Anterolateral Group Research Articles

Dural Arteriovenous Fistulas in the Parasellar Region Other Than the Cavernous Sinus.

Besides cavernous sinus (CS) dural arteriovenous fistulas (AVFs), AVF may develop around the parasellar region. They can cause various symptoms, and some of them may show similar symptoms to those of CS dural AVF. Therefore, these AVFs may be misdiagnosed as CS dural AVFs. In this review, we divided parasellar AVFs into four groups based on their locations related to the CS: anterior group (orbit), anterolateral group (sphenoid wing), posteroinferior group (inferior petrosal sinus and clivus), and posterior group (superior petrosal sinus and petrosal vein). Although parasellar AVFs share common points, there are many differences between the four groups. We herein discuss commonalities and differences in parasellar AVFs based on a review of the literature and our experience.

Anterolateral Versus Posterolateral Approach for Lateral Condylar Fractures of the Humerus in Children.

Background:Two surgical approaches, an anterolateral and a posterolateral approach, have been advocated for lateral condylar fractures (LCFs) of the humerus in children. The purpose of this study was to evaluate the radiographic and clinical outcomes of the 2 surgical approaches.Methods:We retrospectively analyzed the data of consecutive patients <15 years of age with an LCF treated via open reduction and internal fixation through 1 of 2 surgical approaches during the period of April 2000 to March 2019. Patients were classified into the anterolateral (AL) and posterolateral (PL) groups, according to the surgical approach used. Postoperative complications and radiographic and clinical findings (including range of motion and findings on the basis of the Flynn criteria) were investigated. To investigate humeral deformity, the Baumann angle and the carrying angle were measured on anteroposterior radiographs.Results:Sixty-one of 82 patients met the inclusion criteria. The AL group included 17 patients (13 male, 4 female), and the PL group included 44 patients (28 male, 16 female). In the PL group, 7 patients had cubitus varus deformity, 3 had malunion due to unacceptable reduction of fracture fragments, and 6 had elbow joint contracture. In the AL group, the overall clinical results were excellent for 15 patients and good for 2. In the PL group, the clinical results were excellent for 12 patients, good for 14, fair for 6, and poor for 12.Conclusions:An anterolateral approach would be the optimal approach for an LCF in pediatric patients.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Lower-Limb Lymphatic Drainage Pathways and Lymph Nodes: A CT Lymphangiography Cadaver Study.

Background Most lymphatic imaging examinations of the lower limb require intradermal or subcutaneous injection of tracer material into the foot to demonstrate the lymphatic vessels; however, no standard protocol exists, and single or multiple injections are applied at different sites. Purpose To determine the three-dimensional relationships between each lymphatic group of the lower limb and corresponding regional lymph nodes. Materials and Methods A total of 130 lower limbs (55 from men and 75 from women) from 83 fresh human cadavers were studied. Lymphatic vessels were first visualized by using indocyanine green fluorescent lymphography with 19 injection sites in the foot, classified into four distinct lymphatic groups (anteromedial, anterolateral, posteromedial, and posterolateral); dilute oil-based contrast material was then injected. Next, specimens were scanned with CT and three-dimensional images were analyzed. Results The anteromedial and anterolateral lymphatic groups of the lower-leg lymphatic vessels were independent of each other and connected to different regional lymph nodes in the inguinal region. The posteromedial group and the anteromedial group in the lower leg drained to the same inguinal lymph nodes. Only the posterolateral group of lymphatic vessels in the lower leg drained to the popliteal lymph nodes. Leg lymphatic drainage pathways were independent of genital pathways. Conclusion Standard injection sites at the web spaces between the toes did not help visualize some lymph nodes of the lower leg. Additional injection sites in the medial, lateral, and posterior aspect of the foot would be better for evaluating the whole lymphatic pathways and regional lymph nodes and for improving understanding of leg lymphedema. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Weiss and Liddel in this issue.

Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach

BackgroundPericardiectomy is the final treatment for constrictive pericarditis. However, this greatest surgical approach is still very controversial. This study pursued to assess the outcomes in patients with recurrent chronic constrictive pericarditis undergoing reoperated pericardiectomy via median sternotomy versus left anterolateral thoracotomy and to explain which surgical approaches might be better for recurrent chronic constrictive pericarditis.MethodsA total of 24 patients were identified with recurrent chronic constrictive pericarditis and underwent reoperation with pericardiectomy between July 2003 and July 2015. The decision for this surgical approach was mainly dependent on the operating surgeon’s preference. Out of 20 patients, 16 patients underwent pericardiectomy via median sternotomy and 8 patients via left anterolateral thoracotomy pericardiectomy. Their data were obtained retrospectively from the case notes.ResultsBoth groups of patients were similar in age, gender between two operations, and also in peripheral venous pressure, cardiac rhythm and New York Heart Association (NYHA) class distribution. The mortality rates were similar in both groups with one death (12.5%) due to low cardiac output syndrome in the left anterolateral thoracotomy group and two deaths (12.5%) in the median sternotomy group. All the deaths were associated with cardiac complications and happened in the perioperative period. NYHA functional class status enhanced in most of the patients. Patients in both groups had a similar and significant improvement in their NYHA status that improved from 3.4 ± 0.7 to 1.8 ± 0.1 (P = 0.001) in the left anterolateral thoracotomy group and reduced from 3.3 ± 0.6 to 1.9 ± 0.4 (P = 0.001) in the median sternotomy group. There was a significantly greater rate of pulmonary infection in the thoracotomy group than in the median sternotomy group (50% versus 25%, P = 0.02). Nevertheless, there was a significantly greater occurrence of wound infections in the median sternotomy group in 3 patients versus in one patient of the left anterolateral thoracotomy group (18.8% versus 12.5%, P = 0.02).ConclusionsLeft thoracotomy incision was preferred to sternotomy in the current setting of this situation and was done safely without CPB. It avoided life-threatening sternal infection and it also has showed an equal as well las significant enhancement of NYHA status of the patients.

Comparison of lateral approach versus anterolateral approach with Herbert screw fixation for isolated coronal shear fractures of humeral capitellum

BackgroundFor coronal shear fractures of humeral capitellum, the lateral approach is the most commonly used surgical approach. However, exposure range of the anterior aspect of the distal humerus is inadequate. The anterolateral approach has also been adopted to overcome this disadvantage. However, this approach seems anatomically complex due to the risk of iatrogenic injury to the radial nerve. So far, the optimal approach for the treatment of capitellar shear fractures remains inconclusive. The purpose of this study is to prospectively review and compare the early clinical and radiographic outcomes of treated with open reduction and Herbert screw internal fixation through the lateral approach or the anterolateral approach.MethodsTwenty-six patients with isolated capitellar shear fractures were enrolled from January 2013 to December 2017, and randomly assigned to lateral approach group or anterolateral approach group. All the fractures were treated with open reduction and Herbert screw internal fixation through lateral approach or anterolateral approach. Operation time, wound healing complication, elbow joint function, and radiographic evidence were evaluated and compared between two groups.ResultsThe operation via the anterolateral approach took significantly shorter time than via lateral approach (p < 0.05). There were no wound healing problems and infection for both groups. One patient from anterolateral approach group sustained incomplete posterior interosseous nerve palsy, which recovered completely in 4 weeks without residual compromise. All fractures healed well in their normal anatomic position as seen on radiographs. At the final follow-up, no significant difference was found between two groups with respect to the ROM in supination-pronation, ROM in pronation-supination, loss of flexion-extension motion, or loss of pronation-supination motion (p > 0.05). There is no significant difference with respect to MEPI score of elbow joint between two groups (p > 0.05).ConclusionBased on our findings, both lateral approach and anterolateral approach with Herbert screw internal fixation are suitable for coronal shear fractures of capitellum with satisfactory early outcomes. Compared with the lateral approach, the anterolateral approach made the surgical procedure easier and time saving in current series. When the medial aspect of the trochlea is involved for capitellar coronal fractures, the anterolateral lateral approach should be preferred.

