Non-operated Side Research Articles

Lumbar Radiculopathy Confounded: Total Knee Arthroplasty Diminishes the Patellar Tendon Reflex.

Patellar tendon reflexes were elicited among patients who had had a unilateral total knee replacement, those planned for unilateral total knee replacement, and a cohort of controlled patients. Patellar tendon reflex (PTR) response was measured with surface electromyography. The aim of this study was to determine if total knee arthroplasty significantly alters the PTR. As part of the clinical evaluation of the spine, extremity reflexes are provoked. Reflex variation between right and left extremities can be a pathological finding in disease of the spine. It has been noted that in patients who have undergone total knee arthroplasty (TKA), the PTR is diminished on the operative side compared with the contralateral nonoperative side. PTR is part of the clinical exam when evaluating a patient for lumbar radiculopathy. The right and left patellar tendon reflex intensities were measured by quadriceps surface electromyography in 3 groups of patients. Group 1 consisted of 21 patients with unilateral TKA who were at least 6 months postoperative. Group 2 consisted of 18 patients with unilateral severe knee arthritis indicated for TKA. Group 3, serving as the control group, included 20 patients with no evidence of knee arthritis in either knee. The average reflex response for each group was recorded and comparisons were then made between each group. Patients who have undergone unilateral TKA have a PTR on average of 55.1% of their contralateral uninvolved side. This is statistically significant when compared with reflexes in patients who are planned for unilateral total knee arthroplasty, 96.03% (P = 0.001) and when compared with patients without evidence for knee arthritis, 102.2% (P < 0.001). The results of this case control study show that TKAs do significantly diminish PTRs when compared with a contralateral uninvolved knee in the same patient. 3.

The influence of knee malalignment on the ankle alignment in varus and valgus gonarthrosis based on radiographic measurement

PurposeThe lower limb misalignment as calculated by radiography has an evident effect on the development and progression of knee osteoarthritis (OA). However, whether the knee malalignment has an influence on ankle alignment is unknown. The purpose of this study was to discuss the correlation between knee and ankle alignment in varus and valgus gonarthrosis. MethodsThis is a retrospective study of 149 patients with symptomatic varus and valgus knee OA who intend to take total knee arthroplasty (TKA) between January and October 2013. A protocol for the measurement of knee-ankle alignment and angles on full-length standing anteroposterior radiographs of the lower extremity was outlined in detail with step-by-step instructions. Two observers measured the angles chosen. The Pearson’s correlation tests were used for the statistical analysis. ResultsPearson’s correlation test results for unilateral varus or valgus gonarthrosis showed that the varus or valgus deformity of the knee can influence the tilt angle and tibiotalar angle of the ankle in operative side signficantly(p<0.05), and the tilt angle of the ankle can also be affected in nonoperative side (p<0.05). Moreover, the tilt angle of the bilateral ankle can be simultaneously affected in bilateral varus gonarthrosis (p<0.05). ConclusionThese findings suggest that the varus and valgus deformity of the knee can induce the tilt of the ankle and influence the ankle alignment, which may further accelerate the degeneration of the ankle. Moreover, the knee alignment in the nonoperative side can also result in the change of ankle alignment at the same time.

Total Limb Rotation after Unilateral Total Knee Arthroplasty: Side-to-Side Discrepancy.

Total limb rotation, an important anatomical feature of the lower limb, is defined as any rotation of the lower limb on its longitudinal axis. The aim of the present study was to evaluate the discrepancies of rotational profiles of total limb between nonoperated and operated limb following unilateral total knee arthroplasty. We conducted an analysis of the computed tomography (CT) data from 32 patients undergoing primary unilateral total knee arthroplasty. Using these CT scan, rotational profiles of total limb, such as femoral neck anteversion angle expressed as femoral torsion angle (FTA), tibial torsion angle (TTA), knee joint rotation angle (KJRA), and total limb rotation (TLR) were measured. There were significant discrepancies of FTA and KJRA between operated and nonoperated limb following unilateral total knee arthroplasty. The mean difference of operated and nonoperated side for FTA and KJRA were -6.51 ± 11.88 degrees (p = 0.0041) and -6.83 ± 5.04 degrees (p < 0.001), respectively. However, there were no significant discrepancies of TLR, TTA. These results are due to the compensation effect of KJRA. However, excessive external rotation of the femoral component beyond the compensation effect of prosthetic knee joint can lead to a total limb rotational discrepancy in patient undergoing unilateral total knee arthroplasty.

