HSS Score Research Articles

Medial augmentation plating of aseptic distal femoral nonunions

BackgroundDistal femur nonunions are well-recognized contributors to persistent functional disability, with limited data regarding their treatment options. In the current study, we asked whether additional medial augmentation plating is a feasible treatment option for patients with aseptic distal femoral nonunion and intact lateral implants.MethodsWe conducted a single-center, retrospective study including 20 patients treated for aseptic distal femoral nonunion between 2002 and 2017. The treatment procedure included a medial approach to the distal femur, debridement of the nonunion site, bone grafting and medial augmentation plating utilizing a large-fragment titanium plate. Outcome measures were bone-related and functional results, measured by the Hospital for Special Surgery Knee Rating Scale (HSS) and the German Short Musculoskeletal Function Assessment questionnaire (SMFA-D).ResultsEighteen of 20 nonunions showed osseous healing at 8.16 ± 5.23 (range: 3–21) months after augmentation plating. Regarding functional results, the mean HSS score was 74.17 ± 11.12 (range: 57–87). The mean SMFA-D functional index was 47.38 ± 16.78 (range 25.74–71.32) at the last follow-up. Index procedure-associated complications included two cases of persistent nonunion and one case of infection.ConclusionsAccording to the assessed outcome measures, augmentation plating is a feasible treatment option, with a high proportion of patients achieving bony union and good functional outcomes and a few patients experiencing complications.

Comparison of the effects of botulinum toxin type A hamstring muscle injection combined with periarticular injection and simple periarticular injection on early pain and functional recovery after total knee arthroplasty

Objective: This study was designed to compare the effects of hamstring muscle injection of botulinum toxin type A (BoNT/A) combined with periarticular injection to those of simple periarticular injection alone, in terms of early pain reduction and functional recovery following total knee arthroplasty (TKA).
 Methods: This study included 40 patients who underwent elective unilateral TKA at our hospital from February 2021 to December 2021. The patients were randomly assigned to either the experimental group (BoNT/A injection into the hamstring muscle + periarticular injection, n = 20 cases) or the control group (0.9% normal saline injection into the hamstring muscle + periarticular injection, n = 20 cases). The preoperative and postoperative 3-day HSS scores were compared between the two groups. Postoperative visual analog scale (VAS) pain scores were observed and compared between the two groups. The Lovett grading method was used to evaluate the postoperative muscle strength of both groups. Additionally, postoperative knee joint pain scores, maximum active flexion angle, and any postoperative adverse reactions were observed and compared between the two groups.
 Results: The experimental group showed significantly lower VAS pain scores than the control group at 24 h, 48 h, and 72 h after the operation, with a statistically significant difference (P < 0.05). Furthermore, compared to the control group, the patients in the experimental group exhibited larger knee joint active flexion angles at 1 day, 3 days, and 5 days post-operation, also demonstrating a statistically significant difference (P < 0.05). These findings hold scientific significance (P < 0.05). Additionally, the combined administration of BoNT/A hamstring muscle injection with periarticular injection exhibited a low incidence of adverse reactions during the perioperative period and had no significant effect on quadriceps muscle strength.
 Conclusion: The combination of BoNT/A hamstring muscle injection with periarticular injection effectively alleviates early postoperative pain following TKA and promotes early functional recovery of the knee joint.

High tibial osteotomy for acute correction and subsequent gradual tensioning of the posterolateral knee ligament complex in treating genu varum combined with a lateral thrust using the Ilizarov technique in adults: surgical technique and early results