HETEROTOPIC OSSIFICATION FOLLOWING NONCEMENTED HIP REPLACEMENT: A COMPARATIVE STUDY USING MINIMAL INVASIVE SURGERY VS. CONVENTIONAL ANTEROLATERAL APPROACH

Background: A conventional anterolateral approach was previously a remedy for total hip replacement. Currently, an intermuscular approach is relatively safe, provides excellent exposure and causes less soft tissue damage than the traditional approach.&#x0D; Objective: The study aimed to compare heterotopic ossification (HO) between minimal invasive surgery (MIS) and conventional anterolateral approach among patients having noncemented total hip replacement.&#x0D; Methods: A retrospective study was conducted among 47 patients (52 sites) with noncemented total hip replacement who were randomly divided in 2 groups. The first group received treatment with MIS whereas the second group received the conventional anterolateral approach. The incidence of HO was recorded and followed-up for a minimum of 12 months. The demographic data of both groups were analyzed using the chi-square test and the discrete data were analyzed using the chi-square test and Fisher’s exact test.&#x0D; Results: The incidence of HO in the MIS and conventional anterolateral approach group were within 37.9 and 56.5%, respectively. After 12 months of followed-up, the incidence of HO in the MIS group did not significantly differ compared with that of the conventional group (p=0.291). Severe HO was within 13.79 and 8.69%, respectively (p=0.682) and neither group required further surgery.&#x0D; Conclusion: The MIS group showed a lower incidence of HO than that found in the conventional anterolateral approach group without statistical significance.

Thoracolumbar Fractures, Posterior versus Anterior Management: A Case Series and Literature Review

Background Data: The management of unstable traumatic thoracolumbar fractures has shifted from more conservative treatment towards more operative treatment modalities. Different surgical options have been reported in the literature. Purpose: To review two surgical techniques, anterolateral and posterior approaches, in management of thoraco-lumbar fractures and present a brief literature review. Study Design: A retrospective case series with review of literature. Patients and Methods: Thirty patients managed in the period from October 2012 to November 2016 for thoraco-lumbar burst fractures. Two patients’ groups were identified, group 1 underwent anterolateral fixation and included 15 patients whereas group 2 underwent posterior fixation and included 15 patients. Follow up was done at 3 months, 6 months and one year postoperative using VAS for pain assessment and ASIA scale for neurological status evaluation. Radiological outcome involved the vertebral height restoration, spinal canal compromise and kyphus deformity correction. Operative time, operative blood loss and perioperative complications were all reported for both groups. Results: The most common spinal level affected in our study was L1 vertebra in 10 cases. Operative time and blood loss were found to be significantly less in the posterior approach. A significant improvement of VAS has been reported in both study groups with more improvement in the posterior group compared to the anterolateral one. 93.3% of anterior group patients within the showed either improved or fixed neurological status according to ASIA scale where in posterior group all patients showed either improved or fixed neurological status. The mean canal compromise percentage decreased in group 1 from 69.3% preoperatively to 15.62% postoperative whereas in group 2 it decreased from 66.2% preoperative to 18.8%. Kyphotic angle has been corrected in posterior group from 13.42° preoperative to 11° at 6 months and 12.5° at one year, where in anterolateral group has been corrected from 19.42° to 17.57° and 20.9° respectively with a statistically significant difference between both groups (P<0.01). Conclusion: Our data suggest that both anterior and posterior approach showed no difference in neurological outcome in patients with thoraco-lumbar fractures. However anterior approach was superior to the posterior one in spinal canal compromise clearance and kyphotic angle correction.

