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Blood conservation and reduction in the need for allogeneic blood transfusion (ABT) has been a subject of importance in total hip arthroplasty. There are a number of well-recognized parameters that influence blood loss during total hip arthroplasty (THA). The role of surgical approach on blood loss and the rate of ABT during THA is not well studied. The hypothesis of this study was that blood loss and the need for ABT is lower with direct anterior (DA) approach.

In a case-control retrospective cohort study, we analyzed 1,524 primary THAs performed at a single institution by seven fellowship-trained surgeons between January 2015 to March 2017. All patients received THA using either the modified direct lateral (DL) or direct anterior (DA) approach using a standard operating table. The overall ABT rate was 10.2% (155/1,524) in the cohort. Demographic, surgical, and postoperative data were extracted and analyzed. Logistic regression was used to identify independent risk factors for transfusion.

Higher preoperative hemoglobin (p<0.001), use of DA approach (p<0.016) and administration of tranexamic acid TXA, (p=0.024) were identified as independent factors which reduced the odds of ABT. Operative time (p<0.001) was associated with an increased odd of ABT, while age, BMI and type of anesthesia were not statistically significant.

Based on the findings of this study, direct anterior approach for THA appears to be protective against blood loss and reduced ABT rate, when controlling for confounding variables.

Based on the findings of this study, direct anterior approach for THA appears to be protective against blood loss and reduced ABT rate, when controlling for confounding variables.

This study retrospectively evaluated the medium- and long-term results of patients submitted to double-bundle (DB) anterior cruciate ligament (ACL) reconstruction.

A retrospective study of case series at a single center. Cases submitted to isolated ACL reconstruction with at least five years of follow-up were included. ISX-9 beta-catenin activator The following data were collected demographic data; practice of competitive sport before the injury; previous surgery; injury/surgery in the contralateral knee; return to the practices of sports and level; re-injury (postoperative time; mechanism; need for surgery); and symptoms at the last clinical follow-up visit. Descriptive and sub-group analyses were performed.

Sixty-nine patients were included; 52 men (75%), 49 athletes (71%), 47 (68%) with primary injury, mean age of 30 years (SD 10). The patients were followed up for an average of 8.7 years (minimum 5, maximum 11.8) after surgery. After the reconstruction, 67 (97%) returned to the sport; 75% at the same level as before the injury.higher re-injury levels among the athletes in relation to the non-athletes. The rate of return to sport was satisfactory, with 97%, of which 75% were playing at the same level as before the injury.

Tibial plateau fractures account for approximately 8% of the fractures of the elderly. Low bone quality that is more common in the elderly is one of the major challenges in fixing fractures and may be a barrier to achieving satisfactory outcomes after a surgical fracture treatment. Accordingly, surgical fixation of tibial plateau fractures was controversial in the elderly. This study aimed to investigate and compare the clinical outcomes of surgical fixation in patients over and under 60 years of age.

This study was conducted as a retrospective cohort study of data that were prospectively collected. In total, 48 patients who underwent surgery with open reduction and internal fixation before August 2019 were recruited and followed up at least one year after surgery. Demographic characteristics, the range of motion of the knees, visual analog scale (VAS) score of pain intensity, and the Oxford Knee Score (OKS) were obtained in this study. Furthermore, Short Form-36 (SF-36) questionnaire was used to evaluate patient satisfaction.

In total, 19 and 29 patients were over and under 60 years of age, respectively. According to Schatzker's classification, the most common type of fracture was type VI. The range of motion in the knees did not differ significantly between the two groups (P>0.05). Moreover, OKS and the VAS of pain intensity were not significantly different in both groups (P>0.05). In addition, SF-36 scores were not significantly different between elderly patients and the age-matched general population. However, younger patients had lower scores in the physical function and vitality scales of SF-36, compared to the age-matched general population.

Based on the results of the present study, it can be stated that increasing age did not affect the surgical outcomes of patients with tibial plateau fractures.

Based on the results of the present study, it can be stated that increasing age did not affect the surgical outcomes of patients with tibial plateau fractures.

This retrospective study aimed to compare the clinical outcomes of patients with staged and simultaneous bilateral total knee arthroplasty (TKA).

The present study included 100 patients with a mean age of 62±3.72 years from 2014 to 2017. Among them, 51 and 49 patients underwent simultaneous and staged bilateral TKA, respectively. The two groups were compared regarding the range of motion (ROM), Oxford Knee Score (OKS), Western Ontario and McMaster UniversitiesOsteoarthritis Index (WOMAC) improvement, and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores. The mean follow-up duration was 24 months (range 12-36 months).

According to the results obtained from the SF-36 questionnaire (possessing eight different factors of quality of life), there was no significant difference between the two groups. Furthermore, the OKSs were 39.98±1.52 and 38.68±2.55 in the simultaneous and staged groups, respectively. Moreover, the WOMAC improvement scores were obtained at 84.15±2.2 and 83.26±2.6 in thegnificant difference exists in both procedures.

