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Usuelli FG, Efrima B, Van Dijk N. Personalized Resurfacing for Osteochondral Lesions of the Talus. Foot Ankle Clin 2024; 29:307-319. [PMID: 38679441 DOI: 10.1016/j.fcl.2023.08.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Osteochondral lesions of the talus (OLTs) are the most common cause of chronic deep ankle pain. Joint-preserving surgeries include bone marrow stimulating, chondral transporting, and cellular-based procedures. Each procedure has its advantages and disadvantages. For that reason, a focal metallic inlay was developed as a bridge between biologics and conventional joint arthroplasty. Despite promising initial results, prefabricated implants are associated with unpredictable results. This article describes a novel customized patient-specific metal inlay as a treatment option for OLTs.
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Affiliation(s)
| | - Ben Efrima
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Via Francesco nava 31, Milan, Italy.
| | - Niek Van Dijk
- Department of Orthopedic Surgery, Amsterdam UMC location AMC, the Netherlands; Head of Ankle Unit, FIFA Medical Centre of Excellence Ripoll-DePrado Sport Clinic Madrid, Spain; Head of Ankle Unit, FIFA Medical Centre of Excellence Clínica do Dragão Porto, Portugal; Casa di Cura, San Rossore, Pisa, Italy
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Efrima B, Dahmen J, Barbero A, Benady A, Maccario C, Indino C, Kerkhoffs G, Usuelli FG. Enhancing precision in osteochondral lesions of the talus measurements and improving agreement in surgical decision-making using weight-bearing computed tomography and distance mapping. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38591657 DOI: 10.1002/ksa.12172] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Weight-bearing computed tomography (WBCT) enables the creation of a three-dimensional (3D) model that represents the ankle morphology in a standing position. Distance mapping (DM) is a complementary feature that uses color coding to represent the relative intraarticular distance and can be used to outline intraarticular defects. Consequently, DM offers a novel approach to delineating osteochondral lesions of the talus (OLT), allowing for the quantification of its surface, volume and depth. The reliability of DM for OLT measurements has yet to be thoroughly evaluated. This study primarily aims to determine the reliability of DM in measuring the surface, depth and volume of OLT. A secondary objective is to ascertain whether measurements obtained through DM, when integrated with a predefined treatment algorithm, can facilitate consensus among surgeons regarding the optimal surgical intervention. METHODS This cohort comprised 36 patients with 40 OLTs evaluated using WBCT and DM. Two raters used DM to determine the lesion boundary (LB) and lesion fundus (LF) and calculate the lesion depth, surface and volume. The raters were asked to choose between bone marrow stimulation, autologous matrix-induced chondrogenesis and osteochondral transposition based on the measurement. Inter-rater and intra-rater agreement was measured. RESULTS Interclass correlation of the lesion's depth surface produced an excellent inter-rater and intra-rater agreement of 0.90-0.94 p < 0.001. Cohen's κ agreement analysis of the preferable preoperative plan produced a κ = 0.834, p < 0.001, indicating a near-perfect agreement. CONCLUSION WBCT-based 3D modules and DM can be used to measure the lesion's surface, depth and volume with excellent inter-rater and inter-rater agreement; using this measurement and a predetermined treatment algorithm, a near-perfect inter-rater agreement for the preoperative planning was reached. WBCT in conjunction with AI capabilities could help determine the type of surgery needed preoperatively, evaluate the hindfoot alignment and assess if additional surgeries are needed. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ben Efrima
- Orthopedic Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Agustin Barbero
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Amit Benady
- Orthopedic Department, Tel Aviv Medical Center, Tel Aviv, Israel
- Levin Center of Surgical Innovation and 3D Printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | - Cristian Indino
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Gino Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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Efrima B, Barbero A, Maccario C, Indino C, Nocera C, Albagli A, Dahmen J, Usuelli FG. Significant Clinical Improvement After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Follow-Up. Cartilage 2024:19476035241240341. [PMID: 38554040 DOI: 10.1177/19476035241240341] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2024] Open
Abstract
