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Response/recommendation: The use of surgical drains in routine primary total knee and total hip arthroplasty is not recommended., Level of Evidence: High., Expert Voting: Agree 83.52%, Disagree 12.91%, Abstain 3.59%., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: A total of 894 hips were evaluated to describe the survivorship of Exeter cemented femoral stems and report the outcomes and complications of our 'Exeter- era', and there is no study from Central or Eastern Europe demonstrating similar results., Methods: Between January 2000 and December 2009, a total of 894 hips were included who underwent Exeter universal and V40 femoral stems with a mean follow up of 13 years. Cemented Exeter low profile polyethylene cups were used in 889 patients (99.4%) cups. Harris hip score (HHS) was used and statistical outcome measures were calculated with revision as an endpoint for aseptic loosening of the stem, aseptic loosening of any component, all-cause revision of the stem, and all-cause revision of the hip., Results: A total of 103 patients died and 129 (14.4%) operated hips were lost to follow-up before ten years. Out of the 662, ten stems (1.5%) were revised for aseptic loosening. Aseptic loosening of any component was the reason for revision in 43 cases (6.5%), consisting of 40 cup revisions and ten stem exchanges. Periprosthetic fracture occurred in 17 cases (1.9%) Periprosthetic joint infection occurred in 18 cases (2.01%). Three cups were exchanged for recurrent dislocation, and two stems had broken., Conclusion: Exeter hip system has provided reproducible results across different centres worldwide, as it did in our series. Thorough surgical and cementing technique is of utmost importance for achieving these results. The cup is the weak point of the system and use of a hybrid system is worth considering., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

Background: Pathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions., Methods: We performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model., Results: We included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes., Conclusion: Tenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief., (© 2022. The Author(s).)

Aim: This study estimates the costs and outcomes pre- versus post-implementation of an early deterioration detection solution (EDDS), which assists in identifying patients at risk of clinical decline. Materials & methods: A retrospective database analysis was conducted to assess average costs per discharge, length of stay (LOS), complications, in-hospital mortality and 30-day all-cause re-admissions pre- versus post-implementation of an EDDS. Results: Average costs per discharge were significantly reduced by 18% (US$16,201 vs $13,304; p  = 0.007). Average LOS was also significantly reduced (6 vs 5 days; p  = 0.033), driven by a reduction in general care LOS of 1 day (p  = 0.042). Complications, in-hospital mortality and 30-day all-cause re-admissions were similar. Conclusion: Costs and LOS were lower after implementation of an EDDS for general care patients.

Introduction: Extracorporeal hemoadsorption (HA) is a potential adjunctive therapy in severe cases of COVID-19 associated pneumonia. In this retrospective study we report data from critically ill patients treated with HA during the first and second wave of the pandemic. Patients and Methods: All patients, who received HA therapy with CytoSorb within the first 96 h of intensive care unit (ICU) admission without hospital-acquired bacterial superinfection, were included. Clinical and laboratory data were collected: on admission, before (T B ) and after (T A ) HA therapy. Results: Out of the 367 COVID-19 cases, 13 patients were treated with CytoSorb, also requiring mechanical ventilation and renal replacement therapy. All patients were alive at the end of HA, but only 3 survived hospital stay. From T B -T A there was a tendency of decreasing norepinephrine requirement: 193.7 [IQR: 34.8-270.4] to 50.2 [6.5-243.5] ug/kg/day and increasing PaO2/FiO2 ratio 127.8 (95% CI: 96.0-159.6) to 155.0 (115.3-194.6) mmHg but they did not reach statistical significance ( p = 0.14 and 0.58, respectively). Treatment related adverse events were not reported. Conclusion: The treatment was well-tolerated, and there was a tendency toward an improvement in vasopressor need and oxygenation during the course of HA. These observations render the need for prospective randomized trials., Competing Interests: ZM has received lecture honoraria form PULSION Medical, Germany (member of the Getinge Group), ThermoFisher Scientific and Biotest, Germany and he is a senior medical director at CytoSorbents Europe, Berlin, Germany. DB is employed by CytoSorbents Europe, Berlin, Germany; AV holds a contract as an external consultant with CytoSorbents Europe, Berlin, Germany. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Virág, Rottler, Ocskay, Leiner, Horváth, Blanco, Vasquez, Bucsi, Sárkány and Molnár.)

Purpose: Donor site pain affects 32-43 % of patients after anterior cruciate ligament surgery when the autograft is freshly harvested bone-patellar tendon-bone tissue. Our aim was to compare functional and morphological differences between donor sites with and without serum albumin-coated bone allograft filling., Methods: After harvesting and implanting the graft, the tibia site was filled with either fresh autologous cancellous bone enhanced with albumin-coated allograft or autologous bone alone. The patella site was filled either with albumin-coated allograft or with blood clot. Knee function was evaluated by the VISA, Lysholm and IKDC scores and a visual analog scale of pain during standing, kneeling and crouching after six weeks and six months. Computed tomography was performed at six months for morphological evaluation., Results: At six weeks, both groups were still recovering from surgery and the overall knee function was still impaired but the functional scores were significantly higher in the Bone-Albumin group. The pain with crouching and kneeling was also lower as compared to controls. At six months, the knee function scores were close to normal, with a slight decrease in the controls. Pain at kneeling was still prominent in the controls, but significantly lower in the Bone-Albumin group. Computed tomography showed significantly smaller bone defects and higher bone density in the Bone-Albumin group., Conclusions: Results from the present study indicate that donor site pain, a disturbing long-term side effect of bone-patellar tendon-bone surgery, is significantly reduced if bone buildup in the patella and the tibia is augmented by serum albumin-coated bone allografts.

