Patients with achondroplasia often experience knee osteoarthritis, which is marked by varus deviation of the tibia, as well as recurvatum, internal tibial torsion, and mediolateral instability of the knee. This presents a challenge for surgeons, as it necessitates meticulous planning of intricate procedures that may need to be carried out in one or multiple surgical stages. There are few descriptions in the literature of a single-stage complex knee treatment for patients with achondroplasia. Additionally, there is a lack of information on the method used for precisely calculating the dimensions of the bone wedge to be resected during the lateral tibial closure osteotomy procedure. We present the case of a 52-year-old man with achondroplasia (height 122 cm) and deforming osteoarthritis of the knees. The right knee showed severe malalignment with a 36.4° extra-articular varus deformity and multidirectional instability. A single-stage surgery was necessary, involving meticulous planning for a tibial osteotomy and a total knee arthroplasty with a rotating hinge. The clinical and radiological outcomes at 2 years postoperative follow-up were satisfactory. This study outlines the methodology used for single-stage surgical planning with a lateral closing wedge technique, followed by a non-customized total knee arthroplasty in a case of deforming osteoarthritis of the knee with very small anatomical dimensions in a young patient with achondroplasia.
Introduction: Previous literature has shown a high revision rate after a SLAP repair operation, which led to a decreased number of SLAP repairs being performed and an increased emphasis on patient selection. The transition to the ICD-10 coding system has allowed for more descriptive coding, enhancing the validity of the data mined from large databases. This study aims to assess the surgical revision rate, risk factors for revision, and subsequent procedures after a superior labrum anterior and posterior (SLAP) repair surgery. Materials & methods: Data for the study were obtained from the national private insurance database Pearl Diver (years 2007 - 2020). All included patients underwent their first SLAP repair surgery with at least two years of follow-up. Patients were queried using Current Procedural Terminology (CPT) code 29807 and concurrent ICD-10 shoulder pathology diagnosis codes. The database was used to determine the revision rate of Subsequent Shoulder Procedures (SSP). The time between index surgery and subsequent procedures was noted. Finally, a logistic regression analysis with a significance cut-off of p ≤ 0.05 was conducted to determine the risk factors for a subsequent procedure after a SLAP repair. Results: Out of 91 million patients, 15,958 patients (16,611 shoulders) met the criteria for the study. 1,389 (8.36%) repaired shoulders underwent a subsequent shoulder procedure on average 1.13 years after their initial SLAP repair. Younger age (OR = 1.01), elevated CCI (OR = 1.07), female gender (OR = 1.3), tobacco use (OR = 1.37), and obesity (OR = 1.21) significantly increased the risk of a subsequent shoulder procedure. Subacromial decompression, debridement, rotator cuff repair, manipulation under anesthesia, and revision SLAP repair were the most common subsequent procedures. Discussion: An additional procedure may be necessary for approximately 1 in 12 patients a year after SLAP repair surgery. Patients who are younger, female, obese, have an increased CCI, and use tobacco are at increased risk of undergoing a revision procedure. Overall, the rate of revision procedures patients experience after a SLAP repair is less than initially reported.
Fibromyalgia (FM) is a syndrome currently considered idiopathic and multifactorial rheumatic syndrome that causes increased muscle tension, especially during the use of the same muscles. It is characterized by muscle and fibrous tissue (tendons and ligaments) pain of a chronic type associated with stiffness, asthenia (decline in strength with fatigability), cognitive impairment, insomnia or sleep disturbances, and altered sensitivity to stimuli. The etiology is currently unknown. It is under discussion whether to retain it in the definition of the atypical rheumatic syndrome. The hypotheses are oriented according to a multifactorial logic, immunoreumatological in nature with neurological, psychiatric, muscular and metabolic symptoms, although (being a diagnosis by exclusion) it tends to include known phenomena (such as psychiatric symptoms) in a spectrum of heterogeneous symptoms, thus risking diagnostic error, even to accommodate the patient’s needs and wants. This review provides the reader with a comprehensive overview of the disorder, highlighting some aspects that could redefine its clinical framing, thus facilitating a better diagnostic approach to the health problem, from an etiological perspective.
Purpose: This study aimed to develop a prototype Personal Mobility (PM) system with human-robot synchronous motion measurement and sensory feedback as an attention reminder to ensure the safe performance of sustained, step-by-step rehabilitation tailored to the daily living conditions of elderly individuals. Methods: Five healthy adults were fitted with a simulation tool to experience the elderly, and inertial measurement unit sensors were placed on the subjects and the PM device to measure joint movements during two postural movements (sitting to supine and supine to standing). In addition, vibration stimulation and voice guidance were implemented as alerts at a certain set threshold of the joint motion angle. We analyzed the deviation of each joint motion between the subject and the PM device regarding the angle measurements of the trunk, hip, knee, and ankle joints. Results: Trunk angle misalignment was high in the sitting-to-supine position. Hip angle misalignment was greater in the supine to standing position. As an alert system, vibration and voice guidance could be presented to the subject with a 0.3-second delay after the set threshold was reached. Conclusion: The misalignment between a human and a motorized wheelchair in contact with the human is more than several tens of degrees when expressed as the angle change value of the joint motion. We believe that a system that can constantly sense and alert the user regarding whether the user and the PM device are in sync is necessary for PM devices being used in rehabilitation or as daily life support.
Objective: The objective of this study is to know if the method of calculating full training load session eTRIMP using pulse monitors would be able to demonstrate a monotony like the total internal load model through the session-RPE using workload method in a resistance athlete. Methods: This is a one-week observational study that evaluated time, heart rate, and session RPE in a 32-year-old adult during prescribed resistance training to compare Internal Training Load (ITL) using the eTRIMP method with traditional assessment methods that use session RPE multiplied by training session duration, known as session workload calculation. Results: The total load for the week varied between models due to the method of obtaining the result being different, 417 au for the weekly summation based on eTRIMP versus 3321 au using the workload method. However, the monotony of the weekly training prescription was similar, observationally evaluated, between the groups (2.4 for the workload method versus 2.9 for the eTRIMP method). Conclusion: The internal load evaluated by the eTRIMP model seems to show a monotony value like the value calculated by the weekly load using session-RPE and workload. Therefore, evaluating resistance training using the eTRIMP by pulse monitoring model seems to be a useful tool in analyzing training week monotony to maintain high loads favoring the hypertrophy and fat-burning process.
