Minimum One-year Follow-up Research Articles

A comparison of the use of a suprapatellar Chinese Aircraft-shaped Sleeve System versus suprapatellar intramedullary nailing for tibial shaft fractures: Outcomes over a one-year follow-up

IntroductionThis study aimed to investigate the effectiveness and safety of the Chinese Aircraft-shaped Sleeve (CASS) system on the clinical outcomes of tibial intermedullary nailing using a suprapatellar approach for the treatment of tibial fractures in a cohort of adult Chinese patients over a minimum one-year follow-up. MethodsAfter institutional review board approval, skeletally mature patients with Orthopaedic Trauma Association (OTA) type 42 tibial shaft fractures were randomized into either a SP approach using CASS group or a conventional SP approach group after informed consent was obtained. The operations were performed by a single senior orthopaedic surgeon according to group assignments. A group of 33 patients were treated using the CASS system and the other group of 34 patients were treated using a conventional SP approach. Both groups fully complied with research requirements and completed 12 months of follow-up. Magnetic resonance images (MRI) were obtained for the evaluation of the patellofemoral joint (PFJ) and residual debris preoperatively, as well as one week and 12 months postoperatively. Radiographs were used to assess alignment and union, visual analog scores (VAS) were used to assess anterior knee pain, and range of motion (ROM) and the Lysholm knee scoring scales were used for evaluating the operated knee at the 12-month follow-up. ResultsDifferences in cartilage lesion changes observed by MRI between the two groups were statistically significant (P = 0.030 at 1 week postoperatively; P = 0.025 at 12 months postoperatively). No significant differences were evident with respect to debris residue, malalignments, nonunion, VAS, ROM and Lysholm knee scoring scale with the exception of stair climbing (P = 0.02). ConclusionBased on the data of this one-year clinical follow-up study, the SP approach using the CASS system offers the potential to benefit patients suffering from tibial shaft fractures, who will be treated with intramedullary nailing especially for smaller patients.

Comparison of Intravitreal Aflibercept and Ranibizumab for Treatment of Myopic Choroidal Neovascularization: One-Year Results-A Retrospective, Comparative Study.

Purpose To compare one-year treatment outcomes of intravitreal aflibercept (IVA) and intravitreal ranibizumab (IVR) for treatment of myopic choroidal neovascularization (mCNV). Methods The medical records of a total of 30 eyes diagnosed with mCNV and underwent IVA or IVR treatment for a minimum one-year follow-up were studied retrospectively. All the subjects had an axial length >26 mm and received a 1 + PRN (pro re nata) regimen IVA or IVR. Best-corrected visual acuity (BCVA) and central macular thicknesses (CMT) on optical coherence tomography were evaluated before and after treatment. Results There were 12 eyes in IVA group, with a mean age of 60.0 ± 10.2 years. The mean BCVA significantly improved from baseline 1.54 ± 0.76 to 0.85 ± 0.61 and the mean CMT significantly decreased from baseline 384.3 ± 119.1 μm to 305.9 ± 75.4 μm to 305.9 ± 75.4 p : 0.024 and p : 0.024 and μm to 305.9 ± 75.4 μm to 305.9 ± 75.4 p : 0.024 and p : 0.024 and p : 0.024 and p : 0.024 and Conclusions Both IVA and IVR treatment modalities resulted in similar anatomical outcomes but IVA had better visual outcomes in treatment of mCNV.

Predictors of Successful Outcomes Following Revision Total Knee Arthroplasty for Flexion Instability

Background and Hypothesis: Flexion instability is a poorly understood cause of total knee arthroplasty (TKA) failure, often referred to as a “wastebasket” diagnosis for unexplained persistent pain. It remains a challenging diagnosis, with unpredictable outcomes following revision surgery. This study identified predictors of successful patient reported outcome measures (PROMS) following revision for flexion instability.
 Methods: 121 consecutive revision TKAs for flexion instability from 2011-2018 at a single center were retrospectively reviewed. PROMS were prospectively obtained preoperatively and at minimum one-year follow-up. 33 potential predictors of PROMS encompassed: presenting symptoms, demographics/medical covariates, intraoperative observations, and pre/postoperative radiographic measurements. Variables related to outcomes with p≤0.20 in univariate analysis were entered in regression models. Nonsignificant predictors were pruned until only predictors with p<0.05 and the best model statistics were achieved. 
 Results: The sample was 63% female with mean age of 65±11 and BMI of 34±7 kg/m2. Pre- to postoperative changes in three radiographic measurements vital to the stability and function of TKA were related to function (p<0.001), pain (p=0.019), and satisfaction (p=0.030) after surgery. Pain with walking (p≤0.059) and stair climbing (p≤0.048) were almost exclusively related to demographic/medical covariates. Only one of the presenting symptoms commonly associated with flexion instability influenced early revision outcomes (p=0.021).
 Conclusion and Potential Impact: Instability is one of the most common reasons for TKA failure leading to costly revision surgery. To our knowledge, this is the largest flexion instability cohort studied to date, including substantially more predictors in an attempt to elucidate factors indicative of successful treatment outcomes. With the exception of radiographic parameters reflecting surgical decisions, findings suggest that many factors related to outcomes may be beyond the control of arthroplasty surgeons.

