Length of Hospital Stay With Patient-Dependent Determination in Bilateral Scheduled Staged Total Knee Arthroplasty.

Length of hospital stay with patient-dependent determination in bilateral scheduled staged total knee arthroplasty.

Eur J Orthop Surg Traumatol. 2013 Jun 27;
Ishii Y, Noguchi H, Takeda M, Sato J, Suzuki T

The purpose of this study was to approach the length of hospital stay (LOS) by patient-dependent determination and evaluate the effect of contralateral total knee arthroplasty (TKA) on LOS in patients with bilateral osteoarthritis undergoing staged bilateral TKAs.One hundred sixty TKAs in 80 patients with bilateral osteoarthritis were evaluated by retrospective review of their medical records. All patients had scheduled staged bilateral TKA. We investigated the length of hospital stay in each TKA and the postoperative day when patients could perform walking and climbing up and down the stairs with one cane independently. Range of motion in each knee was also evaluated in preoperatively and before discharge. The median interval between the first and second surgeries was 12 months.The first and second TKAs showed a median LOS of 37 and 35 days, respectively, with no significant difference (n.s.). The median number of days before independently walking and climbing up and down the stairs with one cane were 8 and 16 after the first TKA and 7 and 15 after the second TKA, respectively, without significant differences (n.s. for walking, n.s. for stairs).An initial TKA that results in good function might neither facilitate an earlier second rehabilitation nor decrease the LOS. Taking other factors such economics and local conditions that largely influence LOS into account, simultaneous bilateral TKAs might be an effective treatment for bilateral knee arthritis in properly selected patients in terms of decreasing the LOS. HubMed – rehab



Eye (Lond). 2013 Jun 28;
Wallang BS, Das S

Keratoglobus is a rare noninflammatory corneal thinning disorder characterised by generalised thinning and globular protrusion of the cornea. It was first described as a separate clinical entity by Verrey in 1947. Both congenital and acquired forms have been shown to occur, and may be associated with various other ocular and systemic syndromes including the connective tissue disorders. Similarities have been found with other noninflammatory thinning disorders like keratoconus that has given rise to hypotheses about the aetiopathogenesis. However, the exact genetics and pathogenesis are still unclear. Clinical presentation is characterised by progressive diminution resulting from irregular corneal topography with increased corneal fragility due to extreme thinning. Conservative and surgical management for visual rehabilitation and improved tectonic stability have been described, but remains challenging. In the absence of a definitive standard procedure for management of this disorder, various surgical procedures have been attempted in order to overcome the difficulties. This article reviews the aetiological factors, differential diagnosis, histopathology, and management options of keratoglobus.Eye advance online publication, 28 June 2013; doi:10.1038/eye.2013.130. HubMed – rehab



Retina. 2013 Jun 25;
Czajka MP, Frajdenberg A, Johansson B

The aim of the study was to retrospectively review indications, intraoperative and postoperative complications, and outcomes of combined coaxial microincision cataract surgery and 23-gauge vitrectomy for posterior segment disease.The outcomes and findings of surgery in 50 patients (50 eyes) who underwent coaxial microincision cataract surgery and foldable intraocular lens implantation combined with 23-gauge vitrectomy for a variety of indications between January 2010 and March 2012.No posterior capsule tear was observed during surgery. Intraoperatively, a retinal break was found in 9 eyes (18%), which were successfully treated with laser and/or cryotherapy. Corneal suture was done in 6 eyes (12%), 5 of them left and 1 right. Sclerotomy was sutured in 2 left and 2 right eyes, respectively, a total of 4 eyes (8%). In 1 case, 23-gauge vitrectomy was converted to 20-gauge vitrectomy. The postoperative intraocular pressure (millimeters of mercury, mean ± standard deviation) was 16.7 ± 9.8. Hypotony (intraocular pressure < 9 mmHg) occurred in 9 eyes (18%). In 1 eye (2%) posterior iris synechia were observed 2 weeks after surgery, and intraocular pressure was >40 mmHg. Intraocular pressure was normalized after Nd:YAG laser iridotomy. Fibrin reaction in the anterior chamber was observed in 1 eye (2%) Day 1 after surgery. Posterior capsule opacification, which required Nd:YAG laser capsulotomy, was observed in 11 eyes (22%) during the follow-up.Combined sutureless coaxial microincision cataract surgery and 23-gauge vitrectomy offers the advantages of both coaxial microincision cataract surgery (less wound leakage, good anterior chamber stability, and safety) and 23-gauge vitrectomy (decreased inflammation and faster rehabilitation after surgery). HubMed – rehab


