Minimum Five-year Follow-up Research Articles

MP45-16 CRYO ONLINE DATA REGISTRY OUTCOMES: MINIMUM FIVE YEAR FOLLOW UP DATA

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2014MP45-16 CRYO ONLINE DATA REGISTRY OUTCOMES: MINIMUM FIVE YEAR FOLLOW UP DATA David Levy, Christopher Williams, Thomas Polascik, and Stephen Jones David LevyDavid Levy More articles by this author , Christopher WilliamsChristopher Williams More articles by this author , Thomas PolascikThomas Polascik More articles by this author , and Stephen JonesStephen Jones More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1213AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives We report a comprehensive update of 5 year COLD Registry outcomes for patients undergoing primary whole gland prostate cryoablation. Methods A risk stratified cohort of 1,111 treatment naïve patients who underwent primary whole gland cryoablation was identified. 5 year biochemical progression free Kaplan Meier survival curves were constructed based on Phoenix definition. Results Overall bPFS was: 79.9%, 64.1% and 68.1%, low, intermediate and high risk, respectively, (Figure 1). For 817 (73.5%) patients with nadir PSA < 0.4 ng/ml, bPFS was 91%, 80.5%, and 77.6%, low, intermediate and high risk, respectively. Patients with a nadir PSA > 0.4 ng/ml demonstrated 24-month biochemical progression rates in excess of 34%. Continence was preserved in 93.4% of patients, while 5.9% of patients had retention and 0.5% developed a rectal fistula. Potency data entered into the Registry data base revealed that 35% of patients were potent at 12 months. Conclusions 5 year bPFS following prostate cryoablation is comparable to surgical and radiation outcomes across all risk categories with a lower likelihood of procedure related complications. A nadir PSA > 0.4 ng/ml predicts a high likelihood of biochemical progression and warrants close follow up. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e465 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information David Levy More articles by this author Christopher Williams More articles by this author Thomas Polascik More articles by this author Stephen Jones More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Result of a Minimum Five-Year Follow-Up of Hip Arthroplasty Using the Bencox® Hip Stem

Purpose: The purpose of this study is to report the results of artificial hip arthroplasty with minimum five-year follow-up using the Bencox (Corentec) hip stem, the first total hip prosthesis developed in Korea. Materials and Methods: We evaluated 27 hips in patients with femoral neck or intertrochanteric fracture (fracture group) and 58 hips in patients with arthritis or osteonecrosis of the femoral head (arthritis group) who underwent hip arthroplasty using a Bencox hip stem in combination with Bencox bipolar cup and Bencox acetabular cup between September 2006 and February 2008. Patients in the fracture group underwent bipolar hip arthroplasty, and those in the arthritis group underwent total hip arthroplasty. Results: During the follow-up period, there were no cases of revision of the femoral stem. Mean Harris hip score was 94 at the latest follow-up in (femoral neck or intertrochanteric) the fracture group, and improved from 57 preoperatively to 98 at the latest follow-up in the arthritis (or avascular necrosis) group. Radiographically, endosteal bone ongrowth was found in 23 of 27 cases in the fracture group (85.2%) and 56 of 58 cases in the arthritis group (96.6%). Stem loosening, infection, dislocation, and ceramic breakage were not noted. Conclusion: Clinical and radiographic evaluations of hip arthroplasty using the Bencox hip stem showed excellent outcomes with a minimum of five-year follow-up.

Long-Term Clinical Outcome of Two Stage Revision Surgery for Infected Hip Arthroplasty Using Cement Spacer

