Mean Postoperative Visual Analog Scale Research Articles

Surgical Treatment of Meniscal RAMP Lesion.

RAMP lesion, defined as peripheral detachment lesion of posterior horn of medial meniscus, has been shown to accompany anterior cruciate ligament (ACL) ruptures and is thought to play an important role in the knee joint stability. In this study, we aimed to present results of postoperative knee function scores and patient satisfaction after surgical repair of RAMP lesion. We included 15 patients who had undergone knee arthroscopy due to RAMP lesion in 2017. We recorded demographic data, diagnosis, pre- and postoperative International Knee Documentation Committee and Tegner-Lysholm scores of all patients. In this study, we included 15 patients: the number of male and female patients was eight and seven, respectively. The mean age of patients was 26.8 (18-35). Associated injuries included ACL rupture in 12 patients, additional medial meniscus lesion in 3 patients, lateral meniscus lesion in 3 patients, and superomedial patellar plicae syndrome in 2 patients. All patients had the same postoperative rehabilitation protocol. Mean preoperative Tegner-Lysholm knee score was 64.4 (53-75), while it was 82.5 (75-89) postoperatively, and mean preoperative and postoperative Visual Analogue Scale score at last postoperative follow-up were 5.26 (2-8) and 1.06 (0-2), respectively. All differences were found to be statistically significant. Meniscal RAMP lesions are commonly associated with ACL ruptures. RAMP repair significantly increases postoperative knee function scores and patient satisfaction following ACL reconstruction.

Operative Treatment for Hallux Valgus With Moderate to Severe Metatarsus Adductus.

Operative treatment is indicated for patients who have symptomatic hallux valgus (HV) with moderate to severe metatarsus adductus (MA). However, there is limited information available on the operative procedures and outcomes for the treatment of HV with MA. We aimed to investigate the average 10-year follow-up clinical and radiologic outcomes. Seventeen patients (21 feet, average age: 60.1 years) with symptomatic HV with moderate to severe MA were operatively treated. Mean postoperative follow-up duration was 114.4 (24-246) months. All feet had metatarsus adductus angle ≥20 degrees on dorsoplantar weight-bearing radiograph. The procedure included a proximal crescentic osteotomy of the first metatarsal and abduction osteotomy of the proximal third of the second and third metatarsals. The mean American Orthopaedic Foot & Ankle Society scale score improved significantly postoperatively ( P < .001). The mean postoperative visual analog scale score (17 feet) was 2.0 (0-6). Preoperative metatarsalgia was severe in 2 feet, moderate in 17, and mild in 2. At the most recent follow-up evaluation, 11 feet had no pain, 9 had mild pain, and 1 had moderate pain. The mean hallux valgus angle, intermetatarsal angle, and metatarsus adductus angle significantly decreased postoperatively ( P < .001 for all). Recurrence of HV (HV angle ≥ 20 degrees) was observed in 4 feet. The clinical and radiologic results indicated that our novel operative treatment for HV with moderate to severe MA can achieve significant correction of HV with MA deformities and significant improvement in pain and function. Level IV, retrospective case series.

Comparison between Rescue Flap and Double Flap Technique.

Objectives Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no other comparative study between primary reconstruction of septal perforation and secondary healing in the literature. The aim of this study is to evaluate postoperative patient morbidity with or without posterior septal perforation in endonasal pituitary surgery by comparing two commonly used techniques: rescue and double nasoseptal flaps. Design Prospectively randomized study. Setting Tertiary academic center. Participants Sixty patients underwent endoscopic endonasal pituitary surgery. Main Outcomes and Measures Functional results (breathing) using visual analog scale (VAS), sphenoid sinusitis, presence of synechia, perforation in the posterior septum, and crusting in the sphenoethmoidal recess were assessed. Results Pre- and postoperative mean VAS scores were 71.67 ± 11.47 and 67.67 ± 9.71 mm in the intact septum group and 77.67 ± 14.06 and 62.67 ± 10.48 mm in the posterior septal perforation group. There was a significant difference between pre- and postoperative VAS values in all groups. There was significant worsening in both groups; worsening in VAS values was much higher in the posterior septal perforation group. In the posterior septal perforation group, much more crusting was seen. Conclusions This is the first study to compare the postoperative patient morbidity in endoscopic endonasal pituitary surgery with and without a posterior septal perforation. Reconstruction of the posterior septum along with less mucosal loss yields better postoperative nasal symptom score.

