Research and studies

Author : Mohamed Abdo Khalafallah 

Periprosthetic joint infection is a serious complication that can occur following joint replacement surgeries, posing significant challenges to patients and healthcare providers. To mitigate the risk of infection and improve patient outcomes, it is essential to implement comprehensive prevention strategies throughout the perioperative period. This article explores the various methods and protocols available for preventing periprosthetic joint infection, focusing on preoperative, intraoperative, and postoperative management. By understanding and implementing effective infection control measures, healthcare professionals can help reduce the incidence of this debilitating complication and enhance the success of joint replacement procedures. Our goal is to provide the most up-to-date and accurate recommendations based on the latest scientific research findings.  

Before initiating any surgical procedures
 It is crucial to implement key strategies to prevent infections in the operating room. One of the primary strategies is conducting a thorough Risk Assessment and Patient Selection process to ensure that only suitable candidates undergo surgery, thereby reducing the risk of infections. Additionally, practices such as Bacterial Decolonization, Preoperative skin Preparation for both the patient and surgeon, administration of Prophylactic Antibiotics, and the use of Antibiotic-loaded bone cement can further enhance infection prevention measures. By incorporating these strategies into our surgical protocols, we can significantly reduce the likelihood of post-operative infections and promote better patient outcomes. 

In the operating room
There are several management processes that must be carefully considered. These include hair removal, draping, the use of surgical gloves and gowns, anesthesia administration, conservation practices, the duration of the operation, managing operating room traffic, ensuring the availability and proper use of medical equipment and implants, maintaining a sterile operating room environment, and properly closing wounds and applying surgical dressings. It is crucial to meticulously oversee each of these processes to ensure the safety and success of surgical procedures.

 Educating patients about postoperative care instructions and warning signs of infection is crucial for early detection and intervention. By empowering patients to recognize symptoms such as increased pain, swelling, or fever, healthcare providers can address potential infections promptly and prevent complications. Long-term monitoring and rehabilitation plans are essential components of postoperative care for joint replacement patients. Regular follow-up appointments allow healthcare providers to assess healing progress, monitor for signs of infection, and guide patients through rehabilitation exercises to promote optimal recovery and joint function. 

 By adhering to best practices in preoperative assessment, intraoperative infection control, and postoperative management, healthcare providers can significantly reduce the risk of infection and promote better patient outcomes. Continued research and advancements in infection prevention techniques will further enhance the quality of care provided to patients undergoing joint replacement procedures. By prioritizing infection prevention strategies, healthcare professionals can contribute to the overall success and longevity of joint replacements, ultimately improving the quality of life for individuals with prosthetic joints.  

Author : Mohamed Abdo Khalafallah 

Shoulder injuries, particularly those involving the rotator cuff, can significantly impact an individual’s quality of life and ability to perform daily activities. Two surgical approaches commonly used to address these injuries are Superior Capsular Reconstruction and Partial Repair. By examining each approach’s effectiveness and considerations, readers can better understand which treatment option may be most suitable for managing shoulder injuries. Our goal is to conduct a systematic review and meta-analysis of the existing evidence to compare the clinical and functional outcomes between the two procedures, such as constant shoulder score, disabilities of the arm, shoulder, and hand, acromiohumeral distance, re-operation rate, forward flexion, and VAS score. 

Superior capsular reconstruction involves using a graft to replace the damaged superior capsule, providing stability and support to the shoulder joint. In Partial repair, the surgeon repairs only part of the torn rotator cuff, aiming to restore function and reduce pain. 

In shoulder injuries, the decision between superior capsular reconstruction and partial repair can be challenging. In conclusion, the decision between Superior Capsular Reconstruction and Partial Repair for shoulder injuries is a critical one that should be made in consultation with a healthcare provider. Both techniques offer unique benefits and considerations, and understanding the differences in surgical approaches, outcomes, and rehabilitation protocols is crucial for achieving optimal recovery and long-term shoulder function. Ultimately, the choice of treatment should be tailored to the individual patient’s specific condition and goals, ensuring the best possible outcome for their shoulder injury management. 

