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The Burden of Orthopedic Surgery

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 27021

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Prof. Dr. Umile Giuseppe Longo

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Guest Editor

Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
Interests: sports traumatology; arthroscopic surgery of shoulder, knee, and ankle; replacement surgery of shoulder, knee, and hip
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Prof. Vicenzo Denaro

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Full Professor and Consultant in Trauma and Orthopaedic Surgery, Department of Trauma and Orthopaedic Surgery, University Campus Bio-Medico of Rome, Via Álvaro Del Portillo, 200, 00128 Roma, Italy
Interests: spine surgery (scoliosis, spondylolisthesis, spinal stenosis, spinal disc herniation, myelopathy); hip, knee, and shoulder replacement surgery; foot surgery; hand surgery
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Special Issue Information

Dear Colleagues,

On behalf of IJERPH, we are organising a Special Issue about the burden of orthopaedic surgery. IJERPH is a peer-reviewed scientific journal that publishes manuscripts in the interdisciplinary area of environmental health sciences and public health.

Due to the impact in terms of morbidity, long-term disability and health-related quality of life, musculoskeletal disorders are one of the most common reasons for medical examination. Orthopaedic surgery is often the optimal treatment for a broad range of different diseases. With increasing age and population, the number of surgical procedures, payment for medical care and direct and indirect costs go beyond the clinical practice leading to a significant socioeconomic burden. The current literature highlights the need for studies addressing the potential associations between effective health care and management strategies with the aim to improve the standard of care and reduce associated costs.

Therefore, the purpose of this Special Issue is to gather researches that highlight the burden of orthopaedic surgery in terms of the epidemiological impact of specific musculoskeletal diseases, quality of life reduction, and the cost-effectiveness of surgical strategies. We welcome preliminary studies, original research papers, and systematic reviews, as well as meta-analyses.

Prof. Umile Giuseppe Longo
Prof. Vicenzo Denaro
Guest Editors

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Keywords

Musculoskeletal disorders
Surgical procedure
Orthopaedic surgery
Health care systems
Quality of life
Epidemiology
Interdisciplinary medicine

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Published Papers (8 papers)

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Research

9 pages, 599 KiB

Open AccessArticle

Minimal Clinically Important Difference and Patient Acceptable Symptom State for the Pittsburgh Sleep Quality Index in Patients Who Underwent Rotator Cuff Tear Repair

by Umile Giuseppe Longo, Alessandra Berton, Sergio De Salvatore, Ilaria Piergentili, Erica Casciani, Aurora Faldetta, Maria Grazia De Marinis and Vincenzo Denaro

Int. J. Environ. Res. Public Health 2021, 18(16), 8666; https://doi.org/10.3390/ijerph18168666 - 17 Aug 2021

Cited by 43 | Viewed by 4168

Abstract

The Pittsburgh Sleep Quality Index (PSQI) is a valid patient-reported outcome measure developed to assess sleep quality and disturbances in clinical populations. This study aimed to calculate the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS) for the PSQI in patients who underwent rotator cuff repair (RCR). Preoperative and six-month postoperative follow-up questionnaires were completed by 50 patients (25 males and 25 females, mean age 58.7 ± 11.1 years). The MCID of the PSQI was calculated using distribution-based and anchor methods. To calculate the PSQI’s PASS, the 75th percentile approach and the receiver operating characteristic (ROC) curve were used. The MCID from preoperative to 6 months postoperative follow-up is 4.4. Patients who improved their PSQI score of 4.4 from baseline to 6 months follow-up had a clinically significant increase in their health status. The PASS is 5.5 for PSQI; therefore, a value of PSQI at least 5.5 at six months follow-up indicates that the symptom state can be considered acceptable by most patients. Full article

(This article belongs to the Special Issue The Burden of Orthopedic Surgery)

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12 pages, 65403 KiB

Open AccessArticle

Arthroscopic Tenotomy of the Long Head of the Biceps Tendon and Section of the Anterior Joint Capsule Produce Moderate Osteoarthritic Changes in an Experimental Sheep Model

by Umile Giuseppe Longo, Francisco Forriol, Vincenzo Candela, Salvatore Maria Tecce, Sergio De Salvatore, Jose R. Altonaga, Andrew L. Wallace and Vincenzo Denaro

