Medium-term Functional Results Research Articles

Current Management of Acute Severe Ulcerative Colitis: New Insights on the Surgical Approaches

Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency with considerable morbidity. Despite recent advances in medical IBD therapy, colectomy rates for ASUC remain high. A scoping review of published articles on ASUC was performed. We collected data, such as general information of the disease, diagnosis and initial assessment, and available medical and surgical treatments focusing on technical aspects of surgical approaches. The most relevant articles were considered in this scoping review. The management of ASUC is challenging; currently, personalized treatment for it is unavailable. Sequential medical therapy should be administrated, preferably in high-volume IBD centers with close patient monitoring and indication for surgery in those cases with persistent symptoms despite medical treatment, complications, and clinical worsening. A total colectomy with end ileostomy is typically performed in the acute setting. Managing rectal stump is challenging, and all individual and technical aspects should be considered. Conversely, when performing elective colectomy for ASUC, a staged surgical procedure is usually preferred, thus optimizing the patients’ status preoperatively and minimizing postoperative complications. The minimally invasive approach should be selected whenever technically feasible. Robotic versus laparoscopic ileal pouch–anal anastomosis (IPAA) has shown similar outcomes in terms of safety and postoperative morbidity. The transanal approach to ileal pouch–anal anastomosis (Ta-IPAA) is a recent technique for creating an ileal pouch–anal anastomosis via a transanal route. Early experiences suggest comparable short- and medium-term functional results of the transanal technique to those of traditional approaches. However, there is a need for additional comparative outcomes data and a better understanding of the ideal training and implementation pathways for this procedure. This manuscript predominantly explores the surgical treatment of ASUC. Additionally, it provides an overview of currently available medical treatment options that the surgeon should reasonably consider in a multidisciplinary setting.

Revision of total ankle arthroplasty: Survival and medium-term functional results

BackgroundThe objective of this study was to analyze the results and survivorship of total ankle arthroplasty (TAA) revision surgery with standard (Salto Talaris®) or revision (Salto Talaris XT®) implants. MethodsBetween January 2005 and December 2017, all patients undergoing TAA revision at our hospital were included. Indications for revision, type of surgery performed, improvement in function assessed with the AOFAS score, occurrence of complications and implant survival at last follow-up were analyzed. ResultsIn the end, 25 TAA patients who had undergone revision (11 unipolar, 14 bipolar) were included. The mean follow-up time was 5.1 ± 1.9 years. At the last follow-up, function was improved compared to the preoperative AOFAS score (51.3 ± 17.5 vs. 83.5 ± 10.1; p < .001), but not plantar flexion (17.5 ± 5.7 vs. 15.4 ± 7.1; p = 0.28) or dorsal flexion (7 ± 5.6 vs. 8.3 ± 4.9; p = 0.3). Complications occurred in six patients (24 %) that led to reoperation: three infections, one lateral impingement, one implant malposition, and one hindfoot alignment disorder. At the last follow-up, implant survival was 96 %, but the probability of survival without reoperation was 78.7 ± 8.5 % at 4 years. ConclusionTAA revision by arthroplasty is feasible, produces good functional results in the medium term, but has a high risk of complications. The challenge of revision TAA is managing the loss of bone stock and anchoring the new implants.

Total wrist fusion versus total wrist prosthesis: a comparative study

We present a comparative study of 41 total wrist fusions (TWFs) with contoured plate and 22 total wrist prostheses using the Universal 2™ model, with a mean follow-up of 6 years for the fusion and 6.5 years for the prosthesis. We evaluated grip strength, pain according to the visual analogue scale, functional results using the Quick Disabilities of the Arm, Shoulder and Hand and the Patient-Rated Wrist Evaluation, degree of satisfaction and complications, with no significant differences being observed in any of these variables. The results allow us to conclude that total wrist prosthesis implanted in patients with low or moderate functional demands offers medium-term functional results similar to TWF without increasing the number of complications. Level of evidence: III

Elbow dislocation with and without an associated fracture in children: A prospective study of functional outcomes following 3 weeks of immobilization