Rat Model of Trigeminal Neuralgia Using Cobra Venom Mimics the Electron Microscopy, Behavioral, and Anticonvulsant Drug Responses Seen in Patients

Background: A new animal model of trigeminal neuralgia produced by injecting cobra venom into the infraorbital nerve (ION) trunk in rats had been developed. We tested and extended the model by observing the ultrastructural alterations of neurons and ameliorative effect of pregabalin in cobra venom-induced pain behaviors of rats. Objectives: The goal of this study was to prove the feasibility of the cobra venom-induced model of trigeminal neuralgia and to demonstrate the demyelination change of ION and medulla oblongata is the major pathological change of trigeminal neuralgia. Study Design: An experimental study. Setting: Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Aviation General Hospital of China Medical University. Methods: Experiments were carried out on male Sprague–Dawley rats. Video recordings were taken after the cobra venom injection and pregabalin administration. Ultrastructural alterations of ION and medulla oblongata were observed at the electron microscopic level. We also observed alteration in pain behaviors by analysis of video recordings. Results: Compared to the preoperative and sham-operated group rats, experimental group rats exhibited significant changes in exploratory, resting, face-grooming, and head-shake behaviors on 3, 7, 14 days after operation (P &lt; 0.01). The demyelination changes of ION and medulla oblongata were evident after administration of cobra venom to the ION. Compared to the pre-treated (no pregabalin administration) and control group rats, pregabalin group rats showed profound changes in exploratory, resting, face-grooming, and head-shake behaviors throughout the 14 day study period after treatment with drugs (P &lt; 0.01). Limitations: Ultrastructural alterations of ION and medulla oblongata were not examined after the treatment with pregabalin. Conclusions: Video recordings of free behaviors and pregabalin application prove the feasibility of the rat model of trigeminal neuralgia. The results of electron micrographs are consistent with a previous study in humans showing that the demyelination change of axons is the major pathological change of trigeminal neuralgia. The central demyelination alterations may explain why the mechanical threshold was found to be decreased on the non-operated side of experimental animals. Key words: Rat model, cobra venom, trigeminal neuralgia, free behavior, pregabalin, demyelination

Pyrocarbon Proximal Interphalangeal Joint Arthroplasty: Minimum Five-Year Follow-Up

To report the outcomes, complications, and survivorship of pyrocarbon proximal interphalangeal joint arthroplasty at a minimum of 5-year follow-up. A review of 97 implants in 72 consecutive patients from our joint arthroplasty database was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure; Quick Disabilities of the Arm, Shoulder, and Hand score; and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain. Diagnosis was osteoarthritis in 60 joints, rheumatoid arthritis in 12 joints, psoriatic arthritis in 11 joints, and trauma in 14 joints. The average follow-up was 118 months (range, 60-164 months). The mean arc of motion was 35° (range, 0° to 90°). There was no difference in grip strength between operated and nonoperated side. Of the 97 implants, 36 required additional surgery, of which 14 were revised and 22 required reconstruction around a retained implant. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 33 (range, 10-69) and 35 (range, 0-93), respectively. Mean visual analog scores for pain, satisfaction, and appearance were 2 (range, 0-8), 7 (0-10), and 8 (0-10), respectively. All implants had a lucent line with nearly all classified as either Herren grade 2 or 3. Progressive loosening was seen in 48% of implants. Implant survival as assessed by Kaplan-Meier was 85% at both 5 and 10 years. Good pain relief and maintenance of preoperative arc of motion was achieved with no major deterioration over time. Most implant revisions were performed within 24 months of the index procedure. Currently progressive loosening was not translated into revision surgery. Implant revision rate was higher than with other prostheses. Therapeutic IV.