Le jeune âge est associé à un risque plus élevé de mobilisation sous anesthésie pour raideur sur prothèse totale de genou

IntroductionLimited range of motion (ROM) after total knee replacement (TKR) is associated with low function and might require manipulation under anaesthesia (MUA). In order to identify factors associated with a limited ROM we investigated predictors for MUA. MethodsIn a case control study we investigated all patients undergoing primary TKR at a University Hospital in Sweden between 2007–2012. We registered background factors and compared those between the group who underwent MUA and those who did not. Odds ratios (OR) were calculated in a univariate analysis and an adjusted regression analysis. ResultsOf the total of 669 TKRs performed, 31 patients who had undergone MUA were identified. The prevalence of MUA was 4.6 %. The mean increase in ROM after MUA was 27 degrees at final minimum one-year follow-up. After controlling for confounders, patients with good health and young age had increased OR for MUA. OR decreased 0.93 (CI 0.93–0.97) per increased age year in the multiple regression analysis. Diabetes mellitus, BMI and sex did not have a significant effect on the odds ratio for MUA. DiscussionYoung patients undergoing TKR has earlier been identified as a group with a higher grade of dissatisfaction and complications. We found an association between young age and MUA after TKR indicating an additional, rather unknown complication for this group of patients. The background and reasons for this has to be further investigated. Level of evidenceII, Cohort study/case control study (case control is level III).

Outcomes of Primary and Conversion Magnetically Controlled Growth Rods Are Different at Two-Year Follow-up: Results of North American Release

Study designMulticenter retrospective review. ObjectivesTo compare the radiographic outcomes and complication rates in patients with primary and conversion magnetically controlled growing rod (MCGR) implants at one and two years after surgery. Summary of background dataMany initial early-onset scoliosis (MCGR) implantations in the United States were conversions from other types of growth-friendly systems, and the outcome similarities and differences between primary and conversion MCGR implantation procedures are still relatively unknown. MethodsMulticenter retrospective review of EOS patients from two multicenter EOS registries identified consecutive EOS patients treated from 2014 to 2017 with a minimum of one-year follow-up. In addition, a subset of these patients who had two-year follow-up were further analyzed. ResultsIn total, 383 MCGR patients were identified, of which 272 (71%) were primary (P) and 111 (29%) were conversion (C). Group P patients had significantly greater coronal curves at the time of MCGR implantation and greater initial coronal correction. There was no statistically significant difference in Cobb correction at one year or between follow-up at one and two years. The preimplantation thoracic spine height was identical in both groups, with statistically greater improvement at initial implantation in P than in C patients. Significantly greater height gains were seen in P than in C patients in the one-year follow-up cohort. There was a higher rate of complications in the C group than in the P group; however, the difference was not statistically significant. Overall, most complications were implant-related. No loss of curve correction occurred in either group. ConclusionsPatients with primary MCGR insertion can be expected to have greater radiographic correction and spine length gain than those with conversion from growth-friendly instrumentation to MCGR, most likely because of increased spine stiffness in conversion patients. The rate of complications, primarily implant-related, remains higher in conversion than in primary insertion patients. Level of EvidenceLevel III.