IntroductionThe initial management of elbow dislocations in children, emergency reduction and brachial-antebrachial-palmar (BABP) immobilization, remains the most widely used method. Osteosynthesis could be associated in case of fractures. On the other hand, there is no consensus on the duration of immobilization in the recent literature. The objective of this study was to describe the medium-term functional results of a prospective cohort of children presenting with an elbow dislocation immobilized for 3 weeks, with or without an associated fracture. The hypothesis of this study was that 3 weeks of immobilization was sufficient and made it possible to obtain a satisfactory, rapid functional recovery without residual instability. Material and methodAll children with an elbow dislocation with or without an associated fracture were included. The dislocation was urgently reduced and subsequent surgery could be indicated in the event of associated injuries. All the children had 3 weeks of immobilization with a BABP cast. Radiological and clinical follow-up was carried out for 2 years. The parameters evaluated were: 3 functional scores and the range of motion (ROM) of the elbow. Clinical or radiological complications were sought. ResultsA total of 50 children were included, the mean age was 10.6 years (± 2.6). Functional score results were “good’ or “excellent’ at 3 months of follow-up, “excellent’ at 6 months and thereafter. The mean limitation in ROM at the last follow-up was 4.7° (± 7.2°) with all ranges combined. Eighty-two percent of children had a mean limitation in ROM of less than 10°. None of the children presented with a recurrence of elbow dislocation and instability. ConclusionImmobilization of elbow dislocations for 3 weeks in children confers good medium-term functional results without exposing them to the risk of instability, whether or not the dislocation is associated with a fracture. Level of EvidenceII; Prospective cohort study

Good medium-term functional results in reconstruction of lateral femoral condyle osteochondral lesions

IntroductionResults of autologous osteochondral graft (mosaicplasty) are well-reported for the medial femoral condyle but much less for the lateral femoral condyle. The main aim of the present study was to assess results specifically for lateral condyle reconstruction. The secondary objective was to compare results according to the two main etiologies: osteochondritis dissecans (OCD) and osteochondral fracture (OCF). HypothesisThe study hypothesis was that medium-term functional and radiological results of lateral femoral condyle autologous osteochondral graft are good. Material and methodsA single-center retrospective continuous study included 24 patients with symptomatic focal lateral femoral condyle osteochondral lesion treated by osteochondral autograft, at a minimum 24 months’ follow-up. Mosaicplasty was performed for lesions <200 mm2, with associated fixation for lesions >200 mm2 with viable osteochondral fragments. IKDC, Lysholm and KOOS functional scores and pain on visual analog scale (VAS) were collected at last follow-up. Progression toward osteoarthritis was assessed on comparative X-ray. ResultsTwenty patients were analyzed (11 OCD, 9 OCF) at a mean of 66.4±44 months. Mean pain on VAS was 1.8±2 out of 10. Mean subjective IKDC, Lysholm and global KOOS scores were respectively 68.1±26, 76.5±22 and 73.9±21. Two patients showed Ahlbäck grade 2 lateral femorotibial osteoarthritis. Functional results were comparable between OCD and OCF. ConclusionReconstruction of lateral femoral condyle osteochondral lesion by osteochondral autograft gave good medium-term functional results, whatever the etiology. Longer-term studies are needed to assess progression toward osteoarthritis and functional deterioration over time. Level of evidenceIV; retrospective study.

Transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA) for ulcerative colitis: medium term functional outcomes in a single centre

BackgroundTransanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily. The aim of this study is to analyze our initial experience of transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA), considering postoperative complications and medium-term functional outcomes.MethodsOur Center has experienced the transanal approach for proctectomy and IPAA since August 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Fecal continence, genito-urinary activity and global quality of life at 1 and 6 months after ileostomy reversal have been assessed.ResultsUntil March 2019, 8 patients underwent transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA). In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning loop ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding, not required a re-invertation. There were no cases of anastomotic leakage. Medium-term functional outcomes were determined prospectively using previously validated quality of life questionnaires (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, genitourinary and sexual functions were also investigated, showing comparable results with the literature data.ConclusionsIn our experience, transanal proctocolectomy and ileal pouch-anal anastomosis provided good short and medium-term functional results in UC.

Lateral Unicompartmental Knee Arthroplasty in Structure of Modern Knee Replacement: Is It «Woe From Wit» or a Viable Go-To Method?

