bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are single plane intraoperative and biplanar postoperative radiographic measurements of acetabular cup position the same?
Authors: Harold Ryan E , Delagrammaticas Dimitri , Keller Tyler , Butler Bennet , Stover Michael D , Manning David W 
Published: June 2019

Purpose: Supine positioning and the use of fluoroscopy during direct anterior approach total hip arthroplasty (DAA THA) have been reported to improve acetabular component positioning. This study aims to compare 2-dimensional intraoperative radiographic RadLink measurements of acetabular component position with 3-dimensional postoperative 3D SterEOS measurements. Methods: Intraoperative fluoroscopy and RadLink (El Segundo, CA, USA) were used to measure acetabular cup position intraoperatively in 48 consecutive patients undergoing DAA THA. Cup position was measured on 6-week postoperative standing EOS images using 3D SterEOS software (EOS Imaging, SA, Paris, France) and compared to RadLink findings using Student’s t-test. Safe-zone outliers were identified. We evaluated for measurement difference of > +/– 5°. Results: RadLink acetabular cup abduction measurement (mean 43.0°) was not significantly different than 3D SterEOS in the anatomic plane (mean 42.6°, p = 0.50) or in the functional plane (mean 42.7°, p = 0.61). RadLink acetabular cup anteversion measurement (mean 17.9°) was significantly different than 3D SterEOS in both the anatomic plane (mean 20.6°, p = 0.022) and the functional plane (mean 21.2°, p = 0.002). RadLink identified 2 cups outside of the safe-zone. However, SterEOS identified 12 (anatomic plane) and 10 (functional plane) outside of the safe-zone. In the functional plane, 58% of anteversion and 92% of abduction RadLink measurements were within +/– 5° of 3D SterEOS. Conclusions: Intraoperative fluoroscopic RadLink acetabular anteversion measurements are significantly different than 3D SterEOS measurements, while abduction measurements are similar. Significantly more acetabular cups were noted to be outside of the safe-zone when evaluated with 3D SterEOS versus RadLink.
Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings
Authors: Hatcher Abigail M. , Lemus Hufstedler Emiliano , Doria Kathryne , Dworkin Shari L. , Weke Elly , Conroy Amy , Bukusi Elizabeth A. , Cohen Craig R. , Weiser Sheri D. 
Published: June 2019

While food insecurity and poverty worsen mental health outcomes among people living with HIV/AIDS (PLHIV), few intervention studies have targeted poverty and food insecurity as a way to improve mental health. Among HIV-positive patients, addressing such upstream determinants may prove crucial to ensure better mental health and HIV clinical outcomes. We integrated longitudinal, qualitative research into a randomized trial of a livelihood intervention to understand processes and mechanisms for how the intervention may affect mental health among HIV-infected Kenyan adults. In-depth interviews were conducted with intervention participants ( n = 45) and control participants ( n = 9) at two time-points (after intervention start and upon intervention end). Interviews ( n = 85) were translated, double-coded, and analyzed thematically using an inductive-deductive team approach. Participants reported numerous mental health improvements post-intervention including reduced stress, fewer symptoms of anxiety, improved mood, lower depressive symptoms, fewer repetitive and ruminating thoughts, and more hopefulness for the future. Improvements in mental health appear to occur via several mechanisms including: 1) better food security and income; 2) increased physical activity and ability to create fruitful routines around farm work; and, 3) improved sense of self as an active member of the community. Qualitative, longitudinal interviews may help identify intervention mechanisms for improved mental health, but additional research is required to confirm self-reports of mental health changes. These findings suggest that livelihood interventions may improve mental health in multi-faceted ways, and help PLHIV better integrate with their communities. Trial registered at ClinicalTrials.gov: NCT01548599
The fate of delayed revascularization for neglected vascular injury of incompletely amputated digits and hands
Authors: Woo Sang Hyun , Lee Young Keun , Chong Seong Woo , Cheon Ho Jun , Kim Young Woo 
Published: June 2019

