Journal of Musculoskeletal Research

Volumes of interest (VOI) are commonly assigned to image stacks generated from micro-computed tomography to specify areas for bone quantification. However, the size of the VOI can impact the values obtained for trabecular bone parameters. This study aims to investigate the effect of VOI size by applying VOIs of four different diameters (10%, 15%, 20% and 30% of the antero-posterior width). Ten juvenile right distal femora were included, aged from pre-natal to three years. Smaller VOIs were placed within the largest VOI, with multiple locations used for the same VOI size. The observed parameters included bone volume fraction (BV/TV), trabecular bone thickness (Tb.Th), separation (Tb.Sp), number (Tb.N), degree of anisotropy by mean intercept length (DA.MIL) and star volume distribution (DA.SVD). Statistically significant differences between VOI sizes were found for Tb.Sp, Tb.N, DA.MIL and DA.SVD. A possible effect of localized variation was found due to significantly different values for Tb.Th between VOI locations. The effect related to VOI geometry was reflected by DA.MIL and DA.SVD as no significant difference was found between locations. The minimum diametric strut quantity (DSQ, diameter multiplied by Tb.N) of 4 can be implied based on the zero DA.SVD value found in particular VOIs.

Introduction: One of the most challenging and serious complications associated with total joint arthroplasty is prosthetic joint infection (PJI). Advancements in prevention, diagnosis, and treatment of PJI seem promising. Accurate identification of the causal pathogen is a key factor for successful treatment and also for choosing antibiotic treatment. This study was aimed to evaluate the prevalence of PJI and distribution of causative pathogen using microbiological culture and pathological examination.

Methods: A retrospective descriptive study was conducted by collecting data from our center registry from 2018 to 2020. The inclusion criteria of this study were patients diagnosed with hip or knee PJI based on the diagnostic criteria for PJI. The exclusion criteria were incomplete microbiology data which were either refusal to participate or loss of contact. The data extracted from medical records are demographic data such as age, sex, and microbiology and pathological examination data.

Results: A total of 1359 total hip/ knee arthroplasty surgeries were performed during the years 2018–2020. Among them, 1031 were total knee arthroplasty (TKA) and 321 were total hip arthroplasties (THA). During the same period, a total of 52 patients with PJI were treated at our center. There were 31 knee PJI cases (59.61%) and 21 were hip PJI cases (40.38%). Microbiology culture and pathologic anatomy results showed gram positive Staphylococcus sp bacteria, which was the common causal pathogen of PJI. Negative culture results were found in 10/52 (19.23%) of cases.

Conclusions: Staphylococcus sp was the most common causal pathogen of Hip/ Knee PJI in our center. Relatively high rate of culture-negative PJI was observed in this study, further strategies are needed to increase the rate of causal pathogen isolation in hip/ knee PJI cases in our center.

Background: Press-fit implantation of a porous-coated acetabular component without screws can be used for total hip arthroplasty (THA). The purpose of this report is to determine adequate initial stability of the acetabular component by applying a novel method would allow us to avoid screw use and to evaluate the outcomes of an oversized hemispherical cup using the 1 mm press-fit technique.

Methods: We retrospectively evaluated 119 consecutive patients who underwent THA from February 2011 to June 2015. The intra-operative stability of fixation was checked by trying to pull the metal shell out of the acetabulum using the shell holder (pull-out test). We confirmed these tests using a digital hand scale. When we reached 9 to 10 kg (1 kg = 9.81 N), we showed that the acetabular shell achieved good stability. Kaplan-Meier survivorship analysis was performed to calculate the survival rate of the acetabular component.

Results: The mean follow-up was 6.9 years (5–10 years). No component was revised because of loosening, and all implants were radiologically stable within the observation period. One socket had been revised because of failure of dislocation, which had $68^{\circ }$ acetabular inclination. There was an acetabular fracture in one hip, which was operated on prior to THA.

Conclusions: We used a new method to assess the initial stability gained using the press-fit technique, which may allow the surgeon to determine whether adequate initial stability is achieved. Cup position has a significant impact on the risk of revision of press-fit cementless acetabular component. The risk for early failure can be decreased by optimal cup positioning during primary implantation. In addition, while a stable bone-implant connection is desirable, fracture of the acetabulum can be avoided using the 1 mm press-fit technique.