A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus

Background: To search the relationships between the primary nasolacrimal duct obstruction and the angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus.Design: Retrospective study.Participants and methods: Computed tomography findings of 35 patients with primary nasolacrimal duct obstruction and 100 sides of 50 individuals were reviewed. While the study group was composed of patients who had external dacryocystorhinostomy surgery, the control group was composed of patients who had CT scans due to headache, sinusitis and smell dysfunction. Epiphora complaint was evaluated with the lacrimal syringing. The exclusion criteria were: age less than 20 years, previous nose, sinus, turbinate or lacrimal surgery, prior history of maxillofacial fracture, nasopharyngeal malignancy, reflex hypersecretion, and associated pathology of the lacrimal canaliculi.Main outcome measures: The angle of inferior turbinate.Results: The mean angles were 53.2° (range, 37.9–82.9°) for affected side of the study group, 58.6° (range, 32–85.3°) for the unaffected side of the study group and 56.8° (range, 41.2–76.9°) in the control group. The difference between the angles was statistically significant between the study and the control groups (p < 0.05). The difference between the operated and non-operated sides of the study group was also statistically significant (p < 0.05).Conclusion: Although this study was performed in a small group, we thought that the narrow angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus might be a possible causative factor in primary acquired nasolacrimal duct obstructions.

Computed tomography evaluation of hip geometry restoration after total hip resurfacing

BackgroundAnatomic reconstruction of the hip is among the main requirements for hip arthroplasty to be successful. Resurfacing arthroplasty may improve replication of the native joint geometry but has been evaluated only using standard radiographs. We therefore performed a computed tomography (CT) study to assess restoration of hip geometry after total hip resurfacing (HR), comparatively with the non-operated side. HypothesisHR does not change native extra-medullary hip geometry by more than 5mm and/or 5°. Patients and methodsCT was used to evaluate unilateral HR in 75 patients with a mean age of 52.2years (range, 22–67years). The normal non-operated side served as the control in each patient. Mean follow-up was 2.5years (range, 1.9–3.1years). The primary evaluation criteria were femoral offset (FO) and femoral neck anteversion (FNA) and the secondary criteria were cup inclination angle, cup anteversion angle, and lower-limb length. ResultsFO showed a non-significant decrease (mean, −2.2mm; range, −4.5 to +3.7mm). FNA was preserved, with a difference of less than 2° at last follow-up versus the preoperative value. Cup measurements showed a mean anteversion angle of 24.8° (0.9–48.6) and mean inclination angle of 44.1° (32.1–56.3); corresponding values for the native acetabulum were 38.9° (20.5–54.8) and 24.8° (4.8–33.6). The residual lower-limb length discrepancy was less than 1mm (mean, −0.04mm [−1.2 to +1.6mm]). The mean angle between the femoral implant and the femoral neck axis was 5.4° of valgus. DiscussionOur results show that HR accurately restored the native extra-medullary hip geometry. Level of evidenceIII, prospective diagnostic case-control study.

Does Prolonged Reconstruction of Disarticulation Defect With Bone Plate Affect the Electromyography Records of Masticatory Muscles?

For medical or socioeconomic reasons, the primary reconstruction of disarticulation defects with bone plates stays for many years. This study was performed to assess the effect of this delay on electromyography (EMG) records of masticatory muscles. Twenty-five patients treated by insertion of reconstruction plates in disarticulation defects were prospectively included in this study. Electromyography records for masticatory muscles were obtained before surgery and 3 months, 6 months, 1 year, 2 years, and 3 years afterward. Paired t-test was used to determine whether there was significant difference between the EMG values. At 3 years after surgery, the amplitude values of the masseter and temporalis muscles, on the resected side, have decreased by 39% and 60%, respectively, whereas on the nonoperated side, they have increased by 35% and 29%. The peak decrease, on the resected sides, has occurred at 3 months for the temporalis and 2 years for the masseter. On the nonoperated side, the peak increase has occurred at 6 months for both the temporalis and the masseter. A prolonged use of bone plates to reconstruct disarticulation defects leads to alterations in EMG values of masticatory muscles. These alterations present clinically as muscle atrophy on the operated side and hypertrophy on the nonoperated side.