We report the fate of neglected vascular injury in cases of incomplete amputation of the digits and hand after delayed revascularization. Twelve patients underwent primary bone fixation, tendon or skin repair for hand injuries without vessel repair despite ischaemic findings. There was discoloration or necrosis of the fingertips during follow-up examination and the patients were referred to us for treatment. The mean warm ischaemic time was 53 hours (range 17–120). Delayed revascularization was performed with end-to-end anastomosis of the digital arteries in eight and vein graft in four cases. Digital nerves were repaired in four cases and flexor tendons in two cases. Of the 12 cases, eight cases showed complete survival. However, in four patients, complete necrosis of the fingers occurred, with one finger surviving partially. Revision amputation was performed in the four cases where necrosis occurred. We conclude that neglected vascular injury associated with incomplete amputation of digits and hands can be overcome in some patients by delayed revascularization even after prolonged warm ischaemic time. Level of evidence: IV
Non-islet-cell tumour hypoglycaemia in a cat with hepatocellular carcinoma
Authors: Guillen Alexandra , Ressel Lorenzo , Finotello Riccardo , German Alexander J , Freeman Alistair , Blackwood Laura 
Published: June 2019

Case summary An 11-year-old male neutered domestic shorthair cat presented with behavioural changes. Physical examination revealed bradycardia and a cranial abdominal mass. The cat was persistently hypoglycaemic (1.2 mmol/l; reference interval [RI] 3.5–5.5 mmol/l) with decreased fructosamine concentration suggesting chronic hypoglycaemia, and decreased insulin concentration excluding insulinoma. Alanine aminotransferase activity was markedly increased (1219.31 U/l; RI 15–60 U/l). On staging CT a large, multilobulated hepatic mass was identified, with no evidence of metastatic disease. After surgical removal serum glucose concentration and heart rate quickly returned to within the RIs. Histopathology was consistent with a solid-to-trabecular, well-differentiated, hepatocellular carcinoma. There was no recurrence of signs or mass during 8 months of follow-up, and the cat was still alive 20 months after surgery. Relevance and novel information Non-islet-cell tumour hypoglycaemia (NICTH) is a rare but life-threatening paraneoplastic syndrome. In humans, hepatocellular carcinoma is the most common epithelial tumour causing NICTH, but these are uncommon in cats, and associated paraneoplastic hypoglycaemia has not been reported. Possible mechanisms include aberrant secretion of big insulin growth factor 2; however, this could not be confirmed. NICTH should be considered in the differential diagnosis of cats with persistent hypoglycaemia.
Revision Meniscal Repair - Failure rates, clinical outcome and patient satisfaction
Authors: Fuchs Andreas , Kloos Ferdinand , Bode Gerrit , Izadpanah Kaywan , Südkamp Norbert , Feucht Matthias J. 
Published: June 2019

Aims and Objectives: Failure of isolated primary meniscal repair must be expected in 14% - 28%. Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of revision meniscal repair remain unclear. The purpose of this study was therefore to evaluate the clinical outcome and failure rates of revision meniscal repair in patients with re-tears or failed healing after previous isolated meniscal repair in stable knee joints. Materials and Methods: A chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activity (Tegner scale), and patient satisfaction. Results: A total of 12 patients with a mean age of 22 ± 5 years were included. The mean time between primary repair and revision repair was 27 ± 21 months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, re-revision repair was performed. At final follow-up, the mean Lysholm Score was 95.2 with a range of 90-100, representing a good to excellent result in all patients. The final assessment of the KOOS subscores also showed good to excellent results. The mean Tegner scale was 6.8 ± 1.8, indicating a relatively high level of sports participation. Ten patients (83%) were either very satisfied or satisfied with the outcome. Conclusion: In patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. The failure rate is comparable to isolated meniscal repair. Therefore, revision meniscal repair is worthwhile in order to save as much meniscal tissue as possible.
The Reversed Dynamic Patellar Apprehension Test (ReDPAT) mimics anatomical complexity in lateral patellar instability
Authors: Zimmermann Felix , Balcarek Peter 
Published: June 2019