ObjectiveTo report the early results of using the Ilizarov technique in performing medial wedge opening high tibial osteotomy (MWOHTO) combined with gradual tensioning of the posterolateral corner in adult patients presenting with genu varum (GV) and lateral thrust.MethodsA prospective case series study included 12 adult patients with a mean age of 25.2 ± 8.1 years who presented with GV deformity associated with lateral thrust. They were evaluated clinically using the “hospital for special surgery” (HSS) knee scoring system. Radiological evaluation was performed using long film from hip to knee to ankle (HKA) radiographs; the overall mechanical alignment was measured as the HKA angle, the upper tibial deformity was measured as the medial proximal tibial angle (MPTA), and the joint line convergence angle (JLCA) was measured. Surgical technique included using Ilizarov for MWOHTO below the level of the tibial tubercle, acute correction of the GV deformity, fibular osteotomy, and gradual distalization of the proximal fibula.ResultsAfter a mean follow-up of 26.3 ± 6.4 months, all osteotomies were united. All patients achieved fibular osteotomy site bony union except two with a fibrous union. The HSS score showed improvement from a mean preoperative score of 88.7 ± 7.6 to a postoperative 97.3 ± 3.9 (P < 0.05). The overall mechanical lower limb alignment improved significantly from a mean preoperative HKA of 164.5 ± 3.2 to a postoperative 178.9 ± 1.6 (P < 0.05). The MPTA improved significantly from 74.6 ± 4.1 to 88.9 ± 2.3, as well as the JLCA from 12.17 ± 1.9 to 2.3 ± 1.7 (P < 0.05). Grade 1 pin tract infection was developed in four patients and was treated conservatively. In two patients, mild pain over the fibular osteotomy site was relieved over time. The lateral thrust reoccurred at the last follow-up evaluation in the two poliomyelitis patients.ConclusionMWOHTO, concomitant with tensioning the knee lateral soft tissue structure at the same setting through applying an Ilizarov apparatus, showed promising functional and radiological outcomes.

Comparison of the clinical effects for different positions of the weight-bearing axis after high tibial osteotomy

PurposeTo analyze the clinical effects of different positions of the weight-bearing axis (WBA) after high tibial osteotomy (HTO).MethodsThe clinical data of 90 patients who underwent HTO in the Department of Orthopedics at our hospital from June 2018 to June 2021 were retrospectively analyzed. Patients were divided into groups A and B (n = 45 per group) according to different post-HTO WBA positions of the affected side. WBAs in both groups were at 50–60% and 62–66% of the tibial plateau, from inside to outside, respectively. American Hospital for Special Surgery Knee Score (HSS), visual analog scale (VAS) score, femorotibial angle (FTA), and medial proximal tibial angle (MPTA) were recorded and analyzed.ResultsAll patients were followed up with for 12 months. HSS scores increased gradually and VAS scores decreased gradually in both groups preoperatively, and at 3 months, 6 months, and 1 year postoperatively (P < 0.05). Compared to group A, group B had better HHS scores at 6 months and 1 year postoperatively (P < 0.05). There was no significant between-group difference in VAS scores at all aforementioned timepoints (P > 0.05). Postoperative MPTA and FTA were 89.56° ± 2.18° and 177.11° ± 2.63° in group A, and 89.07° ± 1.98° and 177.07° ± 2.36° in group B, respectively, with no significant between-group difference (P > 0.05).ConclusionPatients with post-HTO WBA ranges of 50–60% and 62–66% achieved knee joint function improvement and pain relief. Half a year later, those with a WBA range of 62–66% had better knee joint function scores. However, a comparison of long-term effects warrants further investigation.

Acquired changes in thickness and length of patellar tendon after primary total knee arthroplasty: a prospective ultrasonographic study with over 4 years of follow-up.

Previous literature has reported changes in the length or thickness of the patellar tendon (PT) following primary total knee arthroplasty (TKA). This study aims to determine the structural changes in both the length and thickness of the PT after primary TKA using ultrasound (US) and to investigate the association between these changes and clinical outcomes after a minimum follow-up of 48 months. This prospective study used the US on 60 knees of 32 patients (aged 54-80, mean 64.8±7 years) before and after primary TKA to evaluate changes in both the length and thickness of the patellar tendon. Clinical outcomes were assessed with HSS and Kujala scores. At the latest follow-up evaluation, there was a significant overall shortening of PT by 9.1% (p<0.001), in addition to significant global thickening by 20% (p<0.001). Besides, there was significant thickening by 30% in the proximal 1/3 (p<0.01) and 27% in the middle 1/3 (p<0.01) segments of PT. There was a significant negative correlation between the thickening identified in all three parts of the tendon and both clinical outcome measures (p<0.05). The results show the presence significant changes in PT in terms of length and thickness after primary TKA; in addition, increased thickness in PT was more strongly and significantly associated with inferior clinical outcomes, including functionality and anterior knee pain, than shortness in PT. This study also suggests that the US is a viable, non-invasive method for documenting PT changes in both length and thickness after TKA with serial scans.