PURPOSE This study aims to evaluate the clinical outcomes of arthroscopic autologous matrix-induced chondrogenesis (A-AMIC) for osteochondral lesions of the talus (OLT) at 24 months and 60 months of follow-up. The secondary aim was to assess whether age, body mass index (BMI), and lesion surface affect outcomes. DESIGN Sixty-three patients (32 males, 31 females) with a median age of 37 years [interquartile range (IQR): 25-48] were included. Preoperative and postoperative (24 months and 60 months) clinical outcomes were evaluated using a Visual Analog Score (VAS) for pain during walking, the American Orthopaedic Foot and Ankle Society (AOFAS), Short-Form Survey (SF-12), the Halasi, and the University of California, Los Angeles (UCLA) scores. Patients were categorized according to age, BMI, and lesion surface (1-1.5 cm2 and over 1.5 cm2). The effect of each category was evaluated. RESULTS There were significant improvements in the VAS, AOFAS, SF-12, and UCLA, comparing the preoperative scores to the 60-month follow-up scores (P < 0.001). There were no significant differences in the above-mentioned outcomes between the follow-up periods. Patients older than 33 years had lower SF-12, Halasi, and UCLA scores (P = 0.005, 0.004, and <0.001, respectively). Overweight patients had lower VAS, SF-12, Halasi, and UCLA scores (P = 0.006, 0.002, 0.024, and 0.007, respectively). Lesion size was uninfluential. CONCLUSION A-AMIC yielded clinical improvements at a minimum follow-up of 60 months in patients with symptomatic OLTs, with clinical improvement peaking in the first 2 years, followed by a plateau period. Increased age and BMI were significantly associated with inferior outcomes.
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Affiliation(s)
- Ben Efrima
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Agustin Barbero
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | | | - Cristian Indino
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Chiara Nocera
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Assaf Albagli
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jari Dahmen
- Deparment of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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Segal O, Benady A, Pickholz E, Ovadia JE, Druckmann I, Dadia S, Rath E, Albagli A, Efrima B. MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases. BMC Musculoskelet Disord 2023; 24:969. [PMID: 38102608 PMCID: PMC10722811 DOI: 10.1186/s12891-023-07074-6] [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: 08/13/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This is the first study that attempts to assess the feasibility and efficacy of a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs. METHODS In this retrospective study conducted between 2018 and 2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded. RESULTS All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased Median= -56.9% [-25.6, -72.4]) with a reduction in viable tissue, (Median= -80.4% [-53.3, -95.2]). Four patients required additional CRAs. Only one patient's tumor did not reduce in size. One patient suffered from local muscle necrosis. Pre-operation, the average physical and mental scores 41.6 [29.4, 43] and 26.3 [17.6, 40.9] respectively. Post-operation, the average physical and mental scores were 53.4[38, 59.7] and 38 [31.2, 52.7] respectively. CONCLUSION These findings provide an early indication of the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to treat EDTs safely. Larger cohorts and multicenter evaluations are needed to determine the efficacy of this technique.
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Affiliation(s)
- Ortal Segal
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eliana Pickholz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Druckmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Solomon Dadia
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Efrima B, Barbero A, Ovadia JE, Indino C, Maccario C, Usuelli FG. Axial rotation analysis in total ankle arthroplasty using weight-bearing computer tomography and three-dimensional modeling. Foot Ankle Surg 2023; 29:506-510. [PMID: 37193615 DOI: 10.1016/j.fas.2023.05.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/04/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Post-operative alignment is the most critical indicator for a successful total ankle arthroplasty (TAA). Total ankle malrotation is associated with an increased risk for polyethylene wear and medial gutter pain. Currently, there is no consensus on the correct way to measure the alignment of the tibial and talar component rotations in the axial plane. In the current study, the post-operative analysis system was assessed using weight-bearing computer tomography and a three-dimensional (3D) model. The purpose of the study was to assess the inter-observer and intra-observer agreement of this system. MATERIAL AND METHOD Four angles were measured by two raters independently in two separate readings: posterior tibial component rotation angle (PTIRA), posterior talar component rotation angle (PTARA), tibia talar component axial angle (TTAM), and tibial component to the second metatarsal angle (TMRA). Agreement analysis was quantified according to the interclass coefficient. RESULTS Sixty TAAs across 60 patients were evaluated. A good inter-observer agreement and intra-observer agreement when measuring the PTIRA, PTARA, and TTAM angles was observed along with an excellent inter-observer agreement and intra-observer agreement when measuring the TMRA angle. CONCLUSION In conclusion, the current 3D model-based measurement system demonstrates good to excellent inter and intra-agreement. According to these results, 3D modelling can be reliably used to measure and assess the axial rotation of TAA components. LEVEL OF EVIDENCE Level 3 retrospective study.