Author : Lukas Ernstbrunner

Hypothesis: Is salvage reverse total shoulder arthroplasty (RTSA) a justifiable treatment for failed operative treatment (open reduction-internal fixation [ORIF] or primary and secondary hemiarthroplasty) of proximal humeral fractures in patients younger than 60 years? Methods: Thirty patients (mean age, 52 years; age range, 30-59 years) were reviewed after a mean follow-up period of 11 years (range, 8-18 years). Of the patients, 7 (23%) underwent RTSA for failed ORIF and 23 (77%) for failed hemiarthroplasty. Clinical and radiographic outcomes were assessed longitudinally. Results: At final follow-up, the mean relative Constant score had improved from 25% (±12%) to 58% (±21%, P < .001). Significant improvements were seen in the mean Subjective Shoulder Value (20% to 56%), active elevation (45° to 106°), abduction (42° to 99°), pain scores, and strength (P < .001). Clinical outcomes did not significantly deteriorate over a period of 10 years. Patients with salvage RTSA for failed secondary hemiarthroplasty (n = 8) vs. those for failed ORIF (n = 6) showed significantly inferior active abduction (77° vs. 116°, P = .023). Patients with a healed greater tuberosity (n = 9) showed significantly better external rotation than patients with a resorbed/resected greater tuberosity (n = 13, 21° vs. 3°, P = .025). One or more complications occurred in 18 shoulders (60%), and 6 (20%) resulted in explantation of the RTSA. Conclusions: Salvage RTSA in patients younger than 60 years is associated with a high complication rate. It leads nonetheless to substantial and durable improvement beyond 10 years, provided the complications can be handled with implant retention. Inferior shoulder function is associated with greater tuberosity resorption or resection and inferior overhead elevation with the diagnosis of failed hemiarthroplast

Author : Anshul Sobt

COVID-19 pandemic has created havoc all over the globe and spared no oneregardless of status, gender, location and ethnicity. There were questions raised if traumaand orthopaedic (T&O) procedures actually generated aerosols? The need for a review ofliterature highlighting the nature and impact of aerosol generation within T&O surgery wasnoted.
A comprehensive online search was performed for all published articles in theEnglish language, evaluating AGPs in T&O surgery and the relevant personal protectionequipment used.Results: The search strategy populated 43 studies.
Six studies were identified as duplicates.The shortlisted 37 studies were screened and nine studies were included in the review. Anadditional four studies were included from the bibliography review.Conclusion: Most orthopaedic procedures are high-risk aerosol generating procedures(AGPs).
Conventional surgical masks do not offer protection against high-risk AGPs.
In thecurrent era of COVID-19 pandemic, there is a significant risk to the transmission ofinfection to the theatre staff.
For protection against airborne transmission, appropriatemasks should be used.
These need proper fitting and sizing to ensure full protection whenused.

Author : Mohamed A. Imam

The trial aimed to prospectively compare the functional outcome of patients undergoing arthroscopic rotator cuff repair using Transosseous-Equivalent Double-Row (TEDR) or single-raw (SR) suture anchor techniques at three years postoperatively for both large (over 3cm) and small (under 3cm) tears.
Eighty patients with a symptomatic and MRI proven full-thickness RC tear, who had failed conservative management of at least 6 months duration and who had a complete passive range of motion of the affected shoulder were enrolled in the trial.
Patients were randomized to TEDR repair (n=40) or SR repair (n=40).
Subgroup analysis was conducted for tears < 3 cm (TEDR n = 17, SR n=19) and tears > 3 cm (TEDR n=23, SR n=21).
Primary outcomes included the Oxford Shoulder Score (OSS), the University of California, Los Angeles score (UCLA), and the Constant-Murley Outcome Score (CMS).
The secondary outcomes included a 0-100 mm Visual Analogue Scale (VAS) for pain, range of motion (ROM) and EQ-5D.
All patients completed a follow-up period of three years.
There was a significant difference in the mean OSS postoperative score for tears >3cm (p=0.01) and mean improvement from baseline in the TEDR group (p=0.001).
For tears >3cm, mean postoperative scores were also significantly higher in the TEDR group for UCLA (p=0.015) and CMS (p=0.001).
Post Hoc testing showed that the differences between these groups was statistically significant (p<0.05).
For tears <3cm, a significant postoperative difference in favor of SR repair was seen with mean CMS (p=0.011), and post hoc testing showed that the difference was statistically significant (p=0.015).
No significant difference was seen with mean postoperative OSS or UCLA and post hoc testing did not show a statistically significant difference between groups.
TEDR repair showed improved functional outcomes for tears greater than 3cm when compared to SR repair.
For tears less than 3cm, no clear benefit was seen with either technique.
Level of evidence Level I; Randomized Controlled Trial; Treatment Study

