Conclusions: This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted.
MULTIFILE
Background: Different surgical approaches for total hip arthroplasty (THA) exist, without predisposition when it comes to dislocation risk. The direct anterior approach (DAA) is thought to have reduced risk since soft tissue trauma is minimalized. Therefore, we assessed the dislocation risk for different surgical approaches, and the relative dislocation risk of DAA compared to other approaches. Methods: Six electronic databases were systematically searched for prospective studies reporting dislocation following THA. Proportion meta-analyses were performed to assess the dislocation rate for subgroups of the surgical approach. Meta-analysis for binary outcomes was performed to determine the relative risk of dislocation for the DAA compared to other approaches. Results: Eleven studies with 2025 patients were included (mean age 64.6 years, 44% male, mean follow-up 10.5 months), of which four studies were also used in the risk ratio meta-analysis. Overall dislocation rate was 0.79% (95% CI 0.37–1.69). Subgroup analyses showed that most dislocations occurred in the posterior approaches group (1.38%), however non-significant. Furthermore, the DAA emerged with a non-significant lower risk of dislocation (RR 0.37, 95% CI 0.05–2.46) compared to other surgical approaches. Conclusion: Current literature shows non-significant predisposition for a surgical approach to THA regarding dislocation risk. To what extent patient characteristics influence the risk of dislocation could not be determined. Future research should focus on this, as well as on the influence of a surgeon's experience with a specific approach.
Recycling of plastics plays an important role to reach a climate neutral industry. To come to a sustainable circular use of materials, it is important that recycled plastics can be used for comparable (or ugraded) applications as their original use. QuinLyte innovated a material that can reach this goal. SmartAgain® is a material that is obtained by recycling of high-barrier multilayer films and which maintains its properties after mechanical recycling. It opens the door for many applications, of which the production of a scoliosis brace is a typical example from the medical field. Scoliosis is a sideways curvature of the spine and wearing an orthopedic brace is the common non-invasive treatment to reduce the likelihood of spinal fusion surgery later. The traditional way to make such brace is inaccurate, messy, time- and money-consuming. Because of its nearly unlimited design freedom, 3D FDM-printing is regarded as the ultimate sustainable technique for producing such brace. From a materials point of view, SmartAgain® has the good fit with the mechanical property requirements of scoliosis braces. However, its fast crystallization rate often plays against the FDM-printing process, for example can cause poor layer-layer adhesion. Only when this problem is solved, a reliable brace which is strong, tough, and light weight could be printed via FDM-printing. Zuyd University of Applied Science has, in close collaboration with Maastricht University, built thorough knowledge on tuning crystallization kinetics with the temperature development during printing, resulting in printed products with improved layer-layer adhesion. Because of this knowledge and experience on developing materials for 3D printing, QuinLyte contacted Zuyd to develop a strategy for printing a wearable scoliosis brace of SmartAgain®. In the future a range of other tailor-made products can be envisioned. Thus, the project is in line with the GoChem-themes: raw materials from recycling, 3D printing and upcycling.
The anterior cruciate ligament (ACL) is a strong rope-like tissue which connects the femur to the tibia in the knee joint. Its function is to provide structural stability to the knee while preventing unnatural forward movement of the tibia relative to the femur. Acute complete ACL ruptures during movements like knee hyperextension or sudden changes of direction (pivoting) damage two entities: the ligament itself and its nerve connections to the posterior tibial nerve (PTN). PTN innervation in the ACL is essential for: a) proprioception (e.g. perception of position and movement/acceleration experienced by the ligament), and b) stability of the knee joint. Upon ACL rupture, the orthopedic surgeon reconstructs the ACL with a graft from the hamstring, patellar or quadriceps tendon. After the surgery, the goal is to regain neuromuscular control and dynamic stabilization during rehabilitation as soon as possible for a quick return to sports and daily activities. However, surgeons are not able to reconstruct the nerve gap between the PTN and the grafted ligament due to the microscopic size of the innervation in the ACL. Not linking the PTN to the graft creates a disconnection between the knee joint and the spinal cord. To mitigate these disadvantages in ACL surgery, this study focuses on activating the growth of proprioception nerve endings using a ligament loaded with growth factors (neurotrophins). We hypothesize that neurotrophins will activate proprioceptive fibers of neurons close to the ACL. We describe graft fabrication steps and in vitro experiments to expand on the regeneration capacity of a commercially available ACL-like synthetic ligament called LARS. The results will bring the ACL regeneration field closer to having a graft that can aid patients in regaining mobility and stability during locomotion and running, confidence in the strength of the knee joint, and quick return to sports.
Orthopedische ingrepen, waarbij botten en botfragmenten in de juiste stand met metalen platen aan elkaar gezet worden, worden steeds meer routinematig uitgevoerd. Osteoporose is een aandoening, meestal bij ouderen, die vaak tot botbreuken leidt. Door de vergrijzende bevolking is de verwachting dat het aantal orthopedische operatieve ingrepen, waarbij platen en schroeven toegepast worden, in de komende decennia zullen blijven stijgen. Voor het plaatsen van de metalen platen worden door de chirurg gaten in de botten geboord. Hierin worden schroeven geplaatst. Per situatie zijn die schroeven anders, qua lengte en soort. De diepte van het gat en de hardheid van het bot zijn belangrijke parameters voor de keuze van de lengte en type van de schroeven. Voor bepaling van de schroeflengte moet de boorgatdiepte na het boorproces geometrisch opgemeten worden; een vervelend karwei met kans op fouten. Het type schroef is vooral afhankelijk van de hardheid van het bot. Die hardheid wordt ingeschat op basis van de röntgenfoto’s. Dat proces is echter niet zo nauwkeurig. De chirurgen hebben behoefte aan juiste en eenduidige informatie tijdens hun operaties, nu hebben ze dat slechts ten dele. SLAMOrthopedic is een kennisgedreven startup, voortgebracht door TU Delft, die technologie ontwikkelt voor het ondersteunen van bovengenoemde operaties. De SLAMOrthopedic ‘LaserGauge’ monitort het boorproces tijdens het boren van gaten in botten. Het systeem levert voor elk geboord gat een meetrapport en adviseert de juiste schroeflengte. De chirurgen hebben tijdens validatieproeven hun enthousiasme over de techniek uitgesproken, maar ze hebben nog een aantal wensen geuit waarin SLAMOrthopedic niet kan voorzien, zoals hardheidsindicatiebepaling en de thermische belasting van het botweefsel. Met een aantal aanpassingen van de LaserGauge, lijkt het mogelijk om aan de wensen van de chirurgen tegemoet te komen. In dit kiemvoorstel wordt de conceptuele haalbaarheid hiervan onderzocht.
