patients were identified, with 31 in each group. Parameters were compared to evaluate postoperative outcomes using chi-squared tests, independent-samples t-tests, and z-tests of proportions analyses where applicable.

Results

There were six postoperative infections in the two-stage anteroposterior group compared with three in the one-stage posterior-only group. A total of four patients in the anteroposterior group required revision surgery, compared with six in the posterior-only group. There was a significantly higher incidence of junctional failure associated with the one-stage posterior-only approach (12.9% vs 0%, p = 0.036). Proximal junction kyphosis (anteroposterior fusion (74.2%) vs posterior-only fusion (77.4%); p = 0.382) and distal junctional kyphosis (anteroposterior fusion (25.8%) vs posterior-only fusion (19.3%), p = 0.271) are common postoperative complications following both surgical approaches.

Conclusion

A two-stage anteroposterior fusion was associated with a significantly greater correction of the kyphosis compared with a one-stage posterior-only fusion, with a reduced incidence of junctional failure (0 vs 3). There was a notably greater incidence of infection with two-stage anteroposterior fusion; however, all were medically managed. More patients in the posterior-only group required revision surgery. Cite this article: Bone Joint J 2020;102-B(10):1368–1374.
Risk factors for the local recurrence of giant cell tumours of the sacrum treated with nerve-sparing surgery
Authors: Zhao Yongzhao , Tang Xiaodong , Yan Taiqiang , Ji Tao , Yang Rongli , Guo Wei
Published: November 2020

Aims

There is a lack of evidence about the risk factors for local recurrence of a giant cell tumour (GCT) of the sacrum treated with nerve-sparing surgery, probably because of the rarity of the disease. This study aimed to answer two questions: first, what is the rate of local recurrence of sacral GCT treated with nerve-sparing surgery and second, what are the risk factors for its local recurrence?

Methods

A total of 114 patients with a sacral GCT who underwent nerve-sparing surgery at our hospital between July 2005 and August 2017 were reviewed. The rate of local recurrence was determined, and Kaplan-Meier survival analysis carried out to evaluate the mean recurrence-free survival. Possible risks factors including demographics, tumour characteristics, adjuvant therapy, operation, and laboratory indices were analyzed using univariate analysis. Variables with p < 0.100 in the univariate analysis were further considered in a multivariate Cox regression analysis to identify the risk factors.

Results

The rate of local recurrence of sacral GCT treated with nerve-sparing surgery was 28.95% (33/114). Multivariate Cox regression analysis showed that large tumour size (> 8.80 cm) (hazard ratio (HR) 3.16; 95% confidence interval (CI) 1.27 to 7.87; p = 0.014), high neutrophil-to-lymphocyte ratio (NLR) (> 2.09) (HR 3.13; 95% CI 1.28 to 7.62; p = 0.012), involvement of a sacroiliac joint (HR 3.09; 95% CI 1.06 to 9.04; p = 0.039), and massive intraoperative blood loss (> 1,550 ml) (HR 2.47; 95% CI 1.14 to 5.36; p = 0.022) were independent risk factors for local recurrence.

Conclusion

Patients with a sacral GCT who undergo nerve-sparing surgery have a local recurrence rate of 29%. Large tumour size, high NLR, involvement of a sacroiliac joint, and massive intraoperative blood loss are independent risk factors. Cite this article: Bone Joint J 2020;102-B(10):1392–1398.
The preoperative Oxford Knee Score is an independent predictor of achieving a postoperative ceiling score after total knee arthroplasty
Authors: Clement Nicholas D. , Afzal Irrum , Demetriou Charis , Deehan David J. , Field Richard E. , Kader Deiary F.
Published: November 2020

Aims

The primary aim of this study was to assess whether the postoperative Oxford Knee Score (OKS) demonstrated a ceiling effect at one and/or two years after total knee arthroplasty (TKA). The secondary aim was to identify preoperative independent predictors for patients that achieved a ceiling score after TKA.

