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Almazedi B, Hunt GEG, Bowker A. Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case-control study. Clin Radiol 2024; 79:378-385. [PMID: 38383252 DOI: 10.1016/j.crad.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/05/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
AIM To assess the safety and efficacy of superior hypogastric nerve block (SHNB) in managing periprocedural pain associated with uterine fibroid embolisation (UFE) and in facilitating same-day discharge. MATERIALS AND METHODS Prospectively enrolled case-control study with retrospective analysis comprising 119 eligible patients who underwent UFE for symptomatic fibroids was undertaken at a UK teaching hospital between January 2016 and September 2022. SHNB was administered to 62 participants in addition to systemic analgesia; 57 participants received systemic analgesia alone. SHNB was performed mid-UFE using 20 ml of 0.25% levobupivacaine. Pain scores were assessed using an 11-point (0-10) verbal numerical rating scale (NRS). The study received research and ethics committee approval. Statistical analysis was performed using the chi-square and independent t-test or Mann-Whitney U-test. A p-value of <0.05 defined significance. RESULTS Participants who received SHNB experienced significantly less pain during the first 6 h post-procedure (averaged median pain score 2.6 versus 3.8, p=0.031). SHNB reduced the proportion of participants requiring post-procedural anti-emetics (45% versus 63%, p<0.05). For participants entered on the day-case pathway (SHNB = 34, no-SHNB = 16), those who received SHNB had a higher rate of successful same-day discharge (62% versus 31%, p=0.044). This SHNB group required significantly less opioids for periprocedural pain relief (median oral morphine equivalents; 44 mg versus 80 mg, p=0.020). No SHNB-related adverse events occurred. CONCLUSION SHNB is safe and effective in reducing perioperative pain, opioid requirements, and anti-emetic use in patients undergoing UFE for symptomatic fibroids. SHNB, as an adjunct to analgesic optimisation, facilitates same-day discharge, which is often limited by severe post-embolisation pain.
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Affiliation(s)
- B Almazedi
- Vascular Imaging Unit, Department of Radiology, York Teaching Hospital, York, UK; York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
| | - G E G Hunt
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A Bowker
- Vascular Imaging Unit, Department of Radiology, York Teaching Hospital, York, UK; York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
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Shankar DS, Blaeser AM, Gillinov LA, Vasavada KD, Fariyike BB, Mojica ES, Borowski LE, Jazrawi LM, Cardone DA. Paresthesia Is Predictive of Symptom Recurrence After Fasciotomy for Exertional Compartment Syndrome of the Leg. Sports Health 2024; 16:396-406. [PMID: 36951383 PMCID: PMC11025501 DOI: 10.1177/19417381231160164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Exertional compartment syndrome (ECS) is an underdiagnosed cause of lower extremity pain among athletes. The condition can be managed operatively by fasciotomy to relieve excess compartment pressure. However, symptom recurrence rates after fasciotomy are considerable, ranging from 3% to 17%. HYPOTHESIS Leg paresthesia and its distribution during ECS episodes would be a significant predictor of outcomes after fasciotomy. STUDY DESIGN Retrospective cohort study. LEVEL OF EVIDENCE Level 4. METHODS We conducted a retrospective chart review of patients who underwent fasciotomy for ECS at our center from 2010 to 2020 (institutional review board no. 21-00107). We measured postoperative outcomes including pain frequency and severity, Tegner activity level, and return to sport. Significant predictors of outcomes were identified using multivariable linear and logistic regression. P values <0.05 were considered significant. RESULTS A total of 78 legs (from 42 male and 36 female participants) were included in the study with average follow-up of 52 months (range, 3-126 months); 33 participants (42.3%) presented with paresthesia. Paresthesia was an independent predictor of worse outcomes, including more severe pain at rest (P = 0.05) and with daily activity (P = 0.04), reduced postoperative improvement in Tegner scores (P = 0.04), and lower odds of return to sport (P = 0.05). Those with paresthesia symptoms in the tibial nerve distribution had worse outcomes than those without paresthesia in terms of preoperative-to-present improvement in pain frequency (P < 0.01), pain severity at rest (P < 0.01) and with daily activity (P = 0.04), and return to sport (P = 0.04). CONCLUSION ECS patients who present with paresthesia have worse pain and activity outcomes after first-time fasciotomy, but prognosis is worst among those with tibial nerve paresthesia. CLINICAL RELEVANCE Paresthesia among ECS patients is broadly predictive of more severe recurrent leg pain, reduced activity level, and decreased odds of return to sport after fasciotomy.
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Affiliation(s)
- Dhruv S. Shankar
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Anna M. Blaeser
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Lauren A. Gillinov
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Kinjal D. Vasavada
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Babatunde B. Fariyike
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Edward S. Mojica
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Lauren E. Borowski
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Laith M. Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Dennis A. Cardone
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York
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Xiao Y, Liu Y. Comparison of pain between bilateral ICL surgeries in patients with myopia. BMC Ophthalmol 2024; 24:175. [PMID: 38627709 PMCID: PMC11022364 DOI: 10.1186/s12886-024-03450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The purpose of this study was to compare the preoperative anxiety, aqueous humor monocyte chemoattractant protein-1 (MCP-1) concentration, intraoperative pain, and degree of cooperation of the first eye implantable collamer lens (ICL) surgery with the second eye surgery, of the 1-day interval group with the 1-week interval group, and to investigate the possible causes of these differences, as well as to determine the appropriate interval between bilateral eye ICL surgeries. METHOD The study was a prospective observational study. A total of 120 patients who underwent bilateral ICL surgery at the Department of Ophthalmology, West China Fourth Hospital, Sichuan University, from July to September 2023, were enrolled. The patients were divided into a 1-day interval group and a 1-week interval group. The ICL surgery was performed on both eyes according to the schedule. Anxiety levels, aqueous humor MCP1, cooperativeness, surgical time, pain and satisfaction, and patients' estimations of the time spent in the operation were recorded for each eye. The patients were instructed to recall the intraoperative pain of the first eye surgery after the operation of the second eye. Statistical analyses (two independent samples t-test,two paired samples t-test, the rank-sum test, the chi-square test, non-parametric test with multiple independent samples) were performed to compare the differences between each score in both eyes and two groups. Furthermore, we examined the relationship between pain levels and the reproductive history of the patients. RESULTS In the 1-day interval group, male/female is 22/52, average age is 25.24±5.00. In the 1-week interval group, male/female is 17/29, average age is 25.39±5.57. There was no statistically significant difference between the two groups. In both groups, patients were less nervous, had significantly more pain, had less surgical satisfaction, had a longer estimated operative time, and had elevated preoperative MCP1 during the second eye operation. In the second eye surgery, the patient's cooperation worsened, but it did not lead to an increase in surgical time. A significant proportion of patients, particularly in the 1-week interval group, recalled experiencing reduced pain during the first eye surgery. The 1-week interval group had a higher difference in all indicators between the bilateral surgeries. In the second eye surgery, patients in the 1-week interval group experienced more severe pain, less cooperation, longer estimated operation duration, and a greater MCP1 than those in the 1-day interval group. CONCLUSION Patients undergoing second eye ICL surgery had decreased nervousness, increased pain, decreased cooperation, and satisfaction, and increased MCP1 compared to the first eye surgery. It is recommended that an interval of about one week should be avoided between bilateral surgeries when developing a surgical schedule to improve patients' cooperation, satisfaction, and comfort.
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Affiliation(s)
- Yu Xiao
- West China School of Public Health and West China Fourth Hospital,Sichuan University, Chengdu, Sichuan, China
| | - Yali Liu
- West China School of Public Health and West China Fourth Hospital,Sichuan University, Chengdu, Sichuan, China.
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Deneuville M, Germon C, Sturbois-Nachef N, Chazard E, Chantelot C, Saab M. The Sauvé-Kapandji procedure for post-traumatic distal radio-ulnar arthrosis: Long-term results and analysis of risks factors for revision surgery. Orthop Traumatol Surg Res 2024; 110:103562. [PMID: 36702297 DOI: 10.1016/j.otsr.2023.103562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The Sauvé-Kapandji (SKp) procedure is a frequently used surgery for the management of post-traumatic sequelae of the distal radio-ulnar joint (DRU). Series evaluating long-term outcomes and the risk of complications are rare. The main objective was to describe the long-term clinical and radiographic results after SKp performed in a post-traumatic context. The secondary objectives were to identify postoperative complications, surgical revisions, and their risk factors for occurrence. Our hypothesis was that although SKp confers good clinical results, identifiable risk factors for complications exist. PATIENTS AND METHODS This monocentric retrospective study included all patients for whom an SKp was performed in a post-traumatic context from 2008 to 2018. Pain, satisfaction, range of motion and pre- and postoperative radiographic measurements were recorded. All complications were sought and described, as well as surgical revisions. Several variables were analysed to identify risk factors for revision surgery after SKp: age, sex, initial traumatic mechanism, initial non-surgical or surgical treatment and type of surgery, time until revision surgery with SKp after the initial trauma. RESULTS Thirty-seven patients were included. At a median follow-up of 9.5 years (min 7.3-max 11.5), 22 patients (60%) had a VAS of 0. Range of motion was significantly improved for all the patients (p<0.001). Seventeen (46%) patients had a complication, including 5 (13.4%) cases of ossification, 4 (10.8%) cases of discomfort related to the hardware and 4 (10.8%) painful instability at the proximal ulnar stump. Thirteen (35%) patients required revision surgery. Two risk factors for revision surgery after SKp were found: time period between initial treatment and SKp of less than 7.2 months and an age of less than 53.5 years; the combination of the two factors having a sensitivity of 97.5 and a specificity of 56.7. CONCLUSION SKp in a post-traumatic context significantly improved range of motion and allowed pain control at long follow-up. Revision surgery seemed more frequent in patients under 53.5 years of age and when SKp was performed less than 7.2 months after the initial trauma. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Marine Deneuville
- Service de traumatologie, Hôpital Roger-Salengro, Centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille, France
| | - Charlotte Germon
- Service d'orthopédie-traumatologie, Centre hospitalier de Seclin, rue d'Apolda, 59113 Seclin, France.
| | - Nadine Sturbois-Nachef
- Service de chirurgie orthopédique 1, Hôpital Roger-Salengro, Centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille, France
| | - Emmanuel Chazard
- Service méthodologie, biostatistique, gestion de données et archives, CHU de Lille, rue du Professeur-Laguesse, 59000 Lille, France
| | - Christophe Chantelot
- Service de traumatologie, Hôpital Roger-Salengro, Centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille, France
| | - Marc Saab
- Service de chirurgie orthopédique 1, Hôpital Roger-Salengro, Centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille, France
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Basciani S, Longo UG, Papalia GF, Papalia R, Marinozzi A. Arthroscopic microfracture and associated techniques in the treatment of osteochondral lesions of the talus: A systematic review and metanalysis. Foot Ankle Surg 2024; 30:219-225. [PMID: 38309989 DOI: 10.1016/j.fas.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/16/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Osteochondral lesions of the talus are common in patients suffering even minor trauma; timely diagnosis and treatment can prevent the development of early osteoarthritis. The objectives of this systematic review and meta-analysis were to evaluate the effects of additional procedures on arthroscopic ankle microperforations for osteochondral lesions. METHODS A systematic literature search was conducted using PubMed-Medline, Cochrane Central, and Google Scholar to select clinical studies analyzing the efficacy of platelet-rich plasma (PRP), hyaluronic acid (HA), and bone marrow concentrate (BMC) procedures. Ten articles following PRISMA guidelines with a total of 464 patients were included in this review. Quality assessment using MINORS was performed, and all studies demonstrated high quality. RESULTS The results of the systematic review showed benefits in all patients undergoing infiltrative therapy with PRP, hyaluronic acid, and BMC. The best results in terms of AOFAS score and VAS scale were found in patients undergoing PRP injection. The meta-analysis showed improvements in pain relief and return to daily activities in patients undergoing arthroscopic microperforations and PRP, although not reporting statistically significant results (p = 0.42). CONCLUSION All treatment strategies reported better scores compared to the control groups. Among the various treatments analyzed, the addition of PRP appears to be the most valuable probably for the larger population receiving this treatment, showing excellent outcomes in pain reduction, clinical outcomes, and return to daily activities. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Susanna Basciani
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
| | - Giuseppe Francesco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Andrea Marinozzi
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
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De Nigris Vasconcellos F, Mashiach E, Alzate JD, Bernstein K, Rotman L, Levy S, Qu T, Wegner RE, Shepard MJ, Patel S, Warnick RE, Moreno NM, Martínez Álvarez R, Picozzi P, Franzini A, Peker S, Samanci Y, Elguindy AN, Palmer JD, Lunsford LD, Jose SG, Wei Z, Niranjan A, Blagui S, Iorio-Morin C, Mathieu D, Briggs RG, Yu C, Zada G, Dayawansa S, Sheehan J, Schulder M, Goenka A, Begley S, Khilji H, Urgošík D, Liščák R, Kondziolka D. Impact of Multiple Sclerosis Subtypes on Pain Management in Patients With Trigeminal Neuralgia After Stereotactic Radiosurgery: An International Multicenter Analysis. Neurosurgery 2024; 94:838-846. [PMID: 38051068 DOI: 10.1227/neu.0000000000002790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Trigeminal neuralgia affects approximately 2% of patients with multiple sclerosis (MS) and often shows higher rates of pain recurrence after treatment. Previous studies on the effectiveness of stereotactic radiosurgery (SRS) for trigeminal neuralgia did not consider the different MS subtypes, including remitting relapsing (RRMS), primary progressive (PPMS), and secondary progressive (SPMS). Our objective was to investigate how MS subtypes are related to pain control (PC) rates after SRS. METHODS We conducted a retrospective multicenter analysis of prospectively collected databases. Pain status was assessed using the Barrow National Institute Pain Intensity Scales. Time to recurrence was estimated through the Kaplan-Meier method and compared groups using log-rank tests. Logistic regression was used to calculate the odds ratio (OR). RESULTS Two hundred and fifty-eight patients, 135 (52.4%) RRMS, 30 (11.6%) PPMS, and 93 (36%) SPMS, were included from 14 institutions. In total, 84.6% of patients achieved initial pain relief, with a median time of 1 month; 78.7% had some degree of pain recurrence with a median time of 10.2 months for RRMS, 8 months for PPMS, 8.1 months for SPMS ( P = .424). Achieving Barrow National Institute-I after SRS was a predictor for longer periods without recurrence ( P = .028). Analyzing PC at the last available follow-up and comparing with RRMS, PPMS was less likely to have PC (OR = 0.389; 95% CI 0.153-0.986; P = .047) and SPMS was more likely (OR = 2.0; 95% CI 0.967-4.136; P = .062). A subgroup of 149 patients did not have other procedures apart from SRS. The median times to recurrence in this group were 11.1, 9.8, and 19.6 months for RRMS, PPMS, and SPMS, respectively (log-rank, P = .045). CONCLUSION This study is the first to investigate the relationship between MS subtypes and PC after SRS, and our results provide preliminary evidence that subtypes may influence pain outcomes, with PPMS posing the greatest challenge to pain management.