Intervention effect of injury control orthopedic strategy on fat embolism syndrome associated with long shaft fracture of lower limb

To observe the intervention effect of damage control orthopaedic(DCO) strategy on fat embolism syndrome(FES) associated with long shaft fracture of lower limbs. Retrospective analysis was made on the clinical data of 163 patients with FES associated with lower limb long shaft fractures admitted from January 2015 to May 2021. They were divided into two groups based on the time point of implementing DCO strategy in January 2018. Total of 92 patients were admitted from January 2015 to December 2017 as the control group, and other 71 patients were admitted from January 2018 to May 2021 as the intervention group. The hospital mortality, arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (OI), hemoglobin (Hb), platelet count(PLT), Harris score of hip joint, HSS score of knee joint, AOFAS score of ankle joint, clinical efficacy and complications were observed and compared between two groups. Total of 163 patients were followed up for 12 to 18 months with an average of (16.91±1.22) months. The in-hospital mortality rate in the intervention group was 2.82% (2/71), and that in the control group was 16.30% (15/92), the difference between two groups was statistically significant(χ2=6.455, P<0.05). After the intervention, SaO2, PaO2 and OI in two groups were higher than those before the intervention(P<0.05), and after the intervention, SaO2, PaO2 and OI in two groups were statistically significant(P<0.05). Hb and PLT in two groups after intervention were higher than those before intervention (P<0.001), and there was statistically significant difference in Hb and PLT between two groups after intervention (P<0.05). The Harris score of hip joint, HSS score of knee joint and AOFAS score of ankle joint in both groups after 3 months of treatment were better than those before treatment (P<0.05). The total clinical effective rate of the intervention group was higher than that of the control group(χ2=4.194, P<0.05). The total incidence of complications in the intervention group was lower than that in the control group(χ2=4.747, P<0.05). DCO strategy is helpful to reduce the in-hospital mortality of patients with FES associated with long shaft fracture of lower extremities, eliminate FES symptoms and stabilize vital signs, gain time advantage for phase Ⅱ definitive surgery, and has significant clinical intervention effect, which is worth popularizing.

Comparison of Early Outcome of the Close and Open Technique for the Treatment of Distal Femur Fractures

Objective: To compare the effects of closed and open techniques with its associated complications used for the management of distal femoral fracture in younger to older populations. Methodology: This was a case series study conducted in the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from Sept 2018- March 2019. A total of 66 adult patients were stratified according to treatment technique; closed technique group and open technique group with 33 patients in each group between age 18 - 65 years with fractured close distal 1/3rd shaft of femur distal femur fractures based on AO/OTA classification were included in the study. The Chi-square test was applied to contrast outcomes of closed and open technique and HSS score categories in both procedures. Results: The study findings showed that the mean age of the patient was slightly greater in the open technique group (41.5 + 23.5 years) compared to the closed technique (29.8 + 11.8 years). Most of the patients had type A femur fracture. The postoperative mean HSS knee score was 70.1 + 15.1 in the open technique group compared to 74.5 + 12.5 in the closed technique group with an insignificant difference between the two means (p&lt;0.949). An insignificant difference was observed in postoperative infection, non-union, and implant failure between both groups. Conclusion: This study concluded that superior outcomes such as bony union without infection were achieved in patients with femur fractures treated with closed technique as compared to open technique, although the findings were statistically insignificant. Moreover, the functional outcome of the knee joint was also distinctly improved in the closed technique. Keywords: Â Distal femur fracture, retrograde intramedullary femoral nail, locking compression plate, complications

Proximal versus distal bone transport for the management of large segmental tibial defect: a clinical case series