Tractography of Meyer's loop for temporal lobe resection—validation by prediction of postoperative visual field outcome‬‬‬‬.

Postoperative visual field defects are common after temporal lobe resection because of injury to the most anterior part of the optic radiation, Meyer's loop. Diffusion tensor tractography is a promising technique for visualizing the optic radiation preoperatively. The aim of this study was to assess the anatomical accuracy of Meyer's loop, visualized by the two most common tractography methods—deterministic (DTG) and probabilistic tractography (PTG)—in patients who had undergone temporal lobe resection. Eight patients with temporal lobe resection for temporal lobe pathology were included. Perimetry and diffusion tensor imaging were performed pre- and postoperatively. Two independent operators analyzed the distance between the temporal pole and Meyer's loop (TP-ML) using DTG and PTG. Results were compared to each other, to data from previously published dissection studies and to postoperative perimetry results. For the latter, Spearman's rank correlation coefficient (r(s)) was used. Median preoperative TP-ML distances for nonoperated sides were 42 and 35 mm, as determined by DTG and PTG, respectively. TP-ML assessed with PTG was a closer match to dissection studies. Intraclass correlation coefficients were 0.4 for DTG and 0.7 for PTG. Difference between preoperative TP-ML (by DTG and PTG, respectively) and resection length could predict the degree of postoperative visual field defects (DTG: r(s) = -0.86, p < 0.05; PTG: r(s) = -0.76, p < 0.05). Both DTG and PTG could predict the degree of visual field defects. However, PTG was superior to DTG in terms of reproducibility and anatomical accuracy. PTG is thus a strong candidate for presurgical planning of temporal lobe resection that aims to minimize injury to Meyer's loop.

Does percutaneous internal ring suturing contain risk of ilioinguinal nerve entrapment?

In this study, we aim to assess the alteration of IIN functions in children with inguinal hernias operated on using open or 'percutaneous internal ring suturing' (PIRS). This study was based on a prospective clinical trial of 60 pediatric patients. They were operated on using PIRS or conventional open hernia repair technique. Group 1 included 35 patients who were treated with PIRS technique. Group 2 included 22 patients who underwent a conventional open hernia repair. The ilioinguinal nerve stimuli in both the operational and non-operational areas were evaluated in patients with peripheral EMG for possible ilioinguinal nerve damage on the hernia side before the operation and to reevaluate ilioinguinal nerve function in the third postoperative week. In Group 1, 19 cases underwent a preoperative EMG examination and in 35 cases, EMG examination was obtained postoperatively. Pre- and postoperative EMG results were normal in all cases in Group 1 on both the operational and non-operational sides. In Group 2, 15 preoperative and 25 postoperative EMG examinations were obtained. In Group 2, only one case with a right inguinal hernia who had normal preoperative EMG results showed no IIN response in a postoperative EMG evaluation obtained in the third postoperative week, with a normal left-side response. The EMG was repeated at the three-month postoperative third mark and revealed the same result. In a six-year-old female case, there was a negative EMG response on the non-operative side both pre- and postoperatively.