Purpose: We retrospectively analyzed long-term clinical results after two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for infected total hip arthroplasty. Materials and Methods: Twenty-six hips (group 1: cup exchanged, group 2: cup and stem exchanged) were enrolled in this study. The mean follow-up period was 7.4 years (5 to 11 years). We analyzed the laboratory findings, the time interval between antibiotic-impregnated cement spacer insertion and revision arthroplasty, Harris hip score, Oxford hip score, radiologic changes, and recurrence of infection. Results: Revision hip arthroplasty was performed at 7.5 weeks on average (group 1: 7.2 weeks, group 2: 7.7 weeks) after implant removal and cement spacer insertion. In group 1, Harris hip score was 51.1 points preoperatively, 84.4 points at six months, 89.3 points in at one year, 91.8 points at three years, and 89.8 points at five years. In group 2, the Harris hip score was 49.8 points preoperatively, 78.1 points at six months, 83.7 points at one year, 90.3 points at three years, and 88.7 points at five years. Recurrence of infection developed in one hip in each group. Conclusion: Ninety-two percent of infected hips were eradicated with two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for infected hip arthroplasty at minimum five-year follow-up. When the infection was limited to the hip joint and the stem was fixed well, two-stage revision with stem retained could be a good treatment option.

An uncemented metal-backed glenoid component in total shoulder arthroplasty for osteoarthritis: factors affecting survival and outcome

BackgroundThe reported survivorship of total shoulder replacement (TSR) is variable. This is probably related to implant design. We report the outcome and survivorship of the uncemented glenoid in patients with osteoarthritis receiving a TSR with an intact or repairable rotator cuff at surgery. MethodsThirty-two consecutive patients were analysed after TSR using a screw-fixed porous coated metal-back glenoid performed by a single surgeon, with a minimum follow-up of fiveyears. Thirty-three TSRs in 32 patients (19 women) with a mean age of 67years were analysed, two of whom died before fiveyears of follow-up. Thirty patients (31 shoulders) were monitored for a mean of 95months (60–173months). ResultsThe Constant score improved by 22 points (p<0.001). The only significant predictor of outcome on logistic regression analysis was the preoperative Constant score, with better scores resulting in a lesser improvement at last follow-up (p<0.0001). Implant survivorship at tenyears was 93%. Three were revisions: two for polyethylene wear (both at sixyears) but with a well-fixed glenoid, and another for loosening of the glenoid at 11years postoperatively. Univariate analysis identified that younger age (56year vs. 68years, p=0.03) and a higher combined preoperative Constant score (35.7 vs. 21.5, p=0.03) were both predictors of failure. ConclusionThe uncemented glenoid performs well in the medium term for osteoarthritis of the shoulder in older patients, giving improved and sustained functional outcome. Age and preoperative level of function are predictors of outcome and survival.

Outcome and Complications of Sacropelvic Fixation Using S2 Alar-Iliac (S2AI) Fixation in Adult Deformity Patients Fused to the Sacrum: A Prospective Study with Minimum Five-Year Follow-Up

Outcome and Complications of Sacropelvic Fixation Using S2 Alar-Iliac (S2AI) Fixation in Adult Deformity Patients Fused to the Sacrum: A Prospective Study with Minimum Five-Year Follow-Up

Tension-free vaginal tape-obturator in the treatment of stress urinary incontinence: a prospective study with five-year follow-up

To evaluate the medium-term outcomes of using tension-free vaginal tape-obturator (TVT-O) in the treatment of patients with stress urinary incontinence (SUI). Between December 2004 and November 2005, 103 patients with SUI were enroled and treated with TVT-O with inside-out modification. A minimum five-year follow-up (median, 65 months) was obtained from 100 patients (99.6%). Preoperative and postoperative evaluations were performed for all patients. The objective success rate of the TVT-O procedure was evaluated by a negative stress test. The secondary outcomes measured included one- and five-year subjective success rates, together with the pre- and post-operative urodynamic parameters, complications, quality of life (QOL) analysis, and patient satisfaction. Among the 103 patients, 18 (17.4%) had postoperative voiding difficulties and needed urethral bladder catheterization for various periods. After the TVT-O procedure, complete disappearance of SUI occurred in 87.4% of patients, while improvement was found in about 92%. In addition, there was no difference in the cure rate between year 1 and year 5 after the procedure (P>0.05). In 90 patients, frequency and urge symptoms were significantly improved five years after the procedure (P<0.005), and maximal flow rates were decreased (P<0.05). However, the severity of obstructive symptoms and postvoid residual volumes at five years were not improved compared with one year after the procedure (P=0.10 and P=0.33 respectively). Finally, compared to pre-operation, incontinence severity degree and QOL scale scores were largely improved after the operation (P<0.001), while no difference was found between years 1 and 5 (P=0.11and P=0.09 respectively). Our result shows that the TVT-obturator, a novel mid-urethral sling, is a safe and effective procedure for the treatment of female SUI. Medium-term therapeutic results appear promising but further evaluation of long-term therapeutic outcomes is needed.