Purpose: The use of evidence-based assessment tools is important to differentiate, give prognosis and guide the therapeutic approaches in sciatica. We aimed to evaluate whether physiotherapists’ knowledge and clinical practice in Greece are aligned with up-to-date research recommendations in the assessment of sciatica.

Methods: An online-survey was developed, validated and disseminated in registered physiotherapists in Greece. The survey designed to capture physiotherapists’ demographic characteristics, knowledge and use of patient-reported outcome measures (PROMs), classification systems and neurological tests in sciatica. Descriptive statistics were used to analyze the data.

Results: 381 physiotherapists participated in the survey. Most of the participants reported that at least one or more of the proposed PROMs (85.5%), classification system (87%) or neurological tests (95%). 75.6% of responders use one or more PROMs during the management of patients with sciatica. Pain intensity evaluation tools are the most commonly used (35.9%) followed by disability or psychosocial evaluation scales (25.9% and 22.5%, respectively). 38.8% of participants use the McKenzie classification while almost 90% use common neurological examination tests (myotomes, sensory tests, reflexes, straight-leg-raise, slump and femoral slump test). No association was found between participants’ characteristics and number of assessment tools known or used.

Conclusions: Our findings suggest that physiotherapy practice in Greece is aligned to research recommendations only in terms of delivering common neurological physical examination tests. The knowledge and clinical use of evidence-based tools to assess the treatment outcome and classify patients with sciatica is limited. Further training and organizational or peer support are required to improve the management of the condition.

Purpose: Osteoarthritis (OA) is a complex disease of joints presenting with pain, swelling, stiffness, crepitus, deformation and limitation of function. There are both conservative and surgical modes of treatment for OA. This study is done to compare the therapeutic efficacy of intra-articular ozone, platelet-rich plasma (PRP) and 25% dextrose in the treatment of OA of the knee joint in early stages.

Methods: A total of 120 patients with symptomatic Kellgren and Lawrence grade 2 and 3 of knee OA were studied. They were randomized into three groups and each group received three doses of intra-articular injections of either ozone or PRP or 25% dextrose at intervals of 2 weeks. Patients were advised physiotherapy and analgesics were avoided. Western Ontario and McMaster Universities Arthritis Index and Visual Analog Score for pain were used to evaluate the clinical outcomes for 6 months.

Results: Ozone provided significant relief from pain and improved functionality but was short-lived. PRP and 25% dextrose results were slower initially but gave better results for a longer duration.

Conclusion: Conservative treatment with intra-articular injections has promising results in the treatment of OA. This can be used in patients who are not willing or not fit for surgery.

Introduction: An immense knowledge about the shape of the glenoid cavity is necessary for TSA. This study aims to evaluate the dimension of the glenoid cavity and to compare the morphological measures of scapula between genders.

Materials and methods: A total of 32 males and 32 females were selected for the shoulder scan and the measurements were taken in 2D axial plane and 3D reconstructed images. Statistical analysis was done using SPSS Version 21.0. $P<$ 0.05 was taken as significant.

Result: Out of five diameters that we considered in this study, the superior–inferior (SI) mean glenoid diameter is 33.09 ± 3.82 mm. The anterior–posterior average glenoid diameters AP1, AP2, AP3 and AP4 are 15.08 ± 3.03 mm, 18.12 ± 3.26 mm, 21.03 ± 2.41 mm, 22.1 ± 2.54 mm, respectively, in total population. Six angles were considered, the Axis of glenoid, Axis of scapula, Axis of humeral head, axis of the glenoid neck, Resch angle and version of glenoid, measured 132.51${}^{\circ }$± 5.46${}^{\circ }$, 43.03${}^{\circ }$± 5.04${}^{\circ }$, 132.44${}^{\circ }$± 5.04${}^{\circ }$, 58.48${}^{\circ }$± 6.42${}^{\circ }$, 72.92${}^{\circ }$± 4.79${}^{\circ }$, − 5.21${}^{\circ }$± 1.45${}^{\circ }$, respectively, for the total population. The specific cut-off points for SI, AP1, AP2, AP3 and AP4 are 35, 15.35, 18.1, 21.55 and 22.65, respectively.

Conclusion: The morphological measures such as Axis of glenoid, Axis of humeral head, Resch angle and Axis of scapula show that there exists a statistically significant difference between two genders. Hence, these four measures have a vital role in gender identification of an unknown scapula. All the diameters in this study have got specific cut-off points and it will be most useful to discriminate the gender from an unknown scapula.