Author : Zahra Jaffry

Objectives :
To investigate the impact of COVID-19 on the
well-being of surgeons and allied health professionals as
well as the support provided by their institutions.
Design This cross-sectional study involved distributing an
online survey through medical organisations, social media
Platforms and collaborators:
Setting It included all staff based in an operating theatre
environment around the world.
Participants 1590 complete responses were received
from 54 countries between 15 July and 15 December
2020. The average age of participants was 30–40 years
old, 64.9% were men and 32.5% of a white ethnic
background. 79.5% were surgeons with the remainder
being nurses, assistants, anaesthetists, operating
department practitioners or classified other.
Main outcome measures Participants that had
experienced any physical illness, changes in mental
health, salary or time with family since the start of the
pandemic as well as support available based on published
Results 32.0% reported becoming physically ill. This
was more likely in those with reduced access to personal
protective equipment (OR 4.62; CI 2.82 to 7.56; p<0.001)
and regular breaks (OR 1.56; CI 1.18 to 2.06; p=0.002).
Those with a decrease in salary (29.0%) were more
likely to have an increase in anxiety (OR 1.50; CI 1.19
to 1.89; p=0.001) and depression (OR 1.84; CI 1.40
to 2.43; p<0.001) and those who spent less time with
family (35.2%) were more likely to have an increase in
depression (OR 1.74; CI 1.34 to 2.26; p<0.001). Only
36.0% had easy access to occupational health, 44.0%
to mental health services, 16.5% to 24/7 rest facilities
and 14.2% to 24/7 food and drink facilities. Fewer
measures were available in countries with a low Human
Development Index:
Conclusions :
This work has highlighted a need and
strategies to improve conditions for the healthcare
workforce, ultimately benefiting patient care.

Author : Mohamed A. Imam



The aim of our prospective multicentre study is to evaluate the five-year follow-up outcomes of primary reverse shoulder replacement utilizing two different designs of glenoid baseplates.
There were 159 reverse shoulder replacements (91 cemented and 68 uncemented stems, 67 Trabecular Metal baseplates and 92 Anatomical Shoulder baseplates in 152 patients (99 women) with a mean age of 74.5 (58–90) years. The principal diagnosis was rotator cuff arthropathy in 108 shoulders.
Clinical and functional results improved significantly overall; the adjusted Constant Murley score improved from 28.2 ± 13.3 pre-operatively to 75.5 ± 22.8 ( p < 0.0001) and the mean Subjective Shoulder Value improved from 27.5 ± 20 to 73.8 ± 21.3 points ( p < 0.0001).
Radiologically, there was good bony stability in 88% and 86% of cemented and uncemented stems without significant impact on the Constant Murley score and Subjective Shoulder Value at one, two and five years post-surgery.
There were no significant clinical differences between Trabecular Metal and Anatomical Shoulder baseplates at five years.
There were four cases of intraoperative shaft fractures that were managed with cables.
Although the Trabecular Metal baseplates showed better integration radiologically, there was no significant difference in the mean of Constant Murley, Subjective Shoulder Value and the range of motion depending on the grade of inferior scapular notching at one-, two- and five-year intervals.
Conclusions :
Reverse total shoulder arthroplasty restores the function in shoulder with significant improvements in function and moderate complications with minor differences between both designs of baseplates that were not reflected clinically

Author : Mohamed Imam



To assess the impact of the COVID-19 pandemic on the outcomes of the patients who underwent trauma surgery during the peak of the pandemic.
The UKCoTS collected the postoperative outcomes of consecutive patients who underwent trauma surgery across 50 centres during the peak of the pandemic (April 2020) and during April 2019.
Patients who were operated on during 2020 were less likely to be followed up within a 30-day postoperative period (57.5% versus 75.6% p <0.001).
The 30-day mortality rate was significantly higher during 2020 (7.4% versus 3.7%, p <0.001).
Likewise, the 60-day mortality rate was significantly higher in 2020 than in 2019 (p <0.001).
Patients who were operated on during 2020 had lower rates of 30-day postoperative complications (20.7% versus 26.4%, p <0.001).
Postoperative mortality was higher during the first wave of the COVID-19 pandemic compared to the same period in 2019, but with lower rates of postoperative complications and reoperation.

Author : Benjamin John Floyd Dean

Current National Institute for Health and Clinical Excellence (NICE) guidance advises that MRI
direct from the emergency department (ED) should be considered for suspected scaphoid
This study reports the current management of suspected scaphoid fractures in the
UK and assesses adherence with NICE guidance.
This national cross- sectional study was carried out at 87 NHS centres in the UK involving
122 EDs and 184 minor injuries units (MIUs). The primary outcome was availability of MRI
imaging direct from the ED.
We also report the specifics of patient management pathways
for suspected scaphoid fractures in EDs, MIUs, and orthopaedic services. Overall, 62 of 87
centres (71%) had a guideline for the management of suspected scaphoid fractures.
A total of 11 of 87 centres (13%) had MRI directly available from the ED. Overall, 14 centres
(17%) used cross- sectional imaging direct from the ED: MRI in 11 (13%), CT in three (3%),
and a mixture of MRI/CT in one (1%). Four centres (6%) used cross- sectional imaging direct
from the MIU: MRI in three (4%) and CT in two (2%). Of 87 centres’ orthopaedic specialist
services, 74 (85%) obtained repeat radiographs, while the most common form of definitive
imaging used was MRI in 55 (63%), CT in 16 (19%), mixture of MRI/CT in three (3%), and
radiographs in 11 (13%).
Only a small minority of centres currently oer MRI directly from the ED for patients with a
Suspected scaphoid fracture:
Further research is needed to investigate the facilitators and
barriers to the implementation of NICE guidance

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