Accuracy comparisons of intra-articular knee injection between the new modified anterolateral Approach and superolateral approach in patients with symptomatic knee osteoarthritis without effusion

BackgroundIntra-articular knee injection with steroid or various other agents have been used to control the local inflammation and relieve pain in the osteoarthritis knee. To achieve the maximal potential therapeutic worth and decrease the complications from the inaccurate knee injection, these medications should be delivered directly into the intra-articular space. Injection technique is one of the most important factors for accuracy of knee injection. Therefore, this study was aimed to propose the new modified anterolateral injection technique for higher accuracy of knee injection in symptomatic osteoarthritis knee without effusion. Material and methodsPatients with symptomatic osteoarthritis without effusion were included prospectively from May 2014 to May 2015 and randomized into 2 groups for knee injection: Modified anterolateral (MAL), Standard superolateral (SL). Knee injection was performed by one experienced orthopaedic. Accuracy of injection was test by mini air-arthrography technique. The pain from injection were evaluated by visual analog scale (VAS). Result132 knees were included, 66 knees were modified anterolateral group same as superolateral group. The modified anterolateral injection was significantly yield the higher accuracy rate than the standard superolateral injection (89% vs 58%, P < 0.05). The pain visual analog scale was not significantly different between the modified anterolateral and standard superolateral injection technique (2.61 vs 2.65, P = 0.917) No adverse events were occurred. ConclusionThe new modified anterolateral injection yields the higher pooled accuracy rate. From the accuracy and the advantage of the new modified anterolateral injection, this is the preferred injection technique for the symptomatic osteoarthritis without knee effusion.

Chronic stress induces cell type-selective transcriptomic and electrophysiological changes in the bed nucleus of the stria terminalis

Distinct regions and cell types in the anterolateral group of the bed nucleus of the stria terminalis (BNSTALG) act to modulate anxiety in opposing ways. A history of chronic stress increases anxiety-like behavior with lasting electrophysiological effects on the BNSTALG. However, the opposing circuits within the BNSTALG suggest that stress may have differential effects on the individual cell types that comprise these circuits to shift the balance to favor anxiogenesis. Yet, the effects of stress are generally examined by treating all neurons within a particular region of the BNST as a homogenoeus population. We used patch-clamp electrophysiology and single-cell quantitative reverse transcriptase PCR (scRT-PCR) to determine how chronic shock stress (CSS) affects electrophysiological and neurochemical properties of Type I, Type II, and Type III neurons in the BNSTALG. We report that CSS resulted in changes in the input resistance, time constant, action potential waveform, and firing rate of Type III but not Type I or II neurons. Additionally, only the Type III neurons exhibited an increase in Crf mRNA and a decrease in striatal-enriched protein tyrosine phosphatase (Ptpn5) mRNA after CSS. In contrast, only non-Type III cells showed a reduction in calcium-permeable AMPA receptor (CP-AMPAR) current and changes in mRNA expression of genes encoding AMPA receptor subunits after CSS. Importantly, none of the effects of CSS observed were seen in all cell types. Our results suggest that Type III neurons play a unique role in the BNSTALG circuit and represent a population of CRF neurons particularly sensitive to chronic stress.

Clinical and functional outcomes of patients undergoing anterolateral versus anteromedial surgical approaches for pilon fractures

Background: This study examined the clinical and functional outcomes for two of the most common surgical approaches for pilon fractures: the anteromedial (AM) and anterolateral (AL) approaches to the distal tibia. Methods: A retrospective chart review was performed for 75 patients who underwent operative management of pilon fractures between September 2005 and July 2009. Clinical data points included patient demographics, comorbidities, fracture classification, complications, and days from surgery to clinical and radiographic fracture union. Outcome scores were obtained via phone interview at a single cross-section time point. Results: The AL group had a significantly higher average AO/OTA fracture classification than the AM group (AO/OTA 43 C3 vs. C1) in both the retrospective chart review and the phone interview subanalysis. Despite this difference, the AL group had significantly fewer amputations and shorter time to radiographic healing (P&lt;0.05). In the phone interview subanalysis, functional outcome scores were not significantly different (P&gt;0.05). Average time from surgery to survey collection was 3.28 yr for the AL group and 3.54 yr for the AM group. Conclusions: The approach to pilon fractures should be dictated by the specific fracture pattern and associated soft-tissue injury. Our study shows that both AL and AM approaches had equivalent functional outcomes. This study highlights the importance of choosing the correct surgical approach when operating on pilon fractures and that the AL approach can successfully be used to treat the most complex fractures with fewer soft-tissue complications and faster radiographic healing versus the AM approach.