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Affiliation(s)
- Ben Efrima
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy.
| | - Agustin Barbero
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cristian Indino
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
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Efrima B, Barbero A, Ramalingam K, Indino C, Maccario C, Usuelli FG. Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening. Foot Ankle Int 2023; 44:1061-1069. [PMID: 37542418 DOI: 10.1177/10711007231185328] [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: 08/07/2023]
Abstract
BACKGROUND Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets and endangers specific os calcis subtalar joint (OCST) subtypes without distinct facets. H-LCL is oriented between the posterior and middle facets and should be suitable for all OCSTs. Both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between 2 articular surfaces represented by color patterns. This study aims to measure the safe zones for LCL using 3-dimensional (3D) models and DM; we hypothesize that it could be measured with high reproducibility. METHODS Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. Four angles were measured independently. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies; similarly, the proximal and distal extents of the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. Consequently, the surface available for safe osteotomies were calculated. An interclass correlation was used to assess the agreement between the 2 raters. Additionally, analysis of variance and Mann-Whitney U test were used to compare the safe zones between OCSTs. RESULTS The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees from a line parallel to the lateral border of the calcaneus, respectively, and the proximal and distal extent of the ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. There were no statistically significant differences between the OCSTs. Two raters measured the angles with good to excellent interrater and intrarater agreement. In 18 cases, we were unable to plan for H-LCL or E-LCL osteotomies. CONCLUSION Distance mapping could be used to measure the safe zone, tailor a preoperative plan, and potentially reduce the risk for iatrogenic damage in LCL. 3D models and DM can increase the reliability of preoperative plans in bones with complex 3D structures. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ben Efrima
- Foot and Ankle Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Agustin Barbero
- Foot and Ankle Unit, Humanitas San Pio X Hospital, Milan, Italy
| | | | - Cristian Indino
- Foot and Ankle Unit, Humanitas San Pio X Hospital, Milan, Italy
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Lichtenstein A, Amar E, Halperin D, Factor S, Ohana N, Albagli A, Efrima B, Rath E. The anterior superior iliac spine is a reliable novel landmark for preemptive periacetabular analgesia in hip arthroscopy. J Hip Preserv Surg 2023; 10:119-122. [PMID: 37900892 PMCID: PMC10604053 DOI: 10.1093/jhps/hnad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/16/2023] [Accepted: 04/07/2023] [Indexed: 10/31/2023] Open
Abstract
Appropriate post-operative (post-op) pain control has been shown to reduce length of stay and facilitate day case surgery. Periacetabular injection of bupivacaine is effective in pain reduction after hip arthroscopy. This study aims to evaluate the anterior superior iliac spine (ASIS) as an anatomical landmark to facilitate needle insertion prior to fluoroscopy. The meeting point derived from a vertical line one fingerbreadth distal to the ASIS and a longitudinal line from the greater trochanter (GT) was used as a landmark in 30 consecutive hip arthroscopy patients for periacetabular analgesia. The distance between the tip of the needle and the acetabular roof was measured via fluoroscopy. Needle location was corrected if needed, followed by periacetabular bupivacaine injection (at anterior, lateral and posterior joint aspects). Post-op pain was measured using the Visual Analog Scale (VAS) 4-6 h post-op and at discharge. The ASIS and GT were identified and used for periacetabular analgesia landmarks in all cases. Results revealed that 93.3% of needle entries fell within 10 mm of the lateral acetabular rim and only one case had fallen distal to it. The post-op mean VAS score was 1.03 (range 0-6, standard error - 0.30, median = 0). At hospital discharge, 90% (27/30 of patients) reported VAS score ≤ 5. Twenty-six of the 30 patients were discharged on the same day as the operation (remaining four patients stayed due to accommodation/traveling issues). The ASIS and GT can be used as an anatomical landmark for periacetabular analgesia in hip arthroscopy with reproducible needle location, significant analgesic effect and minimal radiation.