Aims and Objectives: To develop a dynamic physical examination test that functionally simulates actual patellar instability events and that mimics the range of patellar stabilizer insufficiency in an individual patient. Materials and Methods: Seventy-four consecutive patients (male/female 33/41; mean age 22±7 years) with recurrent lateral patellar instability and thirty controls (male/female 16/14; mean age 31±14 years) were prospectively evaluated using the reversed dynamic patellar apprehension test (ReDPAT). The examination starts with the knee flexed at 120°. The knee is then extended while the patella is translated laterally. The maneuver is stopped at first onset of a subjective apprehensive reaction, and the ReDPAT result is considered positive according to this knee joint flexion angle. Anatomical predisposition was assessed according to Dejour’s classification of trochlear dysplasia, tibial tuberosity-trochlear groove distance, tibial tuberosity-posterior cruciate ligament distance, patellar height, and varus/valgus malalignment. Results: The study group had an average of 3.4 ± 1.0 (1-6) anatomical risk factors for lateral patellar dislocation. Severe trochlear dysplasia (84%) and patella alta (49%) were the most common. Test sensitivity, specificity, and accuracy reached 97.3%, 90%, and 95.2%, respectively, and test-retest reliability was good (Pearson’s r 0.84; p<0.0001). The ReDPAT results became positive at a mean knee flexion angle of 58°±17° (20°-90°). Knee flexion angle correlated significantly with the severity of trochlear dysplasia (p=0.018), valgus deformity (p=0.011), and the total number of anatomical risk factors (p=0.02). Conclusion: This study introduced the reversed dynamic patellar apprehension test as a reliable clinical examination tool in the assessment of lateral patellar instability. The results of this study indicate that the degree of knee joint flexion at which the provocative sense of apprehension becomes positive correlates with severity of trochlear dysplasia, valgus deformity and the total number of anatomical risk factors for patellar instability.
Clinical Results of an indivisualised mini-metal implant for Cartilage lesions in the knee
Authors: Holz Johannes , Spalding Tim , Karl Eriksson , Jung Tobias M. , Verdonk Peter , Kösters Clemens 
Published: June 2019

Aims and Objectives: We report prospective detailed results of patients undergoing treatment for chondral defects usingEpisealer, a patient-specific 2nd generation individualized mini-metal implant, based on a three dimensional MRI planing. Materials and Methods: Analysis of consecutive patients from 13 surgeons. Total of 98 patients, of which 59 patients (25 men,34 women) with focal cartilage lesions ICRS grade 3 or 4 underwent partial resurfacing, 48 on medial condyle, 4 lateral condyle and 7 on trochlea. Mean age 48 (27-67) years, mean BMI 28 (21-41). 64% had failed previous cartilage surgery. Detailed specific MRI data was used to manufacture patient-specific implants and guide instruments, to fit the unique anatomy of each individual knee. Implants were uncemented and made of cobalt-chrome, double coated with hydroxyapatite on top of titanium. Demographic, operative and clinical scores (VAS and KOOS) were collected preop and at 6 months, 1 and 2 years postoperatively. Results: All mean KOOS domain scores were significantly improved at 1 and 2 years (p<0.05). Mean preoperative aggregated KOOS (37) improved to 62 at 12 months and remained at 62 also at 24 months (n=32), (p<0.05). Mean VAS score improved from 65 preoperatively to 37 at 24 months. All mean KOOS domain scores were significantly improved at 1 and 2 years (p<0.05). 2 patients (3.4%) underwent revision (at 9 months for infection and at 30 months for progression of arthritis). Conclusion: The study shows excellent early clinical results in the treatment of focal symptomatic cartilage lesions on the femoral condyles or trochlea with a second-generation patient specific metal implant and instruments. Adherence to strict indications has allowed for high patient reported scores and low early revision rate.
Cruciate retaining versus posterior stabilized total knee arthroplasty for the treatment of valgus osteoarthritis?
Authors: Ettinger Max , Savov Peter , Windhagen Henning , Mielke Evelyn , Calliess Tilman 
Published: June 2019

