Background:Management of distal femoral bone defects represents a great challenge, whether these defects are caused by failed total knee arthroplasties or trauma. One method of management is the use of modular hinged total knee implants with distal femoral replacement, depending on the present defects. Such prostheses can be used in revision surgery, acute comminuted distal femoral fracture, or distal femoral fracture with nonunion. This study aimed to analyze the functional outcome and possible complications of the use of modular total knee prostheses in revision surgery or traumatic injuries in patients with femoral defects. Methods:This study was a prospective case series of nononcologic femoral endoprosthetic reconstructions for either revision total knee arthroplasty (TKA) or traumatic femoral defects in eight patients (n = 8) from 2015 to 2020. Patient cases were categorized as failed TKA (n = 4) or traumatic (n = 4). Traumatic patient cases were either distal femoral fractures with nonunion (n = 2) or periprosthetic fractures (n = 2). Mean follow-up was 2.75 yr (range from 6 mo to 4 yr). Clinical outcomes and ambulatory status (able to walk or not) were assessed. Knee Society Scores (KSS) were calculated, and the range of motion (ROM) was assessed. Results:In this group of patients, modular endoprosthetic replacement provided immediate pain relief, early mobilization, and weightbearing. KSS was improved in all patients. ROM was 70 to 90 degrees in four patients, and 90 to 110 degrees in four patients. None of the patients developed soft-tissue infection or implant loosening during the follow-up period. Conclusions:Short-term clinical outcomes for the use of modular endoprosthetic total knee implants in the management of distal femoral defects in either traumatic injury or revision surgery result in good functional outcome and patient satisfaction.
The aim of this retrospective cohort study was to investigate the effect of BMI on 1-year functional outcome, quality of life (QoL) and rate of postoperative complications after shoulder arthroplasty. We included 121 patients (59 men and 62 women) with primary osteoarthritis (OA) who underwent anatomical or reverse total shoulder arthroplasty (TSA or rTSA) between 2011 and 2016. Age, sex, preoperative BMI, preoperative medical status using American score of anesthesiologists (ASA) class, type of prosthesis, preoperative and 1-year postoperative functional outcome using the Constant score and quality of life (QoL) using the EQ-5D as well as postoperative complication rate were documented. Patients were divided into three groups based on their BMI, group 1 (normal weight, BMI <25), group 2 (overweight, BMI 25-30) and group 3 (obese, >BMI 30). All three groups were comparable regarding age, sex and ASA class, preoperative Constant score EQ-5D. We found significant improvement of the Constant score and EQ- 5D at 1-year postoperative follow-up, regardless of BMI (p<0.05). Comparing the three groups, we found no significant differences among them in 1-year Constant score, EQ-5D or postoperative rate of complications. This study showed that BMI did not affect functional outcome, QoL and postoperative complication rate in TSA. These results can help physicians and patients to make reasonable perioperative expectations and planning.
Patients with corona virus disease (COVID)-19 are prone to a variety of myocardial and vascular complications. Recent studies suggest that cardiac valves are also potential targets for the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Calcific aortic valve stenosis (CAVS) is the most common valvular heart disease. Severe COVID-19 has been associated with main risk factors for CAVS, including male sex, older age, cardiovascular co-morbidities, obesity, hypertension, diabetes, and chronic kidney disease. Prognostic implications for concomitant CAVS and SARS-CoV-2 infection have been reported. Changes in CAVS diagnostic, interventional, and follow-up clinical processes have occurred during the COVID-19 pandemic. SARS-CoV-2 may damage aortic valves via both direct injury and indirect mechanisms that include hyperinflammation, oxidative stress, and valve thrombosis. The injury is often acute but may be irreversible and thus favor future CAVS development. Rheumatic heart disease, which develops as a sequel of rheumatic fever, is one example of a possible relation between an acute infection and chronic valvular heart disease. A persistent prothrombotic state, prolonged endothelial dysfunction, and incomplete resolution of inflammation after COVID-19 convalescence may expose the aortic valves to chronic stimulation toward CAVS. Priority of CAVS management in COVID-19 includes avoiding treatment delay and managing underlying pathophysiological state that promotes CAVS.
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