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Affiliation(s)
| | - Elad Mashiach
- Department of Neurological Surgery, NYU Langone Health, New York University, New York , New York , USA
| | - Juan Diego Alzate
- Department of Neurological Surgery, NYU Langone Health, New York University, New York , New York , USA
| | - Kenneth Bernstein
- Department of Radiation Oncology, NYU Langone Health, New York University, New York , New York , USA
| | - Lauren Rotman
- Department of Neurological Surgery, NYU Langone Health, New York University, New York , New York , USA
| | - Sarah Levy
- Department of Neurology, Mount Sinai Corinne Goldsmith Dickinson Center for MS, Mount Sinai , New York , USA
| | - Tanxia Qu
- Department of Radiation Oncology, NYU Langone Health, New York University, New York , New York , USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton , Canada
| | - Ronald E Warnick
- Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati , Ohio , USA
| | | | | | - Piero Picozzi
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano , Italy
| | - Andrea Franzini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano , Italy
| | - Selçuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey
| | - Ahmed N Elguindy
- Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus , Ohio , USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus , Ohio , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, UPMC, Pittsburgh , Pennsylvania , USA
| | - Shalini G Jose
- Department of Neurological Surgery, UPMC, Pittsburgh , Pennsylvania , USA
| | - Zhishuo Wei
- Department of Neurological Surgery, UPMC, Pittsburgh , Pennsylvania , USA
| | - Ajay Niranjan
- Department of Neurological Surgery, UPMC, Pittsburgh , Pennsylvania , USA
| | - Sarra Blagui
- Department of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke , Canada
| | - Christian Iorio-Morin
- Department of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke , Canada
| | - David Mathieu
- Department of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke , Canada
| | - Robert G Briggs
- Department of Neurosurgery, University of Southern California, Los Angeles , California , USA
| | - Cheng Yu
- Department of Neurosurgery, University of Southern California, Los Angeles , California , USA
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles , California , USA
| | | | - Jason Sheehan
- Department of Neurosurgery, UVA, Charlottesville , Virginia , USA
| | - Michael Schulder
- Department of Neurosurgery, North Shore University Hospital (Northwell), Manhasset , New York , USA
| | - Anuj Goenka
- Department of Neurosurgery, North Shore University Hospital (Northwell), Manhasset , New York , USA
| | - Sabrina Begley
- Department of Neurosurgery, North Shore University Hospital (Northwell Zucker School of Medicine), Hempstead , New York , USA
| | - Hamza Khilji
- Department of Neurosurgery, North Shore University Hospital, SUNY Downstate College of Medicine, Brooklyn , New York , USA
| | - Dušan Urgošík
- Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czechia
| | - Roman Liščák
- Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czechia
| | - Douglas Kondziolka
- Department of Neurological Surgery, NYU Langone Health, New York University, New York , New York , USA
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Queyrel É, Lanaret M, Khalil T, Al Gahatany M, Chaix R, Lemaire JJ, Moisset X, Chassin V, Brun L, Dedieu V, Biau J. [Frameless trigeminal neuralgia radiosurgery with a dedicated linear accelerator: From equipment commissioning to initial clinical results]. Cancer Radiother 2024; 28:164-173. [PMID: 38490925 DOI: 10.1016/j.canrad.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 03/17/2024]
Abstract
PURPOSE Radiosurgery for the treatment of trigeminal neuralgia delivers a very high dose in a single fraction, over a few millimeters, at a single isocenter placed along the nerve. We present here the different steps that have been performed to validate small beams by conical collimators, and report the clinical results of the first patients treated on Novalis Tx®, frameless. MATERIAL AND METHODS First, the geometric accuracy of 4 and 6mm conical collimators was evaluated using Winston-Lutz tests; then dosimetric data acquisition was performed using high spatial resolution detectors (PTW 60019 microdiamond and a PTW 60017 E-diode). The corrective factors of the TRS 483 report were applied to calculate the collimator aperture factors. These dosimetric data were then compared with the data implemented in the iPlan® treatment planning system. Then end-to-end tests were performed to control the entire treatment process using an anthropomorphic phantom "STEEV". Between 2020 and 2022, 18 patients were treated for refractory trigeminal neuralgia on Novalis Tx®, frameless, with Exactrac® repositioning. A total of 17 patients were evaluated (one was lost to follow-up) using the BNI score for pain assessment and MRI with a median follow-up of 12 months. RESULTS The quality criteria of geometric and dosimetric accuracy were met for the 6-mm cone but not for the 4-mm cone. All patients were treated with a 6-mm cone with a dose of 90Gy prescribed at the isocenter at the root entry zone. Initial pain control was obtained in 70.5% of our patients, and 53% maintained pain control with a median follow-up of 12 months. All recurrences occurred within 3 to 6 months after radiosurgery. No brainstem toxicity was observed. Six patients had non-disabling facial hypoesthesia, half of whom already had pretreatment hypoesthesia. CONCLUSION The treatment of trigeminal neuralgia on a dedicated linear accelerator is a highly technical treatment whose accuracy and safety are paramount. The physical measurements allowed the commissioning of the technique with a 6mm cone. Our first clinical results are in accordance with the literature.
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Affiliation(s)
- É Queyrel
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - M Lanaret
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - M Al Gahatany
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - R Chaix
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - J-J Lemaire
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France
| | - X Moisset
- Service de neurologie, Neuro-Dol, CHU de Clermont-Ferrand, université Clermont-Auvergne, Inserm U1107, Clermont-Ferrand, France
| | - V Chassin
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France
| | - L Brun
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - V Dedieu
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France.
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Addai D, Zarkos J, Pettit M, Lützner C, Wronka K, Stiehler M. The Effect of Waiting for a Primary Total Hip Arthroplasty on the Overall Hip Function and Quality of Life. J Arthroplasty 2024; 39:974-978.e1. [PMID: 37863273 DOI: 10.1016/j.arth.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The primary aim was to determine whether time spent awaiting primary total hip arthroplasty (THA) affects patient-reported outcome measures (PROMs) using the Oxford Hip score, Harris Hip Score, and visual analogue scale (VAS) pain. The secondary aim was to assess whether patients have worsening HRQoL, while awaiting THA using the European Quality of Life Five Dimension (EQ-5D) index and EQ-5D health VAS. METHODS This was a single center cross-sectional study of 190 patients awaiting THA. Patients were divided into waiting "more than 6 months" and "less than 6 months." Baseline and current scores were compared. Multivariate regression analyses were performed to identify predictors of PROM change. RESULTS No significant intergroup differences were observed for change in preoperative Oxford Hip score, Harris Hip Score, and VAS pain from index consultation to time of study. The EQ-5D index and EQ-5D health VAS decreased significantly further in patients waiting more than 6 months (P = .043, P = .004). Time awaiting THA was significantly associated with a decrease in EQ-5D index and EQ-5D health VAS in multivariate regression (P = .013, P < .001). CONCLUSIONS Waiting more than 6 months is not associated with a decrease in hip-specific PROMs and longer waiting times are not associated with changes in hip-specific PROMs. Waiting time was associated with a decrease in health-related quality of life and patients waiting more than 6 months had significantly higher decreases in EQ-5D scores. This suggests that living longer with hip osteoarthritis leads to a decrease in QoL, not necessarily through perceived osteoarthritis progression. LEVEL OF EVIDENCE Level III cross-sectional study.
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Affiliation(s)
- Daniel Addai
- West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, England; University Centre for Orthopaedics, Trauma & Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | - Jacqueline Zarkos
- West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, England
| | - Matthew Pettit
- St George's University Hospitals, NHS Foundation Trust, London, England
| | - Cornelia Lützner
- University Centre for Orthopaedics, Trauma & Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | - Konrad Wronka
- West Suffolk Hospital, NHS Foundation Trust, Bury St Edmunds, England
| | - Maik Stiehler
- University Centre for Orthopaedics, Trauma & Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
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Yoo SJ, Kang H, Kim B, Lee CH, Song J, Choi S. Which is better? Early versus delayed rehabilitation after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2024; 32:1049-1057. [PMID: 38469925 DOI: 10.1002/ksa.12129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE This study aimed to compare the 5-year clinical and functional outcomes, including repaired tendon healing status, between early and delayed rehabilitation after arthroscopic rotator cuff repair METHODS: A total of 75 patients with rotator cuff tears (less than 5 cm) underwent arthroscopic repairs over a 60-month period. Participants were randomly assigned to early and delayed postoperative rehabilitation groups with distinct protocols. Clinical and functional outcome measures included Constant score, University of California at Los Angeles (UCLA) score, visual analogue scale for pain and isokinetic dynamometer test for muscle strength recovery. Clinical and functional scores were compared between baseline and 5 years postoperatively. Radiologic assessment via magnetic resonance imaging was performed at a minimum of 12 months postoperatively for evaluations of tendon integrity and recurrent tears. RESULTS Baseline characteristics showed no statistically significant differences between groups. Both groups demonstrated equivalent improvement in range of motion and pain scores with no statistical differences. Clinical scores improved significantly in both groups by postoperative 12 months and plateaued. At the postoperative 5-year mark, the early group showed better improvement in the visual analogue scale and UCLA score, while the delayed group had superior Constant scores. Postoperative magnetic resonance imaging revealed six recurrent tears, two in the early group and four in the delayed group, with no statistical differences. Muscle strength recovery showed no differences between the two groups. CONCLUSION Both the early and the delayed rehabilitation groups showed similar outcomes in postoperative range of motion, functional scores, muscle strength recovery and tendon healing in the short- and mid-term follow-ups. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Seung Jin Yoo
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - Hyunseong Kang
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - Byungsuk Kim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - Chae Hyun Lee
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - Jungkook Song
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, South Korea
| | - Sungwook Choi
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
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Andronic O, Suravaram V, Lu V, Wall SJ, Bucher TA, Prosser GH, Yates PJ, Jones CW. What are the Outcomes of Secondary Patella Resurfacing for Dissatisfaction Following Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis of 604 Knees. J Arthroplasty 2024; 39:1093-1107.e1. [PMID: 37871862 DOI: 10.1016/j.arth.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing. METHODS The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197). RESULTS An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I2=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I2 = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%. CONCLUSIONS An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
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Affiliation(s)
- Octavian Andronic
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Vishwa Suravaram
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Wall
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Thomas A Bucher
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Gareth H Prosser
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Piers J Yates
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia
| | - Christopher W Jones
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia; Curtin University, Perth, Australia
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11
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Hong SH, Han SB. Midterm Comparative Analysis of Short Femoral Stem Survivorship in Dorr Type A Femurs. Clin Orthop Surg 2024; 16:201-209. [PMID: 38562642 PMCID: PMC10973610 DOI: 10.4055/cios23268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 04/04/2024] Open
Abstract
Background Proximal-distal mismatch has emerged as a prominent concern in Dorr type A femoral morphology, prompting the exploration of short stems as promising alternatives to conventional stems. This study aimed to evaluate clinical and radiographic outcomes of total hip arthroplasty (THA) using short femoral stems in Dorr type A proximal femoral morphology with a minimum follow-up of 5 years. Methods Patients with short femoral stems in Dorr type A between 2011 and 2017 were included. Patients with the Short Modular Femoral (SMF) stem and Metha stem were recruited and patients with a shortened tapered stem (Tri-Lock BPS) were matched by propensity score matching based on age, sex, body mass index, calcar to canal ratio, and diagnosis. Patient-reported outcomes and the presence of thigh pain were assessed at 5 years postoperatively. Revision rate, complication rate, and radiographic outcomes were also assessed and compared. Results Twenty-two cases (81%) in the SMF stem and 43 cases (65%) in the Metha stem had more than 5 years of follow-up data available. The SMF stem showed a higher failure rate than the other 2 groups, with 18% requiring revision surgery in the SMF stem compared to 4.6% in the Metha stem, and 2.3% in the Tri-Lock BPS. The SMF stem showed considerable complications such as stem position change and lateral cortical hypertrophy with inferior clinical outcomes than the other 2 stem groups. When the Metha stem and the Tri-Lock BPS groups were compared, more intraoperative fractures were observed in the Metha stem, whereas stress shielding and anterior thigh pain were significantly more prevalent in the Tri-Lock BPS. Conclusions The SMF stem might be less reliable than previously reported, showing a high failure rate and increased radiologic complications. Thus, its use for THA in Dorr Type A femurs needs caution. On the other hand, the Metha stem showed comparable outcomes to the shortened tapered Tri-Lock BPS.