Fat Grafts Supplemented with Adipose-Derived Stromal Cells in the Rehabilitation of Patients with Craniofacial Microsomia.

Plast Reconstr Surg. 2013 Jul; 132(1): 141-152
Tanikawa DY, Aguena M, Bueno DF, Passos-Bueno MR, Alonso N

Although first reports of the clinical use of adipose-derived stromal cells suggest that this approach may be feasible and effective for soft-tissue augmentation, there is a lack of randomized, controlled clinical trials in the literature. Thus, this study aimed to investigate whether a faster protocol for isolation of adipose-derived stromal cells and their use in combination with fat tissue improve the long-term retention of the grafts in patients with craniofacial microsomia.Patients with craniofacial microsomia (n = 14) were grafted either with supplementation of adipose-derived stromal cells (experimental group) or without supplementation of adipose-derived stromal cells (control group). The number of viable cells isolated before and after the supplementation of the grafts was calculated, and these cells were examined for mesenchymal cell surface markers using flow cytometry. Computed tomography was performed to assess both hemifaces preoperatively and at 6 months postoperatively.The average number of viable cells isolated before and after the supplementation of the grafts was 5.6 × 10 and 9.9 × 10 cells/ml of fat tissue (p = 0.015). Flow cytometric analysis revealed that the adipose-derived stromal cells were positive for mesenchymal cell markers (>95 percent for CD73 and CD105). Surviving fat volume at 6 months was 88 percent for the experimental group and 54 percent for the control group (p = 0.003).These results suggest that this strategy for isolation and supplementation of adipose-derived stromal cells is effective, safe, and superior to conventional lipoinjection for facial recontouring in patients with craniofacial microsomia.Therapeutic, II. HubMed – rehab


A video-based learning activity is effective for preparing physiotherapy students for practical examinations.

Physiotherapy. 2013 Jun 24;
Weeks BK, Horan SA

To examine a video-based learning activity for engaging physiotherapy students in preparation for practical examinations and determine student performance outcomes.Multi-method employing qualitative and quantitative data collection procedures.Tertiary education facility on the Gold Coast, Queensland, Australia.Physiotherapy students in their first year of a two-year graduate entry program.Questionnaire-based surveys and focus groups were used to examine student perceptions and satisfaction. Surveys were analysed based on the frequency of responses to closed questions made on a 5-pont Likert scale, while a thematic analysis was performed on focus group transcripts. t-Tests were used to compare student awarded marks and examiner awarded marks and evaluate student performance.Sixty-two physiotherapy students participated in the study. Mean response rate for questionnaires was 93% and eight students (13%) participated in the focus group. Participants found the video resources effective to support their learning (98% positive) and rating the video examples to be an effective learning activity (96% positive). Themes emergent from focus group responses were around improved understanding, reduced performance anxiety, and enjoyment. Students were, however, critical of the predictable nature of the example performances. Students in the current cohort supported by the video-based preparation activity exhibited greater practical examination marks than those from the previous year who were unsupported by the activity (mean 81.6 SD 8.7 vs. mean 78.1 SD 9.0, p=0.01).A video-based learning activity was effective for preparing physiotherapy students for practical examinations and conferred benefits of reduced anxiety and improved performance. HubMed – rehab