Effect of Turbinate Intervention on Nasal Functions in Septorhinoplasty Surgery.

This study was performed to evaluate the effect of inferior turbinate reduction on nasal function. A total of 32 patients who underwent septorhinoplasty (SRP) operation were included in the study and assigned into 2 groups as group I who received inferior turbinate reduction during SRP operation consisted of 17 patients and the group II who consisted of 15 patients without inferior turbinate reduction. For 2 groups before and after surgery, visual analogue score and findings of the acoustic rhinometry were recorded both before and after decongestion of the nasal mucosa. Postoperative mean visual analogue scale (VAS) scores revealed a statistically significant reduction compared with preoperative values on right and left side of the nasal cavity, both before and after topical decongestion in group I (P < 0.005). Also in group II, the differences of VAS scores for both sides before and after topical decongestion were statistically significant (P < 0.05). Postoperatively, the increase of the volume measurements at the level of pyriform sinüs (VOL2) value on the right side of the nasal cavity before and after decongestion and volume measurements at the level of the nasal valve (VOL1) values on both sides after topical decongestion were found to be statistically significant in group I. When the VAS scores and acoustic rhinometry measurements of group I and group II patients were compared the difference, for before and after topical decongestion, postoperative mean MCA1 (minimal cross-sectional area at the level of the nasal valve) values for left side and right side of nasal cavity were higher in group I than group II and these differences were statistically significant (P < 0.005). As a result, in the SRP operations, turbinoplasty should be implemented by taking into account the function as well as aesthetic concern. Similar results were obtained in other studies that were carried on.

Pedicled Vascularized Bone Graft of the Distal Radius for Recalcitrant Nonunion of the Distal Humerus.

To analyze the clinical and radiological outcomes of a series of patients treated with a pedicled vascularized bone graft (VBG) of the distal radius for the treatment of recalcitrant atrophic nonunions of the distal humerus. Retrospective clinical study. University-affiliated teaching hospital. Fifteen patients with supracondylar humeral atrophic nonunions with at least 3 previous failed surgical interventions were included. Debridement of the distal humerus nonunion through a posterior elbow approach with provisional fixation was performed. Then, a pedicled VBG was harvested from the distal radius and tunneled back into the humeral bone defect. Iliac crest was used as needed, both for the nonunion and to stabilize the radius. Finally, definitive fixation with 2 locked plates was performed. Radiological results, complications, elbow range of motion, Mayo elbow performance score, and subjective pain were evaluated. There were 4 male and 11 female patients, with a mean age of 51 (range, 28-73) years. The mean follow-up period was 46 (range, 37-72) months with a minimum of 3 years. Radiological consolidation was achieved in all patients. Elbow range of motion was >100 degrees in 11 patients and between 50 and 100 degrees in 4 patients. Preoperative Mayo scores were poor in all patients. At final follow-up, Mayo scores were excellent in 3, good in 9, and fair in 3 patients. The mean postoperative visual analog scale score was 1.2 (range 0-3). Pedicled VBG of the distal radius was shown to be a reliable and effective alternative for the treatment of recalcitrant atrophic nonunions of the distal humerus, when other methods have failed. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Long-term outcome of posterior spinal fusion for the correction of adolescent idiopathic scoliosis

BackgroundAdolescent idiopathic scoliosis (AIS) is the most common form of idiopathic scoliosis, and surgery is considered as one of the therapeutic options. However, it is associated with a variety of irreversible complications, in spite of the benefits it provides. Here, we evaluated the long-term outcome of posterior spinal fusion (PSF) of AIS to shed more light on the consequences of this surgery.MethodsIn a cross-sectional study, a total of 42 AIS patients who underwent PSF surgery were radiographically and clinically inspected for the potential post-operative complications. Radiographic assessments included the device failure, union status, and vertebral tilt below the site of fusion. Clinical outcomes were evaluated using the Oswestry disability index (ODI) and visual analogue scale (VAS).ResultsThe mean age of the surgery was 14.4 ± 5.1 years. The mean follow-up of the patients was 5.6 ± 3.2 years. Complete union was observed in all patients, and no device failure was noticed. Pre- and post-operative vertebral tilt below the site of fusion were 11.12° ± 7.92° and 6.21° ± 5.73°, respectively (p < 0.001). The mean post-operative ODI was 16.7 ± 9.8. The mean post-operative VAS was 2.1 ± 0.7. ODI value was positively correlated with follow-up periods (p = 0.04, r = 0.471). New degenerative disc disease (DDD) was observed in 6 out of 37 (16%) patients.ConclusionIn spite of the efficacy and safety of PSF surgery of AIS, it might result in irreversible complications such as DDD. Moreover, the amount of post-operative disability might increase over the time and should be discussed with the patients.