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Affiliation(s)
- Adi Lichtenstein
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eyal Amar
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dania Halperin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shai Factor
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nissim Ohana
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Orthopedic Department, Meir Medical Center Kfar Saba, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tchernichovsky St 59, Kefar Sava 4428164, Israel
| | - Assaf Albagli
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ben Efrima
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ehud Rath
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Efrima B, Barbero A, Ovadia JE, Indino C, Maccario C, Usuelli FG. Reliability of Cone Beam Weightbearing Computed Tomography Analysis of Total Ankle Arthroplasty Positioning and Comparison to Weightbearing X-Ray Measurements. Foot Ankle Int 2023; 44:637-644. [PMID: 37231710 PMCID: PMC10350699 DOI: 10.1177/10711007231173672] [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: 05/27/2023]
Abstract
BACKGROUND The current reference standard for postoperative evaluation of total ankle arthroplasty (TAA) positioning, weightbearing radiography (WBXR), is subject to technical bias. Weightbearing cone beam computed tomography (WBCT) enables visualization of the foot's complex 3-dimensional (3D) structure under standing load. To date, no WBCT-based system for TAA positioning has been validated. The purpose of this study was to (1) assess TAA positioning using WBCT 3D models and (2) evaluate the agreement levels between 2 raters and thus evaluate the intermethod reliability with respect to WBXR. METHODS Fifty-five consecutive patients were retrospectively reviewed. Two raters independently created a 3D WBCT model using dedicated software and recorded the following measurements: α angle, tibiotalar surface angle (TSA), hindfoot angle (HFA), tibiotalar ratio (TTR), β angle, γ angle, and Φ angle. Measurements were repeated 2 months apart in similar, independent fashion and compared to WBXR. Interobserver, intraobserver, and intermethod agreements were calculated. RESULTS All 7 measurements showed good to excellent intraobserver and interobserver reliability (ICC 0.85-0.95). The intermethod (WBCT vs WBXR) agreement showed good agreement for the γ angle (ICC 0.79); moderate agreement levels for the α angle, TSA angle, β angle, and TTR (ICC 0.68, 0.69, 0.70, and 0.69, respectively); poor agreement for the HFA (ICC 0.25); and negative agreement for the φ angle (ICC -0.2). CONCLUSION Position analysis of TAA using WBCT demonstrated good to excellent interobserver and intraobserver agreement and can be reliably used. Additionally, a negative to moderate agreement between standard WBCT and standard WBXR was found. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Ben Efrima
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Agustin Barbero
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Joshua E. Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cristian Indino
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
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Efrima B, Benady A, E Ovadia J, Albagli A, Rath E, Dadia S, Gortzak Y, Sternheim A, Merose O, Segal O. Favorable outcomes of navigated percutaneous ablation and cementoplasty of bone metastasis in the extremities and pelvis-a case series of 13 cases. J Orthop Surg (Hong Kong) 2023; 31:10225536231171046. [PMID: 37222680 DOI: 10.1177/10225536231171046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES Palliative treatment options for bone metastasis are limited, especially in cases where standard protocols have already failed. The purpose of this study was to evaluate the efficacy and safety of percutaneous ablation, either by cryoablation or radiofrequency, combined with percutaneous cementoplasty using cone-beam guided navigation. The objective was to relieve symptoms and improve functionality in patients suffering from pain secondary to bone metastases, as well as evaluate local disease progression post ablation. METHODS We conducted a retrospective study of 13 patients (average age 63.6 ± 9.8, nine females) with symptomatic skeletal metastases treated using 3D imaging with navigation and followed for at least 12 months. The treatment protocol was implemented either after failure of first line treatment, or as first line when mechanical instability was present. Percutaneous lesion ablation was performed along with percutaneous cementation. RESULTS In this study, we observed a statistically significant decrease in pain. The mean Visual Analog Scale pain score decreased from 7.1 ± 0.4 prior to CRA/RFA to 2.2 ± 0.3 after the procedure (p < 0.001). At the 12-months follow-up, all patients were able to ambulate with no assistance (Eastern Cooperative Oncology Group <2). One minor adverse event (paresthesia) and one major adverse event (drop foot) were resolved at 1 year of follow-up. CONCLUSIONS Treatment of bone metastasis with RFA and CRA in conjunction with cementoplasty using Cone-beam computed tomography navigation provides patients with significant palliative outcomes and in most cases, local tumor control.