This retrospective study compared proximal bone transport and distal bone transport in a series of cases diagnosed with large segmental tibial defects. Patients with a tibial segmental defect (> 5 cm) were eligible for inclusion. Twenty-nine patients were treated using proximal bone transport technique (PBT group) and 21 cases were managed by distal bone transport technique (DBT group). We recorded the demographic information, operation indexes, external fixation index (EFI), visual analog score (VAS), limb function scores, and complications. Patients were followed for 24–52 months. There was no significant difference in operation time, blood loss, time in frame, EFI and HSS score between the two groups (p > 0.05). However, the PBT group displayed better clinical effects than the DBT group, including higher AOFAS scores, lower VAS, and complication incidence (p < 0.05). In particular, the incidence of Grade-II pin-tract infection, transient loss of ankle movement, and foot drop was significantly lower in PBT group than that in DBT group (p < 0.05). Although both methods could be used safely for the management of large segmental tibial defects, the proximal bone transport may confer greater patient satisfaction because of better ankle functions and lower complications.

Abstract No. 40 Embolization of the Superior and Middle Rectal Arteries for the Treatment of Symptomatic Hemorrhoidal Disease using the Combination of Metallic Coils and Microspheres

To investigate the feasibility and initial results of superior and median rectal artery embolization for patients with symptomatic hemorrhoidal bleeding disease. Prospective, single-center cohort that included 10 consecutive patients who underwent superior (SRA) and middle rectal arteries (MRA) embolization with microspheres (1100 μm) and metallic coils, with a follow-up period of 6 months. Embolizations planning and guidance was performed using Embo_ASSIST software with virtual injection (GE Healthcare, IL). Inclusion criteria comprised: Symptomatic hemorrhoidal disease refractory to clinical treatment, and with Goligher classification II or III. Exclusion criteria were previous surgery for hemorrhoidal disease and Goligher classification IV. Technical success was defined as successful catheterization and embolization of the hemorrhoidal arteries using the EmboASSIST software. Hemorrhoid severity (HSS) and the quality of life (QoL) scores were used to evaluate the clinical outcomes. Procedure-related adverse event was defined according to the Society of interventional Radiology in minor or major complications. Ten patients (4 men, 6 women) underwent rectal arteries embolization for hemorrhoidal bleeding disease, with a mean age of 59 (± 13) years old. Goligher classification were level II in 70% and 3 in 30% of patients. Technical success was achieved in all patients. SRA were embolized in 100% and MRA in 80% (90% unilateral and bilateral in 10%). Mean time off work after hospital discharge was 1.4 (±0.7) days. Median procedures time was 102,5 (± 38) minutes. The HSS and QoL scores improved 91% and 85% respectively, without clinical recurrence at the 6 months follow-up (table 1). One patient (10%) had a rectal ischemia that required surgical treatment. Embolization of both superior and middle rectal arteries was feasible and improved symptoms and quality of life in patients with grade II-III hemorrhoidal disease. No clinical recurrence was observed during the first 6-month follow-up.

Single-Stage Externalized Locked Plating for Treatment of Unstable Meta-Diaphyseal Tibial Fractures

(1) Background: Unstable meta-diaphyseal tibial fractures represent a heterogeneous group of injuries. Recently, good clinical results have been reported when applying a technique of externalized locked plating in appropriate cases, highlighting its advantage in terms of less additional tissue injury compared with conventional methods of fracture fixation. The aims of this prospective clinical cohort study were, firstly, to investigate the biomechanical and clinical feasibility and, secondly, to evaluate the clinical and functional outcomes of single-stage externalized locked plating for treatment of unstable, proximal (intra- and extra-articular) and distal (extra-articular), meta-diaphyseal tibial fractures. (2) Methods: Patients, who matched the inclusion criteria of sustaining a high-energy unstable meta-diaphyseal tibial fracture, were identified prospectively for single-stage externalized locked plating at a single trauma hospital in the period from April 2013 to December 2022. (3) Results: Eighteen patients were included in the study. Average follow-up was 21.4 ± 12.3 months, with 94% of the fractures healing without complications. The healing time was 21.1 ± 4.6 weeks, being significantly shorter for patients with proximal extra- versus intra-articular meta-diaphyseal tibial fractures, p = 0.04. Good and excellent functional outcomes in terms of HSS and AOFAS scores, and knee and ankle joints range of motion were observed among all patients, with no registered implant breakage, deep infection, and non-union. (4) Conclusions: Single-stage externalized locked plating of unstable meta-diaphyseal tibial fractures provides adequate stability of fixation with promising clinical results and represents an attractive alternative to the conventional methods of external fixation when inclusion criteria and rehabilitation protocol are strictly followed. Further experimental studies and randomized multicentric clinical trials with larger series of patients are necessary to pave the way of its use in clinical practice.