Postoperative Changes in Olfactory Function After Transcanalicular Diode Laser Dacryocystorhinostomy

Transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) is used much in recent years for the surgery of nasolacrimal duct obstruction (NLDO). Although TCL-DCR is accepted to be minimally invasive, safe, and effective, there is no report focusing on postoperative changes in olfactory function after this procedure. Hence, the aim of this current study was to investigate the changes in olfactory function after TCL-DCR procedure. This study was carried out in 42 volunteers (16 men and 26 women) between the ages of 20 and 81 years. All participants received detailed lateralized olfactory tests preoperatively and at the postoperative first week, first month, third month, and sixth month. After lateralized olfactory tests were performed, the results were grouped according to the side of the nasal passage where the operation was performed for NLDO: the nonoperated side served as the control. The current investigation produced 2 major findings: (1) olfactory function decreased significantly after TCL-DCR procedure at the operated side of the nose compared with the nonoperated side; (2) olfactory abilities of the patients returned to normal within 3 months. The results of this study showed that transcanalicular diode laser could be used safely in terms of olfactory function for dacryocystorhinostomy. Temporary decrease of olfactory function on the side having TCL-DCR should be taken into account when obtaining informed patient consent.

Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing.

The aim of the study was to analyse the patellofemoral alignment in the sagittal plane following tibial fracture surgery with intramedullary nailing and its relationship to parapatellar muscle status. The patellofemoral MRI results of 27 patients (15 males and 12 females) treated with locked intramedullary nailing following tibia shaft fracture were reviewed. The mean age of the patients was 41.8 (±15)years. The patella-patellar tendon angle (P-PT) and the distance between the inferior patellar pole and the tibial tubercle (DP-TT) were evaluated for both the operated extremity and the contralateral normal side. MRI assessment of the infrapatellar fat pad, quadriceps, sartorius, gracilis, semi-membranosus muscles and biceps muscles was also carried out. The correlation between the changes in skeletal muscle mass, the volume of the infrapatellar fat pad and the alterations in the DP-TT distances and P-PT angles were analysed. The quadriceps muscle cross-sectional diameter had a mean of 157.2mm(2) (115.6/319.5) in the operated extremity, and it was 193mm(2) (77.6/282.2) in the non-operated normal side (p=0.001). For the Gracilis muscle, the mean was 84.4mm(2) (19.7/171) at the operated extremity and 75.7mm(2) (26.9/238.2) on the normal side (p=0.05). The cross-sectional areas of the semi-membranosus, sartorius and biceps muscles in the operated and non-operated extremity were not noticeably different (n.s). The P-PT angle was 153° (129.7/156.4) in the operated extremity and 145.7° (137.6/163.4) in the non-operated normal extremity (p<0.05). While DP-TT distance was 11.4mm (9.4/20.4) in the operated extremity, it was 14.1mm (7.3/17.1) in the non-operated extremity (p=0.001). The correlation analyses revealed that the quadriceps hypotrophy negatively correlated (r=-0.4, p=0.02) with the P-PT angle but positively correlated with the increase in gracilis muscle volume (r=0.4, p=0.03). This study revealed that patellofemoral joint kinematics in the operated extremity was diminished in the sagittal plane correlating with the quadriceps muscle volume loss and gracilis muscle hypertrophy. The modalities focused on both preventing and treating the hypotrophy of the quadriceps muscle following the surgical treatment of tibial fracture, which may help to overcome this quite common pathology.

Comparison of Intraoperative and Postoperative Effects of Lateral Epidural and Midline Epidural Anaesthesia in Patients Undergoing Unilateral Lower Extremity Operation.

We aimed to compare lateral and midline epidural anaesthesia using a levobupivacaine-fentanyl combination in patients undergoing unilateral lower extremity operation for anaesthetic effects and postoperative complications. The study included 40 American Society of Anesthesiologists (ASA) I-II group patients. At the L4-5 space, an epidural catheter was placed in patients in Group 1 by directing the tip of the needle at a 45-degree angle to the operation side and in Group 2 with the needle tip in the cephalad direction. Patients in both groups were administered a combination of 10 mL 0.5% levobupivacaine and 50 μg fentanyl via the epidural catheter. Sensorial and motor block levels during the perioperative and postoperative periods and postoperative complications were recorded. The maximum level of sensory block on the operated side was found to be at the T10 (T8-T10) level in both groups, while the level of sensory block on the non-operated side was at the L2 (L3-T10) level in Group 1, and at the T10 (T8-T10) level in Group 2 (p=0.000). The motor block was more intense on the non-operated side in Group 2 than in Group 1. The postoperative motor block ended earlier in Group 1. The incidence of complication development was similar between the groups. With a shorter lasting and lower level sensorial and motor block, lateral epidural anaesthesia may be a more advantageous method than midline epidural anaesthesia.