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Affiliation(s)
- Seok Ha Hong
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Diab MM, Patel S, Young C, Allen IE, Harris HW. Quality of life measures and cost analysis of biologic versus synthetic mesh for ventral hernia repair: The Preventing Recurrence in Clean and Contaminated Hernias randomized clinical trial. Surgery 2024; 175:1063-1070. [PMID: 38135553 DOI: 10.1016/j.surg.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Although the most durable method for ventral hernia repairs involves using mesh, whether to use biologic mesh versus synthetic mesh remains controversial. This study aimed to compare synthetic and biologic meshes with respect to patient-reported quality of life scores and costs after ventral hernia repair surgeries. METHODS This study is part of the Preventing Recurrence in Clean and Contaminated Hernias (PRICE) pragmatic randomized control trial conducted from March 2014 through October 2018. Patients were randomized 1:1 to undergo ventral hernia repair using either a biologic or synthetic mesh. The coprimary outcomes were 2-year changes in Visual Analog Scale, Activities Assessment Scale, Hernia-Related Quality-of-Life Survey, and Short-Form 36 Health Survey (SF-36) quality-of-life scores from repair. The secondary outcome was the overall cost per patient. RESULTS Among the 165 patients included in the study, 82 were randomized to biologic meshes and 83 to synthetic meshes. There were no significant differences in the performance between the 2 mesh types with regard to quality-of-life measures using a mixed model approach. This result was consistent even when performing subgroup analysis based on wound contamination. However, nonparametric tests comparing the differences in quality-of-life measures from preoperative to 24-month postoperative timepoints revealed that the synthetic mesh group showed a greater reduction in disability than biologic mesh for the SF-36 (median [interquartile range] of 20 [5-30] vs 6 [1-20], P = .025). This difference was due to reductions in the physical role limitations (62 [0-100] vs 0 [0-50], P = .018) and the pain (38 [12-50] vs 12 [0-25], P = .012) domains of the SF-36. Overall cost per patient was greater for biologic meshes (mean [95% confidence interval] of $80,420 [$66,485-$94,355] vs $61,036 [$48,946-$73,125], P = .038), regardless of insurance type. CONCLUSION In this randomized clinical trial, there were no differences in changes in quality-of-life scores at the 2-year timepoint except for the SF-36, where the synthetic mesh may be associated with less pain and physical role limitations than the biologic mesh. Overall costs per patient were less for synthetic than biologic mesh.
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Affiliation(s)
- Mohamed Mustafa Diab
- Department of Surgery, University of California, San Francisco, CA; Department of Surgery, Duke University, Durham, NC
| | - Sohil Patel
- Department of Surgery, University of California, San Francisco, CA
| | - Charlotte Young
- Department of Surgery, University of California, San Francisco, CA
| | - Isabel Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - Hobart W Harris
- Department of Surgery, University of California, San Francisco, CA.
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Florence TJ, Say I, Rivera J, Kim J, Li G, Holly LT, Lu DC. Methylprednisolone Following Minimally Invasive Lumbar Decompression: A Large Prospective Single-Institution Study. Spine (Phila Pa 1976) 2024; 49:506-512. [PMID: 37093030 DOI: 10.1097/brs.0000000000004660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/18/2023] [Indexed: 04/25/2023]
Abstract
STUDY DESIGN Prospective randomized. OBJECTIVE Intraoperative methylprednisolone is a common adjunct following microscopic laminectomy/microdiscectomy. The goal of epidural instillation is a rapid symptomatic reduction in irritation of neural elements. There is inconsistent data supporting its use intraoperatively. To understand whether this maneuver results in any clinical effect, we performed a multiyear prospective study. SUMMARY OF BACKGROUND DATA Previous work has demonstrated equivocal effects on pain with a suggestion of an increased risk of complication. These studies tend to suffer from small sample sizes and short follow-ups. MATERIALS AND METHODS Study obtained IRB approval. During the study period from 2013 to 2019, nearly equivalent numbers of patients who had received steroids during MIS decompressions were followed. Primary outcomes included pain (visual analog scale) and disability [Oswestry Disability Index (ODI)] at 2 weeks and 4 months. Secondary outcomes included complications, readmissions, and reoperation rates during the study period. RESULTS Four hundred eighty-six patients were followed for a mean follow-up of 5.17 years. The index case was more likely to be a revision surgery in the steroid group. Across all patients, there was no difference in pain at 2 weeks or 4 months. Disability was reduced at 2 weeks in the steroid group (ODI: 16.71 vs . 21.02, P = 0.04) but not at 4 months. By subgroup analysis, this is largely explained by ODI reduction in patients with high preoperative ODI (13.00 vs . 43.43, P = 0.03). Patients in the steroid cohort were more likely to undergo subsequent spinal surgery during the study period. CONCLUSION Methylprednisolone instillation is associated with a large, transient reduction in ODI for patients with high preoperative ODI; there is no measurable effect on pain. There is equivocal effect on risk of subsequent reoperation. This issue was clarified in peer review but changes did not make it to the abstract. Therefore, the technique is likely best reserved for patients with significant preoperative disability.
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Affiliation(s)
| | | | | | | | - Gang Li
- UCLA Biostatistics, Los Angeles, CA
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14
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Arhos EK, Poulose BK, Di Stasi S, Chaudhari AMW. Individuals with a ventral hernia who report moderate to high fear have worse functional performance than those with low fear. Hernia 2024; 28:643-649. [PMID: 38407674 PMCID: PMC10997437 DOI: 10.1007/s10029-024-02979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Ventral hernia repairs (VHR) are performed to restore the integrity of the abdominal wall. Fear of movement, or kinesiophobia, may develop in patients with ventral hernia due to pain and functional impairments, however it has not yet been objectively measured in this patient population. The purpose of this study was to test the hypothesis that in patients with ventral hernia awaiting surgical repair, higher levels of kinesiophobia would be associated with poorer mobility, abdominal core function, and quality of life. METHODS Seventy-seven participants scheduled for ventral hernia repair were enrolled as part of an ongoing randomized controlled trial (NCT05142618). The Tampa Scale of Kinesiophobia (TSK-11) is an 11-item questionnaire that asks about fear of movement and physical activity restriction. Participants were split into groups based on their TSK-11 score (minimal, low, moderate to high). Primary outcome measures included the five-time sit-to-stand (5xSTS), Quiet Unstable Sitting Test (QUeST), and the Hernia-Related Quality-of-Life (HerQLeS) survey. A one-way ANOVA with a Bonferroni correction compared QUeST, 5xSTS, and HerQLes results between groups. RESULTS Groups were significantly different on 5xSTS (minimal: 11.4 ± 2.6 s, low: 13.8 ± 3.1 s, moderate to high: 17.8 ± 9.8 s; p = 0.001) and HerQLes (minimal: 58.0 ± 27.8, low: 49.4 ± 22.0, moderate to high: 30.6 ± 25.3; p = 0.003) but not QUeST (minimal: - 2.8 ± 2.5, low: - 6.8 ± 10.0, moderate to high: - 5.5 ± 5.0; p = 0.16). CONCLUSION Individuals with moderate to high kinesiophobia have worse pre-operative performance-based (5xSTS) and self-reported (HerQLes) function and quality of life than those with minimal and low kinesiophobia. Future research should examine the influence of kinesiophobia on post-operative outcomes as it may be a potent target for rehabilitation.
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Affiliation(s)
- Elanna K Arhos
- School of Health and Rehabilitation Sciences, Ohio State University, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA.
- Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, OH, USA.
| | - Benjamin K Poulose
- Department of Surgery, Division of General and Gastrointestinal Surgery, Center for Abdominal Core Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Di Stasi
- Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, OH, USA
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Ajit M W Chaudhari
- School of Health and Rehabilitation Sciences, Ohio State University, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA
- Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, OH, USA
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Shubert SB. Editorial Commentary: Polyurethane Meniscal Scaffold Could Serve as a Bridge to Meniscal Allograft or Arthroplasty in Carefully Selected Post-Meniscectomy Patients. Arthroscopy 2024; 40:1262-1263. [PMID: 38219122 DOI: 10.1016/j.arthro.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 01/15/2024]
Abstract
The young, active patient with pain after subtotal meniscectomy represents a troubling clinical situation with limited treatment options. "Post-meniscectomy syndrome" occurs at a rate of 4-25% and is defined as the presence of knee pain and functional limitations due to increased contact stresses and overload of the articular cartilage in a knee compartment, after subtotal or total meniscectomy. Meniscal allograft transplantation (MAT) can have reasonable results for some patients, typically under the age of 50, with no degenerative change, and no, or correctable instability or malalignment. However, MAT is expensive, it is often difficult to access meniscal allograft tissue, and the procedure can be technically challenging for the surgeon. Meniscal scaffolds have been commercially available and examined in small studies in the literature and metanalyses since the early 2000s. Generally, patients have shown clinical improvement with their use, but over time, they have shown signs of radiologic failure (decrease in size of the meniscal scaffold, meniscal extrusion on MRI, or other radiographic changes.) Nonetheless, recent research shows long-term survivorship of a polyurethane scaffold in some, carefully selected patients. While not shown to be chondroprotective, this could serve as a bridge to MAT or arthroplasty.
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McLaughlin CM, Montelione KC, Tu C, Candela X, Pauli E, Prabhu AS, Krpata DM, Petro CC, Rosenblatt S, Rosen MJ, Horne CM. Outcomes of posterior component separation with transversus abdominis release for repair of abdominally based breast reconstruction donor site hernias. Hernia 2024; 28:507-516. [PMID: 38286880 DOI: 10.1007/s10029-023-02942-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/08/2023] [Indexed: 01/31/2024]
Abstract
PURPOSE Abdominally based autologous breast reconstruction (ABABR) is common after mastectomy, but carries a risk of complex abdominal wall hernias. We report experience with posterior component separation (PCS) and transversus abdominis release (TAR) with permanent synthetic mesh repair of ABABR-related hernias. METHODS Patients at Cleveland Clinic Foundation and Penn State Health were identified retrospectively. Outcomes included postoperative complications, hernia recurrence, and patient-reported outcomes (PROs): Hernia Recurrence Inventory, HerQLes Summary Score, Patient-Reported Outcome Measurement Information System (PROMIS) Pain Intensity 3a Survey, and the Decision Regret Scale (DRS). RESULTS Forty patients underwent PCS/TAR repair of hernias resulting from pedicled (35%), free (5%), muscle-sparing TRAMs (15%), and DIEPs (28%) from August 2014 to March 2021. Following PCS, 30-day complications included superficial surgical site infection (13%), seroma (8%), and superficial wound breakdown (5%). Five patients (20%) developed clinical hernia recurrence. At a minimum of 1 year, 17 (63%) reported a bulge, 12 (44%) reported pain, median HerQLes Quality Of Life Scores improved from 33 to 63/100 (p value < 0.01), PROMIS 3a Pain Intensity Scores improved from 52 to 38 (p value < 0.05), and DRS scores were consistent with low regret (20/100). CONCLUSION ABABR-related hernias are complex and technically challenging due to missing abdominal wall components and denervation injury. After repair with PCS/TAR, patients had high rates of recurrence and bulge, but reported improved quality of life and pain and low regret. Surgeons should set realistic expectations regarding postoperative bulge and risk of hernia recurrence.
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Affiliation(s)
- C M McLaughlin
- Department of General Surgery, Division of Plastic Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
| | - K C Montelione
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - X Candela
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Hershey, PA, USA
| | - E Pauli
- Department of General Surgery, Division of Minimally Invasive Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - A S Prabhu
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Krpata
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C C Petro
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Rosenblatt
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M J Rosen
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C M Horne
- Department of General Surgery, Division of Minimally Invasive Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Das G, Singam A, Chakole V, Das S, Sharma V. Efficacy and Safety of Cryoablation Compared with Cooled Radiofrequency Ablation of Genicular Nerves in Advanced Osteoarthritis of the Knee: A Study Protocol of Single-Centric, Assessor-Blinded, Randomized, Parallel-Group, Non-inferiority Study. Cardiovasc Intervent Radiol 2024; 47:508-514. [PMID: 38528172 DOI: 10.1007/s00270-024-03703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE In patients with symptomatic osteoarthritis knee (OAK), cryoneurolysis (CRYO) and cooled radiofrequency ablation (C-RFA) are reported to be effective and safe; however, they have not been compared directly. The objective of this study is to compare CRYO and C-RFA of the genicular nerve (GN) in terms of efficacy and safety profile in patients with Kellgren and Lawrence (KL) grade ≥ 3 OAK. METHODS This single-centric, assessor-blinded, randomized, parallel-group, non-inferiority study will include 80 patients with KL grade ≥ 3 OAK. The patients with ≥ 50% pain relief on diagnostic block of three GNs will be randomized to one of the two groups, i.e., CRYO (n = 40) or C-RFA (n = 40). The three target GNs for the interventions will include: superior medial, superior lateral, and inferior medial. The primary outcome will be efficacy of CRYO or C-RFA at 2, 12, and 24 weeks post-procedure based on the 11-point Numerical Pain Rating Scale. The secondary outcomes will be functional improvement based on 12-item Oxford Knee Score and safety of both the procedures. The study is registered in the Clinical Trials Registry-India. CONCLUSION CRYO and C-RFA provide pain relief and improve functional outcome by preventing transmission of pain signals, though by distinct mechanisms. While C-RFA is an established treatment modality, recent evidence supports CRYO in patients with OAK. This study intends to demonstrate non-inferiority of CRYO against C-RFA, thereby supporting the use of CRYO as an additional treatment modality in patients with KL grade ≥ 3 OAK.
