Background: Synovial biopsy, an important diagnostic tool to evaluate chronic monoarthritis, undifferentiated inflammatory arthritis and neoplasms, remains underutilized in clinical practice due to perceived invasiveness and limited access to specialized techniques. This study evaluates the diagnostic utility and histopathological spectrum of synovial biopsies in a tertiary care centre. Materials and Methods: This retrospective and prospective observational study was conducted over three years (June 2020–June 2023) in a tertiary care institute. Synovial biopsies obtained via needle biopsy or arthrotomy received in the Department of Pathology, were routinely processed and evaluated using Hematoxylin and Eosin (H&E) stain, with special stains wherever indicated. Results: Total 148 synovial biopsies were analysed. The mean age was 49.9 years, M:F ratio was 1.7:1. The most common site was the knee joint (69.5%). Common histopathological diagnosis were chronic non-specific synovitis (46.6%), rheumatoid arthritis (RA) (16.2%), septic arthritis (12.8%), and tuberculous synovitis (11.5%). Diagnostic revision following histopathological examination occurred in 16 /148 cases (10.8%), significantly altering the clinical management. This included seven cases of tuberculosis (TB) initially presenting as acute synovitis, three cases of post-total knee replacement which were originally managed as bacterial infections but reclassified as TB following synovial biopsy and six cases of RA which were initially misclassified as osteoarthritis. Conclusion: Synovial biopsy is a valuable investigation that can be incorporated into diagnostic algorithms for atypical presentations to improve patient outcomes and reduce clinical misclassification. In TB endemic regions, histopathological examination of synovial biopsy can prevent delayed diagnosis and suboptimal management.
Carpal tunnel syndrome causes changes hand proprioception but there are a limited number of studies on joint position sense in patients with CTS. The aim of the study was to investigate the validity and reliability of the ® KForce Sens for the evaluation of wrist joint position sense in individuals with CTS. Wrist joint position sense ® ® ® was assessed with KForce Sens and Baseline electrogoniometer. The validity and reliability of the KForce Sens for wrist position sense evaluation were investigated by comparing the two data sets. The study was conducted in 35 patients (29 females, 6 males) with CTS and 35 healthy individuals (29 females, 6 males). In test-retest ® measurements of the KForce Sens , a significant correlation was found in 60° flexion (ICC=0.730), 30° extension (ICC=0.904), 60° extension (ICC=0.849), 15° ulnar deviation (ICC=0.834) and 10° radial deviation (ICC=0.952). ® ® significant correlation was found between KForce Sens and Baseline electrogoniometer in 30° flexion, 60° flexion, 30° extension, 60° extension, 15° ulnar deviation and 10° radial deviation (p<0.05). The difference in joint position sense was significant in 30° flexion (p<0.001), 60° flexion (p=0.023), 30° extension (p=0.003), 60° extension (p=0.037) compared to the healthy controls. There was no significant difference in ulnar deviation and ® 10° radial deviation movements (p>0.05). The KForce Sens device is a valid and reliable tool for the assessment of wrist joint position sense in patients with CTS. Even if the severity of CTS was mild, joint position sense was lower than that of healthy controls.
There is currently no evidence-based consensus regarding the optimal extent of skin preparation when performing total hip arthroplasty (THA) through the direct anterior approach using dedicated anterior-approach draping systems (DAA Drapes). The purpose of this study was to evaluate the contamination risk associated with different disinfection and draping strategies for anterior-approach THA using a proof-of-concept contamination model. Six commonly used skin preparation protocols were evaluated using a standardized fluorescent contamination model. Protocols ranged from extensive bilateral lower-limb preparation to limited ipsilateral preparation excluding the foot or distal leg. After draping, the operative field was assessed under ultraviolet light for contamination. Contamination rates and distances from the surgical field were recorded and analyzed using non-parametric statistics. No contamination was observed in the four most extensive preparation strategies. Contamination occurred in 28.6% of trials when the ipsilateral foot and ankle were excluded from preparation and in 57.1% of cases when preparation was limited to above the knee. Lifting the leg to disinfect the posterior aspect and disinfecting the contralateral limb did not reduce contamination risk. In this proof-of-concept study, limited skin preparation of the ipsilateral lower limb—particularly omission of the foot and distal leg was associated with a substantially increased risk of surgical field contamination. More extensive measures, such as lifting the leg or disinfecting the contralateral limb, did not confer additional benefit. These findings should be considered hypothesis-generating and require validation through microbiological and clinical outcome studies.
| laithashour100@gmail.com The relationship between recurrent surgical exposure and musculoskeletal health in older adults remains insufficiently characterized. This study aimed to investigate the association between the cumulative number of surgical procedures and total body bone mass (TBBM) and total body lean mass (TBLM) in an older adult population. Data were analyzed from the 2017–2022 biomarker wave of the Midlife in the United States (MIDUS 3) study. TBBM and TBLM were measured using dual-energy X-ray absorptiometry (DXA) with Lunar systems. The number of prior surgeries (minor or major) was retrospectively obtained through structured medical history interviews. Multiple linear regression models were used to evaluate associations between surgical history and body composition measures. Models were adjusted for age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), triglyceride levels, smoking history, dietary habits, medication use, physical activity, and serum creatinine levels. The final analytic sample included 327 participants (41% male) with a mean age of 64.5 ± 9.3 years. Regression analyses showed that a higher number of prior surgeries was significantly associated with lower TBBM (β = −0.094; 95% CI: −0.175 to −0.013; P = 0.021). Further sensitivity analyses including participants with higher threshold of cumulative major surgeries supported this association with a higher effect size. No significant association was observed between number of surgeries and TBLM (P = 0.33), even after conducting sensitivity analysis on cohort who underwent major recurrent surgeries. Healthier dietary habits were significantly associated with higher TBLM (β = 0.073; 95% CI: 0.017 to 0.129; P = 0.011), but not with TBBM (P = 0.507). In conclusion, recurrent surgical exposure was associated with lower total body bone mass but not lean mass in older adults. However, further longitudinal research is needed to fully adjust for potentially-related underlying morbidities.
Optimal timing of definitive fracture fixation in polytrauma patients remains controversial. This study aimed to compare clinical outcomes between Early Total Care (ETC) and Damage Control Orthopedics (DCO). A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, CENTRAL, Scopus, and Web of Science were searched through August 2025. Observational and interventional studies comparing ETC and DCO were included. Outcomes included mortality, sepsis, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), infections, delayed union, hospital stay, and number of surgical procedures. Methodological quality of observational studies was assessed using the Newcastle–Ottawa Scale, while risk of bias for randomized controlled trials was assessed using the Cochrane RoB 2 tool. The NIH Quality Assessment Tool was used for the included case series. Twenty studies (18,852 patients) were analyzed. ETC was associated with reduced hospital stay (WMD = -4.91 days, 95% CI: -6.89 to -2.93), surgical procedures (WMD = -3.39, 95% CI: -3.57 to -3.22), sepsis risk (OR = 0.63, 95% CI: 0.48 to 0.81), and delayed union (OR = 0.23, 95% CI: 0.06 to 0.93). No significant differences existed for mortality (OR = 0.59, 95% CI: 0.28 to 1.24), MODS (OR = 0.85, 95% CI: 0.55 to 1.30), ARDS (OR = 1.18, 95% CI: 0.64 to 2.17), or infections (OR = 1.38, 95% CI: 0.92 to 2.07). ETC was associated with a lower risk of sepsis, shorter hospital stay, and fewer surgical procedures in patients with polytrauma. Major complications and mortality, however, were similar between the two approaches. These findings highlight the importance of patient selection and individualized decision-making based on physiological status.
