Analog Scale Pain Research Articles

ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study

Background: Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored. Methods: In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires. Results: Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P<.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels. Conclusions: ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.

Abstract 24: Iron deposition changes of ipsilateral ventral posterolateral nuclei correlate with central post-stroke pain after thalamic infarction

Objectives: To investigate the correlation between iron deposition changes in the lesioned thalamic nuclei and the presence and severity of central post-stroke pain (CPSP) after thalamic infarction using quantitative susceptibility mapping (QSM) technique. Methods: We consecutively enrolled patients with unilateral chronic thalamic infarction with radiological examination conformed . Detailed and multidimensional pain characteristics measured as follows: Douleur Neuropathique 4 (DN4) questionnaire for validation of neuropathic pain diagnosis, Short-Form McGill Pain Questionnaire (SF-MPQ) for comprehensive representation of pain experience, Present Pain Intensity index (PPI) for current pain severity upon examination, and Visual Analogue Scale (VAS) for overall pain feeling since symptom onset. Age- and sex-matched stoke-free healthy controls were recruited simultaneously. High resolution structural image 3D-T1 BRAVO and QSM sequences were obtained with 3.0T MRI. The voxel-lesion-symptom-mapping (VLSM) was used to determine lesioned thalamic nuclei at the high risk for CPSP. Then ipsilateral QSM values of the whole thalamus and subregions were compared with contralateral side and healthy controls. Partial correlation analysis were performed to explore the relationship between QSM value and pain severity. Results: Finally, 28 CPSP patients, 33 non-CPSP patients and 55 healthy controls were included in the study. Our results indicated no significant difference in overall QSM values of the whole thalamus among the groups. The VLSM results showed lesion involving ventral posterolateral nuclei (VPL) was highly orrelaed with occurance of CPSP ( p FWE =0.0092.). The QSM values of each subnuclei in the thalamus ipsilateral to infarction were lower compared with the contralateral side and healthy controls ( p <0.001). Nonetheless, the QSM values in ipsilateral VPL were higher in CPSP patients campared with non-CPSP patients( p =0.003). Notably, the QSM values in the ipsilateral VPL were significantly correlated to pain severity (all p <0.05). Conclusions: The study showed that altered iron deposition in the VPL nuclei is associated with the occurrence and severity of CPSP following thalamic infarction. Aberrant iron deposition after ischemic thalamus stroke may play an important role in the pathogenesis of CPSP. Key words: Thalamic infarction; Central post-stoke pain; Iron deposition; VLSM; Quantitative susceptibility mapping

Comparative Evaluation of Intra-articular Ozone and Steroid Treatments in Patients with Coxarthrosis under Ultrasound Guidance: A Retrospective Study

Introduction: Osteoarthritis (OA) is the most common degenerative joint disease characterised by the loss of articular cartilage and synovial inflammation. This condition causes stiffness and swelling in the joint, as well as pain, loss of movement and disability. When performed under Ultrasound Guidance (USG), steroid treatments offer several advantages. On the other hand, ozone therapy accelerates anabolic mechanisms, provides vascularisation of cartilage and bone, and slows down the degenerative process. Additionally, it affects inhibitory cytokines, antioxidant enzymes, and neoangiogenesis. Aim: To evaluate and compare the effectiveness of USG intra-articular ozone therapy versus corticosteroid injections in managing hip OA (coxarthrosis) in patients who have not responded to conventional treatments. Materials and Methods: A retrospective comparative study was conducted at Ankara Training and Research Hospital, Ankara, Altındag, Turkey, from August 2021 to August 2022. Patients unresponsive to conventional treatments were divided into two groups: Group A (n=30) received intra-articular steroid (triamcinolone acetonide), and Group B (n=23) received three weekly ozone sessions (200 μg/20 mL), both under USG. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Harris Hip Score (HHS) for functional status, both pre- and post-treatment. Monthly analgesic use was monitored before treatment and at the 1st week, 1st month, 3rd month and 6th month. Statistical analysis were conducted using Unpaired t-tests and Chi-square tests. A p-value <0.05 was considered statistically significant. Results: A total of 53 patients (mean age 63.23±10.50 years) participated in the study. Analgesic needs decreased in both groups, with no significant differences observed in the 1st week, 1st month, 3rd month, and 6th month (p-value=0.139, p-value=0.724, p-value=0.391, p-value=0.546). The most notable improvement occurred one month post-treatment, particularly in low-stage coxarthrosis. Increases in HHS scores and decreases in VAS values for stages 2-3 were statistically significant in both groups (p-value <0.001). Conclusion: The effectiveness of steroid and ozone therapy for coxarthrosis varies by disease stage. Both treatments are more effective in the early stages, while ozone is ineffective and steroids offer limited benefits in advanced stages. Thus, treatment planning should consider the disease stage, and alternative strategies should be explored for advanced cases. Clinicians should prioritise early intervention and seek alternative options for better patient outcomes.

