Surgical technology international
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Unicompartmental knee arthroplasty (UKA) is a feasible alternative to total knee arthroplasty (TKA) for selected patients with severe single-compartment knee osteoarthritis. Robotic-assisted UKA (rUKA) has recently emerged as a complementary tool to ameliorate previous difficulties with manual UKA (mUKA). However, the influence of rUKA compared to mUKA on patient outcomes are still largely unknown. ⋯ In conclusion, unicompartmental knee arthroplasty implants demonstrated comparable survivorship rates whether performed manually or with robotic assistance. However, compared to the manually performed procedure, robotic-assisted unicompartmental knee arthroplasty were found to offer benefits including shorter lengths of hospital stays, decreased postoperative pain scores, and improved functional outcomes.
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Due to the COVID-19 pandemic, important elective procedures, such as screening colonoscopy, have been delayed or cancelled, and there may be a very long waitlist for rescheduling once the moratorium is lifted. However, DNA-based stool sample tests may be useful for colorectal cancer screening when colonoscopy is not available. The aim of this review is to demonstrate the potential utility of enhanced DNA-based stool testing for colorectal cancer screening and diagnosis during crises that strain available healthcare resources, such as the current COVID-19 pandemic. This review shows that DNA-based stool sample tests have the potential to enable colorectal cancer screening to prioritize patients to elective colonoscopy procedures, the continued delay of which during the COVID-19 pandemic has already placed a burden on future elective procedures.
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Due to the rising concern regarding excessive opioid use, several alternative pain control options have been developed for total knee arthroplasty (TKA). Therefore, the purpose of this article was to review non-narcotic treatments to manage pain after TKA. Specifically, we evaluated: 1) acetaminophen; 2) cyclooxygenase-2 (cox-2) inhibitors; 3) gabapentinoids; 4) dexmedetomidine, 5) nerve blocks; 6) local analgesic infiltration; 7) transcutaneous electrical nerve stimulation (TENS); and 8) perioperative bracing. ⋯ The optimal solution for postoperative TKA pain management has yet to be determined. Although several options exist, many of them have been associated with adverse effects limiting their generalizability. Knee braces, however, have been identified as one potentially successful option. Importantly, knee braces are safe for the majority of patients and should be widely recommended for patient use.
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Review
Incisional Application of Negative Pressure for Nontraumatic Lower Extremity Amputations: A Review.
In the environment of diabetes and peripheral vascular disease (PVD), there is a high risk of incisional complications following amputation, including seroma, hematoma, infection, and dehiscence. Incisional negative-pressure wound therapy (iNPWT) is a novel application of negative-pressure wound therapy (NPWT) that may be able to mitigate these complications and reduce the need for revisional surgery (including higher-level major lower-extremity amputations). It may also facilitate an increased rate of healing and earlier return to function. iNPWT has been used successfully in high-risk patients to decrease complications. ⋯ As of yet, no prospective, randomized trial has shown reduced morbidity, earlier return to function, or reduced mortality with the use of iNPWT after a lower-extremity amputation. This review presents recent findings regarding the use of iNPWT. Further studies on this topic are needed.
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Review Comparative Study
Injection Alternatives for the Management of Knee Osteoarthritis Pain.
There has been a rapid increase in opioid-related morbidity and mortality worldwide, and the dangers of excessive opioid use have been observed in patients with chronic musculoskeletal pain, including those diagnosed with knee osteoarthritis. Pain management is an important component of nonoperative treatment in knee osteoarthritis and frequently entails the use of opioids. However, this management technique is not without risks, such as addiction, morbidity, and mortality. Therefore, the purpose of this study was to review the existing literature on the use of opioids in the management of knee osteoarthritis and compare the findings to a new injection management modality. Specifically, we assessed: 1) trends in opioid prescription; 2) patient-reported outcomes; 3) incidence of complications; 4) incidence of abuse and dependence; and 5) mortality related to opioid use in knee osteoarthritis. We then performed a sub-analysis comparing these findings to TG-C, a novel a 3:1 mixture of genetically engineered chondrocytes that has shown promising early phase I, II, and III results. ⋯ The effects of the opioid epidemic on patients with knee osteoarthritis are severe. Excessive opioid use in these patients leads to poorer patient satisfactions as well as increased morbidities and mortalities. Therefore, there is a real need for alternative nonoperative treatment options that effectively reduce pain, and promising results from studies on the efficacy GEC injections demonstrate that they may be an answer to the opioid epidemic observed among osteoarthritis patients.