Incidence, Risk Factors and Clinical Outcome of Proximal Junctional Kyphosis for Patients with Adult Idiopathic Scoliosis: Minimum Five-Year Follow-Up

This study reports the incidence, risk factors, and natural course of proximal junctional kyphosis (PJK) in a long term follow-up of adult idiopathic scoliosis patients undergoing long instrumented spinal fusion and shows that the majority of PJK developed in the early post-op period and can continue to progress over long term. However, few patients required revision surgery for PJK.

Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up. Anandjiwala J, Seo JY, Ha KY, Oh IS, Shin DC. Eur Spine J 2011 Jul 22. [Epub ahead of print

Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up. Anandjiwala J, Seo JY, Ha KY, Oh IS, Shin DC. Eur Spine J 2011 Jul 22. [Epub ahead of print

Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up

To (1) clarify the role of various risk factors in the development of ASD, (2) compare instrumentation configuration with the development of ASD, (3) correlate the radiological incidence of ASD and its clinical outcome and (4) compare the clinical outcome between patients with radiological evidence of ASD and without ASD. This study prospectively examined 74 consecutive patients who underwent instrumented lumbar/lumbosacral fusion for degenerative disease with a minimum follow-up of 5years. Among the patients, 68 were enrolled in the study. All of the patients had undergone preoperative radiological assessment and postoperative radiological assessment at regular intervals. The onset and progression of ASD changes were evaluated. The patients were divided in two groups: patients with radiographic evidence of ASD (group 1) and patients without ASD changes (group 2). Comprehensive analysis of various risk factors between group 1 and group 2 patients was performed. The Visual Analog Scale (VAS) was used to evaluate the clinical outcome and the functional outcome was evaluated using the Oswestry Disability Index (ODI) before and after surgery along with radiological assessment. Radiographic ASD occurred in 20.6% (14/68) of patients. Preoperative disc degeneration at an adjacent segment was a significant risk factor for ASD. Other risk factors such as the age of a patient at the time of surgery, gender, preoperative diagnosis, length of fusion, instrumentation configuration, sagittal alignment and lumbar or lumbosacral fusion were not significant risk factors for the development of ASD. There was no correlation between ASD and its clinical outcome as determined at the final follow-up session. In addition, clinical outcome of patients with ASD and without ASD were not comparable. Patients with preoperative disc degeneration at an adjacent segment were more at risk for the development of ASD. Other risk factors including instrumentation configuration were not significantly associated with ASD. There was no correlation between both the radiological development of ASD and its clinical outcome and the clinical outcome of patients with and without ASD.

Adjacent Segment Disease After Interbody Fusion and Pedicle Screw Fixations for Isolated L4–L5 Spondylolisthesis: A Minimum Five-Year Follow-up

Adjacent Segment Disease After Interbody Fusion and Pedicle Screw Fixations for Isolated L4–L5 Spondylolisthesis: A Minimum Five-Year Follow-up

Pulmonary Function After Thoracoplasty in the Surgical Treatment of Adolescent Idiopathic Scoliosis

