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Purpose: To determine whether additional stem extension for stability is necessary, we performed mid-term follow-up of patients who had been managed with 5-mm metal block augmentation for a tibial defect, where tibial prosthesis was fixed using bone cement without stem extension. Also, we evaluated clinical and radiologic results including survival rate of patients without stem extension. Methods: We retrospectively analyzed patients with tibial bone defect, had undergone primary total knee arthroplasty, and had been treated with 5-mm metal block augmentation without stem extension between March 2003 and September 2013. Among 74 patients (80 cases), 47 patients (52 cases) were followed up for at least 5 years. Results: Mean flexion contracture improved from 8.8° (0–40°) preoperatively to 0.4° (−5° to 15°) at final follow-up (P < 0.01), but there was no significant change in the mean angle of great flexion: 124.6° (75–150°) preoperatively and 126.2° (90–145°) at final follow-up (P = 0.488). Mean range of motion improved from 115.8° (35–150°) preoperatively to 125.5° (90–145°) at final follow-up (P < 0.01). Mean knee score improved from 38.7 points (0–66 points) preoperatively to 93.2 points (79–100 points) at final follow-up (P < 0.01), and mean functional score also improved from 50.4 points (10–70 points) preoperatively to 81.8 points (15–100 points) at final follow-up (P < 0.01). The mean postoperative Western Ontario and McMaster University osteoarthritis score was 19.5 points (0–66.0 points). The mean femorotibial angle was corrected from 9.0° varus (23.0° varus–6.3° valgus) preoperatively to 5.5° valgus (2.2° varus–11.1° valgus) at final follow-up (P < 0.01). There was no change in the mean β-angle, which was 90.7° (87.2–94.9°) immediately postoperative and 90.8° (87.2–94.9°) at final follow-up (P = 0.748) and in the mean δ-angle, which was 86.2° (81.3–90.0°) immediately postoperative and 87.2° (83.1–96.5°) at final follow-up (P = 0.272). Radiolucent lines (RLL) were observed in ten cases (26.3%), and the mean RLL scores at final follow-up were 0.34 points (0–3 points) in the anteroposterior view and 0.42 points (0–6 points) in the lateral view. Scores for the RLL were ≤ 4 points in 36 cases, 5–9 points in two cases. Revision surgery due to aseptic loosening (three cases) is rarely required, and the Kaplan–Meier survival rate at 10 postoperative years was 96.4% Conclusion: When performing 5-mm metal block augmentation for a proximal tibial defect, no additional tibial stem extension can be a good surgical option for the stability of tibial prosthetic construct and mid-term clinical and radiologic results. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Objective To investigate whether there is sex difference in the acupuncture treatment of knee osteoarthritis. Methods　A secondary analysis of data from a multicenter randomized controlled trial was performed. A total of 442 patients with knee osteoarthritis were randomly divided into the acupuncture group (n =145), electroacupuncture group (n =151), and sham acupuncture group (n =146). For the acupuncture group, obligatory acupoints were selected, including ST35, EX-LE4, LV8, GB33, and ashi points, with three matching acupoints along the channel, and the electroacupuncture instrument was connected without any current. The same acupoints were selected for the electroacupuncture group, but the 2/100 Hz dilatational wave was connected. For the sham acupuncture group, eight shallow points that were unrelated to any channel or acupoint were selected, and the electroacupuncture instrument was not connected to a current. For all groups, the intervention lasted 30 min per session, three times a week, for eight weeks in total. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Numerical Rating Scale (NRS) were used for assessment before and after treatment. An effective acupuncture response was defined as a decrease of at least 6 points in the functional index of WOMAC and a decrease of at least 2 points in the NRS. Results　In the acupuncture group, the effective response rate was 58. 8% and 59. 6% for males and females, respectively (P > 0. 05). In the electroacupuncture group, the effective response rate was 62. 5% and 59. 7% for males and females, respectively (P > 0. 05). In the sham acupuncture group, the effective response rate was 52. 5% and 45. 3% for males and females, respectively (P > 0. 05). Conclusion The efficacy of acupuncture in the treatment of knee osteoarthritis is probably unrelated to sex, and the incidence of adverse events seems to be very low regardless of sex, suggesting that acupuncture, as a non-drug therapy, tends is effective and safe. [ABSTRACT FROM AUTHOR]