Dual-pivot bearings improve ambulation and promote increased activity levels in Total knee arthroplasty: A match-controlled retrospective study

BackgroundModern understanding of native knee kinematics reveals more complex pattern of lateral-pivot in early flexion activities, and medial-pivot in deeper flexion (i.e. dual-pivot). The purpose of this study was to compare patient outcomes with a contemporary dual-pivot TKA, designed to replicate anterior-cruciate substitution and stability, with a traditional TKA. MethodsOne hundred and eighty-three dual-pivot TKAs were matched with 183 traditional non-conforming TKAs. All TKAs were cemented and performed with identical perioperative protocols. Patients were matched on age, sex, BMI, and ASA score. Patient-reported outcome measures were prospectively obtained and compared at minimum one-year follow-up. ResultsStudy cohorts were identical with 72% female, average age of 68 years, and BMI of 33 kg/m2. There were no differences in prevalence of fibromyalgia, depression, preoperative narcotic use, or femoral component alignment (p ≥ 0.105). Dual-pivot TKA patients had a greater prevalence of lumbar spine disease (p = 0.012) and more reported their knee never feels normal preoperatively (p = 0.012). Dual-pivot TKA patients reported less walking pain at latest follow-up (p = 0.022). Trends for greater level of participation in very active activities or impact sports (p = 0.067) and more reporting their knee feels normal (p = 0.091) were observed in dual-pivot TKAs. ConclusionPatients with dual-pivot knees reported less walking pain despite greater lumbar spine disease, supporting the potential benefit of lateral-pivot motion in early flexion activities. However, the groups were similar in overall satisfaction suggesting the nuances and potential ceiling-effect of patient satisfaction warrants further study.

Younger age is associated with increased odds of manipulation under anesthesia for joint stiffness after total knee arthroplasty

IntroductionLimited range of motion (ROM) after total knee replacement (TKR) is associated with low function and might require manipulation under anaesthesia (MUA). In order to identify factors associated with a limited ROM we investigated predictors for MUA. We hypothesized that older age was associated with higher MUA due to limited ROM post TKR. MethodsIn a case control study we investigated all patients undergoing primary TKR at a University Hospital in Sweden between 2007–2012. We registered background factors and compared those between the group who underwent MUA and those who did not. Odds ratios (OR) were calculated in a univariate analysis and an adjusted regression analysis. ResultsOf the total of 669 TKRs performed, 31 patients who had undergone MUA were identified. The prevalence of MUA was 4.6%. The mean increase in ROM after MUA was 27 degrees at final minimum one-year follow-up. After controlling for confounders, patients with good health and young age had increased OR for MUA. OR decreased 0.93 (CI 0.93–0.97) per increased age year in the multiple regression analysis. Diabetes mellitus, BMI and sex did not have a significant effect on the odds ratio for MUA. DiscussionYoung patients undergoing TKR has earlier been identified as a group with a higher grade of dissatisfaction and complications. We found an association between young age and MUA after TKR indicating an additional, rather unknown complication for this group of patients. The background and reasons for this has to be further investigated. Level of evidenceII, cohort study/case control study (case control is level III).

Association of Ambulatory Ability on Complications and Medical Costs in Patients with Traumatic Spinal Cord Injury: A Decision-analytic Model.

Purpose The objective of this study was to determine the independent association of ambulatory ability with complications and medical costs in patients with spinal cord injury (SCI).MethodsPatients with SCI between T1-T12 enrolled in the National Spinal Cord Injury Database (NSCID) provided a minimum one-year follow-up. Covariate-adjusted annual rates of important medical complications (pressure sore, urinary tract infection, hospitalization) and associated medical costs were determined over five years post-injury. ResultsA total of 1,753 patients provided data at one-year follow-up and 1,340 patients provided five-year data. At one-year post-injury, 82% of patients were non-ambulatory and 18% were ambulatory. After adjusting for important covariates, ambulatory status was associated with a lower annual probability of urinary tract infection (43% vs. 68%), pressure sore (12% vs. 35%), and hospitalization (23% vs. 34%). Covariate-adjusted base-case medical costs due to urinary tract infection, pressure sore, and hospitalization were 34% lower in ambulatory vs. non-ambulatory patients ($31,358 vs. $47,266) over five years. Probabilistic sensitivity analyses confirmed the base-case results.ConclusionIn spinal cord-injured individuals, the ability to ambulate is independently associated with lower complication risks and associated medical costs over the five-year period following injury. Long-term clinical benefit and cost savings may be realized with assisted or unassisted ambulation in spinal cord-injured patients.