Retrospective case series review. To compare two similar groups of adolescents surgically treated for their spinal deformity either by posterior segmental fusion alone (PSF) or by posterior spinal fusion and thoracoplasty (PSF+T); attention was focused on the long-term effects of thoracoplasty on pulmonary function in the surgical treatment of adolescent idiopathic scoliosis. Posterior spinal arthrodesis with thoracoplasty and an open anterior approach, with respect to a posterior only fusion have been found to have a deleterious effect on pulmonary function for as long as five years postoperatively after surgical treatment of adolescent idiopathic scoliosis. A group of 40 consecutive adolescent patients, surgically treated between 1998 and 2001 by posterior spinal fusion and thoracoplasty, was compared with a similar cohort of 40 adolescents treated in the same period by posterior segmental fusion alone. Pedicle screw instrumentation alone and a minimum five-year follow-up were requested as inclusion criteria. Both a radiographic analysis and a chart review was performed, evaluating the pulmonary function tests (PFTs), the SRS-30 score questionnaire and the Lenke classification system. A radiographic Rib Hump (RH) assessment was also performed. The entire series was reviewed at an average clinical follow-up of 8.3 years. There were no statistically significant differences between the two groups in terms of gender, age (PSF+T: 16.3 y vs. PSF: 15.2 y), Lenke curve type classification and preoperative Cobb's main thoracic (MT) curve magnitude (PSF+T: 66° vs. PSF: 63°), whereas both final MT percent correction (PSF+T: 53.03% vs. PSF: 51.35%; P<0.03), RH absolute correction (PSF+T: -2.1 cm vs. PSF: -1.05; P<0.01) and RH overall percent correction (PSF+T: 55.4% vs. PSF: 35.4%; P<0.0001) were greater in the thoracoplasty group. No statistical differences were observed between the two groups in PFTs both pre-operatively and at last follow-up. Nevertheless, comparing preoperative to final PFT'S within each group, only in the PSF group both forced vital capacity and forced expiratory volume in one second showed a statistically significant improvement at final evaluation. At last follow-up visit, the SRS-30 scores did not show any statistical difference between the two groups (total score PSF+T: 4.1 vs. PSF: 4.3). Our findings suggest that thoracoplasty did not adversely affect long-term PFTs in AIS patients treated by posterior spinal fusion alone using pedicle screws instrumentation, as already highlighted by previous reports. A trend towards better coronal plane correction and rib hump improvement was seen, although not clearly reported in a self-assessment disease-specific questionnaire.

Minimum Five-year Follow-up Study of Cancellous Metal Lübeck Hip System

Minimum Five-year Follow-up Study of Cancellous Metal Lübeck Hip System

A Follow-up Study of Unicompartmental Arthroplasty of the Knee Joint (with a Minimum Five-year Follow-up Period)

A Follow-up Study of Unicompartmental Arthroplasty of the Knee Joint (with a Minimum Five-year Follow-up Period)

Minimum Five-year Follow-up Results of Single-Radius, High-Flex Posterior-Stabilized TKA

We studied 75 primary total knee arthroplasties (TKAs) performed using a single-radius, high-flex posterior-stabilized insert design with a minimum 5-year follow-up to document its implant specific complications and clinical results. Nonprogressive osteolysis was observed at zone 4 of the femoral component in 6 knees (8%) and at zone 1 of the tibial component in 6 knees (8%). However, no complications associated with high flexion designs, such as early aseptic loosening, were observed.Preoperatively, mean Knee Society Knee Score and Knee Society Function Score were 55.1 and 45.5, respectively (range, 10-83 and 20-80, respectively). At last follow-up, mean Knee Society Knee Score and Knee Society Function Score improved to 94.9 and 85.9, respectively (range, 70-100 [P<.0001] and 45-100 [P<.0001], respectively). Mean maximal flexion was 122.1 degrees (range, 90 degrees -140 degrees ) and mean range of motion (ROM) was 110.3 degrees (range, 80 degrees -135 degrees ) preoperatively, and these values improved to 128.9 degrees (range, 110 degrees -150 degrees [P<.0001]) and 127.8 degrees (range, 110 degrees -150 degrees [P<.0001]), respectively, at last follow-up. Preoperative ROM was found to be the only factor significantly correlated with postoperative ROM at last follow-up by univariate (P=.0020) and multivariate analysis (P<.0067). Accordingly, clinical results were comparable to previous reports of high-flex implants without implant-specific complications.