Effects of Instrument-Assisted Soft Tissue Mobilization and Extracorporeal Shock Wave Therapy in Individuals With Lateral Elbow Pain: A Randomized Single-Blind Clinical Trial.

In lateral elbow pain (LEP), it is important to improve pain, grip strength, and function. The aim of this study is to compare the effects of Instrument-Assisted Soft Tissue Mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) methods on pain, grip strength, and function in LEP. Randomized single-blind clinical trial. Forty-eight adults with LEP were randomly assigned to the IASTM, ESWT, and control groups. Home exercise consisting of special static stretching and eccentric strengthening exercises was given to the control group. The ESWT group received a total of 8 sessions of ESWT in addition to home exercise. The IASTM group received a total of 8 sessions of IASTM in addition to home exercise. The visual analog scale for pain, hydraulic hand dynamometer for grip strength, and Patient-Rated Tennis Elbow Evaluation scale for functionality were used for assessment. Data were collected at baseline, after intervention, and at 4-weeks postintervention. At the end of the treatment and the 4-week follow-up, a decrease in pain scores and improvement in muscle strength and functionality was detected in all 3 groups (P < .001). IASTM applications were more effective than ESWT and control groups in reducing pain both after application and at follow-up (P < .001), whereas ESWT application was also effective compared with the control group (P < .001). IASTM applications were more effective than the ESWT and control groups in reducing Patient-Rated Tennis Elbow Evaluation total scores both after the applications and follow-up (P < .001). IASTM was more effective in grip strength than ESWT and control groups (P < .001). It was determined that IASTM and ESWT treatments were effective in reducing pain and increasing grip strength and functionality in both the short and long term in patients with LEP. It was determined that IASTM treatment was superior to ESWT treatment in reducing pain and improving grip strength and functionality.

Outcomes of open reduction and internal fixation using 2.0/2.4 mm locking compression plate in isolated greater tuberosity fractures of humerus

Background: The purpose of this study was to retrospectively evaluate the radiographic and clinical results of a small single or double low-profile plate fixation of 2.0/2.4 mm locking compression plate (LCP) in treating isolated greater tuberosity (GT) fractures of the humerus. Methods: From June 2015 to October 2022, patients who underwent LCP in treating isolated GT fractures of the humerus were included in this study. The radiological and clinical results were analyzed in 15 patients who underwent open reduction and internal fixation used 2.0/2.4 mm LCP. Results: Bone union was achieved in 14 patients (93.3%) and one failed case was treated with a 2.4 mm single LCP fixation. Radiological union was achieved within 10–20 weeks. Complications occurred in two patients (13.3%), including the reduction failure and shoulder stiffness. At the final follow-up, the average clinical scores were as follows: a visual analog scale for pain of 2.1 (range, 0–5) and a University of California, Los Angeles score of 27.2 (range, 18–31). Regarding range of motion (ROM), the average active ROMs were 142° for forward flexion (range, 120°–150°), 147.1° for abduction (range, 120°– 180°), and 59.3° for external rotation (range, 45°–80°). For internal rotation, the average was observed to reach the 10th thoracic vertebra (range, 1st lumbar vertebra–7th thoracic vertebra). Conclusions: The clinical and radiologic outcomes of treating isolated GT fracture using 2.0/2.4 mm LCP were favorable, and double low-profile plate fixation may be beneficial for sufficient fracture stability if possible. Level of evidence: Level IV, case series.

Revealing distinct treatment mechanisms and outcome correlations in patients with interstitial cystitis/bladder pain syndrome after different bladder therapies through urinary biomarker analysis.

Urinary cytokine changes may serve as biomarkers to assess treatment outcomes for interstitial cystitis/bladder pain syndrome (IC/BPS). This study analyzed the changes in urinary cytokines following various bladder therapies and explored their clinical significance in therapeutic mechanisms. A total of 122 patients with IC/BPS treated with platelet-rich plasma (PRP), botulinum toxin-A (BoTN-A), hyaluronic acid (HA), or low-energy shock wave (LESW) were evaluated. Urinary inflammatory and oxidative stress biomarkers were measured at baseline and at 3months posttreatment. Treatment outcomes were assessed using the Global Response Assessment (GRA), a 10-point visual analog score for pain, and the O'Leary-Saint Symptom Score (OSS). A GRA ≥ 2 was considered indicative of effective treatment. Significant symptom improvement was observed in patients treated with PRP and BoNT-A but not with LESW or HA. At 3months post-treatment, PRP therapy led to decreased urinary 8-isoprostane and total antioxidant capacity levels, while BoNT-A therapy reduced monocyte chemotactic protein-1 and 8-hydroxy-2'-deoxyguanosine levels. HA therapy did not alter urinary biomarker levels, whereas LESW therapy increased macrophage inflammatory protein-1 beta and tumor necrosis factor-α levels. Patients with significant urinary biomarker reductions (GRA ≥ 2) demonstrated clinical improvement at 3months. PRP or BoNT-A exhibits anti-inflammatory effects, reflected by reductions in urinary cytokine levels, correlating with positive treatment outcomes. Urinary cytokine changes may play a role to evaluate the mechanisms of action of various treatments in patients with IC/BPS.