Expression changes of Toll-like receptor 4 and its down-stream cytokines in incisional tissues from rats with postoperative pain

Objective To evaluate the changes in mRNA expressions of Toll-like receptor 4 (TLR4) and its down-stream cytokines IL-1β, IL-6 and TNF-a in incisional tissues from a rat with postoperative pain. Methods Incisional pain was induced in 74 male adult SD rats weighing 200-250 g. Paw mechanical withdrawal threshold (PMWT) around the wound on the operated and non-operated sides was measured at 1 day before operation and at 0.5, 1, 2, 6 and 12 hours as well as 1, 2, 3, 5 and 7 days after operation. Skin incisional tissues were removed for determination of mRNA expressions of TLR4, IL-1β, IL-6 and TNF-a using real-time quantitative PCR at 1 day before operation and at 2 and 8 hours as well as 1, 2, 3, 5 and 7 days after operation. Results Compared with the baseline value before operation, PMWT on the operated side was significantly decreased at 0.5 hours-5 days after operation, mRNA expression of TLR4 around the wounds on the operated side was down-regulated at 2 hours after operation followed by a gradual increase, mRNA expressions of IL-1β, IL-6 and TNF-α on the operative side were up-regulated at 2 and 8 hours as well as 1, 2, 3 and 5 days after operation(P 0.05). PMWT on the operated side was lowest at 6 hours after operation followed by the gradualincrease, mRNA expression of TLR4 on the operated side peaked at 2 days after operation, and mRNA expressions of IL-1β, IL-6 and TNF-a respectively peaked at 2 hours, 1 day and 3 days after operation (P<0.05). mRNA expressions of TLR4, IL-1β, IL-6 and TNF-a were negatively correlated with PMWT on the operative side(r= -0.501, -0.743, -0.893, -0.657, P<0.05), and mRNA expressions of IL-1β, IL-6 and TNF-a were positively correlated with the level of TLR4 mRNA(r=0.764, 0.283, 0.667, P<0.05). Conclusion mRNA expressions of TLR4 and its down-stream cytokines IL-1β, IL-6 and TNF-a in skin incisional tissues are up-regulated, which may be involved in the development and maintenance of postoperative pain. Key words: Pain, postoperative; Toll-like receptor 4; Interleukins; Tumor necrosis factor-alpha

A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries.

Background and Aims:Traditional clinical methods like auscultation or inspection have been found to be inaccurate in confirmation of double-lumen tube (DLT) position. Lung ultrasonography (USG) reliably identifies the tidal movement (lung sliding) and the collapse of the lung (lung pulse). We intended to check whether the accuracy of clinical methods can be improved by the addition of USG in confirmation of left DLT (LDLT) position.Methods:A single centred, prospective, comparative study was conducted involving 70 patients undergoing thoracic surgeries requiring the use of LDLT. The patients were assigned to Group A - where LDLT position was assessed by using clinical methods alone, and Group B - where LDLT position was assessed by USG and clinical methods. The correct position was predicted when USG demonstrated the absence of lung sliding and the presence of lung pulse on the operative side, the presence of lung sliding on non-operative side, along with normal airway pressures and oxygenation. The final verification of LDLT position was done by direct observation of lung isolation by one surgeon who was blinded to the method of confirmation. Contingency tables were drawn to calculate sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each method.Results:Compared to clinical methods alone, addition of lung USG improved sensitivity (75% vs. 88%), specificity (18% vs. 75%) and accuracy (57% vs. 85%) for correct prediction of LDLT position.Conclusion:USG is a useful addition to the armamentarium of anaesthesiologist for the confirmation of LDLT position.