Oral sucker in Digenea: structure and muscular arrangement

Digeneans use oral and ventral suckers for attachment, locomotion, and feeding. The structure of these organs is rarely described in detail. I used fluorescent actin staining and confocal laser scanning microscopy to describe musculature arrangement in the oral sucker of eight digenean species (all Plagiorchiida). Scanning electron microscopy and light microscopy of histological sections were used for a general morphological description of the sucker structure. The musculature of the oral sucker is independent from the body wall and the internal muscles. The arrangement of the muscles within the oral sucker is complex; it includes up to 14 groups. Layers of transverse and meridional muscle fibers line the outer surface beneath tunica propria. Transverse muscle bands, meridional fibers, anterolateral groups, and circular or semicircular fibers of the sphincter are present at the rim of the oral sucker. Circular and longitudinal muscle fibers are found beneath the tegument of the buccal cavity. The bulk of the sucker consists of radial muscle bundles, but it also contains chordal muscle bundles, diagonal fibers, and wide lateral muscle bands. Based on the results, I propose that three features determine the complexity of musculature arrangement in the oral sucker: (1) bilateral symmetry of the sucker, (2) incongruity of the main body axis and the own axis of the sucker, and (3) regionalization of the sucker surface. The origin and functioning of the oral sucker are discussed.

Electrocardiographic characteristics of idiopathic ventricular arrhythmias originating from the tricuspid annulus regions

Object: To explore the electrocardiographic characteristics of ventricular arrhythmias (VAs) originating from tricuspid annulus region. Methods: Present study included 169 consecutive patients undergoing catheter ablation of VAs from tricuspid annulus origin in our department from August 2007 to September 2016. Based on the origin sites, the patients were divided into two subgroups, the free wall group (81 cases) and septal wall group (88 cases). Based on the location, patients in the free wall group were classified into anterolateral (22 cases), lateral (26 cases) and posterolateral (33 cases) subgroups. Patients in the septal group were classified into anteroseptal (10 cases), midseptal (71 cases) and posteroseptal (7 cases) subgroups. We analyzed the electrocardiographic features of these patients and in 87 patients with PVCs/VT originating from right ventricular outflow tract. Results: (1) A positive R wave inⅠ, aVL, V(5)-V(6) leads were found among most of patients, only few cases originating from tricuspid annulus anteroseptum group and tricuspid annulus anterolateral group demonstrated qr or qs pattern in aVL lead. 97.53% (79/81) patients demonstrated rS pattern in V(1)-V(3) leads with VAs originating from tricuspid annulus free wall, and 9/10 patients demonstrated rS pattern in V(1) lead with VAs originating from anteroseptum, and 97.44% (76/78) patients demonstrated QS pattern in V(1) lead with VAs originating from midseptum and posteroseptum. Precordial lead transition zone was on or behind V(3) for tricuspid annulus free wall group (96.3%, 78/81), but in front of V(3) for tricuspid annulus septum wall group (47.73%, 42/88) (P<0.01). The S wave's amplitude smaller than-1.81 mV in lead V(2) can be used as a cutoff value to identify if PVC/VT is originating from free wall or septum of TA. R wave in inferior wall leads was found among 98.85% (86/87) patients with PVCs/VT originating from right ventricular outflow tract. Conclusion: A positive R wave in Ⅰ, aVL, V(5)-V(6) leads was found among most of patients with idiopathic ventricular arrhythmias originating from the tricuspid annulus regions, but VAs originating from different portions of tricuspid annulus area have distinct electrocardiographic characteristics.