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Affiliation(s)
- Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yair Gortzak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Omri Merose
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
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Efrima B, Barbero A, Ovadia JE, Indino C, Maccario C, Usuelli FG. Classification of the Os Calcis Subtalar Morphology in Symptomatic Flexible Pediatric Pes Planus Deformity Using Weightbearing CT and Distance Mapping. Foot Ankle Int 2023; 44:322-329. [PMID: 36920029 DOI: 10.1177/10711007231156605] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The etiology of symptomatic pediatric pes planus (PP) deformity is unclear. Reduced os calcis subtalar joint (OCST) anterior facet morphology has been suggested to result in less support to the talar head and a higher propensity to develop PP deformity. Weightbearing computed tomography (WBCT) and distance mapping (DM) offer new opportunities to investigate PP deformity in general and the OCST specifically. The purpose of this study is to investigate the OCST morphology using DM and to classify PP subtalar subtypes with DM using Bruckner's A-D classification system. METHODS Forty feet in 25 patients in a national referral center were evaluated for symptomatic PP deformity that failed nonoperative treatment. A WBCT scan was performed as part of the preoperative evaluation. Visualization of the distance distribution between the articulating surfaces of the subtalar joint was based on a DM technique. Intra- and interobserver agreement of the subtalar morphology was assessed using Bruckner's classification system. RESULTS The mean age was 10.7 ± 1.4 years. The following mean ± SD and median ± ranges were semiautomatically measured for this group: Meary angle -21 ± 8, calcaneal inclination 15 ± 4 degrees, talar coverage angle 39 (range 32.6-49) degrees, and hindfoot moment-arm 16 ± 5 mm. Classifying subtalar morphology using DM yielded an excellent intra- and interobserver agreement. The individual percentages of each individual subtype were calculated: type A 5%, type B 48%, type C 4%, and type D in 44%. CONCLUSION This study demonstrated excellent intraobserver and interobserver agreement in classifying the OCST using DM. A higher prevalence of types B and D was observed compared to types A and C in this PP cohort. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Ben Efrima
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Agustin Barbero
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cristian Indino
- Ankle and Foot Unit, Humanitas San Pio X Hospital, Milan, Italy
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11
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Gurel R, Amzallag N, Benady A, Efrima B, Barriga J, Gortzak Y, Sternheim A, Dadia S, Hasbani N, Segal O. Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the foot and ankle - A series of 14 cases. Foot Ankle Surg 2022; 28:1468-1472. [PMID: 36117006 DOI: 10.1016/j.fas.2022.09.001] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The surgical treatment for osteoid osteoma (OO) in the foot and ankle is challenging. It is difficult to locate the lesion and the anatomy is crowded by sensitive structures. The purpose of this study was to describe the outcomes of navigated mini open-intralesional curettage (NMIC) or navigated minimally invasive radiofrequency ablation (NMRFA) in treating these lesions. METHODS All patients who underwent surgery for OO in the foot and ankle between 2015 and 2020 were included. O-arm navigation was used in All procedures. The choice of NMIC versus NMRFA was made by the surgeon according to the location of the lesion and its proximity to sensitive anatomic structures. RESULTS Fourteen patients were included. Ten were operated by NMRFA and 4 by NMIC. All patients' symptoms related to OO resolved following a single procedure. Average AOFAS score increased by 18.7 (P < .001). Three patients had the following complications: pathologic fracture, superficial infection and transient deep peroneal nerve sensory loss. CONCLUSION Navigated surgical treatment of OO in the foot and ankle is accurate, efficient and safe.