Background Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently there are no VTE prophylaxis guidelines specific to these thoracic surgery patients. Evidenced-based recommendations will help clinicians manage and mitigate risk of VTE in the postoperative period and inform best practice. Objective These joint evidence-based guidelines from The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons aim to inform clinicians and patients in decisions about prophylaxis to prevent VTE in patients undergoing surgical resection for lung or esophageal cancer. Methods The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons formed a multidisciplinary guideline panel that included broad membership to minimize potential bias when formulating recommendations. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment. Results The panel agreed on 24 recommendations focused on pharmacological and mechanical methods for prophylaxis in patients undergoing lobectomy and segmentectomy, pneumonectomy, and esophagectomy, as well as extended resections for lung cancer. Conclusions The certainty of the supporting evidence for the majority of recommendations was judged as low or very low, largely due to a lack of direct evidence for thoracic surgery. The panel made conditional recommendations for use of parenteral anticoagulation for VTE prevention, in combination with mechanical methods, over no prophylaxis for cancer patients undergoing anatomic lung resection or esophagectomy. Other key recommendations include: conditional recommendations for using parenteral anticoagulants over direct oral anticoagulants, with use of direct oral anticoagulants suggested only in the context of clinical trials; conditional recommendation for using extended prophylaxis for 28 to 35 days over in-hospital prophylaxis only for patients at moderate or high risk of thrombosis; and conditional recommendations for VTE screening in patients undergoing pneumonectomy and esophagectomy. Future research priorities include the role of preoperative thromboprophylaxis and the role of risk stratification to guide use of extended prophylaxis. (J Thorac Cardiovasc Surg 2022;▪:1-31) [ABSTRACT FROM AUTHOR]

Background: Several strategies have been devised to reduce the length of stay after orthopedic surgery. Telerehabilitation has proved effective in functional outcomes after orthopedic procedures and is appreciated by patients. There is limited information on fast-track surgery and telerehabilitation protocols for unicompartmental knee arthroplasty (UKA). The purpose of this pilot study was to report and compare functional outcomes and satisfaction levels during first 12 months of recovery in patients who underwent UKA according to a fast-track and telerehabilitation protocol (G1) or standard surgery and rehabilitation program (G2). Methods: Data were retrospectively collected and reviewed for all elective UKAs from January 2018 to November 2019. A total of seven patients undergoing UKA according to the fast-track and telerehabilitation protocol were propensity score matched (1:3 ratio) to 21 patients undergoing standard surgery and rehabilitation. Patients were matched for age, sex, body mass index (BMI), and laterality. The Western Ontario and McMaster University (WOMAC) osteoarthritis index and range of motion (ROM) were collected pre- and postoperatively in both groups for 12 months. In addition, patient' satisfaction was collected at 40 days. Results: The G1 group demonstrated significantly better outcomes in WOMAC index scores at 2, 15, and 40 days (p < 0.001, p < 0.001, p < 0.020, respectively) and a significantly greater knee ROM after surgery and at 2, 15, 40, and 12 months (p < 0.001, p < 0.001, p = 0.014, p < 0.001, p = 0.003, respectively). No patients in either group had postoperative complications. One patient was not completely satisfied in the G2, while no one in G1 reported not being completely satisfied (p = 1.000). Conclusions: This fast-track and telerehabilitation protocol after UKA can potentially be applied to patients as it is safe and effective. At 12-months follow-up, both groups reported favorable outcomes after UKA. However, the G1 score was better regarding WOMAC and ROM when compared with the propensity score-matched G2 program. A larger study is warranted to explore the role of fast-track and telerehabilitation in clinical and functional outcomes of UKA. [ABSTRACT FROM AUTHOR]

Introduction: Emergency medicine (EM) practitioners must be proficient at caring for patients of all ages, including pediatric patients. Traditionally, EM trainees learn pediatric emergency medicine (PEM) through block rotations. This is problematic due to the seasonal nature of pediatric diseases and infrequent critical events. Spaced repetition learning theory suggests PEM would be better learned through longitudinal rotations. The transition to competency-based medical education (CBME) in Canada is accelerating the need to find novel ways to attain competencies in postgraduate training. At McMaster University, senior EM trainees can choose either traditional PEM blocks or longitudinal rotations. Our objective was to understand how learners experience these different rotations given the transition to CBME in Canada. Methods: Using a realist framework of program evaluation, we conducted semistructured interviews with key stakeholders (trainees, program directors, attending physicians) in EM. The realist framework was used to understand how context interacts with theoretical mechanisms to produce outcomes of interest. Data were analyzed using inductive, conventional content analysis. All investigators coded a subset of transcripts independently and in duplicate to achieve intercoder agreement. Results: A total of 13 interviews were completed with trainees (n = 11) and staff physicians (n = 2). The learning experience exists within an educational and clinical context, which are logistically distinct but inseparable. The longitudinal learning experience appears to improve learning through spaced repetition, which prevents atrophy of skills and knowledge while also benefitting from the offsetting of seasonal variability associated with many pediatric diseases. Improved feedback and entrustment are facilitated through the building of coaching relationships over time. Barriers to the learning experience are related mainly to logistical difficulties associated with resolving longitudinal and blocked learning experiences. Improved relationships with the interprofessional team may provide distinct learning opportunities and improved team functioning. Block rotations were identified as more valuable to junior trainees learning fundamental concepts. Conclusions: Longitudinal learning provides numerous advantages to learning PEM, including increased case variety, spaced repetition of core concepts, and a perception of greater entrustment of the learner through formation of coaching relationships over time. Future projects looking to quantify the differences between longitudinal and block learning to objectively show a difference in skills and knowledge are needed. [ABSTRACT FROM AUTHOR]