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.
(1) Background: Achilles tendinopathy (AT) is characterized by load-induced tendon pain, stiffness, and functional impairment that may affect the tendon midportion or insertion. Platelet-rich fibrin matrix (PRFM) is a promising adjunctive therapy for AT. We analyzed 24-month pain and functional outcomes in a cohort of patients managed by tendon debridement and autologous PRFM application to determine whether the combined treatment ensured an early return to sports/work and satisfactory clinical outcomes and functional scores. (2) Methods: The 24-month outcomes of 32 sport-practicing patients with chronic midportion AT treated with debridement and autologous PRFM were evaluated in terms of time to return to sports/work. The AOFAS and VISA-A were computed preoperatively and at 6 and 24 months. Blazina scores were evaluated preoperatively and at 6 months; ankle range of motion was assessed at 1, 6, 12, 24 months; and patient satisfaction was assessed at 24 months. (3) Results: Altogether, all patients had resumed their sport(s) activity, at the same or higher level, after 25.41 days (±5.37). Regarding work, all patients were able to return to their jobs after 16.41 days (±2.43). Ankle dorsiflexion and plantarflexion increased significantly: the AOFAS rose from 54.56 (±6.47) to 97.06 (±4.06) and 98.88 (±2.21) at 6 and 12 months, respectively, and the mean VISA-A score rose from 69.16 (±7.35) preoperatively to 95.03 (±4.67) and 97.28 (±2.43) at 6 and 12 months, respectively, after treatment. There were no complications. Most (90.62%) patients were very satisfied. (4) Conclusions: In symptomatic midportion AT, surgical debridement and autologous PRFM ensured a fast return to sports/work (4 weeks), significantly improving AOFAS and VISA-A and Blazina scores already at 6 months and providing excellent clinical outcomes at 24 months.
Background This retrospective study compares the invasiveness of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA) by assessing three widely used inflammation-related serum markers in the first ten post-operative days. Methods The database of our institution was mined for primary THAs conducted by the DAA or the PLA from February 2020 to June 2022. Demographics and creatine kinase (CK), C-reactive protein (CRP), and white blood cells were compared. Propensity Score Matching (PSM) analysis (1:1 ratio) was conducted based on multiple variables. Results PSM analysis yielded 44 pairs of DAA and PLA patients. CK was significantly higher (p < 0.001) in the DAA than in the PLA group on postoperative day (POD) 2, 5 and 10. The POD2, POD5 and POD10 CK/preoperative CK ratio was 12.9, 5.0 and 0.8 in DAA and 8.8, 3.3 and 0.6 in PLA (p = 0.017, p = 0.012 and p = 0.025, respectively). The POD2, POD5 and POD10 CRP/preoperative CRP ratio was 95.1, 65.6 and 22.8 in PLA and 34.7, 23.3 and 8.9 in DAA (p < 0.001, p = 0.002 and p < 0.001, respectively). Conclusion PSM analysis of early postoperative CK and CRP values demonstrated that the DAA should be considered as a less stressful approach, not as a muscle-sparing or a minimally invasive THA approach.
Objective The aim of the study was to investigate the clinical results of open reduction and internal fixation using a suprapectineal buttress plate for specific acetabular fractures. Methods We conducted a retrospective study involving thirty-three patients with specific acetabular fractures in an academic level 2 trauma center. We performed the ilioinguinal approach with Stoppa window for buttress plating of the quadrilateral surface. Clinical examination, radiographs and computed tomography were done using criteria described by Matta. Functional outcome was evaluated by visual analog scale (VAS), WOMAC, Harris Hip score modified, Hip disability and Osteoarthritis Outcome Score (HOOS) and modified Merle d’Aubignè scoring system. Results Average follow-up was 40.4 months with a minimum of 24 months. Mean age was 59.09 years. The 82% of patients were treated with a suprapectineal plate using ilioinguinal approach with Stoppa window. The 18% of patients required a Kocher-Langenbeck approach in order to get anatomic reduction of posterior wall or column. The 91% of patients were satisfied of their condition during activity of day living and only a small cohort reported walking aids. The worst clinical results were obtained in patients characterized by highest step displacement. Deep infection of surgical wound was observed in 6% of patients. In 3% of patients, one vascular injury occurred during surgery. Conclusion Internal fixation using ilioinguinal approach with Stoppa window and a suprapectineal plate to buttress the quadrilateral plate should be considered a viable treatment of some acetabular fractures. Patients can expect a good functional outcome with a low complication rate.
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