Clinical and radiographic outcomes of chitosan-glycerol phosphate/blood implant are similar with hyaluronic acid-based cell-free scaffold in the treatment of focal osteochondral lesions of the knee joint.

To determine the clinical and radiographic efficacy of chitosan-glycerol phosphate/blood implant versus hyaluronic acid-based cell-free scaffold in patients with focal osteochondral lesion of the knee joint. Clinical data of 46 patients surgically treated using either chitosan-glycerol phosphate/blood implant (25 patients, Group 1) or hyaluronic acid-based cell-free scaffold (21 patients, Group 2) in combination with microfracture were retrospectively evaluated. All lesions were Outerbridge grade III or IV with a mean lesion size of 3.3 ± 0.7cm2. The mean follow-up time was 24.4 months. Visual analogue scale (VAS), Lysholm knee score, and Tegner activity scale were the instruments to evaluate the clinical status. Magnetic resonance observation of cartilage repair tissue (MOCART) system was used to analyze the characteristics of repair tissue. No significant differences were detected between the groups regarding VAS, Lysholm, and Tegner scores at any time interval during the whole follow-up. The mean post-operative VAS and Lysholm scores at the latest follow-up was significantly better in cases with the lesion size ≤ 3cm2 in Group 1 (p = 0.001, p < 0.001, respectively). However, no significant differences according to the lesion size were detected in Group 2 (n.s.). Complete repair with the filling of the defect was achieved in 7 (28%) of the knees in Group 1 and it was 7 (33.3%) of the knees in Group 2 according to MOCART system at the latest follow-up. Single-stage regenerative cartilage surgery using chitosan-glycerol phosphate/blood implant combined to microfracture for focal osteochondral lesions of the knee revealed similar clinical and radiographic outcomes with hyaluronic acid-based cell-free scaffold at short-term follow-up. However, clinical outcomes of hyaluronan scaffold were less sensitive to defect size than chitosan. With the advantages of no hypertrophic repair tissue formation as well as no need to arthrotomy during surgery, chitosan is an effective choice especially in patients with the lesion size ≤ 3cm2. III.

Posterior Nasal Neurectomy In Treatment of Intractable Rhinitis: A Preliminary Series

Objective: To evaluate the efficacy and safety of posterior nasal neurectomy on the treatment of nasal congestion, rhinorrhea, sneezing, and post-nasal discharge in intractable rhinitis patients.&#x0D; Methods&#x0D; Design: Preliminary case series &#x0D; Setting: Tertiary University Medical Center&#x0D; Participants: Ten (10) patients with intractable rhinitis underwent endoscopic posterior nasal neurectomy in both sides. Symptoms were compared pre- and post-operatively one month and one year after surgery using Visual Analog Scale (VAS) scores. Endoscopic pre- and one-month post-operative Lund-Mackay scores were also compared.&#x0D; Results: All four mean nasal symptom scores were reduced significantly at 1-month follow-up for nasal congestion (1.5 ± 1.08 vs 4.1 ± 0.5687, p = .00001), rhinorrhea (0.7 ± 0.823 vs 3.4 ± 0.966, p = .00001) post-nasal discharge (0.9 ± 0.994 vs 2.4 ± 1.5, p = .03), and sneezing (1.1 ± 0.738 vs 3 ± 0.943, p = .02). Mean endoscopic scores were also reduced significantly at one month, from 12.9 ± 2.55 to 4.2 ± 3, p = 0.0001.In the 6 patients that followed up at 1-year, post-operative mean nasal symptoms were still significantly better for congestion (0.6667 ± 0.8165 vs 4 ± 0.632, p = 0.00001), rhinorrhea (0.6667 ± 0.5164 vs 3.67 ± 1.033, p = .001), post-nasal discharge (0.1667 ± 0.40825 vs 2.17 ± 1.835, p = .033), sneezing (0.5 ± 0.54772 vs 3.17 ± 0.983, p = 0.0001). Mean post-operative VAS nasal scores and endoscopic scores were well associated (Correlation Coefficient -.648, p = .048).&#x0D; Conclusion: Posterior nasal neurectomy could be considered as a safety and effective way to treat intractable rhinitis patients in Vietnam.&#x0D; Keywords: Posterior nasal neurectomy, vasomotor rhinitis, allergic rhinitis, vidian neurectomy

