Multiaxial high-modularity spinopelvis (HMSP) fixation device in neuromuscular scoliosis: a comparative study

Pelvic vs Lumbar Fusion in Neuromuscular Scoliosis - A Systematic Review

Study DesignSystematic literature review.ObjectivesPosterior spinal fusion is the golden standard in the treatment of neuromuscular scoliosis. There are different views on whether pelvic fusion is necessary.MethodsA systematic literature review according to PRISMA guidelines was performed. A total of 628 articles were screened. Original articles of neuromuscular scoliosis patients with reference to posterior spinal fusion in the population of ≤20 years of age were included. Operative technique with lumbar pedicle screws was required. Case reports, articles with missing data on pelvic parameters or with a postoperative follow-up of less than 2 years were excluded. A final of 29 original articles were included in the review.ResultsA total of 1611 patients undergoing posterior spinal fusion for neuromuscular scoliosis were included in the analysis with a mean age of 14.0 ± 1.0 years and a mean number of 15.5 ± 0.8 levels fused. Spinal fusion was extended to the pelvis in 1222 cases, while in 389 patients had fusion limited to the lumbar spine. The percentage of main curve correction was slightly higher in pelvic fusion patients 63 ± 10% compared to 58 ± 9% in lumbar fusion group, P < 0.001. Pelvic obliquity correction was superior in the pelvic fusion group, 58% compared to 42% in the spinal fusion group, P < 0.001. Operative time, complication rate and perioperative bleeding were greater in the pelvic fusion group.ConclusionsPelvic fusion in posterior spinal fusion for neuromuscular scoliosis results in small but statistically significant differences in curve correction and pelvic obliquity but increases the risk for perioperative bleeding and other complications. The impact on quality of life should be addressed in future research.

Novel metaphyseal porous titanium cones allow favorable outcomes in revision total knee arthroplasty

INTRODUCTION

Loosening and migration are common modes of aseptic failure following complex revision total knee arthroplasty (rTKA). Metaphyseal cones allow surgeons to negotiate the loss of femoral and tibial bone stock while obtaining stable bony fixation. This study examines the mid-term functional and radiographic outcomes in patients undergoing rTKA utilizing a novel metaphyseal cone system with stems of variable length and fixation methods.

METHODS

This two-center retrospective study examined all patients who underwent rTKA with a novel porous, titanium tibial or femoral cone in combination with a stem of variable length and fixation who had a minimum follow-up of 2-years. Outcome analysis was separated into tibial and femoral cones as well as the stem fixation method (hybrid vs. fully cemented).

RESULTS

Overall, 123 patients who received 156 cone implants were included (74 [60.2%] tibial only, 16 [13.0%] femoral only, and 33 [26.8%] simultaneous tibial and femoral) with a mean follow-up of 2.76 ± 0.66 years. At 2-years of follow-up the total cohort demonstrated 94.3% freedom from all-cause re-revisions, 97.6% freedom from aseptic re-revisions, and 99.4% of radiographic cone osteointegration. All-cause revision rates did not differ between stem fixation techniques in both the tibial and femoral cone groups.

CONCLUSION

The use of a novel porous titanium femoral and tibial metaphyseal cones combined with stems in patients with moderate to severe bone defects undergoing complex revision total knee arthroplasty confers excellent results independent of stem fixation technique.

LEVEL OF EVIDENCE

IV, case series.

Quantitative analysis of a spinal surgeon’s learning curve for scoliosis surgery

Aims

The aim of this study was a quantitative analysis of a surgeon’s learning curve for scoliosis surgery and the relationship between the surgeon’s experience and post-operative outcomes, which has not been previously well described.

Patients and Methods

We have investigated the operating time as a function of the number of patients to determine a specific pattern; we analysed factors affecting the operating time and compared intra- and post-operative outcomes. We analysed 47 consecutive patients undergoing scoliosis surgery performed by a single, non-trained scoliosis surgeon. Operating time was recorded for each of the four parts of the procedures: dissection, placement of pedicle screws, reduction of the deformity and wound closure.

Results

The median operating time was 310 minutes (interquartile range 277.5 to 432.5). The pattern showed a continuous decreasing trend in operating time until the patient number reached 23 to 25, after which it stabilised with fewer patient-dependent changes. The operating time was more affected by the patient number (r =- 0.75) than the number of levels fused (r = 0.59). Blood loss (p = 0.016) and length of stay in hospital (p = 0.012) were significantly less after the operating time stabilised. Post-operative functional outcome scores and the rate of complications showed no significant differences. Take home message: We describe a detailed learning curve for scoliosis surgery based on a single surgeon’s practise, providing useful information for novice scoliosis surgeons and for those responsible for training in spinal surgery. Cite this article: Bone Joint J 2016;98-B:679–85.