Mid-term results of the modular ANCA-Fit femoral component in total hip replacement

We report the minimum five-year follow-up of 352 primary total hip replacements using the uncemented hydroxyapatite-coated ANCA-Fit femoral component with a modular neck and head. The series comprised 319 patients (212 men, 107 women) with a mean age at operation of 64.4 years (28 to 97). The principal diagnosis was osteoarthritis. A total of 18 patients (21 hips) died before their follow-up at five years, nine patients (11 hips) were lost to follow-up, and four (four hips) declined further follow-up. Patient-reported outcomes have been recorded for 288 patients (316 hips). Their mean Oxford Hip Score improved significantly from 41 points (16 to 57) pre-operatively to 20 points (12 to 44) at five-year follow-up. Radiological assessment showed good bony stability in 98% of implants. There were two cases of aseptic loosening of the femoral component. There were no clinical or radiological complications related to modularity. In our series we did not see the high rate of intra-operative fracture previously reported for this implant. This medium-term follow-up study demonstrates that the clinical outcome of the ANCA-Fit femoral component is, to date, comparable with that of other metaphyseal loading femoral components.

Autologous Chondrocyte Implantation in the Knee Joint: Open Compared with Arthroscopic Technique

Autologous chondrocyte implantation is a widely used technique for treating cartilage lesions1-10. The technique, first introduced and described by Brittberg et al. in 199411, required an arthrotomy of the joint, debridement of the lesions, and the suturing of a periosteal flap to create a pocket to host the chondrocytes. Autologous chondrocyte implantation in the knee joint has provided hyaline-like repair tissue11-16, with satisfactory clinical results in 80% to 90% of patients1,7,17. Moreover, autologous chondrocyte implantation has been shown to be a valid alternative to the mosaicplasty and microfracture repair techniques used in the treatment of osteochondral lesions of the knee1,6,13,17-20. In the recent past, to simplify the autologous chondrocyte implantation surgical technique, a three-dimensional hyaluronic acid scaffold was developed to support the autologous chondrocytes13. This scaffold enables an arthroscopic implantation technique to be used21. Furthermore, the chondrocytes embedded on the hyaluronic acid scaffold tend to maintain their original phenotype22 with respect to dedifferentiation induced by the fluid medium23. Despite initial encouraging results with the use of arthroscopic autologous chondrocyte implantation in the treatment of osteochondral lesions of the knee24-26, open and arthroscopic autologous chondrocyte implantation techniques have been compared in only a few studies23,25,26, and these have included only short-term follow-up and limited and nonhomogeneous case series. The aim of this study was to compare the long-term results in two groups of patients in whom osteochondral lesions in the knee joint were treated with the two aforementioned procedures. Patients were evaluated clinically, histologically, and with magnetic resonance imaging, with a minimum five-year follow-up. Between 1997 and 2002, …

Pulmonary Function Following Early Thoracic Fusion in Non-Neuromuscular Scoliosis