Restoration of Talar Height using a Modular Revision Prosthesis after Failed Total Ankle Arthroplasty

Category:AnkleIntroduction/Purpose:Talar component subsidence is the most common indication for revision total ankle replacement. The management of talar bone loss and alteration in the ankle joint center of rotation is challenging following component subsidence. Unfortunately, ankle arthrodesis as a salvage procedure for failed ankle arthroplasty has been associated with high rates of nonunion and collapse. Equally unfortunate, there is paucity in the literature on revision total ankle arthroplasty. The purpose of this study was to report the early outcomes of revision total ankle replacement using a modular prosthesis and metal/cement augmentation to reconstitute talar height following catastrophic failure of the index total ankle arthroplasty.Methods:Retrospective review was performed on sixteen patients who underwent revision total ankle replacement for failed arthroplasty associated with talar component subsidence and subsequent talar bone loss. All patients underwent revision arthroplasty using a revision modular ankle prosthesis and had a minimum of one-year follow-up. Demographic data, postoperative complications, original prosthesis, and concomitant procedures were recorded. Radiographic measurements were performed at three time-points (preoperative, immediately after surgery, and at most recent follow-up) to evaluate alignment of the prosthesis, talar height, and ankle range of motion. Implant survivorship was determined. Failure was defined as >2 mm of talar subsidence, conversion to ankle arthrodesis or below the knee amputation, and/or revision of the prosthesis. Ankle Osteoarthritis Score (AOS), Foot Function Index (FFI), and visual analog score (VAS) were collected at the most recent postoperative visit.Results:Patient follow-up ranged from 12.1 –20.6 months, with a mean follow-up of 15.0 months. The mean preoperative and immediate postoperative talar height was 28.7 mm and 33.4 mm, respectively. There was a significant improvement in talar height of 4.7 mm after revision total ankle replacement (P<0.001). Talar height was maintained at most recent follow-up. The mean preoperative and postoperative radiographic arc of motion was 19.5° and 24.0°, respectively. Two patients, with a mean BMI of 43.5, developed >2 mm of talar subsidence (one patient required revision surgery). The mean postoperative AOS and FFI was 25.0 and 28.8, respectively. The majority of patients (84%) were satisfied with their outcome, and all patients would choose to undergo the same procedure again (vs. arthrodesis or amputation).Conclusion:Revision ankle replacement using a modular prosthesis with metal/cement augmentation allows restoration of talar height. Though we recognize this data constitutes a very early follow up, this cohort has utilized the revision ankle implant with significant repetitive load after which older generation implants underwent secondary subsidence due to poor talar bone stock. Early outcomes demonstrate a predictable method to salvage catastrophic prosthesis failure associated with severe talar subsidence and deformity. The risk of postoperative complications, although moderate, is an acceptable alternative to lower limb amputation/arthrodesis. Further follow-up is warranted to determine functional outcomes and longevity of revision implant systems.

Radiographic and Histological Analysis of a Synthetic Bone Graft Substitute Eluting Gentamicin in the Treatment of Chronic Osteomyelitis.

Introduction: Managing chronic osteomyelitis can be challenging and attention to the osseous dead-space left following resection is an important part of successful treatment. We assess radiographic bone healing following implantation of a gentamicin-eluting synthetic bone graft substitute (gBGS) used at chronic osteomyelitis (cOM) resection. We also describe histological carrier changes from biopsies in nine cases at various time points.Methods:This was a retrospective review of a prospectively collected consecutive series of 163 patients with Cierny-Mader Type III or IV cOM who underwent single-stage excision, insertion of gBGS and definitive soft-tissue closure or coverage. Bone defect filling was assessed radiographically using serial radiographs. Nine patients had subsequent surgery, not related to infection recurrence, allowing opportunistic biopsy between 19 days and two years after implantation.Results: Infection was eradicated in 95.7% with a single procedure. 138 patients had adequate radiographs for assessment with minimum one-year follow-up (mean 1.7 years, range 1.0-4.7 years). Mean void-filling at final follow-up was 73.8%. There was significantly higher void-filling in metaphyseal compared to diaphyseal voids (mean 79.0% versus 65.6%; p=0.017) and in cases with good initial interdigitation of the carrier (mean 77.3% versus 68.7%; p=0.021). Bone formation continued for more than two years in almost two-thirds of patients studied (24/38; 63.2%).Histology revealed active biomaterial remodelling. It was osteoconductive with osteoblast recruitment, leading to the formation of osteoid, then woven and lamellar bone on the substrate's surface. Immunohistochemistry demonstrated osteocyte specific markers, dentine matrix protein-1 and podoplanin within the newly formed bone.Conclusion: This antibiotic-loaded biomaterial is effective in managing dead-space in surgically treated cOM with a low infection recurrence rate (4.3%) and good mean bone void-filling (73.8%). The radiographic resolution of the bone defect is associated with bone formation, as supported by histological analysis.

