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Introduction: Studies that evaluate Middle Eastern patients who have long-term survival after coronary artery revascularization are scarce. The prevalence of diabetes mellitus (DM) is high and rapidly increasing in our region., Methods: The study enrolled consecutive ambulatory or in-patients who had percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery at least 10 years earlier. Collected data included cardiovascular risk factors at the time of the index revascularization and evolution of risk factors since then, the occurrence of cardiovascular events, and the need for coronary revascularization after the index procedure. Events were compared between patients with DM and no DM at baseline., Results: The study population consisted of 891 consecutive patients with 351 patients (39.4%) had DM and 540 patients (60.6%) had no DM. The mean age at baseline was 53.9 ± 8.8 years for DM patients and 53.0 ± 9.8 years for no DM patients ( P = 0.16). At baseline, the DM group had more hypertension (70.9% vs. 27.6%, P < 0.0001), more dyslipidemias (12% vs. 5.2%, P = 0.001) but less smokers compared to no DM group (44.4% vs. 58.3%, P < 0.001). DM and no DM groups had similar proportion of PCI (65.5% vs. 68.3%, P = 0.42) and CABG (34.5% vs. 31.7%, P = 0.43) at baseline. Following the index revascularization procedure, acute coronary events, heart failure, and stroke developed in similar proportions in the two groups. Repeat revascularization after the index procedure showed that the DM group had more PCI compared to no DM group (52.7% vs. 45.4%, P = 0.04) but similar proportions of CABG (7.1% vs. 9.8%, P = 0.20)., Conclusions: In this retrospective observation of Middle Eastern patients who survived at least a decade after coronary revascularization, the DM group had more hypertension and dyslipidemias but fewer smokers compared to no DM at baseline. During follow-up, the DM group required more PCI revascularization compared with no DM group., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Heart Views.)

Background: The purpose of this study was to assess the degree of mismatch between intraoperative navigation data using imageless computer navigation and post-operative CT scan measurements with respect to bone cuts, component and limb alignment during TKA., Methods: Intraoperative navigation data including bone cut verification and overall limb alignment during TKA was compared to postoperative CT measurements of component and limb alignment according to the Perth protocol. The proportion of cases with mismatch between navigation and CT measurements at two and three degree thresholds was identified., Results: In a total sample of 50 primary TKAs, 20% of cases showed a mismatch of more than two degrees between navigation and CT obtained measurements for coronal femoral alignment, 42% for femoral rotation, 16% for tibial component coronal alignment and 32% for overall limb alignment., Conclusion: Mismatch between intraoperative navigation data and postoperative CT measurements suggests that postoperative CT scan alignment data should be interpreted with caution. A surgeon should consider a multitude of factors when analysing component and limb alignment postoperatively., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The aim of this study was to investigate whether the application time of bone cement would have an effect on the cement-bone interface strength in two types of commercially available bone cements. CMW1 Radiopaque(®) (CMW1) and SmartSetHV(®) (SmartSet) were applied to bovine cancellous bone specimens at 2 and at 4 min. Specimens were loaded to failure and the shear strength of the cement-bone interface was calculated. The mean shear strength (±standard deviation) of the cement-bone interface was 2.79 ± 1.29 MPa for CMW1 applied at 2 min; 1.35 ± 0.89 MPa for CMW1 applied at 4 min; 2.93 ± 1.21 MPa for SmartSet applied at 2 min and 3.00 ± 1.11 MPa for SmartSet applied at 4 min. Compared to all other groups, the cement-bone interface strength was significantly lower when CMW1 was applied to the bone specimens at 4 min (p < 0.05). There was no significant difference in the cement-bone interface strength when SmartSet was applied to bone at 2 and at 4 min. Under these testing conditions, the cement-bone interface strength was not affected by the time of application of SmartSet to bone. However, it was significantly lower when CMW1 was applied to bone at 4 min.

Aim: To compare seven commercially available bone graft substitutes (BGS) in terms of these properties and without using any additional biological growth factors., Methods: Porcine osteoprogenitor cells were loaded on seven commercially available BGS and allowed to proliferate for one week followed by osteogenic induction. Staining for live/dead cells as well as scanning electron microscopy (SEM) was carried out to determine viability and cellular binding. Further outcome measures included alkaline phosphatase (ALP) assays with normalisation for DNA content to quantify osteogenic potential. Negative and positive control experiments were carried out in parallel to validate the results., Results: Live/dead and SEM imaging showed higher viability and attachment with β-tricalcium phosphate (β-TCP) than with other BGS (P < 0.05). The average ALP activity in nmol/mL (normalised value for DNA content in nmol/μg DNA) per sample was 657.58 (132.03) for β-TCP, 36.22 (unable to normalise) for calcium sulphate, 19.93 (11.39) for the Hydroxyapatite/Tricalcium Phosphate composite, 14.79 (18.53) for polygraft, 13.98 (8.15) for the highly porous β-Tricalcium Phosphate, 5.56 (10.0) for polymers, and 3.82 (3.8) for Hydroxyapatite., Conclusion: Under the above experimental conditions, β-TCP was able to maintain better the viability of osteoprogenitor cells and allow proliferation and differentiation (P < 0.05).