Background. Results of numerous contemporary studies indicate that medial and lateral unicompartmental knee arthroplasty (UKA) are almost equally effective both in clinical and functional aspects with no statistically significant difference in most cases. Furthermore, both operations tend to reach the effectiveness of total knee arthroplasty (TKA), despite the common opinion that any UKA is a more complex and skill challenging surgery with a less predictable outcome. The purpose — to asses if UKA in the patients with end-stage lateral unicompartmental osteoarthritis is an effective surgical intervention that may allow obtaining good and excellent medium-term functional results, that are comparable to the results of the medial unicompartmental arthroplasty, and to see if there are any benefits in comparison to the total knee arthroplasty (TKA). Materials and Methods. 140 middle-aged and elderly adults with end-stage osteoarthritis underwent knee arthroplasty at Vreden National Medical Research Center of Traumatology and Cheboksary Federal Center of Traumatology, Orthopedics and Arthroplasty. Group I (lateral UKA) (the main ) consisted of 15 patients with knee arthritis and type I Krakow valgus knee deformity, who underwent the lateral UKA with a fixed all-polyethylene tibial component. Group II (medial UKA) included 58 patients with end-stage medial unicompartmental osteoarthritis, who underwent the medial UKA using an endoprosthesis of a similar design. Group III (TKA) was represented by 67 patients with gonarthrosis accompanied by type II Krackow valgus knee deformity, who underwent the total knee arthroplasty with cruciate retaining (CR) prosthesis. The comparison between the groups was carried out regarding the achieved range of motion, functional result (using Oxford Knee Score and Forgotten Joint Score), as well as the rate of different types of complications. Results. During the study, two main objectives were set. The first was to compare the outcomes of the lateral and medial UKA. It was revealed that the lateral UKA allowed the patients to obtain good function of the operated knee, with the best results among the compared groups on the Forgotten Joint Score. The second objective was to compare the results of the lateral UKA and TKA in the patients with type II Krackow knee valgus deformity. Here, our study revealed that the group of UKA (group I) compared to the TKA had better results according to Forgotten Joint Score (71.5±5.3 vs 65.2±7; p = 0.9) and had a slightly lower range of motion according to Oxford Knee Score (34.6±2.3 versus 35.9±2.2; p = 0.7). It is worth noting that in both cases the difference was not statistically significant. Conclusion. Despite the fact that the lateral UKA made it possible to achieve a good functional outcome, the integral score was the same as in the groups with the medial UKA and the total knee arthroplasty. The older patients were more satisfied with the results of the partial arthroplasty than with the results of the total.

Second generation of temporary implantable nitinol device (iTind) in men with LUTS: 2year results of the MT-02-study.

Assessing medium-term functional results of a novel minimally-invasive treatment for lower urinary tract symptoms due to BPO with the second generation of the temporary implantable nitinol device (iTind; Medi-Tate Ltd®, Israel): 2-year follow-up of a single-arm, prospective, international multicenter study. Further, we aimed to identify preoperative baseline parameters predicting response to iTind treatment. Following local ethical committee approval in every participating centre, 81 men with symptomatic BPO (IPSS ≥ 10, peak urinary flow < 12ml/s, and prostate volume < 75ml) were enrolled in this study. Patients with PVR > 250ml, obstructive median lobe, previous prostatic surgery, confounding bladder or sphincter dysfunction based on medical history, active urinary infection and unable to interrupt antithrombotic or antiplatelet treatment were exclusion criteria. A wash-out period of 1month for alpha-blockers and 6months for 5-ARIs was mandatory to avoid confounders. The procedure was performed as previously described: implantation under light sedation and removal 5-7days later with topical sedation. Patients were assessed for perioperative results including OR-time, pain (VAS) and complications (Clavien-Dindo-Grading System); and for functional results (PVR, Qmax, IPSS) and quality of life (QoL) including sexual and ejaculatory function using two yes/no questions. Follow-up assessments were done at 1, 3, and 6months, and 1 and 2years. Of the 81 patients initially enrolled in this study, follow-up included 67 men at 1year and 51 men at 2years. For the 51 men included in the present analysis, the median age was 65years, median prostate volume 37ml (range 16-65ml). Baseline values for IPSS and QoL were 20.51 ± 4.58, 3.96 ± 0.87. Qmax and PVR were 7.62 ± 2.25ml/s and 65.84 ± 38.46, respectively. No intraoperative complications were observed and the average pain level recorded on the visual analogue scale (VAS) was 3.2 ± 1.6. A significant reduction in symptoms and improvement in urinary flow was observed (p < 0.0001) at all assessment points: IPSS-score and QoL improved to 8.51 ± 5.51 and 1.76 ± 1.32, respectively; and Qmax increased to 16.00 ± 7.43ml/s. None of the patients who were previously sexually active reported a deterioration in sexual or ejaculatory functions according to two yes/no questions over the follow-up period. Excluding the patients lost at follow-up, five patients underwent surgery between 12 and 24months. Upon investigation, it was discovered that four of the five patients requiring surgery had median lobes and were protocol deviators. A failure analysis was carried out for all 81 patients in order to identify baseline parameters that could predict treatment failure. 58.33% of patients in the failure group (7 out of 12) had median lobes which was found to be statistically significant (p < 0.0001). None of the other preoperative variables (age, prostate volume, IPSS scores, Qmax, PVR, and PSA) were found to predict response to iTind treatment. iTind treatment for BPO-related LUTS showed marked and durable reduction in symptoms and improvement of functional parameters and quality of life at 24months of follow-up. It was found that median lobe may predict failure of iTind treatment. According to the yes/no questions, ejaculatory and sexual functions do not seem to be effected following treatment, however, this finding must be supported with further studies using the accepted tools.