The impact of sleep interventions combined with enhanced nutritional support on sleep quality, nutritional status, pain management, psychological well-being, and quality of life in postoperative colon cancer patients

ObjectiveTo investigate the synergistic effects of combined sleep interventions and enhanced nutritional support on postoperative recovery in colon cancer patients, with a focus on sleep quality, nutritional status, pain management, psychological well-being, and quality of life.MethodsThis randomized controlled trial included 290 postoperative colon cancer patients admitted to the First Affiliated Hospital of Soochow University between May 2021 and May 2023. Participants were randomized into two groups: the intervention group, which received standard care supplemented with sleep and nutritional interventions, and the control group, which received standard care alone. Outcomes were assessed pre- and post-intervention, including the Pittsburgh Sleep Quality Index (PSQI), nutritional markers (serum albumin, prealbumin, body weight, etc.), Visual Analog Scale (VAS) for pain, Self-Rating Anxiety and Depression Scales (SAS, SDS), and EORTC QLQ-C30 quality of life scores.ResultsThe intervention group demonstrated significantly greater improvements across all assessed domains compared to the control group ( P < 0.005 after Bonferroni correction). Sleep quality (PSQI: 7.81 vs. 10.43, d = 0.81) and nutritional markers (e.g., prealbumin: 230.19 mg/L vs. 188.01 mg/L, d = 1.21 ) improved markedly. Similarly, reductions in pain (VAS: 2.65 vs. 5.19,d = 1.09 ), anxiety (SAS: 42.03 vs. 49.45, d = 0.88), and depression (SDS: 38.17 vs. 49.77,d = 1.02 ) were observed. Quality of life scores significantly increased in the intervention group compared to the control group (EORTC QLQ-C30: 99.29 vs. 88.41, d = 0.92).ConclusionThe combined intervention of sleep enhancement and nutritional support significantly accelerated postoperative recovery in colon cancer patients, demonstrating synergistic effects that improved physical, psychological, and quality-of-life outcomes. These findings underscore the value of integrating multifaceted interventions into standard postoperative care to optimize recovery trajectories and overall well-being.

Clinical and Radiological Comparison of Unilateral Biportal Endoscopic and Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Spinal Degenerative Disease.

Unilateral biportal endoscopic discectomy (UBE) is an emerging and minimally invasive surgeryfor lumbar spinal degenerative disease. However, the efficacy, safety and the radiological changes of dural sac and paraspinal muscle of UBE compared with the conventional percutaneous transforaminal endoscopic discectomy (PTED) remains to be determined. The purpose of the study was to comprehensively compare the clinical efficacy between UBE and PTED in the surgical treatment of lumbar spinal degenerative disease. The clinical and radiological data of patients who underwent single-segment endoscopic surgery for lumbar spinal degenerative disease in our hospital from January 2021 to June 2022 were collected in the retrospective study. The visual analogue score (VAS) for back and leg pain, Oswestry disability index (ODI) before and 3, 6, and 12 months postoperative, changes of the cross-sectional area of the dural sac area and paraspinal muscles on axial T2-weighted MRI, operation time, intraoperative complications, MacNab criteria for evaluating efficacy at 12 months postoperatively, and recurrence rate of symptoms within 12 months were compared between patients undergoing PTED and UBE surgeries. A total of 142 patients were included. Among them 74 patients underwent PTED surgery, and 68 patients underwent UBE surgery. No statistically significant differences were identified between the groups in demographic variables. The average VAS and ODI scores in both groups showed significant improvement during the follow-up but without statistically significant difference between the groups. The average operation time in the PTED group was 74.82 ± 19.49 min shorter than the 81.36 ± 21.37 min in the UBE group, exhibiting no statistically significant difference. Although the incidence of complications and recurrence was lower in the UBE group (4.05% vs. 1.47%, p = 0.354; 4.05% vs. 1.47%, p = 0.354, respectively), these differences did not reach statistical significance. The dural sac area in the PTED group increased byan average of 43.16 ± 14.62 cm2, and it was 68.53 ± 16.42 cm2 in the UBE group. Despite the dural sac area increased in both groups, the UBE group had a statistically significant greater improvement than the PTED group (p = 0.000). The area of the paraspinal muscle in the UBE group was significantly greater postoperatively (34.54 ± 2.75 cm2 vs. 36.22 ± 2.96 cm2, p = 0.001) and significantly less than in the PTED group at 12 months postoperatively (31.17 ± 2.59 cm2 vs. 29.46 ± 3.11 cm2, p = 0.001). Both PTED and UBE surgeries can achieve satisfactory improvement in symptoms and function for patients with lumbar spinal degenerative disease and can be well-maintained as a first-line minimally invasive treatment. However, the UBE technique can achieve a better decompression area to restore the normal shape of the dural sac but may lead to greater paraspinal muscle damage and atrophy.