Int. J. Environ. Res. Public Health 2021, 18(14), 7471; https://doi.org/10.3390/ijerph18147471 - 13 Jul 2021

Cited by 7 | Viewed by 2208

Abstract

Osteoarthritis (OA) of the glenohumeral (GH) joint is a common cause of shoulder pain, resulting in considerable invalidity. Unfortunately, the study of its pathogenesis is challenging. Models of OA are necessary to identify specific targets for therapy and to be able to interfere with the development and evolution of OA. This study aims to assess the effect of an arthroscopic tenotomy of the long head of the biceps tendon (LHBT) and section of the anterior glenohumeral joint capsule on the ovine glenohumeral joint. In addition, the authors aim to validate and evaluate the reliability of a modified semi-quantitative MRI score to assess joint degeneration in a sheep’s shoulder. Eight skeletally mature sheep received an arthroscopic tenotomy of the LHBT and section of the anterior joint capsule and were euthanized four months after surgery. All animals tolerated the surgery well, and no complication was recorded for six weeks. Moderate degenerative changes to the ovine shoulder joint were found on MRI and histological evaluation. The arthroscopic tenotomy of the LHBT and the anterior glenohumeral joint capsule section caused moderate degenerative changes to the ovine shoulder joint. Full article

(This article belongs to the Special Issue The Burden of Orthopedic Surgery)

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9 pages, 23777 KiB

Open AccessArticle

Developmental Hip Dysplasia: An Epidemiological Nationwide Study in Italy from 2001 to 2016

by Umile Giuseppe Longo, Rocco Papalia, Sergio De Salvatore, Laura Ruzzini, Ilaria Piergentili, Leonardo Oggiano, Pier Francesco Costici and Vincenzo Denaro

Int. J. Environ. Res. Public Health 2021, 18(12), 6589; https://doi.org/10.3390/ijerph18126589 - 18 Jun 2021

Cited by 11 | Viewed by 4398

Abstract

Developmental Dysplasia of the Hip (DDH) includes a broad spectrum of hip abnormalities. DDH requires early diagnosis and treatment; however, no international consensus on screening protocol and treatment is provided in the literature. Epidemiological studies are helpful to understand the national variation of a specific surgical procedure and compare it with that of other countries. Data provided by different countries could allow researchers to provide international guidelines for DDH screening and treatment. Limited data are reported regarding trends of hospitalization for DDH, and no public database is available. The purpose of this study was to estimate annual admissions for DDH in Italian patients from 2001 to 2016, based on the hospitalization reports. Data of this study were collected from the National Hospital Discharge Reports (SDO) reported at the Italian Ministry of Health. Descriptive statistical analyses were performed. From 2001 to 2016, 3103 hospitalizations for DDH were recorded in Italy, with a mean incidence of 2.33 (per 100,000 young inhabitants). Females of the 0–4 years old group represented the majority of patients hospitalized for DDH. Full article

(This article belongs to the Special Issue The Burden of Orthopedic Surgery)

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11 pages, 1128 KiB

Open AccessArticle

COVID-19 Changed the Incidence and the Pattern of Pediatric Traumas: A Single-Centre Study in a Pediatric Emergency Department

by Laura Ruzzini, Sergio De Salvatore, Daniela Lamberti, Pierluigi Maglione, Ilaria Piergentili, Francesca Crea, Chiara Ossella and Pier Francesco Costici

Int. J. Environ. Res. Public Health 2021, 18(12), 6573; https://doi.org/10.3390/ijerph18126573 - 18 Jun 2021