Results of the Latarjet coracoid bone block procedure performed by mini invasive approach.

The coracoid block technique described by Latarjet was modified by Patte and Walch in order to increase the glenoid surface. Saragaglia further modified this technique and described a minimally invasive approach which allows faster post-operative recovery. The aim of this study was to evaluate the medium-term functional and radiological results of this technique. This is a single surgeon cohort of 40 shoulders in 38 patients (32 men, 6 women) with an average age of 34.5years operated on between January and December 2014. The skin incision was 3 to 6cm long allowing the bony block to be passed under the subscapularis tendon without sectioning it and to be placed in lying position. The bone block was fixed with a 6.5 cancellous screw or a 7.0 cannulated screw. At an average follow-up of 48months, there were no recurrent dislocations. The average WOSI score was 42, the average Constant score was 95 corrected to 97% and the average SSV was 97. Visual analogue scores were 0 at rest and 0.6 with activity. The bone block healed in 92.5% of cases. It was flush with the edge of the glenoid in 84% of cases, lateralised in 10% and medialised in 6% of cases. Mean internal rotation power was 12kg in the operated shoulder compared with 9kg in the non-operated shoulder. The treatment of recurrent anterior shoulder instability by mini invasive Latarjet gives excellent medium-term functional results. The rate of recurrent dislocation in this series was zero and internal rotation power was well preserved. This is an excellent alternative to arthroscopic procedures which are yet to demonstrate their superiority over open surgery.

Factors affecting the results of tibial pilon fractures treated with open reduction internal fixation

The purpose of this study is to evaluate the short and medium term functional results of tibial pilon fractures treated in our clinic with the open reduction and internal fixation method and to investigate the factors affecting such results. 41 patients who were treated in our clinic between 1995 and 2009 with open reduction and internal fixation were included in this study. Looking at the postoperative radiographs, quality of reduction was evaluated as per the criteria of Ovadia and Beals. Functional results of the patients were assessed in line with the criteria of Teeny and Wiss. With the evaluation of postoperative radiographs, 17 (41.5%) excellent and good, 21 (51.2%) fair and 3 (7.3%) poor results were obtained. Functionally speaking, 26 patients (63.5%) displayed excellent and good, 8 displayed (19.5%) fair and 7 displayed (17%) poor results. It was found out that age, sex, the time spent before the operation, the period of immobilization following the operation and the presence of an accompanying fracture did not have a significant impact on the functional results. It was revealed that the type of fracture affects functional results. A positive correlation was found between the quality of reduction and the functional results. In the light of the findings of this study, it was concluded that in tibial pilon fractures treated with the internal fixation method, the type of fracture and the quality of reduction are important in identifying the short and medium term prognosis.