Efficacy of subcutaneous perispinal infiltration of triamcinolone in patients with symptomatic cervical osteoarthritis.

To assess the efficacy and safety of subcutaneous perispinal infiltration of low dose of triamcinolone and lidocaine indicated for pain control in patients with cervical osteoarthritis (COA). Patients with symptomatic COA resistant to conventional treatment including anti-inflammatory drugs, analgesics, and physical therapy were included. Technetium-99m pyrophosphate (99mTc-PYP) scintigraphy and computerized tomography (CT) fusion scans images were used for diagnosis of COA and as a guide for level(s) of infiltration(s). Infiltration consisted of subcutaneous administration of 1cc of a mixture of triamcinolone (6mg/0.7cc) and 2% lidocaine (6mg/0.3cc) into the posterior central interspinal area, at the levels where the greatest uptake of the radiotracer was observed. Response was assessed using a pain analogue scale (PAS) (range 0-10 with 10 representing worst pain). Forty-two patients were included. Thirty-six (85.7%) were women. The mean age was 59.2 years. Three months after infiltration clinical improvement was confirmed by a decrease in the PAS value: before and after infiltrations was 7.26 (range 4-10, SD:1.48) and 1.97 (range 0-6, SD:1.24), respectively. This difference being statistically significant (P < 0.05). No patient presented local or systemic adverse effects. Low dose subcutaneous perispinal injection of triamcinolone and lidocaine may offer clinical benefits for patients with symptomatic COA refractory to conventional treatments. 99mTc-PYP/CT fusion scans images were useful as a guide for localization of infiltrations.

Differential effects of sound interventions tuned to 432 Hz or 443 Hz on cardiovascular parameters in cancer patients: a randomized cross-over trial

BackgroundThis study investigated whether a sound intervention tuned to 432 Hz (Hz) yields differential effects on cardiovascular parameters and psychological outcomes compared to 443 Hz, which is the concert pitch in German professional orchestras.MethodsUsing a randomized cross-over design, patients with cancer were recruited to receive both a 15-minute sound intervention with a body monochord tuned to 432–443 Hz. Before (pre) and after (post) intervention, cardiovascular parameters were measured using the VascAssist2.0. In addition, visual analogue scales (VAS) for emotional well-being, anxiety, stress, pain and sadness were also assessed pre and post intervention.Results43 patients (8 male, 35 female) with a median age of 61 years (range 35–86) were included. Both interventions led to a significant reduction in heart rate with a more pronounced effect for 432 Hz (median reduction − 3 bpm (432 Hz) vs. median reduction − 1 bpm (443 Hz), p = 0.04). While heart rate variability was increased exclusively by 432 Hz (median increase + 3 ms, p = 0.01), both vascular resistance (median reduction − 5%, p = 0.008) and stiffness (median reduction %, p = 0.04) were significantly reduced by 432 Hz, which was not observed at 443 Hz. Nevertheless, these effects were not significantly different compared to 443 Hz. On the other hand, 432 Hz led to a reduced pulse wave velocity (median reduction − 0.5 m/s, p < 0.001), which was also significantly different compared to 443 Hz (p < 0.001). Improvement in VAS was observed for both groups, with significant increases in emotional well-being and reduction in fatigue, anxiety and stress for both intervention timepoints, although the majority showed no increased VAS scores even before the intervention (median values 0 for anxiety and stress).ConclusionSound interventions tuned to 432–443 Hz exert both positive effects in cancer patients. While psychological outcomes are improved by both interventions, 432 Hz leads to a more pronounced but not significantly different effect to 443 Hz on objective cardiovascular parameters, which reflect deeper relaxation.

Outcomes of Osteosynthesis of Os Subfibulare for Chronic Lateral Ankle Instability With Large Os Subfibulare.