While early spinal fusion may halt progressive deformity in young children with scoliosis, it does not facilitate lung growth and, in certain children, it can result in thoracic insufficiency syndrome. The purpose of this study was to determine pulmonary function at intermediate-term follow-up in patients with scoliosis who underwent thoracic fusion before the age of nine years. Patients who had thoracic spine fusions before the age of nine years with a minimum five-year follow-up underwent pulmonary function testing. Forced vital capacity, forced expiratory volume in one second, and maximum inspiratory pressure were measured and compared with age-matched normal values. Patients with neuromuscular disease, skeletal dysplasias, or preexisting pulmonary disease were excluded, while those with rib malformations were included. The relationships between forced vital capacity and age at the time of surgery, length of follow-up, extent of the fusion, proximal level of the fusion, and revision surgery were studied. Twenty-eight patients underwent evaluation. Twenty patients had congenital scoliosis, three had idiopathic scoliosis, three had scoliosis associated with neurofibromatosis, one had congenital kyphosis, and one had syndromic scoliosis. Seventeen patients had one spinal surgery, while eleven had additional procedures. The average age of the patients was 3.3 years at the time of surgery and 14.6 years at the time of follow-up. The average extent of the thoracic spine fused was 58.7%. The average forced vital capacity was 57.8% of age-matched normal values, and the average forced expiratory volume in one second was 54.7%. The forced vital capacity was <50% of normal in twelve of the twenty-eight patients, and two required respiratory support, implying that substantial restrictive lung disease was present. With the numbers studied, no significant correlation could be detected between the age at the time of fusion or the length of follow-up and pulmonary function. The extent of the spine fused correlated with the forced vital capacity (p = 0.01, r = -0.46). Fusions in the proximal aspect of the spine were found to be associated with diminished pulmonary function as eight of twelve patients with a proximal fusion level of T1 or T2 had a forced vital capacity of <50%, but only four of sixteen patients with a fusion beginning caudad to T2 had a forced vital capacity of <50% (p = 0.0004, r = 0.62). Patients with proximal thoracic deformity who require fusion of more than four segments, especially those with rib anomalies, are at the highest risk for the development of restrictive pulmonary disease. Pulmonary function tests should be performed for all patients who have an early fusion. The pursuit of alternative procedures to treat early spinal deformity is merited.

The survival of support rings in complex acetabular revision surgery

Between 1980 and 2000, 63 support rings were used in the management of acetabular deficiency in a series of 60 patients, with a mean follow-up of 8.75 years (2 months to 23.8 years). There was a minimum five-year follow-up for successful reconstructions. The indication for revision surgery was aseptic loosening in 30 cases and infection in 33. All cases were Paprosky III defects; IIIA in 33 patients (52.4%) and IIIB in 30 (47.6%), including four with pelvic dissociation. A total of 26 patients (43.3%) have died since surgery, and 34 (56.7%) remain under clinical review. With acetabular revision for infection or aseptic loosening as the definition of failure, we report success in 53 (84%) of the reconstructions. A total of 12 failures (19%) required further surgery, four (6.3%) for aseptic loosening of the acetabular construct, six (9.5%) for recurrent infection and two (3.2%) for recurrent dislocation requiring captive components. Complications, seen in 11 patients (18.3%), included six femoral or sciatic neuropraxias which all resolved, one grade III heterotopic ossification, one on-table acetabular revision for instability, and three early post-operative dislocations managed by manipulation under anaesthesia, with no further instability. We recommend support rings and morcellised bone graft for significant acetabular bone deficiency that cannot be reconstructed using mesh.

Are Mobile Bearing Knees Worth the Premium? Mobile Bearing Knees Provide No Early Clinical Benefit at Minimum Five-Year Follow-Up

Modern mobile-bearing knee designs were introduced to reduce wear and improve function. The purpose of this study was to compare total knee arthroplasty of fixed and mobile bearing designs with identical femoral geometry.

Shoulder hemiarthroplasty for acute fractures of the proximal humerus: A minimum five-year follow-up

Significant discrepancy in the functional outcome of hemiarthroplasty for proximal humerus fractures has been reported with short or mid-term follow-up. This study reports the long-term results and rate of complications of shoulder arthroplasty in the treatment of proximal humerus fractures. The review comprised 57 patients (44 women, 13 men) who underwent hemiarthroplasty between 1976 and 1996 as treatment of a proximal humerus fracture and who had a minimum 5-year follow-up (mean, 10.3 years). The mean patient age was 66 years at the time of surgery (range, 23-89 years). According to a modified Neer result rating system, results were satisfactory in 27 patients and unsatisfactory in 30. The mean active elevation was 100 degrees (range, 20 degrees -180 degrees ) and external rotation was 30 degrees (range, 0 degrees -90 degrees ). At the most recent follow-up, 9 patients (16%) had moderate or severe pain and 2 required implant revision or removal. The study data suggest that patients undergoing arthroplasty as treatment of an acute fracture of the proximal humerus may achieve satisfactory long-term pain relief; however, the result for overall shoulder motion is less predictable. In view of these results, current indications, surgical technique, and postoperative treatment may need to be revisited.