Hemi vs. Total joint arthroplasty for hallux rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Advanced-stage arthritis of the first metatarsophalangeal joint (MTPJ), or “Hallux Rigidus” (HR) is a common forefoot pathology. When surgery is indicated, arthroplasty is an alternative to arthrodesis, which aims to preserve MTPJ dorsiflexion. Since it is unclear whether total-toe or hemi-toe devices are preferred implants in MTPJ arthroplasty, we completed a systematic review of the literature and did a meta analysis to test which type of implants clinically outperform in hallux rigidus. Methods: A systematic review of MTPJ arthroplasty was performed using Pubmed, EMBASE, SCOPUS, and Cochrane library for the years 2000 to 2017. Data was extracted from articles containing both preoperative and postoperative endpoints for either hemi or total MTPJ arthroplasty cases. To be eligible for inclusion, studies must have had a mean follow-up window of at least 24 months and standard deviation of outcome. Total eleven studies were included for review, seven studies with hemi replacement and six studies with total arthroplasty. Pooled mean values were calculated, and a forest plot was created comparing pre-and post-operative American Orthopedic Foot and Ankle Score (AOFAS), visual analogue scale (VAS), and range of motion (ROM) results for both hemi-toe and total-toe arthroplasty. Statistical analysis was performed using SPSS. Results: Mean postoperative AOFAS scores in patients undergoing hemiarthroplasty improved by 50.7 points (95%CI: 48.5, 52.8), which was higher than the mean postoperative AOFAS improvement of 40.6 points (95%CI: 38.5, 42.8) seen in total-toe patients. Mean postoperative VAS improvement in hemiarthroplasty was 6.05 points (95%CI: 5.92, 6.18), which was comparable to the mean VAS improvement of 6.29 points (95%CI: 6.02, 6.55) seen in total arthroplasty. Mean postoperative MTPJ ROM improved by 43.0 degrees (95%CI: 39.3, 46.6) in hemi-toe patients, which exceeded the mean ROM improvement of 32.5 degrees (95%CI: 29.9, 35.1) found in total-toe cases. A meta-analysis of the data revealed non-significant statistical trends for AOFAS and ROM in favor of hemiarthroplasty. Conclusion: Hemi-surface implants in MTPJ arthroplasty may improve postoperative AOFAS and ROM results to a greater extent than total-toe devices. High-quality randomized controlled studies are needed to confirm long-term surgical outcomes in these patients.

Posterior Upper Rib Excision for Neurogenic Thoracic Outlet Syndrome---Feasibility and Early Outcomes.

There are several surgical treatment options for neurogenic thoracic outlet syndrome (n-TOS). However, the first rib has been shown to be the common denominator of all TOS forms and the degree of its resection has been shown to correlate with the long-term success. To demonstrate the feasibility of posterior upper rib excision (PURE) and report early outcomes. Nine patients presented with signs and symptoms of n-TOS. Preoperative evaluation involved physical and neurological examination, arm visual analog score (VAS), cervical X-ray, magnetic resonance imaging (MRI) of the cervical spine, and brachial plexus MRI. All patients were operated at a single institution by a single surgeon. Postoperatively, clinical and radiological data were collected. There were 2 men and 7 women in the study with 10 procedures performed. The age range was 18 to 45 with mean of 36.6 yr. Mean preoperative arm visual analog scale score was 7.8. The patients underwent posterior upper rib excision (PURE) by a single surgeon. One patient had bilateral surgery. The causes of TOS were fibrous bands, enlarged C7 transverse processes, narrow scalene triangle, and accessory ribs. All patients improved after surgery in terms of arm pain and quality of life. Postoperative mean visual analog scale score was 1.1 at 6 mo. In addition, neurological examination was normal at 6 mo postoperatively and all patients returned to their previous full-time jobs. Posterior upper rib excision is a feasible surgical option for n-TOS.