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Affiliation(s)
- Ron Gurel
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel..
| | - Nisan Amzallag
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Efrima
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Juan Barriga
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathan Hasbani
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ortal Segal
- Departments of Orthopaedic Surgery and Orthopaedic Oncology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Efrima B, Amar E, Ovadia JE, Levy O, Ben Yehuda O, Rath E. Magnetic Resonance Imaging Is Not Reliable in Classifying Anterior Inferior Iliac Spine Morphology Compared to 3-Dimensional Computerized Tomography. Arthroscopy 2022; 38:793-798. [PMID: 34246520 DOI: 10.1016/j.arthro.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/30/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to determine the reliability of standard magnetic resonance imaging (MRI) evaluation of AIIS morphology compared with three-dimensional (3D) computerized tomography (CT) (reference standard). METHODS Sixty hips in 30 patients met the inclusion criteria. The images were reviewed and classified by two fellowship-trained orthopedic surgeons. A second imaging viewing session was conducted in the same manner for validation of AIIS evaluation. The agreement and accuracy indices between the two raters were calculated for each imaging modality (inter-rater agreement) as well the agreement across the imaging modality for each rater (intermethod agreement). RESULTS The inter-rater agreement for the morphological evaluation of the AIIS for the first session according to 3D CT was .553 (P < .05) and by means of MRI was .0163 (P < .05). The inter-rater agreement for the second session by means of 3D CT was .449 (P < .05) and according to MRI was 0 (P < .05). The inter-method agreement for rater 1 for the first session was .04 (P < 0.05), while the agreement for rater 2 was .016 (P < .05). The intermethod agreement for rater 1 on the second session was .35 (P < 0.05), while that of rater 2 was .297(P < .05). The overall accuracy of MRI compared to 3D CT for rater 1 for the first session was .531, .490, and .959 for types I, II, III respectively and .551, .531, and .980 for the second session for types I, II, and III respectively. The overall accuracy of MRI compared to 3D CT for rater 2 for the first session was .551, .469, and .918 for types I, II, III respectively and .633, .592, and .918 for the second session for types I, II, and III, respectively. CONCLUSION MRI evaluations and subsequent classifications of AIIS morphology demonstrated a poor to slight correlation compared with that of the reference standard of 3D CT. LEVEL OF EVIDENCE Level II, retrospective diagnostic study.