Aims and Objectives: The debate of cruciate retaining (CR) versus posterior stabilized (PS) designs in total knee arthroplasty (TKA) is ongoing. With the posterior cruciate ligament retained, the TKA is supposed to function better in terms of proprioception, balance and kinematics. In contrast to that, PS designs are supposed to lead to higher degrees of flexion and a better femoral rollback. It is known, that the preoperative deformity negatively correlates with inferior results following TKA. When balancing a valgus knee, Ranawat et al. suggest to address the PCL in the first place. It is known that in 60% of valgus knees 1-2 soft tissue releases are necessary in order to achieve neutral alignment. Up to date no study exists, reporting the outcome of CR versus PS TKA in valgus knees. Thus, it was purpose of this study to evaluate the mid term outcome of CR versus PS TKA for the treatment of valgus OA in groups between 3°-6° of valgus, 7-10° of valgus and >10° of valgus. Materials and Methods: With the KOOS score as the primary endpoint, a sample size of 117 cases (78 CR and 39 PS) was needed in order to get a statistical power of 80%.Between 01-2011 and 03-2014 a total of 248 patients with a preoperative valgus >3° were treated with a CR TKA (167 cases) or a PS TKA (81 cases) of the same manufacturer (Stryker Triathlon, Stryker, Kalamazoo USA). CR patients were divided into the following groups: Preoperative valgus >3°-6°, 7°-10° and >10°. PS patients were divided into the following groups: Preoperative valgus >3°-6°, 7°-10° and >10°. The KOOS Score and the Oxford Knee score was collected at the time of follow up. For the CR and PS group failure rates and failure etiologies were analyzed. Patients demographics and were collected as well. Results: 141 patients were included into this study (97 CR and 44 PS cases). The CR group had a mean follow up of 57&#61617; weeks, the PS group had a follow up of 52&#61617;weeks. In the CR group, 11/97 (11%) patients were revised due to a.p. instability, whereas 2/44 (5%) patients were revised in the PS group due to infection or aseptic loosening. There was no difference regarding OKS and the KOOS score between the two groups. Further, there was no difference regarding patients demographics and no correlation between the BMI and the clinical outcome. Conclusion: The most important findings of this study are that the CR group showed a significant higher early revision rate, whereas the clinical mid term follow up results are equal. The CR version of the used system showed significantly higher early failure due to a.p. instability.
Bicompartmental Knee Arthroplasty (BKA) in comparison to unicompartmental (UKA), Patellofemoral (PFA) ans total knee arthroplasty (TKA) – Early Clinical Results
Authors: Holz Johannes , Schneider Stefan , Ilg Ansgar , Kaiser Rene 
Published: June 2019