Cutaneous Hypesthesia and Kneeling Ability After Total Knee Arthroplasty: A Randomized Controlled Trial Comparing Anterolateral and Anteromedial Skin Incision

BackgroundAnterolateral skin incision can preserve the skin sensory of the anterior aspect of the knee and may improve kneeling ability after total knee arthroplasty (TKA). MethodsThis is a prospective, 2-arm, parallel-group, randomized, controlled trial involving patients scheduled for TKA. A total of 118 patients (162 knees) were randomly assigned to receive anterolateral skin incision or anteromedial skin incision with 1:1 treatment allocation. The surgical techniques other than skin incision were identical in both groups. The area of cutaneous hypesthesia was measured by a nonblinded assessor, and kneeling ability was evaluated by 2 blinded assessors at 12 months after surgery. ResultsThe area of cutaneous hypesthesia was significantly smaller in the anterolateral skin incision group than the anteromedial skin incision group (3.0 ± 8.7 cm2 vs 10.6 ± 18.6 cm2; 95% confidence interval, 2.8-12.3 cm2; P = .0019). The rates of patients judged to be able to kneel were significantly higher in the anterolateral skin incision group by both assessors (81% vs 60%; P = .025 and 81% vs 59%; P = .015, respectively) with almost perfect agreement between the 2 assessors (kappa value = 0.94). There were no significant differences in terms of complication rate, including wound complications, between the 2 groups (P > .05). ConclusionCompared with anteromedial skin incision, anterolateral skin incision may provide less cutaneous hypesthesia and better kneeling ability after TKA without increasing complication rate.

Acetabular cup orientation and postoperative leg length discrepancy in patients undergoing elective total hip arthroplasty via a direct anterior and anterolateral approaches

BackgroundTotal hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches.MethodsThe study included 172 patients undergoing an elective THA by a single surgeon at our institution within the study period. Ninety-eight arthroplasties were performed through the ALA and 74 arthroplasties through the DAA. Preoperative planning was performed for all patients. Assessment of the two groups included the following postoperative parameters: abduction angle, cup anteversion angle and leg length discrepancy (LLD). Additional analysis was done to evaluate component positioning by comparing deviation from the Lewinnek zone of safety in both approaches.ResultsFor the DAA the absolute LLD was 11 mm, ranging from -6 mm to 5 mm. For the ALA, the absolute LLD was 36 mm, ranging from -22 mm to 14 mm. None of the DAA patients had an absolute LLD greater than 6 mm. Comparatively, 7.4% of the ALA group exceeded 6 mm of LLD in addition to 2.1% with LLD greater than 10 mm. 15% of the ALA group resided out of the Lewinnek abduction zone compared to 3% of the DAA group (P = 0.016). 17% of the ALA group were out of the Lewinnek anteversion zone as opposed to 8% of the DAA group (P = 0.094).ConclusionOur study demonstrates good component positioning outcomes and LLD values in patients following THA through the DAA compared to the ALA.

Biomarkers of muscle damage increased in anterolateral compared to direct lateral approach to the hip in hemiarthroplasty: no correlation with clinical outcome : Short-term analysis of secondary outcomes from a randomized clinical trial in patients with a displaced femoral neck fracture.