Cited by 19 | Viewed by 2760

Abstract

The first wave of COVID-19 spread worldwide from March to May 2020. Italy was one of the countries in the world where the lockdown period was most prolonged and restrictive. To date, the impact of prolonged lockdown on pediatric traumas has not fully investigated. This paper aimed to analyze, and compare to 2019, the incidence and the fracture pattern in patients admitted to our pediatric hospital during the total lockdown period. A single-center retrospective study was performed. The data were gathered from the Pediatric Emergency Department (PED) of the Bambino Gesù Children Hospital of Rome (Palidoro). This PED is the pediatric referral center for Rome and the hub for pediatric traumas of the region. Any admission diagnosis for fracture, trauma, sprains and dislocation during the lockdown period (10 March–4 May) were included. The demographic data, diagnosis, type of treatment, fracture segment, bone involvement and time interval between trauma and presentation to the PED were recorded. In 2020, a reduction of total traumas and fractures, compared to 2019 (p < 0.001), occurred (81%). Superior limb and inferior limb fractures decreased in 2020 compared to 2019 (p < 0.05). The identification of pediatric traumas and fractures trend could be useful to reorganize the PED. Epidemiological data from the previous lockdown could be helpful to prepare the healthcare system for new pandemic waves. Moreover, sharing national statistics and correlating those to other countries’ protocols, could be helpful to solve problems in case of worldwide emergency situations. Full article

(This article belongs to the Special Issue The Burden of Orthopedic Surgery)

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12 pages, 965 KiB

Open AccessArticle

Influence of Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty. Treatment Algorithm for Patients with Metal Allergy and Knee Osteoarthritis

by Pilar Peña, Miguel A. Ortega, Julia Buján and Basilio De la Torre

Int. J. Environ. Res. Public Health 2021, 18(11), 5997; https://doi.org/10.3390/ijerph18115997 - 3 Jun 2021

Cited by 4 | Viewed by 2449

Abstract

The outcome in total knee arthroplasty (TKA) depends on multiples factors, among them is the psychological condition. In addition, up 15 to 30% of the patients that undergo TKA show little or no improvement after surgery, which implies the diagnosis of a painful TKA is a challenge for the orthopedic surgeon, who must rule out a possible metal allergy (MA). It is considered an exclusion diagnosis. Due to the complex relationship between psychological condition and MA, and according to the worse results in patients treated with a hypoallergenic TKA, we asked: (1). What degree of psychological distress (PD) is present in patients who have a hypoallergenic TKA, and how does it influence the results of quality of life (QoL) and functional capacity. (2). Can we develop a new algorithm for patients with a possible MA that improves the outcomes? A pragmatic clinical study was carried out that included patients who underwent hypoallergenic TKA during three consecutive years. Quality of life and functional capacity were measured with (Western Ontario McMaster Universities Osteoarthritis Index) WOMAC index, the Short Form 12 questionnaire (SF-12) questionnaire, and the The EQ-5D-5L questionnaire essentially consists of two pages: the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS) (Euro-QoL-5D L-VAS (EQ5D)), in all patients. To assess PD, a Psychological Distress Score was developed. SPSS software was performed to statistical analysis, and Student´s test for independent variables with a p < 0.005 as statistically significant. A total of 72 anallergic TKAs in 64 patients were treated during this period; 31.3% of these patients showed features of PD before the surgery. According with the severity of the PD, 60% were classified as severe, 10% as moderate and 30% as mild. Patients with PD had statistically significant worse results on the final WOMAC, SF-12, and EQ5D questionnaires. The final scores of the physical subscale of the SF-12 and EQ5D showed better results in patients diagnosed by psychiatrist. Up to one third of the patients with hypoallergenic TKAs have PD, and their results are clearly inferior to those patients with MA without PD. When PD was diagnosed according with Psychological Distress Score, patients should be carefully assessed in order to determine if a specialist referral is recommended. According with our results, PD should be assessed either by the PCP or by us. If the PD is confirmed, a psychiatry referral is then requested for better preoperative management and treatment. We believe that this approach would lead to better TKA outcomes. Full article

(This article belongs to the Special Issue The Burden of Orthopedic Surgery)

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9 pages, 1830 KiB

Open AccessArticle

Associations between Hip Fracture Operation Waiting Time and Complications in Asian Geriatric Patients: A Taiwan Medical Center Study

by Ching-Yi Shen, Chien-Han Hsiao, Weide Tsai, Wen-Han Chang and Tse-Hao Chen

Int. J. Environ. Res. Public Health 2021, 18(6), 2848; https://doi.org/10.3390/ijerph18062848 - 11 Mar 2021