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Affiliation(s)
- Gautam Das
- Department of Pain Medicine, Daradia: The Pain Clinic, Kolkata, West Bengal, 700067, India
| | - Amol Singam
- Department of Anesthesia & Pain Medicine, JNMC, Wardha, Maharashtra, 442005, India
| | - Vivek Chakole
- Department of Anesthesia & Pain Medicine, JNMC, Wardha, Maharashtra, 442005, India
| | - Sushpa Das
- Department of Pain Medicine, Daradia: The Pain Clinic, Kolkata, West Bengal, 700067, India
| | - Vikas Sharma
- Department of Academic Research, Maverick Medicorum®, 601, Shiv Ganga Apartment, Beltarodi, Nagpur, Maharashtra, 440034, India.
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Yomo S, Oda K, Oguchi K. Long-Term Patient-Reported Outcomes of Stereotactic Radiosurgery for Trigeminal Neuralgia. World Neurosurg 2024; 184:e682-e688. [PMID: 38342166 DOI: 10.1016/j.wneu.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND We aimed to evaluate patient-reported outcomes (PROs) of stereotactic radiosurgery (SRS) for TN in terms of treatment efficacy and toxicity. METHODS We retrospectively analyzed patients who underwent Gamma Knife SRS for idiopathic or classic TN between January 2013 and February 2022. Questionnaires regarding pain relief, treatment toxicity, and post-SRS treatment were sent between late 2022 and early 2023, and the responses received were analyzed. The Faces Pain Scale (FPS, 0: best, 5: worst) was used for quantitative evaluation. RESULTS Responses were received from 51 patients (76%). The mean pre-SRS FPS score was 4.1 (standard deviation (SD) 1.1). Forty-three patients (83%) reported initial pain relief and the best post-SRS FPS score was 1.1 (SD 1.5) (P < 0.001). At a median follow-up of 50 months, the FPS score was still 1.1 (SD 1.6) (P < 0.001). Analysis of factors contributing to durable pain relief showed neurovascular compression to be associated with FPS score improvement (Odds ratio 5.7, 95% CI 1.1-29.7, P = 0.038). Facial dysesthesia had a mean pre-SRS FPS score of 1.7 (SD 2.0) and a mean score of 1.4 (SD 1.7) at the last follow-up (P = 0.32). Eight patients (15%) received post-SRS interventions and 21 (40%) no longer required pharmacotherapy without post-SRS intervention. Forty-four patients (85%) reported being satisfied with SRS. CONCLUSIONS We analyzed PROs of SRS for TN using the FPS and showed SRS to be a safe and effective treatment modality achieving long lasting pain relief.
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Affiliation(s)
- Shoji Yomo
- Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto City, Nagano Prefecture, Japan.
| | - Kyota Oda
- Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto City, Nagano Prefecture, Japan
| | - Kazuhiro Oguchi
- Positron Imaging Center, Aizawa Hospital, Matsumoto City, Nagano Prefecture, Japan
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Corazzelli G, Natale G, Cioffi V, Di Colandrea S, Fiorelli A, de Falco R, Bocchetti A. Giant "Dumbbell" Thoracic Schwannoma: Radical Excision of Rare Lesion in One Surgical Time by Combined Neurosurgical and Thoracoscopic Approach. World Neurosurg 2024; 184:38-39. [PMID: 38185456 DOI: 10.1016/j.wneu.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024]
Abstract
Dumbbell-shaped schwannomas are slow-growing tumors that are typically benign lesions. They account for 6%-14% of spinal neoplasms, with 30% having intradural and extradural components.1 A schwannoma is considered "giant" if it extends beyond the spine by >2.5 cm and involves more than 2 vertebral levels.2 The Eden classification categorizes these tumors into 4 types on the basis of the primary component.3 Surgery is recommended for individuals experiencing prolonged nerve damage and persistent neurogenic pain that cannot be managed.2 There are 3 surgical options for managing thoracic dumbbell schwannomas4: the single-stage posterior-only approach,5 the single-stage anterior-only approach,6 and the single-stage combined posteroanterior neurosurgical and video-assisted thoracoscopic approach. The latter option allows for the most comprehensive lesion control including vascular and nerve structures and optimal hemostasis control. It also avoids spinal instrumentation and provides certainty for complete tumor removal.7Video 1 shows a surgical procedure performed on a 58-year-old woman to remove a thoracic dumbbell neurinoma. The patient consented to the procedure and publication of her image. A simultaneous thoracoscopic and neurosurgical approach was performed. The surgical team successfully removed the schwannoma, and the patient's recovery was smooth, with no neurologic issues or pain. This case highlights the benefits of using a single-stage combined approach for treating Eden II and Eden III giant dumbbell thoracic schwannomas.
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Affiliation(s)
- Giuseppe Corazzelli
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, University "Federico II" of Naples, Naples, Italy.
| | - Giovanni Natale
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Valentina Cioffi
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Di Colandrea
- Department of Anaesthesiology and Intensive Care Medicine, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Alfonso Fiorelli
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaele de Falco
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Bocchetti
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
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20
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Pei Y, Zhu L, Xu Q, Wang J, Sun Y, Wang G. Clinical report of microsurgical treatment of Kohler's disease. Sci Rep 2024; 14:6341. [PMID: 38491143 PMCID: PMC10943104 DOI: 10.1038/s41598-024-57088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 03/14/2024] [Indexed: 03/18/2024] Open
Abstract
The conservative treatment for Kohler's disease will take several months, but some patients still have flatfoot and persistent pain. From October 2013 to July 2015, 3 children with Kohler's disease underwent navicular decompression and micro-circulation reconstruction surgery in our hospital. All the patients have received conservative treatment for more than 3 months and the effect was poor. X-ray showed the bone density of navicular increased significantly. All patients were followed up over 1 year. The 3 patients recovered well. VAS score decreased from 7.0 to 2.6 at 1 month after the operation. The pain symptom disappeared completely on 3 months after surgery. The density of navicular bone recovered to normal. Navicular decompression and micro-circulation reconstruction surgery may quickly improve the ischemic status of navicular bone, alleviate pain symptom and enable patients to resume normal activity as soon as possible.
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Affiliation(s)
- Yantao Pei
- Department of Orthopedics, Department of Hand Surgery, Foot and Ankle Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Lei Zhu
- Department of Orthopedics, Department of Hand Surgery, Foot and Ankle Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Qingjia Xu
- Department of Orthopedics, Department of Hand Surgery, Foot and Ankle Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Juntao Wang
- Department of Orthopedics, Department of Hand Surgery, Foot and Ankle Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yuliang Sun
- Department of Orthopedics, Department of Hand Surgery, Foot and Ankle Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Gang Wang
- Department of Orthopedics, Department of Hand Surgery, Foot and Ankle Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
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21
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Zhang C, Liu D, Zhang Q, Li Q, He L, Lin Y, Ge H. A case control study of vNOTES hysterectomy with the da Vinci surgical system and conventional vNOTES hysterectomy. Medicine (Baltimore) 2024; 103:e37323. [PMID: 38457540 PMCID: PMC10919455 DOI: 10.1097/md.0000000000037323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/10/2024] Open
Abstract
The aim of the case control study was to compare surgical outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with the da Vinci surgical system (dVSS) and conventional vNOTES. A case control study was performed on 25 cases in our hospital. Patients (n = 8) who underwent vNOTES hysterectomy with dVSS were selected to compare with the control group (n = 17) consisted of patients who underwent conventional vNOTES. Patients in the 2 groups underwent different operations respectively, and no case was transferred to transabdominal laparoscopy. In the conventional vNOTES group, 1 patient happened intraoperative hemorrhage of about 1000 mL, and was treated with blood transfusion, and the other one of vNOTES hysterectomy with dVSS had poor incision healing within 1 month after surgery. The other patients had no intraoperative and postoperative complications. The difference of pain scores on the first day (P = .006) and the third day (P = .045) after the 2 surgical methods differed significantly. No statistical differences were observed in operation time, median hospital stay, blood loss, decreased hemoglobin 3 days after surgery, and postoperative white blood cell count. vNOTES hysterectomy with dVSS is safe and feasible, and can achieve the same effect as the conventional vNOTES hysterectomy. And this method may alleviate the pain of patients.
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Affiliation(s)
- Chengling Zhang
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dandan Liu
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiang Zhang
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiaoqiao Li
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li He
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yonghong Lin
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Huisheng Ge
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Traynor C, Coetzee JC. Outcomes of Conversion of Ankle Fusion to Total Ankle Arthroplasty. Foot Ankle Clin 2024; 29:165-170. [PMID: 38309800 DOI: 10.1016/j.fcl.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
With ankle replacements gaining popularity and documented good functional outcomes, there is an increasing number of patients inquiring about the possibility of converting an ankle fusion to a replacement. This could be due to pain, limited function, or increasing adjacent joint arthritis. There is an increasing body of evidence in the literature that a conversion to a replacement is possible and that the outcomes are positive. There are also absolute contradictions for a conversion. An absent fibula, pain of unknown origin, and recent infection fall in this category. Long-term follow-up is needed to see if conversions of ankle fusions to replacements have the same functional results and longevity as primary replacements.
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Affiliation(s)
- Christopher Traynor
- Twin Cities Orthopedics, Minneapolis, MN, USA; Twin Cities Orthopedics, 2700 Vikings Circle, Eagan, MN 55121, USA
| | - J Chris Coetzee
- Twin Cities Orthopedics, Minneapolis, MN, USA; Twin Cities Orthopedics, 2700 Vikings Circle, Eagan, MN 55121, USA.
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23
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Bala A, Olejnik A, Dziedzic T, Piwowarska J, Podgórska A, Marchel A. What helps patients to prepare for and cope during awake craniotomy? A prospective qualitative study. J Neuropsychol 2024; 18:30-46. [PMID: 37036087 DOI: 10.1111/jnp.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023]
Abstract
There is growing interest in awake craniotomies, but some clinicians are concerned that such procedures are poorly tolerated by patients. Therefore, we conducted a study to assess this phenomenon. In this prospective qualitative study, 68 patients who qualified for awake craniotomy were asked to complete the Hospital Anxiety and Depression Scale (HADS)-two days before the surgery and visual analogue scales (VAS) for pain and stress, two days before the surgery and again about two days after. In addition, after their surgery, they took part in a structured interview about what helped them prepare for and cope with the surgery. Most patients tolerated the awake surgery well, scoring low on stress and pain scales. They reported a lower level of stress during the surgery (when questioned afterwards) than before it. Intensity of stress before the surgery correlated negatively with age, positively with HADS anxiety score and positively with stress subsequently experienced during surgery. The level of stress during surgery was associated with stress experienced before the surgery, pain and HADS anxiety and depression scores. Severity of pain during the surgery was positively correlated with stress during surgery and HADS depression and anxiety scores before the surgery. There was no correlation between stress, pain, anxiety and depression and the location of the lesion. Patients have a high tolerance for awake craniotomy. Various factors have an impact on how well patients cope with the operation. Extensive preoperative preparation should be considered a key part of the procedure.
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Affiliation(s)
| | | | - Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Piwowarska
- Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Anna Podgórska
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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24
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Chung J, Albino-Hakim S, Samuels K, Bodansky D, Badia A. The BioPro Thumb Carpometacarpal Hemiarthroplasty: Case Series and Surgical Technique. Tech Hand Up Extrem Surg 2024; 28:26-32. [PMID: 37747076 DOI: 10.1097/bth.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Thumb carpometacarpal (CMC) osteoarthritis is painful and debilitating. Here, we explore outcomes of a modular, press-fit thumb CMC hemiarthroplasty prosthesis (BioPro). This surgical option permits minimal bone resection, sparing the trapezium, hence allowing revision options if necessary. A retrospective review of all cases of the modular thumb CMC implants performed at one community US center between 2018 and 2021 were included and invited for email or telephone review. Electronic records were examined for demographics, patient outcomes, and morbidity. Eleven patients underwent 11 thumb CMC joint hemiarthroplasties, mean age was 64.8 years (SD: 7.68 y), with 6 females. Six received surgery on their dominant extremity. Two were manual workers (both in the medical field), 6 office-based, 2 retired, and 1 homemaker. The preoperative median pain score (Visual Analog Score) was 8/10 (range: 5 to 10), reducing to 1/10 (range: 1 to 10) ( P =0.000033) with a median follow-up of 23 months (range: 13 to 39 mo). In all, 8/11 patients reported they would recommend this surgery to friends and family and opt for the same surgery on their contralateral hand if necessary. One patient reported persistent pain a year postoperatively. On review, the head of the implant was placed too deep into the trapezium. Another center found that this patient had a postoperative trapezium fracture and underwent revision with implant removal and conversion to a suspension arthroplasty. At 12 months, 10/11 thumb CMC hemiarthroplasty showed good pain relief, function, and patient satisfaction. The BioPro has a low risk of subluxation and allows salvage options to remain available should failure occur.