Methods

A retrospective cohort of 5,857 patients undergoing a primary TKA were identified from an established arthroplasty database. Patient demographics, body mass index (BMI), OKS, and EuroQoL five-dimension (EQ-5D) general health scores were collected preoperatively and at one and two years postoperatively. Logistic regression analysis was used to identify independent preoperative predictors of patients achieving postoperative ceiling scores. Receiver operating characteristic curve was used to identify a preoperative OKS that predicted a postoperative ceiling score.

Results

The ceiling effect was 4.6% (n = 272) at one year which increased significantly (odds ratio (OR) 40.3, 95% confidence interval (CI) 30.4 to 53.3; p < 0.001) to 6.2% (n = 363) at two years, when defined as those with a maximal score of 48 points. However, when the ceiling effect was defined as an OKS of 44 points or more, this increased to 26.3% (n = 1,540) at one year and further to 29.8% (n = 1,748) at two years (OR 21.6, 95% CI 18.7 to 25.1; p < 0.001). A preoperative OKS of 23 or more and 22 or more were predictive of achieving a postoperative ceiling OKS at one and two years when defined as a maximal score or a score of 44 or more, respectively.

Conclusion

The postoperative OKS demonstrated a small ceiling effect when defined by a maximal score, but when defined by a postoperative OKS of 44 or more the ceiling effect was moderate and failed to meet standards. The preoperative OKS was an independent predictor of achieving a ceiling score. Cite this article: Bone Joint J 2020;102-B(11):1519–1526.
Can we predict outcome after treatment of long bone osteomyelitis?
Authors: Hotchen Andrew J. , Dudareva Maria , Corrigan Ruth A. , Ferguson Jamie Y. , McNally Martin A.
Published: November 2020

Aims

This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into ‘uncomplicated’ or ‘complex’.

Methods

Patients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome.

Results

In total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH ‘uncomplicated’ osteomyelitis was associated with better QoL compared to BACH ‘complex’ osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2).

Conclusion

Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis. Cite this article: Bone Joint J 2020;102-B(11):1587–1596.
Vitamin E-infused highly cross-linked polyethylene did not reduce the number of in vivo wear particles in total knee arthroplasty
Authors: Orita Kumi , Minoda Yukihide , Sugama Ryo , Ohta Yoichi , Ueyama Hideki , Takemura Susumu , Nakamura Hiroaki
Published: November 2020

Aims

Vitamin E-infused highly cross-linked polyethylene (E1) has recently been introduced in total knee arthroplasty (TKA). An in vitro wear simulator study showed that E1 reduced polyethylene wear. However there is no published information regarding in vivo wear. Previous reports suggest that newly introduced materials which reduce in vitro polyethylene wear do not necessarily reduce in vivo polyethylene wear. To assist in the evaluation of the newly introduced material before widespread use, we established an in vivo polyethylene wear particle analysis for TKA. The aim of this study was to compare in vivo polyethylene wear particle generation between E1 and conventional polyethylene (ArCom) in TKA.

Methods

A total of 34 knees undergoing TKA (17 each with ArCom or E1) were investigated. Except for the polyethylene insert material, the prostheses used for both groups were identical. Synovial fluid was obtained at a mean of 3.4 years (SD 1.3) postoperatively. The in vivo polyethylene wear particles were isolated from the synovial fluid using a previously validated method and examined by scanning electron microscopy.

Results

The total number of polyethylene wear particles obtained from the knees with E1 (mean 6.9, SD 4.0 × 107counts/knee) was greater than that obtained from those with ArCom (mean 2.2, SD 2.6 × 107counts/knee) (p = 0.001). The particle size (equivalent circle of diameter) from the knees with E1 was smaller (mean 0.5 μm, SD 0.1) than that of knees with ArCom (mean 1.5, SD 0.3 μm) (p = 0.001). The aspect ratio of particles from the knees with E1 (mean 1.3, SD 0.1) was smaller than that with ArCom (mean 1.4, SD 0.1) (p < 0.001 ).