JUMBO DUAL-MOBILITY CUP PROVIDES LOW RISK OF DISLOCATION IN REVISION TOTAL HIP ARTHROPLASTY

THA in patients with acetabular bone defects is associated with a high risk of dislocation. Dual mobility (DM) cups are known to prevent and treat chronic instability. The aim of this study was to evaluate the dislocation rate and survival of jumbo DM cups.This was a retrospective, continuous, multicenter study of all the cases of jumbo DM cup implantation between 2010 and 2017 in patients with acetabular bone loss (Paprosky 2A: 46%, 2B: 32%, 2C: 15% and 3A: 6%). The indications for implantation were revisions for aseptic loosening of the cup (n=45), aseptic loosening of the femoral stem (n=3), bipolar loosening (n=11), septic loosening (n=10), periprosthetic fracture (n=5), chronic dislocation (n=4), intraprosthetic dislocation (n=2), cup impingement (n=1), primary posttraumatic arthroplasty (n=8), and acetabular dysplasia (n=4). The jumbo cups used were COPTOS TH (SERF), which combines press-fit fixation with supplemental fixation (acetabular hook, two superior flanges with one to four screws, two acetabular pegs). A bone graft was added in 74 cases (80%). The clinical assessment consisted of the Harris hip score. The primary endpoint was surgical revision for aseptic acetabular loosening or the occurrence of a dislocation episode.In all, 93 patients were reviewed at a mean follow-up of 5.3 ± 2.3 years [0, 10]. As of the last follow-up, the acetabular cup had been changed in five cases: three due to aseptic loosening (3.2%) and two due to infection (2.1%). The survivorship free of aseptic loosening was 96.8%. Three patients (3%) suffered a dislocation. At the last follow-up visit, the mean HSS scores were 72.15, (p &lt; 0.05).Use of a jumbo DM cup in cases of acetabular bone defects leads to satisfactory medium-term results with low dislocation and loosening rates.

Short-term effectiveness of lateral raft plate combined with Jail screw fixation in treatment of tibial plateau collapse fractures involved posterior-lateral column

To investigate the short-term effectiveness of proximal tibial lateral raft plate combined combined with or without Jail screw fixation in the treatment of tibial plateau collapse fractures involved posterior-lateral column. A retrospective analysis was performed on 106 patients (106 knees) with tibial plateau collapse fracture involved posterior-lateral column admitted between January 2016 and January 2021. According to the combination with Jail screw fixation or not, patients were divided into control group (treated by lateral raft plate without Jail screw fixation, 52 cases) and study group (treated by lateral raft plate with Jail screw fixation, 54 cases). There was no significant difference between the two groups in terms of gender, age, affected knee side, cause of injury, Schatzker classification, Tscherne-Gotzen classification, time from injury to operation, and preoperative lateral tibial plateau posterior slope angle (PSA), tibial plateau varus angle (TPVA), Rasmussen anatomical score (P>0.05). The operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, fracture healing time, complications, and lateral tibial plateau PSA, TPVA, Rasmussen anatomical score detected by X-ray films and CT before operation and at 1 year after operation of the two groups were recorded and compared. The number of cases of articular surface collapse in the two groups was recorded at 1 year after operation, and the effectiveness was evaluated by American Special Surgery Hospital (HSS) score. All patients were followed up 12-32 months (mean, 19.5 months). There was no significant difference between the two groups in operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, and fracture healing time (P>0.05). There were 2 patients (3.7%) in the study group and 3 patients (5.8%) in the control group with superficial wound infection, which were cured after debridement and dressing change. There was no significant difference in the incidence between the two groups (χ2=0.252, P=0.616). There was no complication such as vascular and nerve injury, internal fixation failure, nonunion or malunion of fracture, and deep vein thrombosis of lower limbs in both groups. At 1 year after operation, 9 cases (17.3%) in the control group had joint collapse of 2-3 mm, while only 2 cases (3.7%) in the study group had joint collapse, showing significant difference (χ2=5.271, P=0.022). At 1 year after operation, the PSA, TPVA, and Rasmussen anatomical scores of the two groups were significantly improved when compared with preoperative ones (P<0.05); the differences of pre- and post-operative PSA, TPVA, Rasmussen anatomical score, and postoperative HSS score in the study group were significantly better than those in the control group (P<0.05). The lateral raft plate combined with or without Jail screw fixation can achieve satisfactory short-term effectiveness in the treatment of tibial plateau collapse fractures involved posterior-lateral column. Combined with Jail screw, it can enhance the fixation and avoid the occurrence of secondary articular surface collapse, which can be used as a better choice.