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Affiliation(s)
- Ben Efrima
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Ezekiel Ovadia
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, Unite Kingdom
| | - Omer Ben Yehuda
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Chechik O, Maman E, Kazum E, Grunstein A, Ben-Shabat D, Lin R, Efrima B, Factor S, Rotman D, Krespi R, Dolkart O, Rosenthal R. Self-reduction techniques taught via smartphone are effective for anterior shoulder dislocation: prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2021; 29:2338-2341. [PMID: 33033846 DOI: 10.1007/s00167-020-06310-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To prospectively compare the effectiveness of three methods for self-assisted shoulder reduction demonstrated using a smartphone video link. BACKGROUND Anterior shoulder dislocation is very common among young adults. Patients often seek medical assistance in the emergency department to reduce their shoulder. Many techniques for shoulder reduction had been described, some of which do not require professional assistance and can be performed by patients themselves. METHODS Patients admitted with anterior shoulder dislocation were randomized to either the Stimson, Milch or the Boss-Holtzach-Matter technique. Each patient was given a link to watch a short instructional video on his smartphone and instructed to attempt self-reduction. Success of the reduction, pain level, patient satisfaction and complications were recorded. RESULTS The study cohort consisted of 58 patients (mean age was 31.6 (18-66, median = 27), 82% males, 88% right hand dominant). Success rate using Boss-Holtzach-Matter (10 of 19, 53%) and self-assisted Milch (11 of 20, 55%) were significantly higher than with the self-assisted Stimson method (3 of 19, 16%), p < 0.05. Pain levels improved from 8.4 (2-10) to 3.1 (0-10) following the reduction. Patient subjective satisfaction from the reduction attempt was 6.7 (0-10). No complications were observed. CONCLUSION Both the Self-assisted Milch and the Boss-Holtzach-Matter techniques are ideal for reduction of anterior shoulder dislocation without medical assistance. Both methods can be successfully performed without assistance or previous education and taught using an instructional video. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Ofir Chechik
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Eran Maman
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Efi Kazum
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Alon Grunstein
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Dvir Ben-Shabat
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Ran Lin
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Ben Efrima
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Shai Factor
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Dani Rotman
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Rafael Krespi
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Oleg Dolkart
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.
| | - Ron Rosenthal
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
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14
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Efrima B, Ovadia J, Drukman I, Khoury A, Rath E, Dadia S, Gortzak Y, Albagli A, Sternheim A, Segal O. Cryo-surgery for symptomatic extra-abdominal desmoids. A proof of concept study. J Surg Oncol 2021; 124:627-634. [PMID: 34043245 DOI: 10.1002/jso.26528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Extra abdominal desmoid tumors are rare, highly aggressive, and invasive benign soft tissue tumors. Current treatment modalities show high levels of recurrence and comorbidities. Cryo-surgery as an alternative was subsequently investigated. METHODS In this retrospective, single center study 11 patients showing symptomatic tumors were treated with individualized cryo-surgery. Treatment protocol included preoperative planning using computer rendered 3D models, intraoperative navigation and execution using cone beam guidance, and postoperative magnetic resonance imaging image analysis using a gaussian mixture model software. Subjective outcomes were reported using Short Form Health Survey (SF-36) questionnaires. RESULTS Sixteen ablations were performed, each demonstrating a complete match with the determined preoperative plan and model. A total of 9/11 (82%) of patients showed improvements in symptoms and a reduction in tumor volume while 2/11 (18%) did not. Average reduction in tumor volume and viable segments were 36.7% (p = 0.0397) and 63.3% (p = 0.0477), respectively. Mild complications according to the SIR Adverse Event Classification Guidelines were experienced in 3/16 (19%) ablations. SF-36 scores showed a statistically significant improvement (p = 0.0194) in the mental health category and a nonsignificant (p = 0.8071) improvement in the physical health category. CONCLUSION Cryo-surgery using the three-phase protocol as described may improve the overall outcome of future ablation procedures.
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Affiliation(s)
- Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Drukman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
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15
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Rotman D, Efrima B, Yoselevski N, Gurel R, Kazum E, Maman E, Goldstein Y, Chechik O. Early displacement of two part proximal humerus fractures treated with intramedullary proximal humeral nail. J Orthop 2019; 19:59-62. [PMID: 32021038 DOI: 10.1016/j.jor.2019.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/23/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction Proximal humerus nails (PHN) are commonly used for the treatment of simple proximal humerus fractures, and have a reported malunion rate of about 10%. The surgeons who used PHN in one medical institution have noticed a high rate of fracture re-displacement in the early post-operative period. This study's aim is to evaluate the rate of secondary displacement and malunion of patients treated for two part proximal humerus fractures with an angle-stable PHN (MultiLoc), and to assess possible risk factors for this secondary displacement. Methods A retrospective study comprised of 25 consecutive patients with 2 part surgical neck or metaphysis displaced proximal humerus fracture, treated with PHN between the years 2014-2017. Results assessed included radiographic measures (neck-shaft angle) and clinical data: range of motion (ROM) and functional scores (Constant, DASH, SSV). A univariate regression analysis was used to assess possible risk factors for secondary displacement. Results Mean age was 66.6 (range 17-93), and mean follow up was 20 months (range 6-40). Mean neck shaft angle (NSA) changed from 139.1° post operatively to 122.6° at last follow up, with 6 patients (24%) having a NSA change larger than 20°. Two patients (8%) ended up with NSA less than 90°, defined as malunion. The deltoid tuberosity index was found to correlate with the degree of displacement (-0.41, p = 0.04). Conclusions PHN for simple displaced proximal humerus fractures was associated with fair clinical results but an unacceptable rate secondary displacement. The deltoid tuberosity index was found to correlate with the degree of this secondary displacement.