Cited by 7 | Viewed by 2998

Abstract

Early surgical intervention in hip fractures is associated with lower complications. This study aimed to determine the appropriate operation time among Asian geriatric patients. The data of 1118 elderly patients with hip fracture at Mackay Memorial Hospital from 1 January 2011, to 31 July 2019, were retrospectively examined. Association between operation waiting time and the occurrence of complications was calculated using a cubic spline model. Significantly increased incidence of pneumonia, myocardial infarction, and heart failure was observed in 30 and 90 days when the patient’s surgical waiting time exceeded 36 h. The incidence rates of pneumonia across the early and delayed groups within 30 and 90 days were 4.4% vs. 7.9%, and 6.2% vs. 10.7%, those of myocardial infarction were 3.0% vs. 7.2%, and 5.7% vs. 9.3%, and those of heart failure were 15.2% vs. 26.8%, and 16.2% vs. 28.5%. Deep vein thrombosis and pulmonary embolism were not associated with surgical delay. The overall 30-day mortality rate was 5.4%, and no significant difference was observed when the surgical waiting time exceeded 36 h. In summary, operation waiting time exceeding 36-h was associated with increased rates of pneumonia, myocardial infarction, and heart failure in Asian geriatric patients undergoing hip fracture surgery. Full article

(This article belongs to the Special Issue The Burden of Orthopedic Surgery)

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8 pages, 1131 KiB

Open AccessArticle

Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up

by Paolo Domenico Parchi, Matteo Simonetti, Enrico Bonicoli, Nicola Piolanti and Michelangelo Scaglione

Int. J. Environ. Res. Public Health 2020, 17(15), 5624; https://doi.org/10.3390/ijerph17155624 - 4 Aug 2020

Cited by 2 | Viewed by 3519

Abstract

Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required. Full article

(This article belongs to the Special Issue The Burden of Orthopedic Surgery)

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13 pages, 2767 KiB

Open AccessArticle

Epidemiology of Paediatric Shoulder Dislocation: A Nationwide Study in Italy from 2001 to 2014

by Umile Giuseppe Longo, Giuseppe Salvatore, Joel Locher, Laura Ruzzini, Vincenzo Candela, Alessandra Berton, Giovanna Stelitano, Emiliano Schena and Vincenzo Denaro

Int. J. Environ. Res. Public Health 2020, 17(8), 2834; https://doi.org/10.3390/ijerph17082834 - 20 Apr 2020

Cited by 19 | Viewed by 3116

Abstract

Limited knowledge is accessible concerning the tendencies of hospitalization for skeletally immature patients with episodes of shoulder dislocation. Our research aim was to evaluate annual hospitalizations for shoulder dislocation in paediatric patients in Italy from 2001 to 2014, on the basis of the official data source as hospitalization reports. The second purpose was to investigate geographical diversification in hospitalization for shoulder dislocation in regions of Italy. The last aim was to make statistical predictions of the number of shoulder dislocation hospitalization volumes and rates in skeletally immature patients based on data from 2001 to 2014. An examination of the National Hospital Discharge records (SDO) kept at the Italian Ministry of Health regarding the 14 years of our study (2001 through 2014) was conducted. These data are anonymous and include patient’s age, gender, domicile, region and time of hospitalization, and the kind of reimbursement (public or private). In the 14-year study time, 344 hospitalizations for shoulder dislocation of patients aged 0–14 years took place in Italy. The male/female hospitalization ratio varied from a maximum of 3.0 (2001) to a minimum of 1.1 (2013), with a mean average ratio in the 2001–2014 timespan of 2.0. Almost half of the hospitalizations (49.1%) were performed in the South. The mean incidence of hospitalizations in Italy for shoulder dislocation in patients with less than 14 years was 0.3 for every 100,000 inhabitants in the same class of age. The most common treatment was a closed reduction (60.8%), followed by open stabilization (16.6%) and arthroscopic procedures (13.7%). The present registry study shows a low incidence of hospitalization for shoulder dislocation in young patients. The most common treatment for a shoulder dislocation in paediatric patients is a closed shoulder reduction. Regions from the south and the centre of Italy are marked by an inferior number of operations and a higher number of hospitalization for closed shoulder reduction. Full article

(This article belongs to the Special Issue The Burden of Orthopedic Surgery)

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