Background: To examine the safety and efficacy of topical use of tranexamic acid (TA) in total knee arthroplasty (TKA)., Methods: An electronic literature search of PubMed Medline; Ovid Medline; Embase; and the Cochrane Library was performed, identifying studies published in any language from 1966 to February 2013. The studies enrolled adults undergoing a primary TKA, where topical TA was used. Inverse variance statistical method and either a fixed or random effect model, depending on the absence or presence of statistical heterogeneity were used; subgroup analysis was performed when possible., Results: We identified a total of seven eligible reports for analysis. Our meta-analysis indicated that when compared with the control group, topical application of TA limited significantly postoperative drain output (mean difference: -268.36ml), total blood loss (mean difference=-220.08ml), Hb drop (mean difference=-0.94g/dL) and lowered the risk of transfusion requirements (risk ratio=0.47, 95CI=0.26-0.84), without increased risk of thromboembolic events. Sub-group analysis indicated that a higher dose of topical TA (>2g) significantly reduced transfusion requirements., Conclusions: Although the present meta-analysis proved a statistically significant reduction of postoperative blood loss and transfusion requirements with topical use of TA in TKA, the clinical importance of the respective estimates of effect size should be interpreted with caution., Level of Evidence: I, II., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The Achilles tendon is the most frequently ruptured tendon in the lower limb and comprises approximately 20% of all large tendon ruptures.Spontaneous rupture of the Achilles tendon is usually observed in healthy, active individuals in the third to fifth decades of life and is twice as common in males. It usually occur following high-performance activities.The authors report a case of unusual presentation of bilateral simultaneous Achilles tendon ruptures that occurred following a low-effort-level sport and in the absence of risk factors. In the case presented, nonoperative treatment led to a successful outcome.

Unlabelled: The Achilles tendon is the most frequently ruptured tendon in the lower limb and comprises approximately 20% of all large tendon ruptures. Spontaneous rupture of the Achilles tendon is usually observed in healthy, active individuals in the third to fifth decades of life and is twice as common in males. It usually occurs following high-performance activities. The authors report a case of unusual presentation of bilateral simultaneous Achilles tendon ruptures that occurred following a low-effort-level sport and in the absence of risk factors. In the case presented, nonoperative treatment led to a successful outcome., Level of Evidence: Therapeutic, Level IV, retrospective case study.

Objective: To compare the cost implications of treatment of persistent fracture non-unions before and after application of recombinant human bone morphogenetic protein-7 (BMP-7)., Method: Of 25 fracture non-unions, 9 were treated using BMP-7 alone and 16 using BMP-7 and bone grafting. These patients were prospectively followed up, and the costs incurred were analysed., Results: The mean number of procedures per fracture performed before application of BMP-7 was 4.16, versus 1.2 thereafter. Mean hospital stay and cost of treatment per fracture before receiving BMP-7 were 26.84 days and pound 13,844.68, versus 7.8 days and pound 7338.4 thereafter. The overall cost of treatment of persistent fracture non-unions with BMP-7 was 47.0% less than that of the numerous previous unsuccessful treatments (p=0.001)., Conclusions: Treating fracture non-unions is costly, but this could be reduced by early BMP-7 administration when a complex or persistent fracture non-union is present or anticipated.

Total ankle arthroplasty has become an increasingly performed procedure for the treatment of ankle arthritis. Failures related to polyethylene inserts can result from uncorrected deformities or malalignment of the components. We report a case of a 63-year-old man who underwent total ankle arthroplasty for osteoarthritis of the ankle. The talar component was placed in neutral alignment. Initial postoperative recovery and rehabilitation were unremarkable. At 9 months postoperatively, plain radiographs of the ankle showed worsening varus tilt when compared with radiographs taken earlier. There was also radiographic evidence of separation of the posterior metal marker, suggestive of a fracture of the polyethylene insert. Revision surgery to correct the varus tilt and replace the polyethylene insert was performed. At operation, the polyethylene insert was found to be intact with no evidence of fracture. The posterior metal marker of the polyethylene insert was found to be extruded from the insert. Small degrees of ankle prosthesis malalignment can lead to various degrees of polyethylene liner failure, such as metal marker extrusion. This article also shows that these metal markers may not be accurate indicators of the integrity of the polyethylene insert.

Recombinant human activated protein C (rhAPC) also known as drotrecogin alfa (activated) has known antithrombotic, anti-inflammatory, and profibrinolytic properties in severe sepsis. Treatment with rhAPC (Xigris) has been shown to reduce mortality in patients with severe sepsis. The lack of any trials of rhAPC in trauma patients means that a definitive recommendation regarding its use in the polytraumatised patient, in whom severe head trauma or other contraindications for the use of rhAPC have been excluded remains controversial at present. This article describes the current evidence of its efficacy and safety in severe sepsis with relation to surgery and trauma.