Os subfibulare (OS) is commonly found in patients with chronic lateral ankle instability (CLAI). When performing lateral ligament reconstruction for CLAI, excision of a large OS can cause substantial lateral ligament defects making anatomic repair challenging. This study analyzed clinical and radiologic outcomes among patients who underwent osteosynthesis of the OS for chronic lateral ankle instability and a large OS. 28 ankles with CLAI and a large OS (≥10 mm) that underwent osteosynthesis of the OS between June 2007 and July 2021 were included in the study and followed for ≥24 months. Visual analog scale (VAS) for pain, Karlsson-Peterson ankle score, and Medical Outcomes Study Short Form Health Survey-36 physical component summary (SF-36 PCS), talar tilt angle, and anterior displacement of the talus were used to assess clinical and radiologic outcomes. All reoperations and complications were also evaluated. The mean OS size was 15.4 mm (range, 12.2-21.0 mm). The mean follow-up period was 78.9 months (range, 24.0-177.0 months). Mean VAS score, Karlsson-Peterson ankle score, SF-36 PCS, talar tilt angle, and anterior displacement of the talus all improved significantly, from preoperative values of 5.3 ± 1.8, 38.4 ± 10.6, 45.6 ± 10.8 points, 11.1 ± 5.7 degrees, and 7.3 ± 1.9 mm, to 0.9 ± 1.4, 88.7 ± 12.6, 80.2 ± 12.3 points, 3.9 ± 2.0 degrees, and 4.8 ± 1.3 mm, respectively, by the last follow-up. The overall complication rate was 10.7% (3 ankles); the reoperation rate was 7.1% (2 ankles). Osteosynthesis of the OS produced satisfactory outcomes in patients with CLAI and a large OS. This method may be a viable surgical option for patients with this condition.

Comparative approach for abdominal wall reconstruction after ventral hernia: open versus minimally invasive surgery.

The classic open ventral hernia repair provides excellent results in recurrences. However, wound complications are the Achilles heel for a good overall clinical outcome. Laparoscopic surgery is in general associated with less pain, better esthetic results, faster recovery, and lower incidence of wound complications. Robotic procedures provide increased degrees of freedom, may improve ergonomics, and allow scaling and performance of finer movements deemed difficult through alternate surgical approaches. The aim of this study is to compare outcomes between open and minimally invasive approaches, with the primary objective of determining differences in postoperative course and hospitalization. Patients underwent any of the three procedures: open Rives-Stoppa, laparoscopic eTEP or robotic eTEP between June 2020 and January 2024 for the treatment of one or more midline abdominal wall hernias alongside rectus abdominis diástasis. The width diameter of the hernias was between 3 and 10cm and techniques that did not place the mesh in a retromuscular position or required component separation are excluded. Robotic surgery had a lower score on the visual analogue scale for pain at discharge (p-value < 0.00). Minimally invasive surgery allows for the placement of larger meshes compared to the open approach (p < 0.05), although the surgical time is longer (p-value < 0.00). There were no statistically significant differences for hospital stay (p-value = 0.46), complications (p-value = 0.52) or recurrence (p-value = 0.70). Minimally invasive surgery allows for the placement of larger meshes compared to the open approach without increasing the morbidity of the procedure or the immediate postoperative pain, despite generally having longer operative times.

Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison

Background: Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery. Purpose: To compare minimum 10-year patient-reported outcomes (PROs) and survivorship in patients who underwent primary hip arthroscopic surgery for femoroacetabular impingement syndrome and labral tears according to sex. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent primary hip arthroscopic surgery between March 2009 and May 2011 were reviewed. Patients with minimum 10-year PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were eligible. Exclusion criteria included previous ipsilateral hip conditions or surgical procedures, Tönnis grade >1, or dysplasia (lateral center-edge angle <25°). In the subanalysis, female patients were matched to male patients using a 1:1 ratio by age, sex, and body mass index. Results: A total of 375 hips had a minimum 10-year follow-up. There were 249 female (mean age, 36.8 ± 13.1 years) and 126 male (mean age, 38.9 ± 13.1 years) hips. Survivorship was defined as no conversion to total hip arthroplasty. Female and male hips exhibited similarly high rates of survivorship (80.3% vs 72.2%, respectively; P = .076). Female hips underwent secondary arthroscopic surgery at a statistically higher rate of 14.5% (P = .021) and had higher rates of capsular repair and iliopsoas fractional lengthening (P < .0001 and P < .001, respectively). Male hips had a significantly higher rate of acetabular labrum articular disruption/Outerbridge grade 3 and 4 damage at 54.0% compared with female hips (both P < .001) and underwent femoroplasty and acetabular microfracture at significantly higher rates of 88.1% versus 51.0%, respectively, and 16.7% versus 4.8%, respectively (both P < .001). In the subanalysis, both groups showed significant improvements in all PROs from baseline (all P < .001). Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher self-reported mean satisfaction score of 9.0 compared with 8.4 (P = .003) and a greater magnitude of improvement in 10-year PROs (ΔmHHS: 29.3 ± 17.5 vs 23.1 ± 19.8, respectively [P = .036]; ΔNAHS: 33.2 ± 21.3 vs 25.1 ± 19.5, respectively [P = .012]; ΔHOS-SSS: 47.0 ± 32.0 vs 32.7 ± 31.9, respectively [P = .008]; and ΔVAS: –4.6 ± 2.7 vs −3.5 ± 2.0, respectively [P = .009]). However, all PROs at a minimum 10-year follow-up were similar between the groups. Conclusion: After undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome, both female and male patients reported significant improvements in all PROs at a minimum 10-year follow-up and high patient satisfaction, with similar final functional scores. Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher satisfaction score and a greater magnitude of improvement in PROs postoperatively.