Conclusion

This is the first report of in vivo wear particle analysis of E1. E1 polyethylene did not reduce the number of in vivo polyethylene wear particles compared with ArCom in early clinical stage. Further careful follow-up of newly introduced E1 for TKA should be carried out. Cite this article: Bone Joint J 2020;102-B(11):1527–1534.
Prospective comparison of functional outcomes of primary reverse shoulder arthroplasty for acute fractures versus rotator cuff deficiencies
Authors: Sebastia-Forcada Emilio , Lizaur-Utrilla Alejandro , Mahiques-Segura Gerard , Ruiz-Lozano Matias , Lopez-Prats Fernando Anacleto , Alonso-Montero Carolina
Published: November 2020

Aims

The purpose of this study was to determine whether there were long-term differences in outcomes of reverse shoulder arthroplasty (RSA) undertaken for acute proximal humeral fracture versus rotator cuff deficiency with a minimum follow-up of five years.

Methods

This was a prospective cohort study comparing 67 patients with acute complex proximal humeral fracture and 64 patients with irreparable rotator cuff deficiency who underwent primary RSA. In the fracture group, there were 52 (77.6%) females and 15 (22.4%) males, with a mean age of 73.5 years (51 to 85), while in the arthropathy group, there were 43 (67.1%) females and 21 (32.9%) males, with a mean age of 70.6 years (50 to 84). Patients were assessed by the Constant score, University of California Los Angeles shoulder score (UCLA), short version of the Disability of the Arm Shoulder and Hand score (QuickDASH), and visual analogue scales (VAS) for pain and satisfaction. Radiological evaluation was also performed.

Results

Mean follow-up was 8.4 years (5 to 11). There were no significant differences in mean absolute (p = 0.125) or adjusted (p = 0.569) Constant, UCLA (p = 0.088), QuickDASH (p = 0.135), VAS-pain (p = 0.062), or range of movement at the final follow-up. However, patient satisfaction was significantly lower in the fracture group (p = 0.002). The complication rate was 1.5% (one patient) versus 9.3% (six patients), and the revision rate was 1.5% (one patient) versus 7.8% (five patients) in the fracture and arthropathy groups, respectively. The ten-year arthroplasty survival was not significantly different (p = 0.221).

Conclusion

RSA may be used not only for patients with irreparable rotator cuff deficiencies, but also for those with acute complex proximal humeral fractures. We found that RSA provided similar functional outcomes and a low revision rate for both indications at long-term. However, satisfaction is lower in patients with an acute fracture. Cite this article: Bone Joint J 2020;102-B(11):1555–1559.
The use of tobacco is a modifiable risk factor for poor outcomes and readmissions after shoulder arthroplasty
Authors: Schwartz Andrew M. , Farley Kevin Xavier , Boden Susanne H. , Wilson Jacob M. , Daly Charles A. , Gottschalk Michael B. , Wagner Eric R.
Published: November 2020

Aims

The impact of tobacco use on readmission and medical and surgical complications has been documented in hip and knee arthroplasty. However, there remains little information about the effect of smoking on the outcome after total shoulder arthroplasty (TSA). We hypothesized that active smokers are at an increased risk of poor medical and surgial outcomes after TSA.

Methods

Data for patients who underwent arthroplasty of the shoulder in the USA between January 2011 and December 2015 were obtained from the National Readmission Database, and 90-day readmissions and complications were documented using validated coding methods. Multivariate regression analysis was performed to quantify the risk of smoking on the outcome after TSA, while controlling for patient demographics, comorbidities, and hospital-level confounding factors.

Results

A total of 196,325 non-smokers (93.1%) and 14,461 smokers (6.9%) underwent TSA during the five-year study period. Smokers had significantly increased rates of 30- and 90-day readmission (p = 0.025 and 0.001, respectively), revision within 90 days (p < 0.001), infection (p < 0.001), wound complications (p < 0.001), and instability of the prosthesis (p < 0.001). They were also at significantly greater risk of suffering from pneumonia (p < 0.001), sepsis (p = 0.001), and myocardial infarction (p < 0.001), postoperatively.