Introduction: Carpet weaving is one of the most common occupations in Iran. Studies have shown that the majority of workers in these industries are women and these people are exposed to high occupational risks such as musculoskeletal disorders (MSDs). This study aimed to evaluate the hands activity level and upper extremity work-related musculoskeletal disorders (UEWMSDs) symptoms in female carpet weavers (FCWs).

Methods: This case-control observational study was performed on 150 FCWs of a carpet weaving workshop as a case group and 150 office staff as a control group. In order to assess the risk factors for UEWMSDs, the Hand Activity Level-Threshold Limit Value (HAL-TLV) method was used. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used to assess the prevalence of UEWMSDs symptoms in the past year. Data were analyzed using SPSS-V 24.

Results: The mean final scores of the HAL_TLV for the case and control groups were 1.04 and 0.15, respectively. The results of the statistical analysis showed a statistical significant difference between the mean of HAL, NPF, and HAL_TLV variables in case and control groups ($P$ $<$ 0.001). Also, the results showed a statistical significant difference between the mean scores of the incidence of discomfort in the Shoulder, Forearm, and Wrist areas in the case and control groups ($P$ $<$ 0.001).

Conclusion: The results of this study show the effect of increasing the level of hand activity on UEWMSDs symptoms. To reduce the level of hand activity and UEWMSDs symptoms in FCWs, there should be increased focus on work time, work speed, and the use of ergonomic, lightweight hand tools.

Perilunate dislocations and perilunate fracture-dislocations are high-energy wrist injuries, characterized by a spectrum of bony and ligamentous damage. Clinical presentation often includes decreased range of motion, swelling and pain, and a palpable wrist deformity, while radiographic evaluation of the wrist may reveal abnormal radiocarpal and intercarpal collinearity and bony insult. This particular trauma may be difficult to detect due to nonspecific clinic presentation and subtle imaging findings, and can be missed in up to 25% of initial evaluations. Prompt recognition is essential for optimal patient outcomes, as the majority of patients are young adults and thus duration of disability is significant.

Objective: The purpose of this study was to demonstrate the sonographic appearance of acute spontaneous anterior tibialis tendon (ATT) rupture, to describe the later sonographic appearance of ATT after 4–6–8 weeks of conservative treatment, and to describe the clinical outcome of these patients.

Methods: This was a retrospective study of seven patients, physically active men, aged 40–75, who presented with clinical symptoms suggesting ATT rupture. All patients were treated conservatively by case immobilization and went through a follow-up ultrasound examination 4–6–8 weeks afterwards, until clinical recovery. Two patients had ultrasound examination one year after the injury.

Results: All seven patients had a complete tear of the ATT with a visible gap between the torn tendon ends seen on sonography. The mean gap size at the time of initial examination was 2 cm. There was a disruption of the normal fibrillar pattern of the tendon, with non-clear fluid accumulated in the gap between the torn tendon ends. Using real-time dynamic ultrasound revealed paradoxical movement with retraction of the torn tendon ends and increasing the distance between the torn ends. All patients were treated conservatively. Sonographic follow-up examinations after 4, 6, 8 weeks revealed restoration of the tendon continuity with good active and passive movements. All seven patients demonstrated irregular and thickened tendon with echogenic scar. Clinically, at 6–8 weeks they had good range of motion (ROM) of the ankle enabling them to resume their normal daily activity.

Total hip arthroplasty (THA) is an emerging surgery in the field of orthopedics with a successful outcome in treating various problems of the hip joint. THA in hip ankylosis is a challenging procedure. Comprehensive pre-operative planning is needed to avoid complications and obtain reasonable functional outcomes. Complete history taking is needed to determine the etiology, indications, type of ankylosis (spontaneous or surgical), age since ankylosis occurred, and previous complications. Physical examination is also important and is focused on the location of the previous incision, limb length discrepancy (LLD), femoral and sciatic nerves, vascular status, pelvic obliquity, spine problems, and range of motion of the ipsilateral knee, and also of contralateral hip and knee. In addition, surgery rehabilitation also becomes one of the important points to get a good clinical outcome. We reported the results of total hip arthroplasty to treat hip ankylosis as sequelae of childhood hip pathology.