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25
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Klukowska AM, Staartjes VE, Dol M, Vandertop WP, Schröder ML. Predictive value of the five-repetition sit-to-stand test for outcomes after surgery for lumbar disc herniation: prospective study. Eur Spine J 2024; 33:956-963. [PMID: 37993742 DOI: 10.1007/s00586-023-08046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/22/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE It is unknown whether presence of pre-operative objective functional impairment (OFI) can predict post-operative outcomes in patients with lumbar disc herniation (LDH). We aimed to determine whether pre-operative OFI measured by the five-repetition sit-to-stand test (5R-STS) could predict outcomes at 12-months post-discectomy. METHODS Adult patients with LDH scheduled for surgery were prospectively recruited from a Dutch short-stay spinal clinic. The 5R-STS time and patient reported outcome measures (PROMs) including Oswestry Disability Index, Roland-Morris Disability Questionnaire, Visual Analogue Scale (VAS) for back and leg pain, EQ-5D-3L health-related quality of life, EQ5D-VAS and ability to work were recorded pre-operatively and at 12-months. A 5R-STS time cut-off of ≥ 10.5 s was used to determine OFI. Mann-Whitney and Chi-square tests were employed to determine significant differences in post-operative outcomes between groups stratified by presence of pre-operative OFI. RESULTS We recruited 134 patients in a prospective study. Twelve-month follow-up was completed by 103 (76.8%) patients. Mean age was 53.2 ± 14.35 years and 50 (48.5%) patients were female. Pre-operatively, 53 (51.5%) patients had OFI and 50 (48.5%) did not. Post-operatively, patients with OFI experienced a significantly greater mean change (p < 0.001) across all PROMs compared to patients without OFI, except leg pain (p = 0.176). There were no significant differences in absolute PROMs between groups at 12-months (all p > 0.05). CONCLUSIONS The presence of OFI based on 5R-STS time does not appear to decrease a patient's likelihood of experiencing satisfactory post-operative outcomes. The 5R-STS cannot predict how a patient with LDH will respond to surgery at 12-month follow-up.
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Affiliation(s)
- Anita M Klukowska
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands
| | - Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands.
- MICN Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Manon Dol
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands
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Meena A. CORR Insights®: Variations in 1-year Trajectories of Levels of Pain and Capability After Shoulder Arthroplasty Are Associated With Baseline Mental Health. Clin Orthop Relat Res 2024; 482:523-525. [PMID: 37788348 PMCID: PMC10871755 DOI: 10.1097/corr.0000000000002877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Amit Meena
- Consultant, Arthroplasty and Arthroscopy, Shalby Hospital, Jaipur, India
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Gavrilovski A, Dimovska AG, Spasov M, Kostov H, Igor IM, Jonoski K, Trpeski S. Alternative Treatment of Gonarthrosis: Proximal Fibular Osteotomy. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2024; 45:13-18. [PMID: 38575383 DOI: 10.2478/prilozi-2024-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Gonarthrosis is arthrosis of the knee joint, a chronic non-inflammatory disease manifested by progressive destruction of the intra-articular cartilage, accompanied by abnormal formation of the bones form the joint, changes in the synovial membrane and synovial fluid. Gonarthrosis is the most common type of arthrosis. Gonarthrosis can be treated conservatively and operatively. Among well-established surgical options for the treatment of medial gonarthrosis are high tibial osteotomy (HTO), unicompart-mental knee arthroplasty (UKA), and total knee arthroplasty (TKA). Proximal fibular osteotomy (PFO) or superior partial fibulectomy is a relatively recent procedure proposed to reduce knee pain in patients with medial compartment. AIM Our study aims to demonstrate an alternative treatment for gonarthrosis with proximal fibular osteotomy and reduced knee pain in patients with medial compartment osteoarthritis of the knee. MATERIALS AND METHODS At the Department of Orthopedics and Traumatology at J.Z.U "Borka Taleski" Prilep in the period from 2018 to 2021, 14 cases were treated, of which 11 were female and 3 were male. All patients were aged between 62 and 82 years with a mean age of 71.3 years. Patients had a severe degree of gonarthrosis (III/IV) according to Kellgren-Lawrence classification. Arthroscopy was performed in 2 patients. The fibula osteotomy was 7 cm away from the fibular head, with 1 cm resected bone fragment from the fibula. RESULTS The average duration of the surgery was 30 minutes. Patients were followed up on the 7th day, first month, 3 months and 6 months after surgery. The final evaluation of function was done after 6 months by examining the active and passive movements of the knee joint. In all 14 patients we have excellent results with pain reduction, improvement of movement and quality of life. CONCLUSION Proximal fibular osteotomy is an option for medial compartment osteoarthritis of the knee. Current literature is limited to small case series which report good outcomes in pain reduction, including the correction of varus deformity in medial gonarthrosis. Further studies are needed to determine the place of the PFO in the medial gonarthrosis management algorithm before it can be recommended for routine clinical use.
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Affiliation(s)
| | | | - Marko Spasov
- University Clinic of Traumatology (TOARILUC), Skopje, RN Macedonia
| | - Hristijan Kostov
- University Clinic of Traumatology (TOARILUC), Skopje, RN Macedonia
| | | | - Kire Jonoski
- General Hospital Borka Taleski, Prilep, RN Macedonia
| | - Simon Trpeski
- University Clinic of Traumatology (TOARILUC), Skopje, RN Macedonia
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Te Molder MEM, Verhoef LM, Smolders JMH, Heesterbeek PJC, van den Ende CHM. Prioritization of Adverse Consequences After Total Knee Arthroplasty Contributing to a Poor Response: A Best-Worst Scaling Exercise Among Total Knee Arthroplasty Patients and Knee Specialists. J Arthroplasty 2024; 39:651-657.e1. [PMID: 37611678 DOI: 10.1016/j.arth.2023.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) can have a number of adverse consequences for patients that might contribute to a poor outcome. This study aimed to prioritize these consequences, from the perspective of patients and knee specialists. METHODS There were 95 TKA patients and 63 knee specialists who prioritized a set of 29 adverse consequences, based on a previous qualitative study, using a Maximum Difference Scaling method. A hierarchical Bayesian analysis was used to calculate relative importance scores. Differences and agreements between patients versus knee specialists and satisfied versus dissatisfied patients were analyzed using Mann-Whitney-U tests and Kendall's coefficients of concordance. RESULTS There were 4 out of 5 items in the top-5 of both patients and knee specialists that were similar, however, the ranking was different. The highest-ranked consequence for patients was: "Inability to do normal activities such as walking, cycling, swimming and heavy household chores", while knee specialists ranked: "No improvement in pain during the day" as the highest. "No improvement in walking" was in the patients' top-5, but was not ranked in the top-5 of knee specialists. For satisfied and dissatisfied patients, the top-5 of consequences was similar. CONCLUSION Comparable perspectives were found for patients versus knee specialists and satisfied versus dissatisfied patients on the importance of adverse consequences after TKA. However, when looking in more detail, differences in ranking of specific subitems suggest that patients place slightly more importance on the inability to perform valued activities, while knee specialists prioritize lack of pain relief to a higher degree.
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Affiliation(s)
- Malou E M Te Molder
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Lise M Verhoef
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - José M H Smolders
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Cornelia H M van den Ende
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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29
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Leyendecker J, Benedict B, Gumbs C, Eysel P, Bredow J, Telfeian A, Derman P, Kashlan O, Amin A, Konakondla S, Hofstetter CP, Ogunlade J. Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes. J Neurosurg Spine 2024; 40:359-364. [PMID: 38064701 DOI: 10.3171/2023.10.spine23936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/06/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients. METHODS Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18-30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure. RESULTS A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (-3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (-4.4 ± 3.2 vs -2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: -11.4 ± 11.4 vs -9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: -4.3 ± 3.9 vs -3.5 ± 3.8, p = 0.28). CONCLUSIONS The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.
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Affiliation(s)
- Jannik Leyendecker
- 1Department of Neurological Surgery, University of Washington, Seattle, Washington
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Braeden Benedict
- 3Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Peer Eysel
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Jan Bredow
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
- 5Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Germany
| | - Albert Telfeian
- 6Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Osama Kashlan
- 8Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
| | - Anubhav Amin
- 2Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Sanjay Konakondla
- 9Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania
| | | | - John Ogunlade
- 3Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
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Wu CY, Huang HM, Lee HC, Tang CH, Chen YH, Chiu CD. Transforaminal Unilateral Biportal Endoscopic Spinal Surgery for Extraforaminal Lumbar Disc Herniation: A Retrospective Observational Study. World Neurosurg 2024; 183:e658-e667. [PMID: 38181875 DOI: 10.1016/j.wneu.2023.12.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Biportal endoscopic spinal surgery (BESS) is recommended as a safer and less destructive option for lumbar disc herniations. However, limited data exist on clinical outcomes for extraforaminal lumbar disc herniation (ELDH) surgery. This retrospective study presents our preliminary experience with transforaminal unilateral BESS for ELDH. METHODS Patients with lumbar radiculopathy refractory to conservative treatment, diagnosed with ELDH by magnetic resonance imaging, and treated with transforaminal unilateral BESS in 2021-2023 in 2 institutions in Taiwan were eligible for inclusion. Those with lumbar spondylolisthesis grade 2 or more with segmental instability, history of drug abuse or psychiatric diseases, or with a follow-up duration <1 year were excluded. Primary outcomes included visual analog scale for pain, assessed at 1 week, 1 month, 6 months, and 1 year using generalized estimating equations analysis; success and satisfaction of BESS graded by the Macnab criteria; and perioperative complications. Secondary outcomes were operative time and hospital length of stay. RESULTS Seventeen patients were included in the analysis, with a mean age of 65.8 years; 11 (64.7%) were males and 15 (88.2%) had no prior lumbar spine surgery. mean operative time was 107.9 minutes, and length of stay was 3.5 days. Graded by Macnab criteria, 16 (94.1%) of patients had good to excellent outcomes. Only 1 patient experienced complications. No recurrence/reoperation was observed. Generalized estimating equations analysis showed that postoperative visual analog scale scores decreased significantly at 1 week (adjusted Beta [aBeta] = -5.47, standard error: 0.29, P < 0.001), 1 month (aBeta = -5.82), 6 months (aBeta = -5.88), and 1 year (aBeta = -6.29). CONCLUSIONS Transforaminal unilateral BESS is an alternative and feasible method for treating ELDH, producing good surgical outcomes with few complications and sustaining pain improvement. Future studies with larger patient numbers and comparisons between BESS and other minimally invasive techniques for ELDH are warranted.
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Affiliation(s)
- Chih-Ying Wu
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Department of Neurosurgery, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan; Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Hsiang-Ming Huang
- Department of Neurosurgery, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Han-Chung Lee
- Neuroscience Center, Everan Hospital, Taichung, Taiwan
| | - Chih-Hsin Tang
- Graduate Institute of Biomedical Science, College of Medicine, China Medical University, Taichung, Taiwan; Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Health Science, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Di Chiu
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Science, College of Medicine, China Medical University, Taichung, Taiwan; Spine Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
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Zhu B, Li J, Li X, Feng S, Li B. Core decompression combined with platelet-rich plasma-augmented bone grafting for femur head necrosis: a systematic review and meta-analysis. Int J Surg 2024; 110:1687-1698. [PMID: 38181110 PMCID: PMC10942211 DOI: 10.1097/js9.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The clinical potential of biologic augmentation in core decompression and bone grafting for femoral head necrosis is widely acknowledged, with platelet-rich plasma (PRP) being a frequently employed biologic adjunct. However, its clinical application is not standardized, and high-level evidence is lacking. This study aimed to evaluate the efficacy and safety of core decompression and bone grafting combined with PRP for femur head necrosis. METHODS Several databases were systematically retrieved for randomized controlled trials comparing core decompression and bone grafting combined with or without PRP. A systematic review and meta-analysis were conducted following the PRISMA 2020 and AMSTAR 2 guidelines. The study is registered with PROSPERO under the code CRD42022361007, and it is also listed in the research registry under the identification number reviewregistry1537. RESULTS Eleven studies with 642 participants (742 hips) were included. The pooled estimates revealed that when core decompression and bone grafting were combined with PRP, the Harris hip score (mean difference: 7.98; 95% CI: 5.77-10.20; P <0.001), visual analog scale (SMD: -0.68; 95% CI: -0.96 - -0.40; P <0.001) and the pain component of Harris hip score (SMD: 8.4; 95% CI: 4.12-12.68; P <0.001), and reduction of radiographic progression [risk ratio (RR): 0.40; 95% CI: 0.27-0.59; P <0.001] were superior to core decompression and bone grafting alone. Fewer patients with treatment failure (RR: 0.27; 95% CI: 0.14-0.52; P <0.001) and higher good-to-excellent results (RR: 1.48; 95% CI: 1.17-1.86; P <0.001) were observed in treatment groups than control groups. Meanwhile, the pooled analysis substantiated the superior safety profile of PRP (RR: 0.29; 95% CI: 0.11-0.77; P =0.01). CONCLUSIONS The combination of core decompression and bone grafting with PRP is superior to the approach without PRP, demonstrating enhanced effectiveness in terms of function, pain relief, and radiographic progression. Additionally, it results in lower rates of treatment failure and adverse events. However, further high-quality RCTs are needed to evaluate their effectiveness due to methodological and implementation limitations observed in the existing evidence.