Periprosthetic BMD after cemented uncemented total hip arthroplasty: a 10-year follow-up study

Background and purposesInsertion of a metallic implant into the femur changes bone loading conditions and results in remodeling of femoral bone. To quantify these changes in bone mineral density (BMD) after total hip arthroplasty, we monitored femoral bone with dual X-ray absorptiometry (DXA). Materials and methodsThe periprosthetic bone mineral density was measured in seven Gruen zones at scheduled time intervals during a 10-year follow-up. A total of 38 patients went through either cemented (n=13) or uncemented arthroplasty (n=25). ResultsDuring the 1st post-operative year BMD decreased markedly in both groups mainly in the calcar area (Gruen zone 7); 21.9 % in the uncemented group (p<0.005) and 26.1 % in the cemented group (p<0.005). After that there was a slight continuous BMD loss in the proximal part of the femur and a slight increase in the distal part of femur, especially after uncemented THA. In the non-operated control side, BMD showed only a slight decrease during the follow-up (0.9 %, p=0.003). InterpretationThe study shows that when a good prosthesis-bone integration with or without cement is achieved, remodeling of the periprosthetic bone decreases after the 1st post-operative year and the bone loss reflects merely normal ageing.

Transcalvarial brain herniation volume after decompressive craniectomy is the difference between two spherical caps

Decompressive craniectomy (DC) is a surgical procedure used to relieve severely increased intracranial pressure (ICP) by removing a portion of the skull. Following DC, the brain expands through the skull defect created by DC, resulting in transcalvarial herniation (TCH). Traditionally, people measure only changes in the ICP but not in the intracranial volume (ICV), which is equivalent to the volume of TCH (VTCH), in patients undergoing DC.We constructed a simple model of the cerebral hemispheres, assuming the shape of the upper half of a sphere with a radius of 8cm. We hypothesized that the herniated brain following DC also conforms to the shape of a spherical cap. Considering that a circular piece of the skull with a radius of a was removed, VTCH is the volume difference between 2 spherical caps at the operated side and the corresponding non-operated side, which represents the pre-DC volume underneath the removed skull due to the bilateral symmetry of the skull and the brain.Subsequently, we hypothesized that the maximal extent of TCH depends on a because of the biomechanical limitations imposed by the inelastic scalp. The maximum value of VTCH is 365.0mL when a is 7.05cm and the height difference between the spherical caps (Δh) at its maximum is 2.83cm. To facilitate rapid calculation of VTCH, we proposed a simplified estimation formula, VˆTCH=12A2Δh, where A=2a. With the a value ranging between 0 and 7cm, the ratio between VˆTCH and VTCH ranges between 0.77 and 1.27, with different Δh values. For elliptical skull defects with base diameters of A and C, the formula changes to VˆTCH=12ACΔh.If our hypothesis is correct, surgeons can accurately calculate VTCH after DC. Furthermore, this can facilitate volumetric comparisons between the effects of DCs in skulls of varying sizes, allowing quantitative comparisons between ICVs in addition to ICPs.

Great auricular nerve preservation in parotid gland surgery: Long-term outcomes.