Infants with esophageal atresia and right aortic arch: Characteristics and outcomes from the Midwest Pediatric Surgery Consortium

PurposeRight sided aortic arch (RAA) is a rare anatomic finding in infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF). In the presence of RAA, significant controversy exists regarding optimal side for thoracotomy in repair of the EA/TEF. The purpose of this study was to characterize the incidence, demographics, surgical approach, and outcomes of patients with RAA and EA/TEF. MethodsA multi-institutional, IRB approved, retrospective cohort study of infants with EA/TEF treated at 11 children's hospitals in the United States over a 5-year period (2009 to 2014) was performed. All patients had a minimum of one-year follow-up. ResultsIn a cohort of 396 infants with esophageal atresia, 20 (5%) had RAA, with 18 having EA with a distal TEF and 2 with pure EA. Compared to infants with left sided arch (LAA), RAA infants had a lower median birth weight, (1.96 kg (IQR 1.54–2.65) vs. 2.57 kg (2.00–3.03), p = 0.01), earlier gestational age (34.5 weeks (IQR 32–37) vs. 37 weeks (35–39), p = 0.01), and a higher incidence of congenital heart disease (90% vs. 32%, p < 0.0001). The most common cardiac lesions in the RAA group were ventricular septal defect (7), tetralogy of Fallot (7) and vascular ring (5). Seventeen infants with RAA underwent successful EA repair, 12 (71%) via right thoracotomy and 5 (29%) through left thoracotomy. Anastomotic strictures trended toward a difference in RAA patients undergoing right thoracotomy for primary repair of their EA/TEF compared to left thoracotomy (50% vs. 0%, p = 0.1). Side of thoracotomy in RAA patients undergoing EA/TEF repair was not significantly associated with mortality, anastomotic leak, recurrent laryngeal nerve injury, recurrent fistula, or esophageal dehiscence (all p > 0.29). ConclusionRAA in infants with EA/TEF is rare with an incidence of 5%. Compared to infants with EA/TEF and LAA, infants with EA/TEF and RAA are more severely ill with lower birth weight and higher rates of prematurity and complex congenital heart disease. In neonates with RAA, surgical repair of the EA/TEF is technically feasible via thoracotomy from either chest. A higher incidence of anastomotic strictures may occur with a right-sided approach. Level of evidenceLevel III.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P24. Matched-pair cohort study of spinal surgery in HIV-infected patients: minimum one-year follow-up