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Affiliation(s)
| | | | | | - Shengyi Feng
- Department of Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Bo Li
- Department of Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Grubnik VV, Parfentiev RS, Grubnyk VV, Grubnik YV, Sliepov VV. Transabdominal and retroperitoneal adrenalectomy: comparative study. Surg Endosc 2024; 38:1541-1547. [PMID: 38092972 DOI: 10.1007/s00464-023-10533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/12/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Laparoscopic adrenalectomy is recognized as the "gold standard" approach for benign adrenal tumors. The majority of surgeons opt for laparoscopic transabdominal adrenalectomies (LTA), while retroperitoneoscopic adrenalectomies (RPA) in the prone position have certain advantages for patients. The aim of this study was to compare the effectiveness and safety of the transabdominal and retroperitoneoscopic laparoscopic adrenalectomies. MATERIALS AND METHODS Between 2000 and 2021, our clinic performed 472 laparoscopic adrenalectomies. The age ranged from 19 to 79 years, with a mean age of 50.5 ± 10.2 years. The patient pool consisted of 315 women and 157 men. Tumor sizes ranged from 1 to 10 cm. RESULTS In a study of 316 patients undergoing LTA versus 156 with RPA, the TLA averaged 82.5 min (70-98), while the RPA took 56.4 min (46-62) (P < 0.001). Intraoperative blood loss was 110 cc for the LTA group and 80 cc for the RPA group (P < 0.05) Conversion rates stood at 2.5% for transabdominal and 4.5% for retroperitoneoscopic procedures (P = 0.254). At 24 h post-operation, pain scores were 3.6 and 1.6, respectively (P < 0.001). Time to resume solid oral intake was 15.2 h for TLA and 8 h for RPA, with hospital stays at 4.5 days and 3 days respectively (P < 0.001). Short-term complications occurred in 8.9% of transabdominal and 12.2% of retroperitoneoscopic patients (P = 0.257). CONCLUSIONS For small tumors, RPA offers advantages over the transabdominal method in surgery time, blood loss, post-op pain, and recovery. These benefits are enhanced for patients with prior abdominal surgeries. However, large tumors present challenges in the retroperitoneal approach due to limited space and anatomical orientation. If complications emerge, surgeons can seamlessly switch to the LTA.
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Affiliation(s)
| | - Roman S Parfentiev
- Odessa National Medical University, Valikhovskiy lane, 2, Odesa, Ukraine
| | - Viktor V Grubnyk
- Odessa National Medical University, Valikhovskiy lane, 2, Odesa, Ukraine.
| | - Yurii V Grubnik
- Odessa National Medical University, Valikhovskiy lane, 2, Odesa, Ukraine
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Acar E, Hapa O, Gürsan O, Balcı A, Aydemir S, Mukat A, Ağca S, Çeltik M, Gedik G. Effect of cam resection depth on clinical outcomes after primary hip arthroscopy. Hip Int 2024; 34:228-234. [PMID: 37661665 DOI: 10.1177/11207000231197358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND The amount of resection or the starting point of the resection on the femoral head for cam lesions in femoroacetabular impingement (FAI) is controversial. AIM The purpose of this study was to study the effect of postoperative resection depth, and resection arc ratio of cam lesion on the frequency of achieving substantial clinical benefit (SCB), patient acceptable state (PASS) in modified Harris Hip Score (mHHS) and Hip Outcome Score Activity of Daily Living (HOSADL), 2 years postoperatively. PATIENTS AND METHODS All patients who underwent first-time hip arthroscopy for FAI with a 2-year follow-up were included in this study. Patient-reported outcomes included the mHHS, HOSADL, and visual analogue scale for pain (Pain VAS). Radiological parameters such as alpha angletraditional (αT), alpha anglecartilage (αC), resection arc ratio (% alpha anglecartilage-alpha angletraditional/360°), resection depth (''D''mm) and resection depth ratio 'D%' (D/femoral head diameter %) were measured using the 45° Dunn view. RESULTS We identified 26 patients (27 hips) with 2-year follow-up. There were 10 female and 16 male patients. The mean age of the patients was 33 ± 12 years.Higher frequency of achieving SCB threshold for mHHS was related to labrum repair (73% vs. debridement '27%' p = 0.03), lower preoperative αT (64° vs. 76°, p = 0.04), lower preoperative mHHS (54 vs. 81, p < 0.001) and higher preoperative VAS scores (8 vs. 7, p = 0.02). Higher frequency of reaching PASS threshold for mHHS was associated with lower αC (82°vs. 92° p:0.02), lower RA (8% vs. 11%, p = 0.03), lower D (2.8 mm vs. 4.5 mm p:0.03), lower D% (4.7% vs. 8.4% p = 0.04) and higher postoperative mHHS (97 vs. 82 p < 0.001). CONCLUSIONS A higher frequency of achieving SCB for HOSADL was related to lower D% (5% vs. 10.5%, p = 0.04).Cam resection depth affects the frequency of achieving clinically meaningful scores and resection depth less than 6% of the femoral head diameter seems to be appropriate for optimal results. The starting point of resection on head cartilage needs to be <90° when alpha angle is used for reference.
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Affiliation(s)
- Emre Acar
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Onur Hapa
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Onur Gürsan
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Ali Balcı
- Department of Radiology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Selahaddin Aydemir
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Alaa Mukat
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Selahattin Ağca
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Mustafa Çeltik
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Gökay Gedik
- Department of Radiology, Dokuz Eylül University Hospital, İzmir, Turkey
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Kaiser D, Hoch A, Sutter R, Zingg PO. Gluteus maximus tendon transfer as a salvage option for painful chronic hip abductor insufficiency: clinical and MRI results with a minimum follow-up of 24 months. Hip Int 2024; 34:240-247. [PMID: 37670460 PMCID: PMC10935620 DOI: 10.1177/11207000231197760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/09/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Chronic hip abductor insufficiency is a rare debilitating condition. In cases refractory to conservative treatment and not amenable to direct repair an augmentation becomes necessary. The preferred salvage method at our institution is augmentation with the anterior third of the gluteus maximus tendon. The aim of this study is to describe the results of 8 patients, treated for painful chronic hip abductor insufficiency with gluteus maximus muscle transfer, after a minimal follow-up of 24 months including a full clinical and MRI evaluation of the hip abductors pre- and postoperatively. METHODS We retrospectively reviewed a consecutive series of 8 patients who were surgically managed for painful chronic hip abductor insufficiency. All patients had a Trendelenburg sign, impaired muscle strength (M ⩽ 3) as well as a complete avulsion of the hip abductors with marked fatty degeneration (⩾3). Pain levels, muscle strength, functional scores as well as a postoperative MRI was obtained after a minimal follow-up of 24 months. RESULTS The mean age of the patients was 69 years, mean follow-up was 35 (26-54) months. Pain was significantly reduced postoperatively to VAS 2.5 from VAS 5 (p = 0.046). Trendelenburg sign remained positive in all patients and hip abductor strength did not improve significantly from 2.4 to 3.1 (p = 0.19). Complete healing of the transferred tendon was confirmed by MRI in all patients at last follow-up. CONCLUSIONS In the setting of painful chronic hip abductor insufficiency refractory to conservative treatment with advanced muscle degeneration without the possibility of a direct reconstruction the gluteus maximus tendon transfer significantly decreased pain. The effect on hip abductor strength and patient-reported functional outcome scores is limited. Despite the modest results it remains our preferred salvage treatment option for lack of better alternatives. Larger studies are necessary to confirm these findings.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Wang S, Yao S, Wei J, Shang L, Xu C, Ma J. Psychometric Properties of the Brief Pain Inventory Among Patients With Osteoarthritis Undergoing Total Knee Arthroplasty Surgery. J Arthroplasty 2024; 39:672-676. [PMID: 37648099 DOI: 10.1016/j.arth.2023.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is characterized by pain and functional restrictions, necessitating precise and reliable pain evaluation for effective disease surveillance and postoperative treatment appraisal. METHODS This investigation recruited 110 participants who were slated to receive unilateral total knee arthroplasty (TKA) and administered 3 self-reported questionnaires: the Brief Pain Inventory (BPI), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 5-level EuroQoL Group's 5-dimension questionnaire (EQ-5D-5L), at baseline and 1 year after surgery. Using standard statistical methods and indicators, the BPI was subjected to a battery of psychometric evaluations, including assessments of reliability, validity, and responsiveness. RESULTS At baseline, there were no significant ceiling or floor effects observed. Additionally, the internal consistency reliability (Cronbach's alpha) of the BPI was above 0.8, suggesting that the questionnaire items are adequately related to one another. The study found moderate to very strong correlations between the pain and physical function domains of the BPI and Western Ontario and McMaster Universities Osteoarthritis Index, as well as a strong correlation between the functional interference dimension of the BPI and the EQ-5D, supporting the construct validity of the BPI. Also, the BPI was found to be responsive to changes in pain over time, with a responsiveness index ranging from 2.55 to 3.19. CONCLUSION The BPI assessment tool demonstrated good reliability, validity, and responsiveness in knee osteoarthritis patients who have undergone TKA and can be a useful measurement tool in clinical research to evaluate the effectiveness of pain management strategies and surgical interventions.
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Affiliation(s)
- Shunxing Wang
- Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China; Xi'an Medical University, Xi 'an, China
| | - Shuxin Yao
- Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jie Wei
- State Key Laboratory of Cancer Biology, Department of Pathology, The First Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Lei Shang
- Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi'an, China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jianbing Ma
- Department of Knee Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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He XZ. [Clinical affect of contralateral knee pain on patients undergoing total knee arthroplasty]. Zhongguo Gu Shang 2024; 37:191-5. [PMID: 38425072 DOI: 10.12200/j.issn.1003-0034.20220448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate the effect of contralateral knee pain on joint dysfunction and treatment satisfaction on the operative side 1 year after total knee arthroplasty(TKA) in patients with osteoarthritis. METHODS From March 2019 to January 2021, 635 patients underwent TKA including 296 males and 339 females, with an average age of (69.33±9.38) years old, the duration of symptoms was (1.15±0.44) years. According to the degree of pain visual analogue scale(VAS) in the contralateral knee joint 12 months after operation, the patients were divided into three groups, 423 patients with no or mild pain(VAS 0 to 3), 105 patients with moderate pain(VAS 4 to 6), 107 patients with severe pain(VAS 7 to 10). The related factors of knee function and satisfaction score 12 months after operation were analyzed and compared on different contralateral knee pain levels. RESULTS The contralateral knee pain VAS was significantly reduced after TKA. Old age, high body mass index, high WOMAC scores of postoperative knee joint, moderate and severe pain of contralateral knee joint were the risk factors of dissatisfaction (P<0.05), OR were 1.285, 1.665, 2.319, 1.863 respectively. The high degree of knee pain on the operation side and the ladder room in the home environment were the risk factors for the high WOMAC scores 1 year after discharge(P<0.05). Adherence to exercise and functional training after discharge were the protective factors for patients with high WOMAC scores 1 year after discharge(P<0.05), OR were 3.016, 1.738, 0.619, 0.574 respectively. CONCLUSION TKA can alleviate the pain of contralateral knee joint. Contralateral knee pain does not affect the WOMAC scores after TKA, but it will reduce the treatment satisfaction of patients.
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Affiliation(s)
- Xin-Zhuang He
- Department of Orthopaedics, Yongmei Group General Hospital, Yongcheng 476600, Henan, China
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Rechenmacher AJ, Yancy WS, Bolognesi MP, Ryan SP, Jiranek WA, Horn ME. Does Medically Supervised Weight Loss Prior to Total Knee Arthroplasty Improve Patient-Reported Pain and Physical Function? J Arthroplasty 2024; 39:350-354. [PMID: 37597821 DOI: 10.1016/j.arth.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Weight loss is commonly recommended before total knee arthroplasty (TKA) despite inconsistent evidence for better outcomes. This study sought to examine the impacts of preoperative weight loss on patient-reported and adverse outcomes among TKA patients supervised by a medical weight management clinic. METHODS This study retrospectively analyzed patients who underwent medical weight management supervision within 18 months before TKA comparing patients who did and did not have clinically relevant weight loss. Preoperative body mass indices, demographics, Patient-Reported Outcomes Measurement Information System physical function and pain interference scores, pain intensity scores, and adverse outcomes were extracted. Multivariable linear regressions were performed to determine if preoperative weight loss correlated with patient-reported outcomes after controlling for confounders. RESULTS There were 90 patients, 75.6% women, who had a mean age of 65 years (range, 42-82) and were analyzed. There were 51 (56.7%) patients who underwent clinically relevant weight loss with a mean weight loss of 10.4% and experienced no difference in adverse outcomes. Preoperative weight loss predicted significantly improved 3-month postoperative physical function (β = 15.2 [13.0-17.3], P < .001), but not pain interference (β = -18.9 [-57.1-19.4], P = .215) or pain intensity (β = -1.8 [-4.9-1.2], P = .222) scores. CONCLUSION We found that medically supervised preoperative weight loss predicted improvement in physical function 3 months after TKA. This weight loss caused no major adverse effects. Further research is needed to understand the causal relationships between preoperative weight loss, medical supervision, and outcome after TKA and to elucidate potential longer-term benefits in a larger sample.