BRUCELLA INFECTION FOLLOWING TOTAL JOINT ARTHROPLASTY

Brucellosis is a common zoonotic infection that carries a high economic burden in China especially in Xinjiang. Purpose of the message:To discuss the treatment of brucella infection following total joint arthroplasty and find out its curative effect. Methods. We analyzed 8 patients with who infected joint brucella after received arthroplasty in our department from March 2009 to March 2019, whose ages were from 55 to 79 years old (average age was 65.6 ± 1 years). The following parameters were measured in the pre- and post-operation periods: HSS and Harris score, range of knee motion (ROM), VAS, erythrocyte sedimentation rate (ESR) and C-reactive Protein (CRP). From x-ray to find out post-operate curative effect of revision operation. Results. All cases had pain and elevated ESR. Deep vein thrombosis (DVT) and nerve damage were not found in these cases. There were no sinuses on the skin have be found. All patients received total joint arthroplasty and infected with brucella post operation receive revision operation at last. All cases were followed-up for 6-30 months; the average follow-up period was14 ± 0.5 months. Post operation we took an HSS and Harris score and X-rays to find out its curative effect after revision operation. There were also no patients with aseptic loosening or fracture of prosthesis during or post- revision operation, no recurrence had been found. The average ROM of knee was improved to 90 ± 3°. Conclusions. Recent clinical results indicate that systemic antibrucellosis chemotherapy and surgery technical is effective to treat the patients following. Revision operation can significantly improve the function of the joint and relieve pain.

Evaluation of the Results of Patients Who Have Retrograde Intramedullary Nailing Surgery for Femur Supracondylar Fractures

Introduction: Supracondylar femur fractures are usually seen after high-energy trauma. Our study evaluated the surgical results of patients who underwent retrograde intramedullary nailing surgery. Materials and Methods: Thirty patients were treated with retrograde intramedullary nailing for femoral supracondylar fractures in a single clinic between January 2015 and September 2018. The clinical, functional, and radiological findings were analyzed retrospectively. Demographic data of the patients in our study, length of hospital stay, time until surgery, presence of additional trauma, complication rates, type of trauma, HSS and NEER scoring criteria for functional evaluation, and AO classification were used to determine fracture types. Results: Eighteen (60%) patients had high-energy trauma as the etiological cause, while 12 (40%) had fractures due to low-energy trauma. There were four open fractures and 26 closed fractures in the patients. The patients were evaluated according to the HSS and NEER evaluation systems. According to the HSS scoring system, 8 (26.7%) had excellent, 9 (30%) good, 12 (40%) moderate, and 1 (3%) poor results. According to the NEER scoring system, 7 (23.3%) excellent, 10 (33.3%) good, and 13 (43.4%) intermediate results were obtained. Conclusion: In supracondylar femur fractures, retrograde intramedullary nailing is a method that should be preferred in appropriate cases because of the low amount of bleeding, rapid mobilization, good union since the fracture hematoma is not evacuated, and good postoperative functional results.

Difference in Muscle Strength and Functional Outcome in Direct Lateral Approach versus Posterior Approach in Total Hip Arthroplasty: A Prospective Cohort Study.