Conclusion

Smokers have an increased risk of readmission and medical and surgical complications after TSA. These risks are similar to those found for smokers after hip and knee arthroplasty. Many surgeons choose to avoid these elective procedures in patients who smoke. The increased risks should be considered when counselling patients who smoke before undertaking TSA. Cite this article: Bone Joint J 2020;102-B(11):1549–1554.
Dual mobility total hip arthroplasty in the treatment of femoral neck fractures
Authors: Cha Yong-Han , Yoo Jun-Il , Kim Jung-Taek , Park Chan-Ho , Ahn Young-Sun , Choy Won-Sik , Ha Yong-Chan , Koo Kyung-Hoi
Published: November 2020

Aims

To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA).

Methods

Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA.

Results

A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z −4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z −3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z −4.2).

Conclusion

While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA. Cite this article: Bone Joint J 2020;102-B(11):1457–1466.
Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions
Authors: Buddhdev Pranai K. , Vanhegan Ivor S. , Khan Tahir , Hashemi-Nejad Aresh
Published: November 2020

Aims

Despite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients.

Methods

Surgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8).

Results

The most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function.

Conclusion

Operating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients. Cite this article: Bone Joint J 2020;102-B(11):1491–1496.
Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations
Authors: Klemt Christian , Limmahakhun Sakkadech , Bounajem Georges , Xiong Liang , Yeo Ingwon , Kwon Young-Min
Published: November 2020

Aims

The complex relationship between acetabular component position and spinopelvic mobility in patients following total hip arthroplasty (THA) renders it difficult to optimize acetabular component positioning. Mobility of the normal lumbar spine during postural changes results in alterations in pelvic tilt (PT) to maintain the sagittal balance in each posture and, as a consequence, markedly changes the functional component anteversion (FCA). This study aimed to investigate the in vivo association of lumbar degenerative disc disease (DDD) with the PT angle and with FCA during postural changes in THA patients.

Methods

A total of 50 patients with unilateral THA underwent CT imaging for radiological evaluation of presence and severity of lumbar DDD. In all, 18 patients with lumbar DDD were compared to 32 patients without lumbar DDD. In vivo PT and FCA, and the magnitudes of changes (ΔPT; ΔFCA) during supine, standing, swing-phase, and stance-phase positions were measured using a validated dual fluoroscopic imaging system.

Results

PT, FCA, ΔPT, and ΔFCA were significantly correlated with the severity of lumbar DDD. Patients with severe lumbar DDD showed marked differences in PT with changes in posture; there was an anterior tilt (-16.6° vs -12.3°, p = 0.047) in the supine position, but a posterior tilt in an upright posture (1.0° vs -3.6°, p = 0.005). A significant decrease in ΔFCA during stand-to-swing (8.6° vs 12.8°, p = 0.038) and stand-to-stance (7.3° vs 10.6°,p = 0.042) was observed in the severe lumbar DDD group.

Conclusion

There were marked differences in the relationship between PT and posture in patients with severe lumbar DDD compared with healthy controls. Clinical decision-making should consider the relationship between PT and FCA in order to reduce the risk of impingement at large ranges of motion in THA patients with lumbar DDD. Cite this article: Bone Joint J 2020;102-B(11):1505–1510.
The prevalence and impact of gender bias and sexual discrimination in orthopaedics, and mitigating strategies
Authors: Halim Usman A. , Elbayouk Abdulrahman , Ali Adam M. , Cullen Clare M. , Javed Saqib
Published: November 2020

Aims

Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours.

Methods

A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database in April 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to which we adhered. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were included for review.

Results

Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. A narrative review was performed in light of the significant heterogeneity displayed by the eligible studies. A total of 13 papers discussed the prevalence of GBSD, while 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. The impact of this includes poor workforce representation, lower salaries, and less career success, including in academia, for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions.