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Affiliation(s)
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Maggie E Horn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
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Lundqvist E, Kempe L, Krauss W, Sagerfors M. Pyrolytic Carbon Hemiarthroplasty for Proximal Interphalangeal Joint Arthritis, Long-Term Follow-Up. J Hand Surg Am 2024; 49:99-107. [PMID: 38069955 DOI: 10.1016/j.jhsa.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE The purpose of this study was to assess the long-term clinical, subjective, and radiographic results of pyrocarbon hemiarthroplasty for proximal interphalangeal joint (PIPJ) arthritis at a single institution. METHODS Patients treated with a pyrolytic carbon hemiarthroplasty between 2005 and 2015 were contacted for a clinical follow-up visit. Patients were assessed before surgery, one year after surgery, and again after a mean of 11 years (range: 6-16 years). Objective outcomes were assessed with grip strength, pinch strength, and range of motion (ROM). Subjective outcomes were assessed by the Disabilities of the Arm, Shoulder, and Hand score, Canadian Occupational Performance Measure (performance and satisfaction), and Visual Analog Scale pain scores at rest and during activity. Radiographic assessments were completed according to Sweets and Stern as modified by Wagner et al. RESULTS A total of 68 fingers in 52 patients underwent PIPJ hemiarthroplasty. Thirty-six arthroplasties in 29 patients were available for the long-term follow-up, five patients had died, and the remaining cases were contacted by phone. Three cases were lost to follow-up. Preoperative diagnoses included 41 fingers with osteoarthritis or posttraumatic arthritis, and 27 fingers with inflammatory arthritis. Eight cases had undergone revision at the time of follow-up, and the 10-year implant survival was 72%. The revisions were performed after a mean of two years after surgery. Three patients had undergone soft-tissue procedures. Visual Analog Scale pain scores, Disabilities of the Arm, Shoulder, and Hand scores, and Canadian Occupational Performance Measure scores improved significantly compared with that before surgery. Grip strength and pinch grip remained unchanged. However, PIPJ ROM deteriorated significantly one year after surgery, when compared with that before surgery. CONCLUSIONS Pyrocarbon hemiarthroplasty of the PIPJ has an acceptable long-term implant survival, and the significant improvement in pain scores and patient-reported outcomes is maintained over time. Pyrocarbon hemiarthroplasty could be a viable option in the management of PIPJ arthritis. Patients should be advised that PIPJ ROM deteriorates over time. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Eva Lundqvist
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Louise Kempe
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Wolfgang Krauss
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marcus Sagerfors
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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Samanci Y, Yoruk Oner SS, Peker S. Alexithymia and depression may predict treatment failure in patients undergoing Gamma Knife radiosurgery for trigeminal neuralgia: the potential contribution of colored pain drawings. J Neurosurg 2024; 140:507-514. [PMID: 37548559 DOI: 10.3171/2023.6.jns23834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/01/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Gamma Knife radiosurgery (GKRS) effectively achieves high rates of pain control in trigeminal neuralgia (TN); however, psychological factors can also impact how individuals perceive pain and respond to treatment. The authors aimed to measure the effects of alexithymia and depression on GKRS outcomes, as well as the potential role of colored pain drawings (CPDs) in identifying patients who require additional psychological support. METHODS Seventy-three medically intractable, typical patients with TN were included. Participants completed a visual analog scale (VAS), the Toronto Alexithymia Scale (TAS-20), and the Turkish version of the Beck Depression Inventory-II (BDI-II). Participants used colored pens to draw their pain patterns on standardized face charts and CPDs were categorized as expected or unexpected. Based on the Barrow Neurological Institute pain scale, patients were categorized as responders or nonresponders. RESULTS Most patients (63%) were female, and the median age was 60 (range 27-88) years. Of 73 patients, 56 (76.7%) were responders and 17 (23.3%) were nonresponders. Forty-nine patients (67.1%) had expected CPDs, whereas 24 (32.9%) had unexpected CPDs. Responder and nonresponder groups had similar ages, genders, education, comorbidities, and initial VAS scores. Both groups preferred the colors red and black to describe intense pain (79.2% vs 67.3%, p = 0.411). Significantly better pain relief was observed in patients with expected CPDs than in those with unexpected CPDs (87.8% vs 54.2%, p = 0.003). The unexpected CPD group had significantly more alexithymia (58.3% vs 32.7%, p = 0.045). The mean BDI-II score of the cohort was 26 (range 15-37) and was significantly higher in the unexpected group (28.3 vs 24.8, p = 0.028). Unexpected CPD (OR 12.540) and higher TAS-20 score (OR 3.22) increased treatment failure risk. CONCLUSIONS The outcomes of TN treatment can be influenced by psychological factors, and patients with TN with higher total TAS-20 and BDI-II scores, along with unexpected CPDs, had an increased likelihood of treatment failure. CPDs can be accessed quickly and may allow the physician to screen out most patients with unfavorable psychometrics and proceed with the necessary treatment with appropriate psychological support.
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Affiliation(s)
- Yavuz Samanci
- 1Department of Neurosurgery, Koç University School of Medicine, Istanbul
- 3Gamma Knife Center, Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| | | | - Selcuk Peker
- 1Department of Neurosurgery, Koç University School of Medicine, Istanbul
- 3Gamma Knife Center, Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
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Hasse JM, Meng S, Silpe S, Naziruddin B. Nutrition challenges following total pancreatectomy with islet autotransplantation. Nutr Clin Pract 2024; 39:86-99. [PMID: 38213274 DOI: 10.1002/ncp.11106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/13/2024] Open
Abstract
Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical treatment option for patients with chronic pancreatitis who have not responded to other therapies. TP offers pain relief whereas IAT preserves beta cell mass to reduce endocrine insufficiency. During the surgical procedure, the entire pancreas is removed. Islet cells from the pancreas are then isolated, purified, and infused into the liver via the portal vein. Successful TPIAT relieves pain for a majority of patients but is not without obstacles, specifically gastrointestinal, exocrine, and endocrine challenges. The postoperative phase can be complicated by gastrointestinal symptoms causing patients to have difficulty regaining adequate oral intake. Enteral nutrition is frequently provided as a bridge to oral diet. Patients undergoing TPIAT must be monitored for macronutrient and micronutrient deficiencies following the procedure. Exocrine insufficiency must be treated lifelong with pancreatic enzyme replacement therapy. Endocrine function must be monitored and exogenous insulin provided in the postoperative phase; however, a majority of patients undergoing TPIAT require little or no long-term insulin. Although TPIAT can be a successful option for patients with chronic pancreatitis, nutrition-related concerns must be addressed for optimal recovery.
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Affiliation(s)
- Jeanette M Hasse
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Shumei Meng
- Division of Endocrinology, Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
| | - Stephanie Silpe
- Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Bashoo Naziruddin
- Islet Cell Laboratory, Baylor Research Institute, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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Wagner KR, Horner NS, Gilat R, Kaiser JT, Meeker ZD, Swindell HW, Cotter EJ, Yanke AB, Cole BJ. Revision and Primary Meniscal Allograft Transplantations Provide Clinical Benefit at Mid-Term Follow-Up: A Matched-Cohort Analysis of Patient-Reported Outcomes, Reoperations, and Failures. Arthroscopy 2024; 40:412-421.e1. [PMID: 37422026 DOI: 10.1016/j.arthro.2023.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To report the mid-term outcomes of patients who underwent revision meniscal allograft transplantation (RMAT) and compare survivorship free from reoperation and failure with a matched cohort of patients who underwent primary meniscal allograft transplantation (PMAT). METHODS A retrospective review of prospectively collected data identified patients who underwent RMAT and PMAT between 1999 and 2017. A cohort of PMAT patients matched at a ratio of 2:1 with respect to age, body mass index, sex, and concomitant procedures served as the control group. Patient-reported outcome measures (PROMs) at baseline and at a minimum of 5 years postoperatively were collected. PROMs and the achievement of clinically significant outcomes were analyzed within groups. Graft survivorship free from meniscal reoperation and failure (arthroplasty or subsequent RMAT) was compared between cohorts using log-rank testing. RESULTS During the study period, 22 RMATs were performed in 22 patients. Of these RMAT patients, 16 met the inclusion criteria (73% follow-up rate). The mean age of RMAT patients was 29.7 ± 9.3 years, and the mean follow-up period was 9.9 ± 4.2 years (range, 5.4-16.8 years). There were no differences between the RMAT cohort and the 32 matched PMAT patients with respect to age (P = .292), body mass index (P = .623), sex (P = .537), concomitant procedures (P ≥ .286), or baseline PROMs (P ≥ .066). The patient acceptable symptomatic state was achieved by the RMAT cohort for the subjective International Knee Documentation Committee score (70%), Lysholm score (38%), and Knee Injury and Osteoarthritis Outcome Score subscales (Pain [73%], Symptoms [64%], Sport [45%], Activities of Daily Living [55%], and Quality of Life [36%]). In the RMAT cohort, 5 patients (31%) underwent subsequent reoperation at a mean of 4.7 ± 2.1 years (range, 1.7-6.7 years) and 5 patients met the criteria for failure at a mean of 4.9 ± 2.9 years (range, 1.2-8.4 years). There were no significant differences in survivorship free from reoperation (P = .735) or failure (P = .170) between the RMAT and PMAT cohorts. CONCLUSIONS At mid-term follow-up, most patients who underwent RMAT achieved the patient acceptable symptomatic state for the subjective International Knee Documentation Committee score and the Knee Injury and Osteoarthritis Outcome Score subscales of Pain, Symptoms, and Activities of Daily Living. Additionally, there were no differences in survival free from meniscal reoperation or failure between the PMAT and RMAT cohorts. LEVEL OF EVIDENCE Level III, retrospective comparative cohort.
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Affiliation(s)
- Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nolan S Horner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Hasani W Swindell
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eric J Cotter
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A..
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Tarassoli P, Warnock JM, Lim YP, Jagota I, Parker D. Large multiplanar changes to native alignment have no apparent impact on clinical outcomes following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:432-444. [PMID: 38294963 DOI: 10.1002/ksa.12044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE This study sought to examine if achieved postoperative alignment when compared to the native anatomy would lead to a difference in Patient Reported Outcome Measures (PROMs), and whether the achieved alignment could be broadly categorised by an accepted alignment strategy. METHODS A retrospective cohort study of prospectively collected data on patients undergoing single primary or bilateral simultaneous total knee arthroplasty (TKA) was carried out. CT scans were used to determine the mean change ("delta values") between the pre and postoperative; hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle and femoral implant rotation. Femoral implant flexion and tibial implant slope were measured postoperatively. The primary outcome was the relationship of the variables to the change in KOOS pain subscale after one year. The secondary outcome was the number of knees which could be categorised postoperatively to an alignment strategy, and the mean PROMs in each cohort. RESULTS A total of 296 knees in 261 patients were available for analysis. With regards to the primary outcome, the delta values for each variable did not demonstrate any association with the change in knee injury and osteoarthritis outcome score (KOOS) pain score. Approximately 46% of knees could not be categorised to an alignment strategy based on postoperatively measured alignment, with no significant difference between each cohort with regards to the change in KOOS Pain score. CONCLUSION Achieved alignment does not consistently match accepted alignment strategies, and appears to confer no benefit to clinical outcomes when the native anatomy is most closely approximated, nor results in poorer outcomes in outliers. This study highlights the importance of routine three dimensional pre and postoperative imaging in clinical practice and for the valid analysis of outcomes in studies on alignment. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Payam Tarassoli
- Sydney Orthopaedic Research Institute, St Leonards, Australia
| | | | - Yoong Ping Lim
- Sydney Orthopaedic Research Institute, St Leonards, Australia
- The University of Sydney, Camperdown, Australia
- Charles Darwin University, Casuarina, Australia
| | - Ishaan Jagota
- 360 Med Care Pty Ltd, Pymble, Australia
- Flinders University, Adelaide, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, St Leonards, Australia
- The University of Sydney, Camperdown, Australia
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Lesch C, Nessel R, Adolf D, Hukauf M, Köckerling F, Kallinowski F, Willms A, Schwab R, Zarras K. STRONGHOLD first-year results of biomechanically calculated abdominal wall repair: a propensity score matching. Hernia 2024; 28:63-73. [PMID: 37815731 PMCID: PMC10891228 DOI: 10.1007/s10029-023-02897-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Every year around 70,000 people in Germany suffer from an abdominal incisional hernia that requires surgical treatment. Five years after reconstruction about 25% reoccur. Incisional hernias are usually closed with mesh using various reconstruction techniques, summarized here as standard reconstruction (SR). To improve hernia repair, we established a concept for biomechanically calculated reconstructions (BCR). In the BCR, two formulas enable customized patient care through standardized biomechanical measures. This study aims to compare the clinical outcomes of SR and BCR of incisional hernias after 1 year of follow-up based on the Herniamed registry. METHODS SR includes open retromuscular mesh augmented incisional hernia repair according to clinical guidelines. BCR determines the required strength (Critical Resistance to Impacts related to Pressure = CRIP) preoperatively depending on the hernia size. It supports the surgeon in reliably determining the Gained Resistance, based on the mesh-defect-area-ratio, further mesh and suture factors, and the tissue stability. To compare SR and BCR repair outcomes in incisional hernias at 1 year, propensity score matching was performed on 15 variables. Included were 301 patients with BCR surgery and 23,220 with standard repair. RESULTS BCR surgeries show a significant reduction in recurrences (1.7% vs. 5.2%, p = 0.0041), pain requiring treatment (4.1% vs. 12.0%, p = 0.001), and pain at rest (6.9% vs. 12.7%, p = 0.033) when comparing matched pairs. Complication rates, complication-related reoperations, and stress-related pain showed no systematic difference. CONCLUSION Biomechanically calculated repairs improve patient care. BCR shows a significant reduction in recurrence rates, pain at rest, and pain requiring treatment at 1-year follow-up compared to SR.