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Affiliation(s)
- Dani Rotman
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Yoselevski
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Gurel
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efi Kazum
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Goldstein
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Efrima B, Safran N, Amar E, Bachar Avnieli I, Kollander Y, Rath E. Simultaneous pigmented villonodular synovitis and synovial chondromatosis of the hip: case report. J Hip Preserv Surg 2018; 5:443-447. [PMID: 30647936 PMCID: PMC6328742 DOI: 10.1093/jhps/hny034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/01/2018] [Indexed: 11/22/2022] Open
Abstract
This report presents a case of a 37-year-old female with a history of hip pain. Magnetic resonance arthrography revealed loose bodies within the joint and synovial hypertrophy indicative of synovial chondromatosis (SC). Hip arthroscopy revealed free chondral bodies and focal villonodular synovial proliferation. The focal synovial proliferation was excised, a total synovectomy performed, and all cartilaginous free bodies removed. A post-operative histological examination of the removed nodular mass and synovium yielded evidence of both SC and pigmented villonodular synovitis (PVNS). A 1-year post-operative clinical examination showed marked clinical improvement and no signs of recurrence on MR images. Despite the clinical similarities, PVNS and SC are two distinct conditions that, to our knowledge, have never been reported as simultaneously occurring in a hip joint. The simultaneous presence of both pathologies may suggest a common origin of synovial metaplasia.
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Affiliation(s)
- Ben Efrima
- Orthopedics Division, Tel-Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv, Israel
| | | | - Eyal Amar
- Minimal Invasive Orthopedics Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ira Bachar Avnieli
- Department of Orthopedics, Barzilai Medical Center, Ashkelon, Israel and
| | | | - Ehud Rath
- Minimal Invasive Orthopedics Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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17
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Bachar Avnieli I, Amar E, Efrima B, Kollander Y, Rath E, Volaski H. Hip arthroscopy as a treatment for obturator neuropathy secondary to intra-pelvic ganglion: a case report. J Hip Preserv Surg 2018; 5:319-322. [PMID: 30393561 PMCID: PMC6206690 DOI: 10.1093/jhps/hny023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/02/2018] [Indexed: 11/13/2022] Open
Abstract
The most common types of cystic lesions around the hip joint are synovial or ganglion cysts. In rare cases, the cysts can compress adjacent structures and cause symptoms to arise. Obturator neuropathy secondary to a hip ganglion cyst is a rare phenomenon, with scarce reports on suggested treatment options. Hip arthroscopy is a potential minimally invasive treatment that has yet to be described in such cases. We present a 52-year-old male suffering from obturator neuropathy caused by an intra-pelvic ganglion cyst arising from the hip joint. Hip arthroscopy was performed for decompression of the cyst and dilation of the stalk opening. Six-month post-operative follow-up showed resolution of symptoms and complete elimination of the cyst on magnetic resonance imaging.
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Affiliation(s)
- Ira Bachar Avnieli
- Department of Orthopedics, Barzilai Medical Center, 2 Hahistadrout St., Ashkelon, Israel
| | - Eyal Amar
- Minimal Invasive Orthopedics Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv, Israel
| | - Ben Efrima
- Orthopedics Division, Tel-Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv, Israel
| | - Yehuda Kollander
- Orthopedic Oncology Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv, Israel
| | - Ehud Rath
- Minimal Invasive Orthopedics Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv, Israel
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