To compare increase in serum creatine kinase (CK) and its association with functional outcome between the muscle-sparing anterolateral approach and the direct lateral approach to the hip in patients with displaced femoral neck fracture (FNF). In this randomized trial, we enrolled eligible patients between 70 and 90years of age with FNF. Patients were allocated to an uncemented hemiarthroplasty inserted through a direct lateral or an anterolateral approach. The primary endpoints were pain and patient satisfaction assessed by the Visual Analogue Scale (VAS). Among secondary endpoints was increase in CK at 24 and 48h compared to baseline and its association with surgical parameters, Timed up and Go Test (TUG), Harris Hip Score (HHS), and the presence of a Trendelenburg sign using correlation analysis. This paper reports on increase in serum CK and its association with functional outcome. At 24h, there was a mean increase from baseline in total CK of 228U/L (95% CI 187 to 269; P < 0.001). There was a difference between groups at 24h in CK increase with higher levels in the anterolateral group (mean difference 80U/L; 95% CI - 0.5 to 162; P = 0.05). Likewise, at 48h, there was a mean difference of 117U/L (95% CI 22 to 212; P = 0.01). No correlation was found between CK values and functional assessments. Compared with the direct lateral approach, the anterolateral approach yielded higher levels of postoperative CK. However, there was no correlation between levels of CK and functional outcome. ClinicalTrials.gov Identifier: NCT02028468.

Posterior or anterolateral approach in hip joint arthroplasty - Impact on frontal plane moment

BackgroundAnterolateral surgical approach in hip joint arthroplasty necessitates division of the hip abductor muscle complex, which may compromise postoperative gait observed in the frontal plane. The aim of the study was to compare frontal plane moment after hip joint arthroplasty by anterolateral or posterior approach and to explore which compensatory strategies patients use to decrease frontal plane moment. MethodsTwenty-eight patients were randomized by sealed envelopes to hip resurfacing arthroplasty surgery by anterolateral (ad modum Watson) or posterior (ad modum Moore) approach, performed by two senior surgeons. Gait analyses were performed using 3D motion capture before surgery, 3, and 12 months after surgery. Peak ground reaction force was extracted for early and late stance and the corresponding frontal plane moment was defined. Measures of lateral trunk inclination, pelvic drop and hip abduction were obtained for the stance phase of the affected leg. FindingsAn effect of surgical approach on frontal plane moment for the affected leg was found during early stance phase (p = 0.006) where average frontal plane moment in the anterolateral groups was 202.42 N mm/kg in less compared to the posterior group after one year. A similar effect from baseline to 12 months for trunk inclination (p = 0.03) and an overall negative correlation between frontal plane moment and trunk inclination was found (r = −0.66, p = 0.03). InterpretationFrontal plane moment during early stance was less one year after hip joint arthroplasty through anterolateral compared to posterior approach. Patients' primary strategy to reduce frontal plane moment seems to be increased lateral trunk inclination.

Curative effects of mPCNL in semi-supine anterolateral position for complicated renal stones

Objective To evaluate the clinical effect, safety and indication of mini-percutaneous nephroscope lithoipsy (mPCNL) in semi-supine anterolateral position for complicated renal stones. Methods From January 2010 to June 2016, clinical data of 360 patients with complicated renal stones who divided into prone position, lateral decubitus position and semi-supine anterolateral position group were retrospectively reviewed.Factors such as stone-free rate (SFR), operation duration, complications hospitalization time were analyzed among the three groups. Results All operations were successful. The mean operation time of the semi-supine anterolateral position groups was(65±24)min, 1 patient had colon injury, 4 patients had pyelocaliceal perforation, the SFR was 89.2% (214/240). The blood loss, stone-free rate, complications and position comfort after one session by semi-supine anterolateral position were significantly advantageous compared with the other body positions. Conclusions mPCNL in semi-supine position is an safety and effective method to deal with complicated kidney stones with a high success rates and a quite low complication. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Posture