Comparing Treatment Options for Large Talar Osteochondral Lesions

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: The surgical treatment of large or revision osteochondral (OCD) lesions of the talus remain challenging. Currently, there are several treatment options for these patients, including: osteochondral autograft (OATS), allograft cartilage extracellular matrix (Arthrex BioCartilage), and particulated juvenile articular cartilage allograft (Zimmer DeNovo). Due to the relative rarity of these procedures, the literature comparing these three modalities is scarce. The aim of this study was to assess midterm clinical outcomes after these surgical treatments for large or revision talar OCD lesions. Methods: Hospital IRB approval was obtained. We reviewed surgical case logs and identified 78 total patients between 2003- 2015 for inclusion in this retrospective study. Thirty-three patients were excluded due to incomplete preoperative or postoperative outcome scoring data, and 23 patients are pending followup, leaving a cohort of N = 22 patients (5 OATS, 5 DeNovo, 12 BioCartilage). Functional outcomes preoperatively and postoperatively were evaluated using Short Form 12-item Physical and Mental Health Survey (SF12 M and SF12P) and Foot Function Index (FFI) scores, ability to return to sport or work, and the need to return to the OR for revision surgery. Data were compared using paired student’s t-test and a one way ANOVA. Results: Mean age was 38y with mean followup of 4.3y (range 1.1-12.5). Of 22 patients, three were revisions. Mean lesion size was (12.6x9.1x6.5 mm). All groups showed significant improvements in FFI (p &lt; 0.05) compared to preoperative baseline. Only the BioCartilage group showed significant improvement in SF12P (37.6 vs 47.8, p&lt;0.05). The OATS and DeNovo groups did not show a significant increase in SF12P, and none of the groups demonstrated significant improvement in SF12 M. All patients returned to work, and 8/11 (73%) athletes returned to sport. There were no significant differences between groups when comparing SF12, FFI, and return to sport/work. Revision surgery was necessary in 6/22 (28%) patients. Post-hoc power analysis revealed limited power (0.23), and effect size (f=0.32) may be due to small sample size. Conclusion: All three treatment methods resulted in good medium-term functional results for the treatment of large or revision talar OCD lesions. However, we were unable to distinguish significant differences between OATS, Biocartilage, and Denovo, likely due to small cohort numbers and low power. Further study is warranted with increased patient numbers to improve power and differentiate among the three treatment options, as well as provide longer clinical and radiographic follow-up.

The Arthroscopic All-Inside Tibial-Inlay Reconstruction of the Posterior Cruciate Ligament: Medium-Term Functional Results and Complication Rate

The present study evaluates the medium-term functional and radiological outcome as well as complications following an arthroscopic tibial inlay reconstruction of the posterior cruciate ligament (PCL). A total of 39 patients (mean age: 32.6 ± 12.4 years) with acute and chronic PCL instabilities received a single-bundle all-inside arthroscopic tibial inlay reconstruction with quadriceps tendon autograft and were available for clinical follow-up on average after 3.8 ± 1.8 years. Assessment was conducted utilizing visual analogue scale (VAS), International Knee Documentation Committee (IKDC), Tegner, Lysholm, and knee injury and osteoarthritis outcome (KOOS) scores. VAS, Tegner, Lysholm, and subjective IKDC-scores averaged to 2.75 ± 1.95, 4 (1-9), 77.19 ± 17.54, and 75.18 ± 19.29 points, respectively. Mean KOOS results were 80.66 ± 1.98 for pain, 74.72 ± 17.72 for symptoms, 88.44 ± 13.95 for activities of daily life, 65.35 ± 27.96 for sports and recreation, and 60.01 ± 25.36 for quality of life. Overall IKDC-score rating was A2, B28, C5, and D4. The overall complication rate of 5.4% was caused by one superficial infection, one patellar fracture, and one lesion to the popliteal artery. Arthroscopic tibial inlay reconstruction is a valuable procedure regarding medium-term subjective and objective outcome measures. Return to sports, subjective satisfaction, and objective stability are predictable. The complication rate is acceptable but particular precaution is recommended to protect the popliteal artery and adjacent structures at risk.

Hook plate fixation for acute acromioclavicular dislocations without coracoclavicular ligament reconstruction: a functional outcome study in military personnel.