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Affiliation(s)
- C Lesch
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - R Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Am Gesundbrunnen 20‑26, 74078, Heilbronn, Germany
| | - D Adolf
- StatConsult, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - M Hukauf
- StatConsult, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - F Köckerling
- Vivantes Humboldt Hospital Berlin, Center for Hernia Surgery, Academic Teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - F Kallinowski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - A Willms
- General and Visceral Surgery, Bundeswehrkrankenhaus Hamburg, Lesserstrasse 180, 22049, Hamburg, Germany
| | - R Schwab
- General, Visceral and Thorax Surgery, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Strasse 170, 56072, Koblenz, Germany
| | - K Zarras
- Visceral, Minimal Invasive and Oncological Surgery, Marien Hospital Düsseldorf, Schloßstraße 85, 40477, Düsseldorf, Germany
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Murata S, Takami M, Iwasaki H, Hashizume H, Yukawa Y, Minamide A, Nakagawa Y, Tsutsui S, Okada M, Nagata K, Ishimoto Y, Teraguchi M, Iwahashi H, Murakami K, Taiji R, Kozaki T, Kitano Y, Yoshida M, Yamada H. Outcomes and Vertebral Osteophytes and Bulging Intervertebral Discs Occupancy as a Decision-Making Tool for Surgical Success in Patients Undergoing Microendoscopic Foraminotomy for Lumbar Foraminal Stenosis. World Neurosurg 2024; 182:e570-e578. [PMID: 38052363 DOI: 10.1016/j.wneu.2023.11.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The objective of this study was to determine the long-term outcomes of microendoscopic foraminotomy in treating lumbar foraminal stenosis and identify the optimal extent of decompression that yields improved results and fewer complications. METHODS A retrospective cohort study reviewed the medical records of 95 consecutive patients who underwent microendoscopic foraminotomy for lumbar foraminal stenosis. Clinical outcomes were assessed using the Japanese Orthopaedic Association scoring system and visual analog scale for low back and leg pain. Surgical success was determined by meeting significant improvement thresholds for back and leg pain at 2 years postoperatively. Multiple regression analysis identified factors associated with improved pain scores. Receiver operating characteristic curve analysis determined the cut-off values for successful surgeries. RESULTS Significant improvements were observed in Japanese Orthopaedic Association and visual analog scale scores for back and leg pain 2 years postoperatively compared with preoperative scores (P < 0.0001) and sustained over a ≥5-year follow-up period. Reoperation rates were low and did not significantly increase over time. Multiple regression analysis identified occupancy of the vertebral osteophytes and bulging intervertebral discs (O/D complex) as surgical success predictors. A 45.0% O/D complex occupancy cutoff value was determined, displaying high sensitivity and specificity for predicting surgical success. CONCLUSIONS This study provides evidence supporting the long-term efficacy of microendoscopic foraminotomy for lumbar foraminal stenosis and predicting surgical success. The 45.0% O/D complex occupancy cut-off value can guide patient selection and outcome prediction. These insights contribute to informed surgical decision-making and underscore the importance of evaluating the O/D complex in preoperative planning and predicting outcomes.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan; Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | | | - Akihito Minamide
- Spine Center, Dokkyo Medical University Nikko Medical Center, Nikko City, Tochigi, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Katsuragi, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Motohiro Okada
- Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yuyu Ishimoto
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masatoshi Teraguchi
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Iwahashi
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Kimihide Murakami
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yoji Kitano
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Munehito Yoshida
- Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Gaspar J, Botelho J, Proença L, Machado V, Chambrone L, Neiva R, Mendes JJ. Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: A randomized clinical trial on patient-reported outcome measures. Clin Implant Dent Relat Res 2024; 26:113-126. [PMID: 38018261 DOI: 10.1111/cid.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To compare patient-reported outcome measures and additional surgical outcomes after sinus floor elevation (SFE) with osseodensification (OD) versus lateral window (LW), both with simultaneous implant placement. MATERIALS AND METHODS Twenty participants requiring single-implant rehabilitation with residual bone height (RBH) ≤4 mm were enrolled. Pain experience, quality of life (QoL) via the Oral Health Impact Profile-14 (OHIP-14), analgesics intake, and other symptoms were self-reported for a week on a daily basis. Surgery duration, complications, and implant stability quotient at baseline (ISQ T0 ) and after 6 months (ISQ T6 ) were registered. Participants were followed up for 1 year. RESULTS From Day 0 (day of surgery) to Day 3, pain experience was significantly lower (p < 0.05) in the OD group. OHIP-14 score was significantly lower (p < 0.05) in the OD group on all postoperative days, except on Day 5. Average analgesics intake was significantly lower (p < 0.001) in the OD group. Surgery mean duration was significantly higher (p < 0.001) in LW compared to OD (71.1 ± 10.4 vs. 32.9 ± 5.3 min). After osseointegration period, all implants were successfully restored with screw-retained crowns. CONCLUSIONS Within the limitations of this study, it can be concluded that OD and LW techniques were similarly effective in SFE with simultaneous implant placement when RBH ≤ 4 mm. However, OD significantly outperformed LW in pain experience, impact on self-perceived QoL, surgery duration, postoperative edema, and analgesics intake.
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Affiliation(s)
- João Gaspar
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Caparica, Almada, Portugal
| | - João Botelho
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Caparica, Almada, Portugal
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Luís Proença
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Caparica, Almada, Portugal
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Caparica, Almada, Portugal
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
| | - Leandro Chambrone
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
- Department of Periodontology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rodrigo Neiva
- Department of Periodontology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - José João Mendes
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
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Verma NN. Editorial Commentary: Subacromial Balloon Spacer Is an Alternative to Rotator Cuff Repair in Older, Lower-Demand Patients Who Prioritize Pain Relief and Faster Recovery Over Strength Restoration. Arthroscopy 2024; 40:249-250. [PMID: 38296433 DOI: 10.1016/j.arthro.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 02/08/2024]
Abstract
The subacromial balloon spacer was originally designed to treat massive irreparable rotator cuff tears in patients with pain but preserved function, and favorable results have been reported. However, surgeons have expanded its application to include use as an adjunct for salvage procedures such as superior capsular reconstruction and tendon transfer, as a delivery device for steroids or biologics, and as an augmentation in the setting of primary or revision rotator cuff tear. When adapting technology to new techniques, one must ask, What is the basis by which we can expect success? In rotator cuff repair, the technology of anchor, suture, and repair configurations is such that mechanical failure is rare. Failure occurs because of lack of biological healing. It is hard to imagine how the balloon may improve biology. In addition, an intact tendon is not required for acceptable patient function or pain relief. The balloon spacer is an alternative to repair in properly selected older, lower-demand patients who prioritize pain relief over strength restoration in exchange for faster recovery.
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Hodge PE, Rabak OJ, Perriman DM, Scarvell JM, Smith PN, Lynch JT. Are Kinematics an Indicator of Outcome After Total Knee Arthroplasty? J Arthroplasty 2024; 39:343-349.e1. [PMID: 37572724 DOI: 10.1016/j.arth.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND A proportion of total knee arthroplasty (TKA) patients are dissatisfied postoperatively, particularly with their ability to perform higher-demand activities including deep-kneeling and step-up where kinematic parameters are more demanding. The purpose of this study was to examine the relationship between knee kinematics of step-up and deep-kneeling and patient-reported outcome measures following TKA. METHODS Sixty-four patients were included at minimum 1-year follow-up. Participants performed a step-up and deep-kneeling task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Associations between kinematics and patient-reported outcome measures, including Oxford Knee Score, American Knee Society Score, surgical satisfaction, and pain were assessed using log-transformed step-wise linear regressions. RESULTS A higher total Oxford Knee Score was associated with more external rotation and more adduction at maximal flexion during kneeling and more external rotation and minimum flexion during step-up. Improved American Knee Society Score was associated with increased internal-external rotation during step-up. Improved surgical satisfaction was associated with greater maximum flexion and more external rotation at maximal flexion during deep-kneeling and more femoral internal rotation at terminal extension during step-up. An improved pain score was associated with greater maximum flexion and more femoral external rotation during deep-kneeling, as well as greater internal femoral rotation during step-up. CONCLUSION The ability to move through full flexion/extension range and end-of-range rotation is important kinematic parameters that influence patient-reported outcome measures. Implant designs and postoperative rehabilitation should continue to focus on achieving these kinematic targets for enhanced outcomes after TKA.
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Affiliation(s)
- Phillipa E Hodge
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Owen J Rabak
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Diana M Perriman
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Jennie M Scarvell
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Paul N Smith
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Joseph T Lynch
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
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Athlani L, De Almeida YK, Martins A, Seaourt AC, Dap F. Thumb basal joint arthritis in 2023. Orthop Traumatol Surg Res 2024; 110:103772. [PMID: 38000508 DOI: 10.1016/j.otsr.2023.103772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/17/2023] [Indexed: 11/26/2023]
Abstract
Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal joint arthritis causes pain, loss of strength during pinch grips, and eventually stiffness and progressive deformity of the thumb column. Conservative treatment must be implemented first. It aims to spare the joint by using standardized methods. It must be initiated as soon as pain starts, not once the deformity has settled in. There is broad agreement that surgery is indicated when pain relief is not achieved after at least 6months of conservative treatment. The available surgical techniques can be classified as joint-sparing (extra-articular) and joint-sacrificing (intra-articular). The former consists of trapeziometacarpal stabilizing ligament reconstruction, subtraction osteotomy of the first metacarpal and thumb carpometacarpal denervation. The latter consists of trapeziometacarpal fusion, trapeziectomy (and its variants) and implant arthroplasty. Except in very specific cases, trapeziectomy and trapeziometacarpal implant arthroplasty with a total joint prosthesis or an interposition implant are the two main surgical techniques for treating basal joint arthritis. After reviewing the pathophysiology and the diagnosis of thumb basal joint arthritis, we will provide an overview of the available treatment options, with emphasis on the accepted surgical strategies in 2023. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Lionel Athlani
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHRU de Nancy, Nancy, France.
| | | | - Antoine Martins
- Centre de chirurgie de la main, urgences main Auvergnes, hôpital privé La Châtaigneraie, Beaumont, France
| | - Anne-Charlotte Seaourt
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHRU de Nancy, Nancy, France
| | - François Dap
- Service de chirurgie de la main, chirurgie plastique et reconstructrice de l'appareil locomoteur, CHRU de Nancy, Nancy, France
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Singh J, Rassir R, Sierevelt IN, van Geene OFF, Rademakers MV, Spekenbrink-Spooren A, Nolte PA. Total Knee Arthroplasty in the Post-Traumatic Knee: Revision Risks and Functional Outcomes Compared to Osteoarthritic Knees. A Report of Primary Procedures From the Dutch Arthroplasty Register. J Arthroplasty 2024; 39:363-367. [PMID: 37598781 DOI: 10.1016/j.arth.2023.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) for post-traumatic arthritis (PTA) poses higher challenges and increased risks of complications compared to TKA for osteoarthritis (OA). This study aimed to compare implant survivorships, reasons for revision, and patient-reported outcome measures between OA and PTA as indications for TKA. METHODS We selected all primary TKAs for PTA or OA between 2007 and 2020 from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies). The study included 3,897 TKA procedures for PTA (median follow-up 4.6 years; interquartile range: 2.2, 7.3) and 255,259 procedures for OA (median follow-up 4.7 years; interquartile range 2.2, 7.6). A total of 10,480 revision procedures were performed across both groups (238 in PTA knees; 10,242 in OA knees). We analyzed the prevalence of preoperative comorbidities and postoperative complications, as well as the reasons for revision, and calculated the implant survival rates. RESULTS The survival revision rate in the OA group was significantly lower at both follow-up moments (5- and 10- years). The likelihood for revision was increased in TKA for PTA compared to TKA for OA (hazards ratio: 1.16 [95% confidence interval 1.02 to 1.33], P = .03). The most common reason for a revision was instability and arthrofibrosis in the PTA group compared to patellar pain for the OA group. CONCLUSION This study demonstrated an increased risk for revision for any reason in TKA for PTA compared to OA. Revision for instability and arthrofibrosis were more prevalent in the PTA group, while revision for patellar pain was less prevalent compared to TKA for OA.
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Affiliation(s)
- Jiwanjot Singh
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Rachid Rassir
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands; Orthopedic Department, Xpert Clinics, Amsterdam, The Netherlands
| | | | | | - Anneke Spekenbrink-Spooren
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies), s-Hertogenbosch, The Netherlands
| | - Peter A Nolte
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Balazs CGC. Editorial Commentary: Subacromial Balloon Spacer for Irreparable Rotator Cuff Tears Produces Clinical Improvement, Yet the Mechanism of Action Is Unclear. Arthroscopy 2024; 40:551-552. [PMID: 38296451 DOI: 10.1016/j.arthro.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 02/08/2024]
Abstract
Subacromial balloon spacers, a treatment option for massive irreparable rotator cuff tears, have been available in the United States since 2021 and much longer in Europe. The device has been described as a humeral head depressor that increases the subacromial space, centers the humeral head preventing superior migration, and improves deltoid mechanical advantage. This is not convincing. Balloon deflation occurs 3 months after implantation, eliminating the head-depressing effect, and the balloon fully degrades within 15 months. Some propose scarring in the subacromial space smoothes the acromial-humeral articulation; this is also unconvincing. The scar is not thick. Clinical studies largely report unchanged or worsened acromiohumeral interval after surgery. Short-term case series show improvement in pain and function, but comparative studies show mixed results. There may be some advantages over partial rotator cuff repair, but debridement alone may be sufficient treatment, and the generally positive short-term results do not determine whether symptom relief persists over the long term after balloon degradation. A recent clinical study does show mid-term improvement, but the mechanism remains unclear, and, if it is a result of smooth subacromial scarring, tuberoplasty may be an alternative.
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