Uncemented three-dimensional-printed prosthetic replacement for giant cell tumor of distal radius: a new design of prosthesis and surgical techniques

IntroductionCurrently, it is challenging to treat giant cell tumor (GCT) of distal radius. For Campanacci grade III or recurrent GCTs, en bloc resection has been accepted as a better treatment option. Although numerous methods are available for reconstruction, all of them have some limitations in joint function and complications. In this study, our aims were to treat the GCT of distal radius with uncemented three-dimensional (3D)-printed prosthesis and to present and evaluate the surgical techniques and short-term outcomes.MethodsBetween September 2015 and March 2017, 11 patients with distal radius GCTs were treated with personalized uncemented 3D-printed prosthesis. The preoperative/postoperative pain, range of motion, and grip strengths of all patients were evaluated. Oncological results, complications, and degenerative changes in the wrist joint were evaluated. Functional outcomes were assessed according to the disabilities of the arm, shoulder, and hand (DASH) questionnaire and Mayo wrist scoring systems.ResultsThe average follow-up was 14.45 months (range, 8–18 months). There was a significant decrease in the mean postoperative visual analog scale score (2.33) compared with the preoperative score (5.22; p<0.001). The mean DASH score and Mayo wrist score of the wrist joint function were 18.7 and 72, respectively. There was no local recurrence or lung metastasis. No complication associated with prosthesis was observed, including aseptic loosening, subluxation, and breakage. Joint space narrowing, or disuse osteoporosis, was also not found in all cases.ConclusionEn bloc resection and reconstruction with a personalized uncemented 3D-printed prosthesis can be alternative options to treat Campanacci grade III or recurrent GCTs of distal radius and can result in short-term oncologic salvage, good postoperative function, and low complication rate. However, a long-term follow-up is required to determine the outcome.

Suprapedicular Circumferential Opening Technique of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for High Grade Inferiorly Migrated Lumbar Disc Herniation.

Purpose To evaluate the efficacy of suprapedicular circumferential opening technique (SCOT) of percutaneous endoscopic transforaminal lumbar discectomy (PETLD) for high grade inferiorly migrated lumbar disc herniation. Material and Methods Eighteen consecutive patients who presented with back and leg pain with a single-level high grade inferiorly migrated lumbar disc herniation were included. High grade inferiorly migrated disc was removed by the SCOT through PETLD approach. Outcome evaluation was done with visual analog scale (VAS) and Mac Nab's criteria. Result There were 14 males and 4 females. The mean age of patients was 53.3 ± 14.12 years. One, 4, and 13 patients had disc herniation at L1-2, L3-4, and L4-5 levels, respectively, on MRI, which correlated with clinical findings. The mean follow-up duration was 8.4 ± 4.31 months. According to Mac Nab's criteria, 9 patients (50%) reported excellent and the remaining 9 patients (50%) reported good outcomes. The mean preoperative and postoperative VAS for leg pain were 7.36 ± 0.73 and 1.45 ± 0.60, respectively (p < 0.001). Improvement in outcomes was maintained even at final follow-up. There was no complication. Conclusion In this preliminary study we achieved good to excellent clinical results using the SCOT of PETLD for high grade inferiorly migrated lumbar disc herniation.

Microendoscopic discectomy for lumbar disc herniations.