The choice between posterior approach (PA) and direct lateral approach (DLA) for total hip arthroplasty (THA) remains a contentious issue regarding clinical outcome optimization and restoring patient function. Previous studies have evaluated the postsurgical outcomes mostly in the form of Harris hip score (HHS), and the data to objectively measure the postoperative muscle power is scarce. We intend to objectively compare the hip abduction and extension strengths and other functional outcomes with a very simple tool in PA and DLA in the Indian population as most patients do not undergo as intensive rehabilitation in the postoperative period as in the western world. A total of 158 patients underwent THA during the study period, of which 48 met inclusion criteria and only 42 completed 6 months follow-up. Patients were evaluated preoperatively, postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months follow-up. At each visit, muscle strength was tested using a customized sling device mounted on a pulling apparatus fitted on the wall, as well as a pain score (VAS), Harris hip score (HHS), and Short Form Survey (SF-36). The study showed statistically significant better hip muscle strength at 2 weeks postoperative for leg press test and 2 weeks as well as 6 weeks postoperative for hip abduction strength in the PA. However, no differences were noted during the 3 or 6 months follow-up period among the DLA and PA. The surgical approach used has no effect on VAS, HHS, or SF-36 scorings. The weak abductor mechanism at 2 and 6 weeks and extension mechanism at 2 weeks in a cohort of DLA in contrast to the PA are seen in the early postoperative period and hence are short-lived muscle weakness. However, there is no effect on VAS, HSS, and SF-36 scores. Therefore, the surgical approach is to be chosen according to the surgeon's expertise.

Comparing the Efficiency of the Femoral Neck System and the Cannulated Compression Screw in Treating Femoral Neck Fractures in Patients Who Are Young and Middle-aged Indian Population

Background: There are no long-term studies regarding the clinical effectiveness of a novel fixation technique (femoral neck system [FNS]) for femoral neck fractures. The primary aim of this study was to compare the effectiveness of two internal fixation techniques (FNS and cannulated compression screw [CCS]) for treating femoral neck fractures in individuals between the ages of 20 and 40 years. Materials and Methods: Data of patients who underwent internal fixation surgery for femoral neck fractures in our hospital between January 2018 and January 2020 with CCS and between January 2020 and January 2022 with FNS were retrospectively evaluated. The groups of CCS and FNS were separated based on the various internal fixation techniques. Demographics about all patients, including sex, age, body mass index, and fracture type were recorded. Pre-operative and 1-year post-operative follow-up of patients was to assess femoral neck shortenings and the Harris Hip score was used to evaluate joint function. Post-operative complications such as femoral head necrosis, non-union, and femoral neck shortening were noted. Results: 30 patients each of CCS and FNS system fixation were enrolled in the study. The male-to-female ratio was 21:9 and 18:12 for CCS and FNS, respectively. The average age of both groups was around 30 years. Compared to patients treated with CC screws, patients who had FNS treatment required less time to recuperate and resume normal activities. The HSS score improvement at 2 weeks and 12 weeks was significantly better in the FNS system than CCS fixation. There was improvement in flexion, abduction, and external rotation range of motion in FNS compared to CCS. There was no statistically significant difference between the two groups in the incidence of femoral head necrosis or fracture non-union following surgery. Conclusion: Patients treated with FNS for femoral neck fractures in the age range of 20–40 years can achieve better hip scores than CCS fixation and also have improved range of motion in flexion, abduction, and external rotation. Keywords: Femoral neck system, cannulated cancellous screw, femoral neck fractures, harris hip score

Retracted: Effect of Proprioception and Balance Training Combined with Continuous Nursing on BBS Score and HSS Score of Patients Undergoing Total Knee Arthroplasty.

[This retracts the article DOI: 10.1155/2022/7074525.].

Comparison of patient outcomes with and without graft following modified high tibial osteotomy

Objectives. The aim of this study is to evaluate the early results of patients with and without grafting with the proximal tibia medial biplanar open wedge osteotomy technique used in the surgical treatment of varus gonarthrosis and to compare them with the literature. Materials and Methods. Thirty-six patients with medial gonarthrosis with varus alignment were included in the study. The proximal tibia medial biplanar open wedge osteotomy was performed on thirtysix knees. In eighteen of these patients, a tricortical graft was applied to the osteotomy site from the iliac wing being noted as Group 1. The other patients who did not receive grafts constituted Group 2. All patients were evaluated according to the Ahlbäck classification. Leg length radiographs were taken for all patients, and the osteotomy angle was calculated according to Paley's measurements. Results. Although the mean union-time at the osteotomy site was shorter in the Group 1, it was not statistically significant. No significant difference was observed in terms of HSS scores, and no reduction loss was observed in any patient. The hematoma was seen in three patients in Group 2 and one patient in Group 1. The donor site problems were observed in 10 patients in Group 1. Conclusions. With proximal tibia medial biplanar osteotomy, frontal plane and sagittal plane deformities can be corrected in patients with varus gonarthrosis, and good clinical results can be obtained without using grafts, thus avoiding donor site complications.