Conclusion

GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty. Cite this article: Bone Joint J 2020;102-B(11):1446–1456.
SERS chip fabricated by the thermal effect in a double-metal-cladding waveguide
Authors: Yin Yaoyao , Wang Meng , Xu Tian , Yin Cheng , Jin Yonglong
Published: November 2020

Different from ordinary planar waveguide structure, we designed a double-metal-cladding waveguide (DMCW) for easier light coupling into the guiding layer from free space. In contrast to evanescent waves in a surface plasmon polariton waveguide, an oscillating wave is generated in the guiding layer. and a similar Fabry–Perot (FP) cavity can be formed by the DMCW. In past work, the FP cavity excited by the DMCW was used to study the refractive index of light, while in this work, the FP cavity is used to excite the photothermal effect of the metal substrate. It is a good connection between light and heat. The photothermal effect is investigated to promote the galvanic replacement reaction in the substrate. Although the experiment process is destructive to the DMCW structure, a surface-enhanced Raman scattering (SERS) chip is prepared on the basis of the photothermal effect in the DMCW. It shows that the DMCW can convert the energy of incident light into thermal energy, and then prepare the SERS chip. The chip has better uniformity, stronger activity, and higher sensitivity. The results demonstrate that the morphology of the SERS substrate created via the DMCW is far more elaborate than that via the surface plasmon polariton waveguide.
Long-distance fiber optic vibration sensing using convolutional neural networks as real-time denoisers
Authors: Liehr Sascha , Borchardt Christopher , Münzenberger Sven
Published: November 2020

A long distance range over tens of kilometers is a prerequisite for a wide range of distributed fiber optic vibration sensing applications. We significantly extend the attenuation-limited distance range by making use of the multidimensionality of distributed Rayleigh backscatter data: Using the wavelength-scanning coherent optical time domain reflectometry (WS-COTDR) technique, backscatter data is measured along the distance and optical frequency dimensions. In this work, we develop, train, and test deep convolutional neural networks (CNNs) for fast denoising of these two-dimensional backscattering results. The very compact and efficient CNN denoiser “DnOTDR” outperforms state-of-the-art image denoising algorithms for this task and enables denoising data rates of 1.2 GB/s in real time. We demonstrate that, using the CNN denoiser, the quantitative strain measurement with nm/m resolution can be conducted with up to 100 km distance without the use of backscatter-enhanced fibers or distributed Raman or Brillouin amplification.
Generation of a meter-scale THz diffraction-free beam based on multiple cascaded lens-axicon doublets: detailed analysis and experimental demonstration
Authors: Xiang Feidi , Liu Defeng , Xiao Long , Shen Sishi , Yang Zhengang , Liu Jinsong , Wang Kejia
Published: November 2020

An effective approach is proposed for obtaining a long-distance THz diffraction-free beam with meter-scale length. Multiple 3D-printed lens-axicon doublets are cascaded to form the generation system. In order to manifest the physical mechanism behind the generation process of this long-distance diffraction-free beam, we make a detailed comparative analysis of three beams: the ideal Bessel beam, the quasi-Bessel beam generated by single axicon, and the diffraction-free beam generated by the lens-axicon doublets. Theoretical results show that the zero-radial-spatial-frequency component plays a key role during the generation process of the third beam. Moreover, the intensities of this component are enhanced with the increase in the number of lens-axicon doublets, making the diffraction-free length longer. An experiment containing three lens-axicon doublets is performed to demonstrate the feasibility of our design. A 0.1-THz beam with one-meter diffraction-free length was successfully generated. Further experiments indicate that this THz diffraction-free beam also has a self-healing property. We believe that such long-distance diffraction-free beams can be used in practical THz remote sensing or imaging.
Multipole decomposition for interactions between structured optical fields and meta-atoms
Authors: Mun Jungho , Moon Seong-Won , Rho Junsuk
Published: November 2020