To assess sensory outcomes and quality of life (QoL) in two groups of patients with and without great auricular nerve (GAN) preservation during parotidectomy. Retrospective chart review. The posterior branch of the GAN was preserved in 42 patients (group A) and sacrificed in 13 (group B). Tactile, heat, and cold sensitivities were investigated by dividing GAN territory into seven areas. Comparisons between operated (OS) and nonoperated sides (NS) within each group, and between the OS of the two groups were made. The QoL questionnaire was administered. In group A, normal tactile, heat, and cold sensitivities ranged from 16.7% to 66.7%, 11.9% to 73.8%, and 21.4% to 81%, respectively, in different OS areas. Significant differences between OS and NS were found, except for the preauricular superior area. In group B, normal tactile, heat, and cold sensitivities ranged from 0% to 61.5%, 0% to 53.8%, and 7.7% to 76.9%, respectively, in different OS areas. Significant differences between OS and NS were found except for the preauricular superior (tactile sensitivity), and preauricular superior and helix/concha areas (cold sensitivity). Comparing the OS tactile and thermic sensitivities between the two groups, only the lobule area showed differences. The preauricular inferior area was different only for heat. The QoL questionnaire showed different hypoesthesia extension between the two groups. All other items were comparable. Sensory deficits are commonly reported despite GAN preservation. Lobule and preauricular inferior areas showed differences in terms of tactile and thermic sensitivities, with better outcomes in group A. QoL seems tolerable despite GAN sacrifice. 4

Clinic and electromyographic results of latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears.

BackgroundThis study examines the clinical and electromyographic results of latissimus dorsi transfer (LDT) using a combined open and arthroscopic technique for the treatment of symptomatic irreparable posterosuperior rotator cuff tears.MethodsBetween 2006 and 2009, LDT was performed in 14 patients (mean age 59 years) with massive and symptomatic irreparable posterosuperior rotator cuff tear. The patients were examined preoperatively and postoperatively with mean follow-up of 52 months using the Constant score, and the integrity of the latissimus dorsi (LD) transfer was assessed by ultrasound in all cases and by MRI in ten cases. The functional activity of the LD transfer was compared to the non-operated side using surface electromyography.ResultsAll patients demonstrated a significant improvement in the Constant score (p = 0.001), from a preoperative score of 33 points (range 10–55 points) to a postoperative score of 59 points (range 13–80 points). The subjective assessment score was good to excellent in 12 patients (85%), and 11 patients (78%) would be willing to undergo surgery again. Integrity of the transferred tissue was confirmed in 13 of the 14 cases using ultrasound and MRI. Surface electromyographic signal showed increased activation of the transferred latissimus dorsi when performing active movements of external rotation (p = 0.002) and abduction-elevation (p = 0.009).ConclusionsOur results indicate that LDT significantly improves function and diminishes pain in patients with a massive posterosuperior rotator cuff tear. The combined open and arthroscopic technique preserves the deltoid muscle and controls the LD tendon reinsertion. Surface electromyographic signal confirms the active function of the transferred muscle.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-014-0083-6) contains supplementary material, which is available to authorized users.

Do the Patients Really Need Concentrated and/or Accelerated Rehabilitation Program After ACL Surgery? A New Lightened Rehabilitation Program

Objectives:The purpose of this study was to design and assess the outcomes of the new lightened rehabilitation program after anterior cruciate ligament reconstruction (ACL-R).Methods:Thirty-two of the 57 patients with ACL-R using tibialis anterior grafts completed the study. The patients in the lightened rehabilitation program were compared with patients in standard rehabilitation program. The two groups were assessed using International Knee Documentation Committee (IKDC) and Lysholm scores, isokinetic knee muscle strength, knee joint position sense, and hop test.Results:There were no significant differences in muscle strength of the quadriceps and hamstring at 60°/s, 180°/s, and 330°/s between the operative and non-operative side in the lightened rehabilitation group while there was significant difference in muscle strength of the quadriceps and hamstring at 60°/s between the operative and non-operative side in the standard rehabilitation group. There were significant differences in muscle strength of the quadriceps and hamstring at 330°/s and joint position sense at 75°, 45°, and 15°between the operative side of the patients in lightened rehabilitation group and operative side of the patients in standard rehabilitation group. There was no difference in the knee joint position sense at 15°, 45°, and 75°, between the operative and non-operative side in the both groups.Conclusion:Clinical relevance of this study is that the new lightened rehabilitation program should be also succeeding as much as standard rehabilitation program after ACL-R. It is suggested that future studies might evaluate the effects of the new lightened rehabilitation program for different grafts and professional athletes.