Clinical and radiographic comparison of robot-assisted single-position versus traditional dual-position lateral lumbar interbody fusion.

The potential of robot-assisted (RA) single-position (SP) lateral lumbar interbody fusion (LLIF) warrants further investigation. This study aimed to assess the efficacy of RA-SP-LLIF in improving both clinical and radiographic outcomes in patients undergoing lumbar spinal fusion surgery. A total of 59 patients underwent either RA-SP-LLIF (n = 31 cases) or traditional LLIF (n = 28 cases). Surgical parameters including operative duration, estimated blood loss, and fluoroscopy duration were recorded. Clinical outcomes were assessed using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 36-item Short-Form Health Survey (SF-36). Radiographic parameters were also evaluated. There were no significant differences between the two groups in terms of postoperative and last follow-up times, but both groups demonstrated significant improvements in VAS scores. Similarly, ODI and SF-36 scores showed comparable improvements. Radiographic parameters did not significantly differ between the groups preoperatively, postoperatively, and at last follow-up (p > 0.05). Neither group showed significant improvements in pelvic tilt and sacral slope parameters compared to baseline postoperatively and at last follow-up (p > 0.05). However, the RA-SP-LLIF group exhibited significantly greater improvements in lumbar lordosis (LL; p < 0.01), segmental lordosis (SL; p < 0.01), and pelvic incidence-LL mismatch (PI-LL; p < 0.01) immediately postoperatively compared to baseline, although these differences were not significant at subsequent evaluations. Similarly, the traditional LLIF group improved the LL, SL, and PI-LL parameters postoperatively. Importantly, there was no statistically significant difference in the Bridwell grade and complications between the two groups (p = 0.83 and p = 0.88, respectively). However, the RA-SP-LLIF group had significantly shorter operative and fluoroscopy durations compared to the traditional LLIF group (p = 0.04 and p < 0.01, respectively). Both RA-SP-LLIF and traditional LLIF surgeries achieved satisfactory lordotic correction. However, RA-SP-LLIF surgery demonstrated shorter operative and fluoroscopy times compared to traditional LLIF surgery. Therefore, RA-SP-LLIF is a promising technique for enhancing surgical efficiency, safety, and precision in lumbar spinal fusion procedures.

Mid- to Long-Term Outcomes of Two-Stage Revision Arthroplasty for Periprosthetic Joint Infection of the Shoulder.

Background/Objectives: Periprosthetic joint infection (PJI) after shoulder arthroplasty is often treated with a two-stage approach, but the data on the mid- to long-term outcomes remain scarce. This study aimed to evaluate the clinical outcomes of two-stage revision arthroplasty for shoulder PJI with a minimum follow-up of five years. Methods: This retrospective study identified 59 shoulders in 58 patients who underwent the first stage of a two-stage revision arthroplasty for shoulder PJI at our institution between 2007 and 2018. Of these, 29 shoulders in 29 patients (49.2%) did not undergo reimplantation or the patient passed away before reaching five years of follow-up. The remaining 30 shoulders in 29 patients were included in the study. The clinical assessments included the active range of motion, the visual analogue scale (VAS) for pain, the Subjective Shoulder Value (SSV), the Constant Score (CS), and the 12-Item Short Form Survey (SF-12), supplemented by detailed clinical and radiological evaluations. Results: The mean age of the 29 patients was 75.9 ± 10.4 years. The average follow-up duration was 8.3 ± 2.8 years. The most common indications for primary shoulder arthroplasty were primary osteoarthritis (n = 12, 40%) and fractures (n = 12, 40%). At the first stage, nine cases (30%) showed negative cultures, while C. acnes and S. epidermidis were each identified in eight cases (26.7%). Four shoulders (13.3%) experienced recurrent infections. At the follow-up, the mean abduction was 86 ± 48.1°, the mean forward flexion was 97.8 ± 50.1°, the mean external rotation was 20.5 ± 19.9°, and the internal rotation reached the lumbosacral region. The mean VAS pain score was 1.5 ± 2.1, the mean SSV was 51.8 ± 28.4%, the mean CS was 54.6 ± 21.0, and the mean SF-12 was 81.0 ± 16.0. Conclusions: Two-stage revision arthroplasty for shoulder PJI results in satisfactory subjective and objective outcomes, with a low overall reinfection rate. However, the high rates of mortality and failure to reimplant must be carefully considered when managing expectations in this challenging cohort.