BACKGROUND CONTEXT With the overall advancement in management of patients with human immunodeficiency virus (HIV) infection/AIDS, especially antiretroviral therapy regimens, HIV infection is now considered as a chronic disease and the longevity of these patients has significantly improved for the last two decades. As such, an increasing number of patients with HIV-infection are now potential candidates for elective surgical procedures such as spine surgery. In 2015, an estimated 1.1million adults and adolescents were living with HIV and 39,782 patients were newly diagnosed with HIV infection annually in 2016 (CDC data). Despite this increasing prevalence and incidence of the disease, the literature regarding clinical outcomes of spine surgery in patients with HIV is surprisingly scarce. As is the same as patients with other concurrent immunocompromising co-morbidities such as steroid use, diabetes mellitus, organ recipients, and/or chemo or radiation therapy, postoperative infection is one of the most concerning complications. Furthermore, bone mineral densities of HIV-infected patients are reported to be lower than noninfected controls, which could have some potential indications for worse long-term outcomes such as pseudoarthrosis. Thus, we aimed to characterize clinical outcomes of spine surgery in patients with HIV infection in order to facilitate judicious patient selection and comprehensive informed consent, which are of paramount importance in surgical decision-making processes for this high-risk cohort. PURPOSE Summarize clinical outcomes of spine surgery in patients with HIV, such as readmission rate, infectious complications, fusion rate, and mortality to address surgical indications for this specific cohort. STUDY DESIGN/SETTING Retrospective, single-center, propensity-matched cohort. PATIENT SAMPLE Patients who underwent spine surgery with HIV infection were included and compared with a matched-cohort without HIV infection OUTCOME MEASURES CD4 absolute count/uL, HIV-1 RNA copy numbers/mL, 30-day readmission rate, 90-day medical complication rate, one-year surgical site infectious complication rate, one-year fusion rate, and one-year mortality METHODS Single-center, retrospective data review from 2010 to 2016 yielded a total of 4,968 patients of spine surgery. Amongst those, 45 patients had HIV infection. Patients from the database were propensity-matched for age, sex, diagnoses, procedures, co-morbidities other than HIV at a 1:2 ratio, which yielded 90 matched-patients. Clinical outcomes of (A) 45 patients with HIV infection and (B) 90 matched-patients were compared and statistically analyzed. Intergroup comparison of binary variables was performed via Fisher's exact test. Intergroup comparison of continuous variables was achieved using unpaired t-tests. All reported p values are 2-sided and p values RESULTS No statistically significant differences were noted for baseline characteristics including age, sex, diagnoses, procedures, and co-morbidities. There were no statistically significant intergroup differences in operative data such as operative time and operated levels. the HIV-infected patient group had higher rates of 30-day readmission (11.1% vs. 2.2%, P=.04), one-year surgical site infectious complication (13.3% vs. 3.3%, P=.06), and one-year pseudoarthrosis (17.8% vs. 4.4%, P=.02) as well as longer hospital stay (6.8days vs. 4.6days, p CONCLUSIONS Spinal surgery in HIV-infected patients was associated with worse short- and long-term clinical outcomes, including higher rates of 30-day readmission, one-year infectious complication rate, and one-year pseudoarthrosis rate. Furthermore, CD4 absolute count may have some role in preoperative risk stratification. These results warrant further investigation of this cohort on multicenter, prospective basis, which should facilitate better patient selection for spine surgery and detailed informed consent, thereby potentially benefitting patients with HIV infection in the future.

One-stage surgery for adult chronic osteomyelitis: concomitant use of antibiotic-loaded calcium sulphate and bone marrow aspirate.

To report our experience with one-stage treatment of chronic osteomyelitis using a prospective protocol involving the concomitant use of the antibiotic-loaded calcium sulphate pellets with addition of bone marrow aspirate after bony debridement. A total of 30 patients with the mean age of 26.2years were treated according to a protocol that included (1) surgical debridement of bone and infected tissues, (2) local antibiotic therapy including vancomycin and garamycin loaded on calcium sulphate space filling biodegradable pellets, (3) bone marrow aspirate added to the biocomposite, (4) primary closure with external fixation (when needed) and (5) intravenous antibiotics according to culture and sensitivity results. After a minimum of oneyear follow-up, infection was eradicated in 23 (76.7%) patients, the average rate of filling of the bony defect was 70.47%, complete filling of defect in 15 patients (50%) and pathological fracture in one patient. The technique proved safety and efficacy in eradicating the infection and bony healing of the defects after debridement. Simple bone marrow aspiration is cheap, reproducible, safe and not exhausting the scanty autograft resources.

Effect of Stem Cell Augmented Micronized Allograft on Arthrodesis in the Ankle and Foot

Category: Basic Sciences/Biologics Introduction/Purpose: Both primary and revision arthrodesis are mainstays of foot and ankle surgery. Many studies have investigated the effect of autograft, varying forms of bone graft substitutes, and of biologic agents on bone healing, including in the setting of arthrodesis. A commercially available stem cell augmented micronized allograft (Via Graft®) is comprised of micronized (100-300 microns) allograft bone with marrow-isolated adult multilineage inducible cells (MIAMI cells). It has been proposed as an alternative to autograft and as an adjunct to arthrodesis. We present a series of 86 patients with minimum one-year follow-up who underwent either primary or revision arthrodesis with Via Graft®, with or without additional graft. Methods: Between 2015 and 2016, 86 patients treated with Via Graft® were identified with minimum one-year follow-up. Data was collected including demographic information, BMI, smoking history, medical comorbidities; indication for fusion (including Charcot arthropathy, posttraumatic arthritis, rheumatoid arthritis, AVN, congenital anomalies, neuromuscular disorders, revision surgery, post-infectious, previous total ankle arthroplasty, posterior tibial tendon dysfunction); procedure performed (ankle, hindfoot, midfoot, or forefoot fusion), number of joints fused, use of additional graft, radiographic union, and complications. Fusion was evaluated based upon radiographic or CT evidence of osseous bridging. The unit of the analysis was the joint. Generalized Linear Mixed Model (GLMM) was utilized to evaluate the association between fusion and the data set described above. Statistical analyses were performed using SAS® 9.4. Results: 191 joints were fused in 86 patients (F: 48, M: 38). Mean age was 58.7 years, mean follow-up was 15.8 months. Radiographic union was achieved in 163/191 (85.3%) joints. Age, gender, smoking status, presence of diabetes, history of Charcot, revision fusion, or use of cancellous autograft or allograft demonstrated no statistically significant differences in fusion rates. Intramedullary talocalcaneal arthrodesis (IMTCA), with or without additional joints fused simultaneously (p=.001), use of structural allograft (most commonly femoral head)(p&lt;.001), structural autograft (p=.001), history of previous TAA (p&lt;.0001), and history of AVN (p=.042) demonstrated statistically significant rates of nonunion, despite use of Via Graft® (Table 1). Conclusion: This study is the largest series to date of Via Graft® augmentation of arthrodesis. Lower union rates were found to be associated with patients undergoing hindfoot fusion with an IMTCA with or without additional joints fused, a history of failed total ankle replacement or AVN of the talus, and use of femoral head allograft. However, this preliminary study requires further analysis given the difficult and salvage nature of these cases. As bony union is multifactorial, the selection of bone graft and biologic agents is an important factor, but may not be sufficient to overcome the biology of the host.

Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults.

Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults.

Midfoot Charcot Reconstruction with Intramedullary Beaming

Category: Midfoot/Forefoot Introduction/Purpose: Midfoot Charcot osteoarthropathy is characterized by non-infectious osteolysis that often leads to midfoot collapse and resultant ulceration. Deformity and ulceration often lead to deep infection and amputation. Midfoot reconstruction with intramedullary screws (beams) is a recently described technique that provides deformity correction and a stable construct without the extensive exposure required for plate fixation. The purpose of this study is to examine the clinical outcomes and complications of patients with midfoot Charcot managed with midfoot osteotomy, realignment arthrodesis, and stabilization using intramedullary beams. Methods: A surgical database query of a tertiary-care foot and ankle center was performed from January 2013 to July 2016 to identify patients with midfoot Charcot who underwent corrective osteotomy with internal beam fixation. 24 patients (Median Age: 60; Median BMI: 32.5; Diabetic: 79%; Insulin Dependent: 74%) were identified and included in the final analysis. Patients with minimum one-year follow-up were evaluated with physical examination, weight-bearing radiographs, and patient-reported outcome measures (FAAM and VR-12). The primary outcome measure was defined as restoration of a stable, plantigrade, ulcer- free foot. Secondary outcome measures include quantitative angular correction, rates of reoperation, post-operative infection, and amputation. Results: The lateral Meary’s angle median improved from -29° preoperatively to -21° on final postoperative radiographs (p&lt;0.001). Likewise, the AP Meary’s angle median improved from 17° to 2° (p&lt;0.001). 43% of midfoot osteotomies were united on final radiographs. An ulcer-free, stable, plantigrade foot was obtained in 83% of patients. Deep infection developed in six (25%) patients. The presence of a preoperative ulcer was found to be predictive of postoperative infection (p=0.04); all six deep infections occurred in patients with preoperative ulceration. 63% of patients required reoperation. Three (13%) patients progressed to amputation at a median nine postoperative months, all for deep infection. The final postoperative median FAAM score was 21. The VR-12 median score was also 21 (PCS: 32, MCS: 67). Conclusion: Results from the FAAM indicate that patients with midfoot Charcot are severely disabled overall, moderately disabled with ADLs, and mostly unable to participate in sport. Results from the VR-12 indicate that patients continue to have poor healthcare quality of life, even following Charcot reconstruction. Midfoot Charcot reconstruction with intramedullary beaming allows for restoration of an ulcer-free, plantigrade foot in most patients, but the complication rates are high, especially in patients with pre-operative ulceration. Despite a low bony union rate, improvement in both the lateral and AP Meary’s angle and clinical success is often obtainable with a relatively low amputation rate.