Interactions between structured optical fields (SOFs) and meta-atoms have been intensively studied, and stimulated by recent advancements on the generation of SOFs and on the synthesis of exotic meta-atoms. Multipole expansion is an efficient and accurate theoretical framework for studying such problems. In this work, explicit expressions of SOFs and their beam-shape coefficients are provided, and their properties are also briefly discussed; the considered SOFs include Laguerre-Gaussian (LG) beams, tightly-focused LG beams, Bessel beams, and cylindrical vector beams. Using the multipole expansion, selective excitations of multipolar resonances of a sphere is discussed. In addition, angular momentum dichroisms of a chiral sphere and an anisotropically chiral meta-atom are calculated to demonstrate selective excitation of multipoles with the desired order, parity, and orientation using engineered SOFs with angular momentum.
Fading-free polarization-sensitive optical fiber sensing
Authors: Wang Xuefeng , Zhao Can , Wu Hao , Liao Ruolin , Chen Wen , Tang Ming
Published: November 2020

Conventional polarization-sensitive optical fiber sensors (POFS) sometimes can hardly detect external disturbances at some special locations where the polarization state of light has little change with the fixed analyzer. This phenomenon is the so-called polarization-induced signal fading that leads to alarm missing in the forward transmission POFS system and deteriorates locating accuracy in the polarization optical time-domain reflectometry system. To eliminate the fading phenomenon and maintain the high sensitivity along the whole sensing fiber, we propose a forward transmission polarization-sensitive optical fiber sensing scheme using polarization-maintaining fiber with the slow axes 45° aligned splicing at both the input and detection ends. Theoretical and experimental results indicate that the system works at the most sensitive state and the signal fading phenomenon is eliminated. This system promises potential applications in perimeter security and physical parameters measurement.
Polarization-sensitive triple plasmon-induced transparency with synchronous and asynchronous switching based on monolayer graphene metamaterials
Authors: Zhang Xiao , Liu Zhimin , Zhang Zhenbin , Gao Enduo , Luo Xin , Zhou Fengqi , Li Hongjian , Yi Zao
Published: November 2020

A monolayer graphene metamaterial comprising four graphene strips and four graphene blocks is proposed to produce triple plasmon-induced transparency (PIT) by the interaction of three bright modes and one dark mode. The response of the proposed structure is analyzed by using couple mode theory and finite-difference time-domain simulations, with the results of each method showing close agreement. A quadruple-mode on-to-off modulation based on synchronous or asynchronous switching is realized by tuning the Fermi levels in the graphene, its modulation degrees of amplitude are 77.7%, 58.9%, 75.4%, and 77.6% corresponding to 2.059 THz, 2.865 THz, 3.381 THz, and 3.878 THz, respectively. Moreover, the influence of the polarized light angle on triple-PIT is investigated in detail, demonstrating that the polarization angle affects PIT significantly. As a result, a multi-frequency polarizer is realized, its polarization extinction ratios are 4.2 dB, 7.8 dB, and 12.5 dB. Combined, the insights gained into the synchronous or asynchronous switching and the polarization sensitivity of triple-PIT provide a valuable platform and ideas to inspire the design of novel optoelectronic devices.
Phase-only modulation of light
Authors: Kesaev Vladimir V. , Kiselev Alexei D.
Published: November 2020

We disclose the method to obtain polarization insensitive phase-only modulation that preserves both the state and the degree of polarization of light modulated using a medium with controlled birefringence. We find that, in the double-pass configuration involving reflection from the Faraday rotator mirror, such a medium acts as the phase-only modulator. The experimental data measured in the Michelson-interferometer-based setup for deformed-helix ferroelectric liquid crystal cells are found to be in good agreement with the theoretical results. For such cells, we experimentally demonstrate high-frequency (4 kHz modulation rate)