Retrospective comparison of cortical bone trajectory and pedicle screw in lumbar fusion for patients over 80, including sagittal balance: a single-center study

BackgroundComparative studies of posterior lumbar interbody fusion with cortical bone trajectory and pedicle screw in older patients, particularly in those aged ≥ 80 years, are rare. This study aimed to retrospectively analyze the clinical and surgical outcomes following posterior lumbar interbody fusion with pedicle screw fixation compared to cortical bone trajectory in patients aged ≥ 80 years with degenerative lumbar spine disease.MethodsWe included 68 patients aged ≥ 80 years who underwent degenerative lumbar spinal surgery at our spine center between January 2011 and December 2020. Of these 68 patients, 24 and 44 underwent posterior lumbar interbody fusion with cortical bone trajectory and pedicle screw, respectively.ResultsThe Visual Analog Scale for back pain was significantly lower in the cortical bone trajectory group than in the pedicle screw group at 6 months postoperatively (P = 0.049). The Oswestry Disability Index was significantly lower in the cortical bone trajectory group than in the pedicle screw group at 6 months postoperatively (P = 0.05). The estimated blood loss and operation time were significantly lower in the cortical bone trajectory group than in the pedicle screw group (P = 0.017 and P < 0.001, respectively). Postoperative morbidity was also lower in the cortical bone trajectory group (P = 0.049).ConclusionsDespite these limitations, our study findings indicate that cortical bone trajectory is not inferior to posterior lumbar interbody fusion with pedicle screw fixation if there is a need for fusion in older patients aged ≥ 80 years.

Efficacy and safety of acupuncture with moxibustion for knee osteoarthritis: a meta-analysis of randomized controlled trials

BackgroundOsteoarthritis (OA) is prevalent, yet its management remains challenging. This meta-analysis aims to evaluate the efficacy of acupuncture combined with moxibustion versus other standard treatments in patients with knee osteoarthritis (KOA) based on randomized controlled trials (RCTs).MethodsSearches were conducted in Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to retrieve relevant RCTs. Data on baseline characteristics, treatment efficacy, and adverse events were extracted. The analysis utilized pooled weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (CIs) to assess the superior treatment modality.ResultsA total of 18 RCTs were included. Acupuncture combined with moxibustion demonstrated significant improvement in the visual analog scale (VAS) for pain and the long-term (> 60 weeks) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function compared to other treatments. In contrast, short- (< 4 weeks) and mid-term (6–60 weeks) WOMAC outcomes for pain, stiffness, and physical function indicated varied results. The overall efficacy rate also favored the combined therapy significantly in the short- and mid-term evaluations. Notably, this therapy was associated with fewer adverse events.ConclusionThe meta-analysis reveals that acupuncture combined with moxibustion is notably more effective and safer than other treatment modalities for KOA, particularly during mid- and long-term follow-up periods.

Pain control and analgesic requirements following laparoscopy-assisted transversus abdominus plane (TAP) block compared to port site infiltration post-paediatric laparoscopic appendicectomy. A Randomised controlled trial.

Appendicectomy is a common procedure in children. Regional anaesthesia helps reduce requirements for opioids and hospital stay and enhances recovery. Laparoscopic-assisted Transversus Abdominus Plane block (L-TAP) was shown to be efficient and potentially superior to port site infiltration (PSI); however, this was not previously studied in paediatric appendicitis. This study aimed to evaluate the effectiveness of L-TAP compared to PSI in children undergoing laparoscopic appendicectomy (LA). A single-blinded RCT was performed to compare L-TAP to PSI with 0.25% plain bupivacaine at the end of an LA. Patients aged 6-16 years diagnosed with uncomplicated acute appendicitis (AAST grade 1) were randomised to either group in a 1:1 fashion. Complicated appendicitis, open or Lap-converted to open appendicectomies, were excluded. Outcome measures included the total amount and number of doses of opiates and clonidine required, length of stay (LOS), and visual analogue score (VAS) of pain. 49 patients in the PSI group and 41 in the L-TAP group were included; the mean age was 11.3 ± 2.4 years. There was no significant difference in age and weight between the groups. One patient in each group required opioid-based patient-controlled analgesia (PCA) in the theatre recovery room; however, on retrospective review, this was not clinically warranted. Seven patients in each group required morphine while in recovery (p = 0.4). There was no significant difference in total morphine (PSI 0.12 vs L-TAP 0.04 mg/kg body weight, p = 0.1) and clonidine (PSI 0.57 vs L-TAP 0.59 micro gm/kg body weight, p = 0.5) requirement during the hospital stay. Patients in the L-TAP group had two hours shorter LOS than the PSI group (38.0 ± 3.9 vs 39.7 ± 4.1, p = 0.38). There was no significant difference in VAS scores. There was no difference between L-TAP and PSI. L-TAP was feasible, easy to earn, and safe. We recommend that it be considered in clinical protocols and local guidelines as part of the peri-operative analgesia regimen, especially when ultra-sound guided blocks are unavailable. Overall, patients with uncomplicated appendicitis who undergo LA have low VAS scores and require mostly simple analgesia.