In 1925, Calvé described vertebra plana as an aseptic necrosis of bone involving a single vertebral body of the spinal column. This theory was set aside in 1954 by Compere, who concluded that vertebra plana is caused by eosinophilic granuloma and not by osteochondritis as suggested by Calvé. It has been well documented in literature that many factors other than eosinophilic granuloma can cause vertebra plana-like destruction of the vertebral body. However, the definition of the terms was not clear, and there was no consensus on whether to call these cases vertebra plana or not. Some authors did, some did not. Anyhow, no publication so far has reported on osteochondritis as a rare cause of vertebra plana. The case of a 12-year-old girl, presented here by the authors, suggests this explanation. Some important conclusions can be drawn from this regarding the nomenclature, the diagnosis, and the therapy.

Patients with osteoarthritis (OA) of the knee were treated with chondroitin sulfate (CS, Condrosulf, IBSA, Lugano, CH) in a randomized, double-blind, placebo-controlled study, performed in two centres. The efficacy and tolerability of oral CS capsules 2 x 400 mg/day vs placebo was assessed in a 6-month study period. Patients with idiopathic or clinically symptomatic knee OA, with Kellgren and Lawrence radiological scores I-III, were included in this trial. Clinical controls were performed at months 0, 1, 3 and 6. Eighty patients completed the 6-month treatment period. Lequesne's Index and spontaneous joint pain (VAS) decreased constantly in the CS group; on the contrary, slight variations of the scores were reported in the placebo group. The walking time, defined as the minimum time to perform a 20-meter walk, showed a statistically significant constant reduction only in the CS group. ANOVA with repeated measures showed a statistically significant difference in favor of the CS group for these three parameters. During the study, patients belonging to the placebo group reported a higher paracetamol consumption, but this consumption was not statistically different between the two treatment groups. Efficacy judgements were significant in favor of the CS group. Both treatments were very well tolerated. All these results strongly suggest that chondroitin sulfate acts as a symptomatic slow-acting drug in knee OA.

In this preliminary study, authors describe their experiences with revision of the cup and with that of the femoral stem. Former has been performed by them since 1993 39 times on 37 patients, the latter 3 times on 3 patients. The method was successful in most of the cases; the anatomical integrity was preserved and stability was satisfactory.

Authors report on the control examinations of 108 patients on a peduncular system, known since 1986 and applied successfully in the operative treatment of various diseases of the lumbosacral spine. The results of healing of 69 patients in whom the fusion of the lumbosacral spine was performed because of long standing low-back pains are analysed. They describe also other possibilities given by the peduncular system, among others the correction and stabilization of the lumbar kyphosis in Becterew's disease, the postlaminectomy kyphosis and the lumbar scoliosis of adults. Cases of trauma and tumor in which this method of stabilization was also successfully used are also mentioned.

A case is introduced with osteogenesis imperfecta, suffered from left femoral fracture and a consecutive hypertrophic callus formation, with extreme swelling on the thigh. Concerning the laboratory tests the only significant difference was the elevation in alkaline phosphatase activity and a moderate elevation in ESR. The case is reported because of it's accidental appearance.

The aim of these in vitro series of experiments was to state whether the medicaments used in the treatment of loss of bone density the Calcitonin, NaF and Ipriflavon do have a direct effect on the preosteoblast cells. The results show that both the Calcitonin and Fluorid stimulated the development of the fibroblast colonies and the NaF had a role in the increase of the alkaline phosphatase too. In the concentration of Ipriflavon applied no effect could be demonstrated in any parameter.

The results of 3 bone biopsies in patients with Sillence I. type of osteogenesis imperfecta are described. The biopsy material was examined with light microscope histomorphometric and various electron microscopic methods. Histomorphometry showed that the osteoid rim (OS%) and the steroid surface covered by osteoblasts (OB%) was significantly greater, in the same time the relative quantity of osteoid (Vvos%) was significantly less, compared with the normal bone. Electron microscopy showed the broadening and unevenness of the mineralization front. The diameters of the collagen fibers were quite unstable compared with the control. The structure of the newly developed apatit crystals was not different, although their measure was less than of the control. The microanalytical examinations of Ca/P relation of the crystal phase did not show any difference.

In the present study comparative evaluation has been carried out between the groups of patients (31 in each group, private and National Health Service) treated by posterolateral lumbar spine fusion for mechanical lower back pain. The same surgical team was involved in the treatment. The patients were evaluated independently at an average follow-up of more than three years in each group. The acceptable clinical results (good and fair) showed a remarkable difference between the two groups, with the private group enjoying the better outcome. The difference of final outcome was analyzed by looking at the waiting time for surgery, the social classification of the patients and the provision of state benefit for disability.

Authors report on the results of the operative fusion of the lumbar spine performed by them between 1 March 1987 through 31 December 1990. Based on the assessment of 243 cases they call attention to the importance of the correct indication and operative technique and of the close supervision. It is stated that the use of the internal fixation improves the results of the operative fusions.

It was found as a result of preclinical experimental examinations, performed in Hungary and Japan that Ipriflavone stimulates calcitonin secretion through increasing the oestrogene effect. Its effect of hindering bone resorption works presumably also this way. Authors report on experiences and results gained in 408 treatment years of 114 primary and secondary osteoporotic patients. The results of clinical experiments in Hungary, Japan and Italy are similar. The treatment with Osteochin and calcium is an effective therapy of osteoporosis. The progression of the loss of bone mass can be hindered, the number of bone fracture is diminished in proportion of time and the method proved to be effective in 79 per cent of the patients. Out of the gastric complaints, found in 5.5 per cent of the cases no side effect was observed.