The effect of surgical approach on gait mechanics after total hip arthroplasty

BackgroundFew studies have compared the biomechanical outcomes of different surgical approaches for hip arthroplasty. The purpose of this study was to compare hip, pelvic, and trunk kinematics and kinetics between individuals who underwent a posterior or anterolateral approach. MethodsForty-five individuals between 40 and 80 years old underwent motion analysis during overground gait prior to hip arthroplasty and 3 months after surgery. Walking speed, hip flexion angle, hip extension angle, adduction angle and moment, trunk angle, trunk lean, and pelvis drop were compared between approaches. FindingsThere were 30 subjects in the posterior group and 15 subjects in the anterolateral group. The groups did not change differently over time as there were no significant interaction effects. However, there were main effects for time; walking speed increased 19.9% (p < .001), hip flexion angle increased 3.3 degrees (p = 0.014) and peak hip extension increased 4.5 degrees (p = .001), and peak hip adduction significantly increased 1.9 degrees (p = .004) for the sample as a whole. Trunk angle (p = .283) and trunk lean (p = .401) did not significantly change between time points, but there was a significant increase in pelvic drop (p = .003). InterpretationSurgical approach did not affect biomechanical outcomes 3 months after arthroplasty. Both groups showed improvement in sagittal plane hip kinetics and kinematics. However, increased pelvic drop may be indicative of residual hip weakness in both groups.

Less periprosthetic bone loss following the anterolateral approach to the hip compared with the direct lateral approach

Background and purpose — The loss of bone mineral in the proximal femur following hip arthroplasty may increase the fracture risk around uncemented stems. We hypothesized that the surgical approach to the hip might influence bone mineral changes around the femoral stem in patients with a femoral neck fracture (FNF).Patients and methods — This was a pre-specified subgroup analysis (n = 51) of an ongoing randomized trial (n = 120) in patients with FNF. Participants were allocated to an uncemented hemiarthroplasty inserted through a direct lateral (Hardinge) approach or an anterolateral (modified Watson-Jones) approach. The 51 patients (mean age 83 (70–90) years, 33 women) were measured by dual-energy X-ray absorptiometry (DXA) to assess changes in periprosthetic bone mineral density (BMD).Results — The mean change in total BMD differed between groups at 12 months in favor of the anterolateral group (4.8%, 95% CI 0.0–9.6; p = 0.05). DXA at 3 months displayed BMD loss in the proximal Gruen zones in the lateral group compared with the anterolateral group. Zone 1 (–5.0% vs. 2.7%), zone 2 (–4.3% vs. 4.1%), zone 6 (–6.5% vs. 0.0%) and zone 7 (–11% vs. –2.4%, all p < 0.05).Interpretation — DXA measurements in this study indicate that surgical approach to the hip influences periprosthetic BMD. Clinical implications remain uncertain. Our conclusions should be interpreted with caution as we did not perform adjustments for multiple tests, possibly leading to inflation of false-positive findings.

The assessment of portal-tract healing after knee arthroscopy

ObjectiveThe aim of this study was to analyse the pattern of portal-tract healing, to compare the healing time of anteromedial and anterolateral portal tracts and to assess the impact of portal-tract delayed healing on the post-operative sub-acute and chronic anterior knee tenderness. MethodsThe study included 104 patients (68 males and 36 females; mean age: 49 ± 3.16 years (range; 17–66)) who have undergone knee arthroscopy. Puncture wounds were divided into two groups, (1) anteromedial and (2) anterolateral groups. Each group contained 104 portal-tracts. Healing of portal tracts was evaluated using sequential superficial ultrasonographic examinaitons. Visual analogue scale (VAS) was used to measure pain related to delayed tract healing and its association with the post-operative sub-acute and chronic anterior knee tenderness. ResultsAnteromedial and anterolateral tracts total healing time average values were 47 days and 28 days respectively. The VAS average values of anteromedial tracts after 2 weeks, one month, three months, six months and one year were 8.2, 6.3, 4, 1.9 and 0.6 respectively, and for the anterolateral tracts 7.4, 5.5, 2.8, 1.2 and 0.2 respectively. A statistical significance was detected between the two groups at the first and third months with P values 0.042 and 0.0035 respectively. ConclusionsAnteromedial tracts closed later than anterolateral tracts. Both portal-tracts delayed closure is a potential for post-operative sub-acute and chronic anterior knee tenderness after arthroscopic surgery. Four grades of tract healing were recognized. Portal-tract ultrasonography is advised in persistent post-operative sub-acute and chronic anterior knee tenderness. Level of evidenceLevel III, Therapeutic study.