Bio-Occlusive Gauze with Tegaderm: A Dressing for Surgical Wounds in Primary THA and TKA

Background: We introduce a simple, cost-effective bio-occlusive dressing to be used for primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA).Methods: The gauze-Tegaderm™ (GT) dressing consists of a 5cm wide 8-layered gauze covered by 3 to 5 medium-sized Tegaderm transparent films. We prospectively evaluated 100 consecutive primary THA’s and 107 consecutive primary TKA’s utilizing this dressing with a minimum of one-year follow-up.Results: In the primary THA group, there was one surgical site infection (SSI) requiring oral antibiotic treatment. There were no cases of periprosthetic joint infection (PJI). In the primary TKA group, there were two surgical site infections requiring oral antibiotic treatment and one case of chronic PJI requiring a two-stage exchange protocol.Discussion: Our SSI and PJI rates are comparable to published rates in the literature. The GT dressing is a simple, inexpensive dressing that can compete against the many proprietary bio-occlusive dressings that are more expensive and are not readily available worldwide. Our favorable review has merited a large volume randomized controlled study comparing the GT dressing to another proprietary bio-occlusive dressing.

A comparison of the ultrathin Orsiro Hybrid sirolimus-eluting stent with contemporary drug-eluting stents: A meta-analysis of randomized controlled trials.

Recent studies suggest the Orsiro sirolimus-eluting stent (O-SES), which has ultrathin struts with a biodegradable sirolimus-eluting polymer coating, performed better than contemporary drug-eluting stents (DES). We performed a meta-analysis to compare clinical outcomes for all randomized controlled trials (RCTs) of O-SES vs contemporary DES. PubMed, Cochrane CENTRAL, and meeting abstracts were searched for all RCTs comparing O-SES with contemporary DES. Pooled estimates of longest available clinical outcomes at a minimum of one-year follow-up, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. We included 8 RCTs with a total of 11,176 patients (5444 O-SES and 5732 contemporary DES [3537 EES, 1295 ZES, and 1264 BP-BES) with a mean age of 65±11, 74% were male, 40% underwent PCI for stable angina, and 56% for ACS. We assessed outcomes comparing O-SES vs. everolimus-eluting stents, vs. permanent-polymer DES, and vs. all DES including biodegradable-polymer DES. Orsiro performed comparably in all categories with a trend toward a reduction in myocardial infarction (0.83 [0.68, 1.02], p=0.07) and stent thrombosis (0.75 [0.54, 1.04], p=0.08). Overall, the Orsiro SES had similar clinical outcomes to contemporary DES with a trend toward reduction in myocardial infarction and stent thrombosis.

Percutaneous CT-guided facet joint synovial cyst rupture: Success with refractory cases and technical considerations

Percutaneous image-guided rupture of lumbar facet synovial cysts can improve clinical outcomes and obviate the need for open surgery. This series describes eleven patients who had successful CT-guided lumbar facet synovial cyst ruptures, 82% of which experienced excellent pain relief at a minimum of one-year follow-up. Of the five patients who failed prior fluoroscopic-guided synovial cyst rupture, 80% had a successful CT-guided rupture and one-year sustained pain relief. These findings reinforce minimally invasive CT-guided treatment as an excellent option to improve patient symptoms and potentially avoid open surgery.

Acetabular Defect Reconstruction with Trabecular Metal Augments: Study with Minimum One-year Follow-up.

PurposeHigh rates of mechanical failure have been reported in type III acetabular defects. Recently porous trabecular metal augments have been introduced with, excellent biomechanical characteristics and biocompatibility, allowing early stability and greater bone ingrowth. The aim of the study was to assess the short term clinical and radiological outcome of the trabecular metal augments.Materials and MethodsWe performed, 22 revision total hip arthroplasties (THA) and 6 primary THA (total 28) using trabecular metal augments to reconstruct acetabular defect between 2011 to 2015. Among 28 patients, 18 were males, 10 females. Mean age of patients was 61.21 years. Paprosky classification for acetabular bone defects was used. Eighteen cases were classified as grade 3 A and 10 cases as grade 3B. Hip center was calculated in each case preoperatively and compared postoperatively to check whether it has been brought down. Clinical outcome assessed using Harris hip score (HHS) and radiological outcomes as osteolysis in acetabular zones and osseointegration, according to Moore's criteria.ResultsHHS improved from 58.00 to 86.20. Centre of rotation of hip joint corrected from 38.90 mm preoperatively to 23.85 mm postoperatively above the interteardrop line. Among 28 patients, 18 patients had three or more signs of osseointegration (Moore's criteria), during final follow up and 10 had one/two signs. No radiolucency, osteolysis, or loosening found during follow up radiographic examination.ConclusionOur study showed that trabecular metal augments were highly satisfactory in short term. However, long term study is required for better evaluation.