Comparison of clinical efficacy of different internal fixation methods in older adult patients with osteoporotic fractures of proximal humerus.

To compare the efficacy of three treatment methods for older adult patients with osteoporotic proximal humerus fractures: proximal humerus locking plate (PHILOS) combined with calcium sulfate injection, PHILOS plate alone, and artificial hemi-shoulder joint replacement. The clinical data of 48 older adult patients with osteoporotic proximal humerus fractures admitted to the Shoulder and Elbow Surgery Department of Zhongshan Hospital Affiliated with Dalian University from February 2018-August 2021 were retrospectively analyzed. The patients comprised 18 males and 30 females, with a mean age of (68.6 ± 5.8) years. The 48 patients were divided into three groups based on their treatment methods: Group A: 16 patients treated with PHILOS plate combined with calcium sulfate injection. Group B: 16 patients treated with the PHILOS plate alone. Group C: 16 patients treated with artificial hemi-shoulder joint replacement. Key parameters such as operation time, blood loss, incision length, operation cost, and shoulder joint motion at the final follow-up were recorded and compared. Shoulder joint function was evaluated using the American Shoulder and Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS) for pain, University of California Shoulder Joint Score (UCLA), and Brief Shoulder Function Test (SST). There were no statistically significant differences in the preoperative general data between the three groups (P > 0.05), indicating comparability. There was no significant difference in operation time, blood loss, and incision length among Groups A, B, and C (P > 0.05). However, Group C had significantly higher operation costs compared to the other two groups (P < 0.05). At the final follow-up, there were no significant differences in shoulder flexion and rotation among the three groups (P > 0.05). However, a statistically significant difference in abduction was observed between Group A and Group C (P < 0.05). No significant differences were found in ASES, VAS, UCLA, and SST scores among the three groups at the last follow-up (P > 0.05).Complications occurred in 1 patient (Group A), 3 patients (Group B), and 4 patients (Group C), showing a statistically significant difference among the groups (P < 0.05). All three surgical methods are effective in treating older adult osteoporotic proximal humerus fractures, as they significantly alleviate pain and restore joint function. However, the use of a PHILOS plate combined with calcium sulfate injection (Group A) is particularly effective, demonstrating reliable clinical efficacy with fewer complications.

Convertible metal-backed glenoid in total shoulder arthroplasty.

The aim of this study was to report long-term clinical outcomes of a modern convertible metal-backed glenoid (MBG) in total shoulder arthroplasty (TSA). After a minimum of 15 years, a previously studied cohort of 35 patients who received a modern convertible MBG during the period 1996 to 2005 was contacted for clinical and radiological follow-up. At last follow-up, patients were evaluated radiologically and clinically according to the Constant Score, Simple Shoulder Test, and visual analogue scale for pain. Complications and revisions were recorded, and survival analysis was performed. At the last follow-up, 20 patients were contacted. Of these, 15 patients had experienced at least one complication, and ten underwent revision surgery. The mean time to revision was 13.8 years (7 to 20). Cuff failure was the most common complication. Conversion to reverse shoulder arthroplasty, while maintaining the baseplate, was possible in five cases, with good results. In patients in whom the baseplate was removed, revision was performed significantly later (18.4 vs 11.1 years; p = 0.016). The general revision-free survival was 73% (95% CI 49.5 to 87.3) at 15 years and 38% (95% CI 11.8% to 64.3%) at 20 years, while MBG revision-free survival was 96.0% (95% CI 74.8% to 99.4%) at 15 years and 54% (95% CI 16.2% to 80.8%) at 20 years. Clinical scores showed a negative trend over time, although not statistically significant. Radiologically, polyethylene wear was observed in all cases and was complete in 12 out of 19 cases, and five glenoids were 'at risk' for loosening. At long-term follow-up, convertible MBG-TSA revealed a high rate of complications and revision surgery, mainly due to soft-tissue failure and polyethylene wear occurring with time. Prompt conversion to RSA maintaining the baseplate provided good results and a low complication rate. Radiological follow-up at about ten years is strictly recommended and, if metal-to-metal contact is observed, conversion to RSA is advisable. These results emphasize the need for continued research into improving TSA outcomes, especially in cases of MBG usage.