The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel. This prospective study was carried out at a tertiary care military orthopaedic centre during 2012–2013 using clavicular hook plate for management of acromioclavicular injuries without coracoclavicular ligament reconstruction in 33 patients. All patients underwent routine implant removal after 16 weeks. The functional outcome was assessed at 3, 6 and 12 months after hook plate removal and 2 years from the initial surgery using the Constant Murley and UCLA Scores. All the patients were male serving soldiers and had sustained acromioclavicular joint dislocation (Rockwood type III). Mean age of the patient group was 34.24 years (21–55 years). The mean follow-up period in this study was 23.5 months (20–26 months) after hook plate fixation and an average of 19.9 months (17–22 months) after hook plate removal. The average Constant Score at 3 months after hook plate removal was 60.3 as compared to 83.7 and 90.3 at 6 months and 1 year, respectively, and an average of 91.8 at the last follow-up that was approximately 2 years after initial surgery which was statistically significant (p value <0.05). The UCLA Score was an average of 15.27, 25.9 and 30.1 at 3, 6 months and 1 year, respectively, after removal of hook plate which improved further an average of 32.3 at the last follow-up, which was also statistically significant (p value <0.05). Clavicular hook plate fixation without coracoclavicular ligament reconstruction is a good option for acute acromioclavicular dislocations producing excellent medium-term functional results in high-demand soldiers.

Displaced proximal humeral fractures: When is surgery necessary?

BackgroundSeveral therapeutic methods have been traditionally used in the treatment of displaced proximal humeral fractures; however, the indication of these treatments is still controversial. The purpose of this study was to compare the medium-term functional results of four methods commonly used in the treatment of proximal humeral fractures [conservative treatment, proximal humeral nails (PHN), percutaneous K-wiring (PKW), and locking-plates (LP)] taking into consideration the type of fracture and the age of the patients. MethodsWe conducted a retrospective cohort study on patients with proximal humeral fractures treated with one of the following methods: conservative treatment, PHN, PKW, or LP. Functional results were assessed using the absolute Constant score and the disabilities of the arm shoulder and hand score (DASH). The functional outcome was analysed according to age (≥65 years and <65 years) and fracture type (displaced 2-fragment and 3–4-fragment fractures). ResultsA total of 113 patients were included in the study, with a mean age of 65.3 SD 15.2 years and average follow-up time of 26.2 SD 12.6 months. Patients under 65 years had higher Constant scores when treated with PHN and PKW than those treated conservatively (77.2 vs. 54.7, p=0.01 and 74.0 vs. 54.7, p=0.03, respectively). Patients above 65 years had higher Constant scores when treated with PKW compared to PHN and conservative treatment (68.7 vs. 51.9, p=0.02 and 68.7 vs. 55.9, p=0.029, respectively). In 2-fragment fractures, PKW resulted in higher Constant scores than conservative treatment (70.4 vs. 53.9, p=0.048). No differences were found in the final outcome between patients treated with LP and those treated conservatively regardless of age, and fracture type. There were also no differences between any of the evaluated methods in the treatment of 3–4-fragment fractures. ConclusionThe use of PKW was associated with better functional results than conservative treatment in individuals of all ages, especially in patients with 2-fragment fractures; PKW also achieved better functional results than PHN in elderly patients. PHN was superior to conservative treatment in young individuals. No significant differences were found between LP and conservative treatment in any of the analysed categories.

Midterm results of robot-assisted sacrocolpopexy.

Robotic assistance simplifies laparoscopic procedures. We hypothesize that robot-assisted sacrocolpopexy is a rapid and safe procedure with satisfying short-term and midterm functional results. After informed consent, we enrolled 101 consecutive patients undergoing sacrocolpopexy at Alfried Krupp Hospital, Essen, Germany. After a median follow-up of 22 months, we assessed midterm functional results as the primary endpoint. Secondary endpoints included surgical duration, blood loss, intraoperative complications, and postoperative complications. We described frequencies as counts (percent) and continuous data as median [interquartile range (Q1-Q3)] or mean [standard deviation (SD)], as appropriate. We enrolled 101 patients. The mean age was 69 years (SD 11); 75 women (74.3 %) had undergone previous abdominal surgery. Among the patients, 95 (94.1 %) presented with anterior vaginal wall prolapse Baden-Walker grade 2-3, 74 (73.3 %) vaginal vault prolapse, and 9 (8.9 %) concomitant rectocele. Fifty (50 %) patients underwent a modified Burch procedure in addition to sacrocolpopexy. The median surgical duration was 96 min (Q1-Q3 83-130). There were six (5.9 %) minor intraoperative complications but no conversions to open surgery. Postoperatively, we registered five (4.9 %) Clavien-Dindo grade I complications, three (3.0 %) grade II complications, and one (1.0 %) grade III complication. After a median follow-up of 22 months (Q1-Q3 12-49), the patients reported significant decreased impact of pelvic organ prolapse (POP) on quality of life as well as bother resulting from POP symptoms. The overall success rate, defined as none or minor impact of POP on quality of life, was 75 %. In this single-surgeon study, robot-assisted sacrocolpopexy was a safe and rapidly performed procedure that achieved good medium-term functional results.