Tibiofemoral lift-off and resulting laxity following total knee arthroplasty: Frequency in a series of 906 continuous cases and functional consequences at 4 years’ follow-up in a case-control study

BackgroundTibiofemoral instability is one reason for early revision of total knee arthroplasty. It can be the consequence of tibiofemoral laxity, especially in the coronal plane with tibiofemoral lift-off. But does femoral condyle lift-off on conventional postoperative radiographs suggest the presence of laxity or potential instability? To our knowledge, this question has not yet been answered. This led us to conduct a retrospective study to evaluate (1) the frequency of lift-off on postoperative radiographs, (2) the relationship between lift-off and laxity in the short term and (3) the functional consequences of lift-off. HypothesisPostoperative lift-off is a rare event that is predictive of laxity. MethodsWe carried out a single-center retrospective study using postoperative radiographs from patients who underwent primary total knee arthroplasty between 2014 and 2016. The sample consisted of 906 patients. Lift-off was defined as a tibiofemoral angle of 3° or more on immediate postoperative radiographs (day 0) that were non-weightbearing and had no stress applied. The functional outcomes were determined in the 17 patients identified as having lift-off who had been operated in the first year (2014) to ensure the follow-up was long enough. These patients were compared to 34 matched control patients who were operated the same year and chosen randomly among patients not having lift-off. The matching ratio was 2 controls to 1 case. Preoperative and surgical data were compiled from each patient's electronic medical record. Patients were evaluated at 4 years postoperatively using the subjective Oxford-48, objective HSS score, IKS score, overall patient satisfaction and stress radiographs of the knee. The cases of lift-off observed in 2014 (n=17) were paired with a control group of patients selected randomly during 2014. ResultsThe frequency of the lift-off event was 63/906 or 7%. The frequency was consistent over the three years studied: 7.1% in 2014 (19/269), 6.2% in 2015 (22/354) and 7.8% in 2016 (22/283). There was no significant difference between the two groups (17 with lift-off and 34 without) in the sex, age, body mass index and coronal plane deformity (preoperative HKA angle). At a mean follow-up of 4 years (range 12–49 months), the knees with postoperative lift-off had more laxity (p=0.002), particularly laxity when varus stress was applied (p=0.009). There were no other significant differences in the outcomes. DiscussionImmediate postoperative lift-off after total knee arthroplasty is not a rare event, with a 7% frequency in our study. While it reveals that laxity is present in the particular compartment, there is no evidence of functional consequences at 4 years’ follow-up; however, a long-term assessment is required to verify this finding. Level of evidenceIII – case-control study.

Prediction of Radar Echo Space-Time Sequence Based on Improving TrajGRU Deep-Learning Model

Nowcasting of severe convective precipitation is of great importance in meteorological disaster prevention. Radar echo extrapolation is an effective method for short-term precipitation nowcasting. The traditional radar echo extrapolation methods lack the utilization of radar historical data as well as overlooking the nonlinear motion of small- to medium-sized convective systems in radar echoes. To solve this, we propose a deep-learning model combining CNN and RNN. The model T-UNet proposed in this paper uses an efficient convolutional neural network of UNet architecture with a residual network, where the encoder and decoder networks are connected by nested dense skip paths, while a TrajGRU recurrent neural network is added at each layer, to achieve the perceptual capability of time series. The quantitative statistical evaluation showed that the use of T-UNet could improve the nowcasting skill (CSI score, HSS score) by a maximum of 10.57% and 7.80% over a 60 min prediction cycle. Further evaluation showed that T-UNet also improved the prediction accuracy and prediction performance in the strong echo region.