Bilateral total knee arthroplasty (BTKA) under the same anesthesia (simultaneous) or staged are options for patients with end-stage arthritis of the knee that carries advantages and limitations. Not all patients are candidates for simultaneous BTKA, and therefore, surgeons prefer to stage the two TKAs. The optimal safe interval between two TKAs is not known. The present systematic review aimed to determine the optimal time interval between the two stages of BTKA.

Pubmed and Scopus databases were searched to identify publications from January 1979 to November 2017 in English that compared the outcomes of staged BTKA performed using various time intervals between the two TKAs. Data on systemic and local complications following staged BTKA were extracted, and the pooled data were analyzed to adjust for age.

In total, 23 studies that enrolled 117,090 patients undergoing staged BTKA were included in this systematic review. A significant increase was observed in the incidence of myocardial infarction (OR=8.4 a higher risk of systematic complications. However, the shorter time intervals between the two TKA may reduce the risk of other complications. This information may help surgeons' council patients better when deciding on the optimal time interval between two TKAs.Obesity is associated with a greater prevalence of symptomatic knee osteoarthritis. Obese patients are thought to have worse outcomes following unicompartmental knee arthroplasty (UKA).The aim is to compare clinical and functional outcomes of UKA in obese to non-obese patients. A systematic review on six databases (PubMed, MEDLINE, Embase, Web of Science, Scopus, and CENTRAL) from inception through July 2020 was performed. We extracted data to determine revision risk (all-cause, septic, and aseptic), complication risk, and infection risk, functional outcome scores (Knee Society Score [KSS], Oxford Knee Score [OKS], and range of movement [ROM]) in patients with obesity (BMI >30kg/m2) to non-obese patients (BMI less then 30kg/m2). Meta-analysis was performed using a random effects model. The MINORS criteria was used for quality assessment. Twelve of 715 studies were eligible. Compared with non-obese patients, obese patients had a higher risk ratio for all-cause revision (RR 1.49; 95% CI 1.04 to 2.13; p = 0.03); aseptic revision (RR 1.36; 95% CI 1.01 to 1.81; p=0.04) and complications (RR 2.12; 95% CI 1.17 to 3.85; p=0.01). No significant differences were found in risk of septic revision and overall infection. Obese patients also had lower KSS scores (MD -3.21; 95% CI -5.52 to -0.89; p less then 0.01), OKS scores (MD -2.21; 95% CI -3.94 to -0.48; p=0.01), and ROM (MD -7.17; 95% CI -12.31 to -2.03; p less then 0.01). The average MINORS score was 14.2, indicating a moderate quality of evidence. In conclusion, the risk of revision, aseptic revision, and complications are higher in obese patients. The clinical significance of a lower functional score in obese may not be appreciable. Despite the greater risks, there is no conclusive evidence that obesity should be a contraindication to UKA. Further studies are required to corroborate the current conclusions with higher-quality study designs.The posterior cruciate ligament (PCL) is the primary stabilizer to posterior tibial translation of the knee. PCL injuries classically occur as the result of a posteriorly directed force against the anterior part of the tibia. They frequently occur as multiligament injuries or with concomitant cartilage or meniscal injuries. The posterior drawer test is highly sensitive and specific for PCL injuries. Posterior stress radiography is critical for objective assessment of posterior tibial translation and grading of PCL injuries. Grade I and II injuries may be treated nonoperatively, but in general isolated grade III injuries and multiligament injuries require surgical intervention due to the inevitable development of osteoarthritis. Anatomical and biomechanical studies have led to the development of an anatomic double-bundle reconstruction, which has been reported in clinical outcome studies to result in better functional and objective outcomes than single-bundle reconstructions. This article focuses on the clinically and surgically relevant anatomy and biomechanics of the PCL, diagnosis and treatment of PCL injuries, and a description of the anatomic double-bundle PCL reconstruction technique.Purpose Motion artifacts in magnetic resonance (MR) images mostly undergo subjective evaluation, which is poorly reproducible, time consuming, and costly. Recently, full-reference image quality assessment (FR-IQA) metrics, such as structural similarity (SSIM), have been used, but they require a reference image and hence cannot be used to evaluate clinical images. We developed a convolutional neural network (CNN) model to quantify motion artifacts without using reference images. Approach The brain MR images were obtained from an open dataset. The motion-corrupted images were generated retrospectively, and the peak signal-to-noise ratio, cross-correlation coefficient, and SSIM were calculated. The CNN was trained using these images and their FR-IQA metrics to predict the FR-IQA metrics without reference images. Receiver operating characteristic (ROC) curves were created for binary classification, with artifact scores less then 4 indicating the need for rescanning. ROC curve analysis was performed on the binary classification of the real motion images.