AKILE™ total ankle arthroplasty: Clinical and CT scan analysis of periprosthetic cysts

IntroductionDespite good clinical results following total ankle replacement (TAR), the development of large periprosthetic cysts (>400 mm2) in the medium-term is a source of concern. ObjectiveThe primary objective of this study was to detect any large periprosthetic cysts in a cohort of AKILE™ patients using radiographs and CT scans, and then to compare these findings to published ones. Material and methodsA total of 127 TAR procedures were performed between June 1995 and January 2012. We retrospectively reviewed 68 cases with the newest AKILE™ implant design that had a minimum follow-up of 36 months. The average follow-up was 81±33 months; eight patients were lost to follow-up. The outcomes consisted of analyzing radiographs (A/P and lateral weight bearing views, Meary view and lateral views of flexion/extension) and helical CT scans, performing clinical evaluations (range of motion, AOFAS score, Foot Function Index, pain levels) and determining the survivorship of TAR implants. ResultsTAR survival at 5 years was 79% for in situ implants and 62% for revision-free implants. The AOFAS score improved from 33.7±14.7 to 77.1±15.1 (out of 100) and the pain sub-score was 30.2±9.7 (out of 40) at the last follow-up. The average ankle range of motion was 32.3°±12.7° on the radiographs. CT scan revealed Type A cysts (<200 mm2) under the talar implant in 52% of cases and in the tibia in 50% of cases; these cysts were smaller than 100 mm2 in 80% of cases and had no effect on the implants. No periprosthetic cysts larger than 400 mm2 in size were identified. DiscussionThe medium-term functional results and survivorship are comparable to those reported for other TAR designs. The incidence of cysts was low overall and there were no large-diameter cysts, which should improve long-term survival. The implant's design and materials likely played a role in preserving the periprosthetic bone stock. The AKILE™ TAR has distinctive features related to the low rate of large periprosthetic cysts in the medium-term. Level of evidenceIV (retrospective case series).

Retrospective Evaluation of the Results of Arthroscopy Assisted Reduction and Osteosynthesis of Tibial Plateau Fractures and the Role of the Arthroscopy at Tibial Plateau Fractures

Objectives:Aim of this study is to compare the medium and long term functional and radiological results of 31 patients with tibial plateau fractures, treated by same surgeon with arthroscopy assisted reduction and osteosynthesis between 2006 and 2013.Methods:This study is designed as evaluation of retrospective case series. 52 patients who has administered Tepecik Education and Research Hospital or Private Izmir Hospital between 2006 and 2013 with tibial plateau fracture and treated by same surgeon with arthroscopic assisted reduction and osteosynthesis is evaluated. Patients with insufficient data and cannot continue follow-up are excluded. 31 patient is included to study meeting our criteria. Injury mechanism, physical examination findings, operation records, concomitant intra articular pathologies, need for allograft or autograft and radiological investigations are retrospectively obtained from hospital medical record system. Preoperative evaluation depends on Schatzker Classification. Patients with floating knee, ipsilateral tibia diaphysis fracture, distal femoral intraarticular fracture, compartment syndrome or neurovascular injury is excluded from study. We didn’t take Schatzker Class is not an exclusion criteria. Results are investigated with Rasmussen radiological and clinical scores statistically.Results:31 patients (23 male, 7 female) with mean age of 46,3 (min. 18- max. 67) is included our study with the mean follow-up of 45 months. Simultaneous meniscus lesion is detected in 15 patients and repair or partial meniscectomy is performed depending on the lesion. 10 patients need for allograft or autografting for joint surface restoration. Medial and/or lateral plate osteosynthesis is performed depending on fracture configuration. Final average Rasmussen functional score is calculated 25,7 and final average Rasmussen radiological score as 16,5. Secondary arthroscopic debridement is needed in 3 patients with arthrofibrosis.Conclusion:First arthroscopy assisted intra-articular fracture treatment is done in 1993 at knee joint and technique is improved with years. With the published satisfactory results of arthroscopy assisted series, current treatment of choice in tibial plateau fractures became arthroscopy assisted osteosynthesis, same as our routine application in our clinics. Advantages of arthroscopy is opportunity of treatment of concomitant intra articular pathologies, differentiation of these lesions as acute or degenerative and chronic more objective than any other imaging modality, detection of chondral injury more accurate and control of anatomical reduction of fracture lines. Downside of our study is lack of control group. Our conclusion is arthroscopy assistance in tibial plateau fractures improves results without increase in compartment syndrome or other complication rate when compared to literature.

