Anderson Orthopaedic Clinic

The measurement of glenoid and reverse total shoulder arthroplasty (rTSA) inclination has both clinical and research relevance. The purpose of this study was to better understand if and how much radiographic projection and scapula position affect the perception of glenoid inclination. Twenty computed-tomography (CT) scans of arthritic shoulders were used to create digitally reconstructed radiographs (DRR) through 3° increments of inclination, retraction and protraction on a scapular coordinate system. The reverse total shoulder arthroplasty (rTSA) and total shoulder arthroplasty (TSA) angles were measured on each image. The mean range (difference between maximum and minimum values) of rTSA and TSA angle measurements based on simulation of scapula inclination was 14° and 17°, respectively. Nineteen of 20 cases showed a trend towards a higher rTSA and TSA angle with greater forward inclination. With simulated scapula retraction, the maximum difference between rTSA and TSA angle measurements was a mean 11° and 14°, respectively. With simulated scapula protraction, the maximum difference observed for rTSA and TSA angle measurements based was a mean 14° and 11°, respectively. Scapula protraction and retraction did not produce consistent or linear trends in rTSA or TSA angle measurement. The radiographic measurement of rTSA and TSA angles is moderately variable based on scapula protraction, retraction and inclination. Forward inclination may increase the perception of superior tilt.

Background The increasing prevalence of total knee arthroplasty (TKA) owing to population aging imposes a considerable financial burden on healthcare systems. In this study, we analyzed the cost structure of TKA in Japan, where comprehensive cost data beyond hospital length of stay (LOS) are limited. Methods We retrospectively analyzed 100 consecutive TKAs (89 patients) for primary osteoarthritis performed by a single surgeon between April 2017 and December 2024. LOS was determined based on patient satisfaction and confidence in daily life, without premature discharge owing to medical reasons. The primary outcome measures were total hospital cost (THC) and its components: admission management (AM), surgery, surgery-related expenses, and rehabilitation. We also evaluated the impact of age, sex, body mass index, operation time, American Society of Anesthesiologists grade, clinical scores, and LOS on these costs. Results The median LOS was 31 days, with a median THC of JPY 2,268,700 (approximately USD 15,125, based on an exchange rate of USD 1 to JPY 150). The four components of THC accounted for nearly equal proportions between 24.0 % (585,194/2,268,670) and 25.7 % (582,970/2,268,670). THC was strongly correlated with LOS (r=0.751, p<0.001) and weakly correlated with age (r=0.364, p<0.001). After adjusting for multiple comparisons, LOS, AM, and rehabilitation remained significantly and positively associated with THC. Conclusions We observed that in the Japanese fee-for-service healthcare system, where surgical fees are typically fixed, prolonged LOS greatly increased hospital administrative and rehabilitation expenses. Conversely, under patient-centered discharge criteria, the near-equivalent cost structure also suggested the requirement for a certain period of comprehensive inpatient care. These findings underscore the need for novel strategies to optimize LOS and control THC.

IntroductionMulti-staged and personalized in nature, psychosocial interventions for cardiac surgery patients explain the necessity of relying on the potential of interdisciplinary interactionObjectivesTo present the review of the model of interdisciplinary interaction of experts and institutions in the course of psychosocial interventions for cardiac surgery patients, which is currently used in the Chuvash Republic.MethodsThis model involves the experts and institutions of the regional healthcare system, the regional system of social care, the regional and federal system of education, non-governmental medical and health resort institutions, and private practitioners.ResultsIn the center of this model is the Regional Cardiology Center, which interacts with the Psychotherapeutic Center and the Republican Mental Hospital’s Helpline. It also involves the town hospitals and the central district hospitals, non-governmental clinics and private practitioners. The process of rehabilitation and follow-up care continues in the regional health resorts. The social service centers provide additional support. The institute of chief experts of the regional Health Care Ministry, which includes a psychiatrist, cardiologist, psychotherapist, and psychologist, oversees the overall activity. The clinic faculty professors and associate professors are involved in the development of the programs.ConclusionsThe practical results of using the regional model of interdisciplinary interaction enhance the potential of psychosocial interventions for cardiac surgery patients.Disclosure of InterestNone Declared

BACKGROUND: The annual increase in operative deliveries in obstetrics is steadily leading to an increase in the number of women with placenta accreta spectrum disorders. Cesarean section in patients with placenta accreta spectrum can be done only by surgeons of the highest qualification in operating rooms with the best technical equipment. Every year, the surgical delivery techniques for such patients get better and better, pursuing the goal of preserving the uterus and minimizing intraoperative complications and blood loss.&#x0D; AIM: The aim of this study was to assess the effectiveness of the intraoperative bladder filling technique during delivery in patients with placenta accreta spectrum.&#x0D; MATERIALS AND METHODS: All patients were randomly divided into two groups: 22 pregnant women (Group 1) who underwent caesarean section with metroplasty using intraoperative bladder filling technique and 19 pregnant women (Group 2) who underwent caesarean section with metroplasty without bladder filling. We analyzed the course of the operation, the measures taken to prevent blood loss, the time and scope of surgery, as well as surgical complications. Statistical analysis was performed using the non-parametric Mann-Whitney U-test and Fishers exact test.&#x0D; RESULTS: Patients of the both study groups were comparable in age, number of pregnancies in history, number of medical abortions, spontaneous abortions and non-developing pregnancies, as well as in the number of uterine scars in history. The total blood loss was 2177.8 114.9 ml in Group 1 and 2545.7 158.8 ml in Group 2 (p 0.05). Duration of surgery was 2 hours 45 7.1 minutes in Group 1 and 3 hours 31 4.1 minutes in Group 2. The bladder injury occurred in one patient in Group 1 in three patients in Group 2 (p 0.05).&#x0D; CONCLUSIONS: In patients with placenta accreta spectrum, the use of the bladder filling technique and mobilization of the bladder during cesarean section with metroplasty can reduce the percentage of intraoperative complications (incidence of bladder injury), intraoperative blood loss and the duration of surgery.

BACKGROUNDFemoral and tibial stress injuries are commonly found in long distance running athletes. Stress fractures have rarely been reported in athletes performing high intensity interval training (HIIT) exercise. The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises. CASE SUMMARYA 26 year old female presented with bilateral medial tibial pain. She had been performing HIIT exercise for 45 min, five times weekly, for a seven month period. Her tibial pain was gradual in onset, and was now severe and worse on exercise, despite six weeks of rest. Magnetic resonance imaging (MRI) revealed bilateral medial tibial stress syndrome. As she was taking norethisterone for birth control, a dual energy X-ray absorbitometry scan was performed which demonstrated normal bone mineral density of her lumbar spine and femoral neck. She was managed conservatively with analgesia and physiotherapy, but continued to exercise against medical advice. She presented again six months later with severe right hip pain. MRI of her right hip demonstrated an incomplete stress fracture of her subtrochanteric region. Her symptoms resolved with strict rest and physiotherapy. CONCLUSIONHIIT may cause stress injury of the tibia and femur in young individuals.