Aims and Objectives: The purpose was to evaluate the clinical outcomes of patients with knee osteoarthritis treated with bicompartmental arthroplasty (BKA) in comparison to unicompartmental (UKA), patellofemoral (PFA) and total knee arthroplasty (TKA) in a single center. Materials and Methods: This is a prospective study analyzing a consecutive series of 396 patients from two surgeons in a single center. In 191 men and 205 women either partial or total knee replacement were performed. Their mean age at surgery was 63±6,85 years and mean BMI 29,55±5,00 kg/m2. In 238 patients UKA, in 125 TKA, in 21 PFA and in 11 patients BKA was performed. Implants were cemented and made of cobalt chrome in partial knee and zirconium oxide in total knee replacement. Demographics and patient reported outcomes (VAS, KOOS, Oxford Knee Score (OKS)) were collected preoperatively and 3,6 and 12 months postoperatively. A total of 202 patients have thus far completed the 12 months follow-up time point. Results: All mean KOOS and OKS scores improved significantly 1 year after surgery (p<0.05). Mean preoperative aggregated KOOS improved from 49,0±14,1 to 74,3±17,8 in UKA, from 44,1±12,9 to 67,5±9,4 in PFA, from 46,1±15,1 to 71,0±14,8 in TKA and from 45,7±13,8 to 72,6±9,7 in BKA (p<0.05). Mean preoperative aggregated OKS improved from 25,1±7,6) to 38,5±9,7 in UKA, from 23,0±7,6 to 36,8±3,8 in PFA, from 23,4±8,2 to 37,3±8,1 in TKA and from 22,9±9,6 to 37,0±1,5 in BKA (p<0.05). The mean pain level (VAS)decreased from pre-treatment to 12 months after surgery in UKA from 5,5 to 1,6, in PFA from 6,1 to 2,5, in TKA from 6,0 to 1,9 and in BKA from 6,6 to 2,6. One patient (0.4%) underwent revision (at 3 month for inlay dislocation). Conclusion: This study shows excellent early clinical results of patients treated with unicompartmental, bicompartmental and total knee arthroplasty. Adherence to strict indications lead to a significant improvement of patient reported outcomes and a low revision rate one year postoperatively. The reported results for BKA are comparable to those of patients treated with unicompartmental arthroplasty. We conclude that bicompartmental arthroplasty is a safe and reliable surgery for patients with bicompartmental osteoarthritis.
Is cocontraction a potential cause of tibial internal rotation restriction in patients with knee endoprostheses?
Authors: Haberer Christine Suzanne , Weiss Stefan , Komnik Igor , David Sina 
Published: June 2019

Aims and Objectives: The ischiocrural muscles play an important role in the rotation of the tibia. The main objective of the study was to examine the extent to which an increased cocontraction of the SEMITEN and BIZFEM in patients with bicondylar (TKA) and unicondylar prostheses (UKA) under the influence of everyday forms of stress restricts the tibial rotation. Materials and Methods: 3-D-motion analysis in patients after TKA or UKA was performed to record joint kinematics before and after knee prosthesis. Inclusion criteria: Age 50-70 years, no other prostheses, BMI <31, no relevant diseases, surgery - period 04/2015 to 04/2016. Out of a total of 550 patients finally 22 patients (w:11/m:11) could be included: TKA (n = 11), UKA (n = 9). To imitate various movement patterns of ADL, a parcour was built with a ramp and a staircase with 3 steps. Kinematic data were recorded with 10 infrared 100 Hz cameras. Muscular activities were measured bilaterally with a wireless EMG system (1000 Hz, myon320, muon, CH). Walking speed was collected through a time-gate system (WEKO, Weitmann & Konrad GmbH & Co. KG, DE). Static analysis was performed by statistical nonparametric assignment (SnPM). The WOMAC score was used for subjective assessment of dysfunctions. Results: In normal walking, there was no difference in tibial rotation compared to the non-operated knee in either the TKA or the UKA group. In SnPM analysis, statistically significantly reduced tibial rotation was shown on the downturn of a ramp in the TKA group at the operated knee. The UKA group showed no significant differences on the ramp to the non-operated knee. Concerning co-contraction of the SEMITEN and BIZFEM in the EMG analysis in the operated knee joint, no deviation from the non-operated knee could be shown. When climbing stairs, the SnPM internal rotation analysis revealed significant differences between the TKA and the UKA group (stance phase). Similar to the group comparement a restricted axial rotational movement compared to an operated to non - operated knee joint in the TKA - group could be show.n Especially during the stairway, the knee internal rotation of the prosthesis was impaired compared to the non-operated knee. On the other hand, when climbing stairs, the internal rotation was mostly significantly reduced during the stance phase. The SnPM analysis showed statistically significant asymmetries in the UKA group during stairway walking. The disturbed internal rotational movement showed the UKA group in the operated knee joint compared to the un-operated knee joint to the same extent as the TKA group only during the run down from the ramp. Conclusion: The assumption that cocontractions between the SEMITEN and the BIZFEM contributes to the impairment of internal rotation can not be confirmed from the data available to us. Other influences must be the cause.