Outcome and medium-term functional results of anterior rectopexy for rectocele repair

This retrospective observational study was designed to assess patients’ satisfaction after anterior rectopexy, with or without sacropexy, for treatment of symptomatic rectocele in a group of women with anterior rectoceles. Between February 1995 and March 2011, all female patients who underwent an anterior rectopexy for large (>grade 2) anterior rectocele were included in the study. Preoperatively, the rectocele was assessed at rectovaginal examination and a defecography was performed. Rectovaginal examination was repeated in all patients 6 weeks postoperatively and a control defecography was performed 6 months after surgery. Follow-up included a standard telephone questionnaire and chart review. The surgical techniques used were anterior rectopexy (ARP; n = 21) and ARP + sacropexy (ARP + SP; n = 20). Mean age of the study group was 60 years (range = 36–77) and median parity was 2.6 (range = 0–8). Median follow-up from anterior ARP ± SP to functional assessment was 40 months (range = 4–83). In both groups, two of the initial main clinical symptoms (discomfort due to feeling of prolapse and outlet obstruction) improved significantly (p grade 2) anterior rectocele.

Health technology assessment in evolution – focal therapy in localised prostate cancer

Focal therapy in prostate cancer aims to treat only the part of the gland harboring clinically significant disease while preserving the rest of the tissue. This approach may substantially reduce treatment-related toxicity without compromising disease control outcomes. Short- to medium-term functional and oncological results in prospective interventional studies are promising, but comparative effectiveness research against standard of care is required to incorporate focal therapy among standard options. In this review, we discuss the actual stage of assessment and results of sources of energy commonly used to deliver focal therapy. We also provide our viewpoint on how the field will evolve in the near future.

Comparison of minimally invasive approach versus conventional anterolateral approach for total hip arthroplasty: a randomized controlled trial

It is a general belief among hip surgeons that minimally invasive surgical (MIS) approach for implantation of a total hip arthroplasty (THA) allows an improved and faster postoperative rehabilitation because of reduced muscle and soft-tissue damage, less postoperative pain and blood loss, and shorter hospital stay compared with conventional approaches. In the published relative literature though, there are controversial reports and debates on this matter. To our knowledge, there is no study on the medium-term functional results comparing MIS and traditional approaches for total hip replacement. The purpose of this prospective comparative controlled study was to compare MIS with conventional approach, on terms of pain, blood loss, and functional recovery over a follow-up period of 4 years. In a total of 90 consecutive randomly selected adult patients, who suffered from unilateral primary hip osteoarthritis, a cementless Zweymüller-Plus THA (SL-Plus stem, Bicon screw socket) was implanted by a single senior orthopedic hip surgeon in one institution in the same period. Forty-five patients (group A) were operated using an MIS anterolateral, short incision, muscle-sparing approach and 45 (group B) with a conventional (anterolateral modified Watson-Jones) approach under partial detachment of gluteus medius and minimus. Anthropometric data, blood loss, short-form 36 questionnaire, visual analog scale pain score, and walking endurance were included in the analysis. Approach-related surgical complications (trochanter major fracture, Bicon malposition) were recorded. Data were collected postoperatively and at 4-year follow-up. Two patients of group A and eight patients of group B were excluded from the final analysis. Thus, 80 patients were eligible for the final evaluation 4 years postoperatively. Postoperative pain score was less in the MIS group. However, no differences in perioperative blood loss, functional outcome, and walking endurance were shown between groups. No difference in Bicon cup implantation angle was measured in postoperative roentgenograms between group A and B patients, no intraoperative trochanter fracture occurred in any patient of both groups. The present prospective randomized study revealed no significant mid-term clinical and functional benefit for patients who underwent a THA through an MIS in comparison with those who were managed with a conventional open approach.