2
π

phase-only light modulation governed by the average phase shift and solve the problem of optical axes switching.
Dispersion tailoring of femtosecond laser written chirped fiber Bragg gratings by selective femtosecond laser post-processing
Authors: Imogore Timothy O. , Krämer Ria G. , Goebel Thorsten A. , Matzdorf Christian , Richter Daniel , Nolte Stefan
Published: November 2020

We present the tuning of the dispersion properties of a femtosecond (fs) laser inscribed chirped fiber Bragg grating (CFBG), realized by selectively modifying the refractive index of the already inscribed CFBG by fs laser post-processing. This Letter demonstrates for the first time, to the best of our knowledge, a flexible approach for tailoring higher-order dispersion terms of a fs inscribed CFBG via fs post-processing of selected grating regions, thus paving the way, e.g., for applications in dispersion management of ultrashort pulse fiber lasers.
Picosecond stimulated Raman scattering at 3000 and 3430 cm−1 OH vibrations without optical breakdown: publisher’s note
Authors: Pershin Sergey M. , Vodchits Alexander I. , Khodasevich Inna A. , Grishin Mikhail Ya. , Lednev Vasily N. , Orlovich Valentin A. , Chizhov Pavel A.
Published: November 2020

This publisher’s note contains corrections to Opt. Lett. 45, 5624 (2020)OPLEDP0146-959210.1364/OL.402358.
Wannier quasi-classical approach to high harmonic generation in semiconductors
Authors: Parks A. M. , Ernotte G. , Thorpe A. , McDonald C. R. , Corkum P. B. , Taucer M. , Brabec T.
Published: November 2020

An intuitive and complete understanding of the underlying processes in high harmonic generation (HHG) in solids will enable the development and optimization of experimental techniques for attosecond measurement of dynamical and structural properties of solids. Here we introduce the Wannier quasi-classical (WQC) theory, which allows the characterization of HHG in terms of classical trajectories. The WQC approach completes the single-body picture for HHG in semiconductors, as it is in quantitative agreement with quantum calculations. The importance of WQC theory extends beyond HHG; it enables modeling of dynamic processes in solids with classical trajectories, such as for coherent control and transport processes, potentially providing better scalability and a more intuitive understanding.
LabWAS: Novel findings and study design recommendations from a meta-analysis of clinical labs in two independent biobanks
Authors: Goldstein Jeffery A. , Weinstock Joshua S. , Bastarache Lisa A. , Larach Daniel B. , Fritsche Lars G. , Schmidt Ellen M. , Brummett Chad M. , Kheterpal Sachin , Abecasis Goncalo R. , Denny Joshua C. , Zawistowski Matthew
Published: November 2020

Phenotypes extracted from Electronic Health Records (EHRs) are increasingly prevalent in genetic studies. EHRs contain hundreds of distinct clinical laboratory test results, providing a trove of health data beyond diagnoses. Such lab data is complex and lacks a ubiquitous coding scheme, making it more challenging than diagnosis data. Here we describe the first large-scale cross-health system genome-wide association study (GWAS) of EHR-based quantitative laboratory-derived phenotypes. We meta-analyzed 70 lab traits matched between the BioVU cohort from the Vanderbilt University Health System and the Michigan Genomics Initiative (MGI) cohort from Michigan Medicine. We show high replication of known association for these traits, validating EHR-based measurements as high-quality phenotypes for genetic analysis. Notably, our analysis provides the first replication for 699 previous GWAS associations across 46 different traits. We discovered 31 novel associations at genome-wide significance for 22 distinct traits, including the first reported associations for two lab-based traits. We replicated 22 of these novel associations in an independent tranche of BioVU samples. The summary statistics for all association tests are freely available to benefit other researchers. Finally, we performed mirrored analyses in BioVU and MGI to assess competing analytic practices for EHR lab traits. We find that using the mean of all available lab measurements provides a robust summary value, but alternate summarizations can improve power in certain circumstances. This study provides a proof-of-principle for cross health system GWAS and is a framework for future studies of quantitative EHR lab traits.