Introduction:Lumbar disc herniation is one of the main causes of discogenic low back pain and reported to affect 60%–80% of people during their lifetime. The two main surgical modalities for intervertebral disc surgery are standard open discectomy and minimally invasive discectomy which include percutaneous endoscopic lumbar discectomy and microendoscopic discectomy (MED). We report our experience with the same technique of MED to evaluate the efficacy of MED for lumbar disc pathology.Aims and Objectives:The aims and objectives were to study the efficacy, advantages, and associated limitations and complications of MED in lumbar disc herniations.Materials and Methods:This study was carried out on 300 patients who had single-level herniated disc. The procedure was done by Microscopic Endoscopic Tubular Retraction System. Preoperative assessment of Visual Analog Scale (VAS) and modified Suezawa and Schreiber (MSS) clinical scoring system was documented 1 day prior to surgery. Postoperative results were determined to be excellent, good, fair, or poor according to MacNab criteria and also evaluated by MSS clinical scoring system on postoperative day 7 and after 6 months.Results:A total of 187 patients were males and 113 patients were females and a majority of patients were in the age group of 31–40 years. A total of 192 patients had disc herniations at L4–L5 level. The mean operative time was 82 min and the mean hospital stay was 5.3 days. Eighteen cases (6%) developed postoperative complications including discitis, dysesthesia, recurrent prolapsed intervertebral disc, residual disc, dural tear, and nerve root injury. Mean preoperative VAS score was 8.7 and the mean postoperative VAS scores at postoperative day 7 and at 6 months were 2.25 and 1.12, respectively. The mean preoperative MSS score was 3.27 and the MSS scores at postoperative day 7 and at 6 months were 7.42 and 8.2, respectively. The overall successful outcome of the endoscopic discectomy after 6-month follow-up on the basis of VAS improvement percentage was 87.6%, MSS scoring percentage was 91.6%, and MacNab scoring percentage was 92.67%.Conclusion:MED is a safe and effective technique. It offers decreased blood loss, shorter operative time, shorter in-hospital stay, decreased need for pain medication, decreased rate of infection, and a shorter return to work time. Limitations of this technique include a learning curve which is related to surgery time, complications, conversion to open procedures, and recurrent disc herniation.

Efficacy of Magnesium Sulfate Added to Local Anesthetic in a Transversus Abdominis Plane Block for Analgesia Following Total Abdominal Hysterectomy: A Randomized Trial

Background: Major abdominal surgeries are associated with severe pain, which can affect respiratory and cardiac functions if insufficiently treated; this increases postoperative morbidity. Objective: We aim at evaluating the efficacy of magnesium sulfate as an adjuvant to local anesthetic in an ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in total abdominal hysterectomy. Study Design: A prospective, randomized, double-blinded clinical trial. Setting: An academic medical center. Methods: This study is registered at https://clinicaltrials.gov (no.: NCT02930707). This randomized, double-blinded clinical trial included 60 women undergoing total abdominal hysterectomy that were divided into 2 groups (30 patients per group). Group I received a TAP block with 20 mL per side of 0.25% bupivacaine plus 2 mL magnesium sulphate 10% (200 mg). Group II received a TAP block with 20 mL per side of 0.25% bupivacaine. Visual analog scale (VAS) scores, the time of the first analgesic request, total morphine consumption, and any side effects were assessed and recorded. Results: The mean postoperative VAS score was significantly reduced in group I compared to group II in all of the time-points except after 10 hours. The mean time of the first request for rescue analgesia was significantly prolonged in group I (15.67 hrs.) compared to group II (7.33 hrs.) (P &lt; 0.001), and the mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in group I (7.63 ± 2.93 mg) than in group II (16.20 ± 3.24 mg) (P &lt; 0.001). No significant difference in side effects was observed. Limitations: Sample size. Conclusion: The addition of 200 mg of magnesium sulfate to bupivacaine in an ultrasound-guided TAP block significantly reduced postoperative opioid requirements, prolonged the duration of analgesia, and reduced the VAS score in patients who underwent abdominal hysterectomy, without significant side effects. Key words: Magnesium sulfate, TAP block, postoperative pain, total abdominal hysterectomy

Short-term Clinical and Radiographic Results of the Salto Mobile Total Ankle Prosthesis.

The mobile-bearing Salto total ankle prosthesis has been reported to have promising outcomes. However, clinical reports on this prosthesis are few, and most have been published by the inventors and disclosed consultants. We retrospectively reviewed 59 patients who received Salto prosthesis unilaterally. The average follow-up was 35.9 (range, 6-56) months. Clinical and radiologic results were evaluated. Clinical results were evaluated according to visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS) pain and disability score, and ankle range of motion (ROM) in dorsiflexion/plantarflexion. In the radiographic evaluation, we measured the tibial angle (TA), talar angle (TAL), tibial slope, and talocalcaneal angle (TCA) on weightbearing radiographs. By the last follow-up, 7 of 59 patients (11.9%) had undergone reoperation, and 3 of 59 implants (5.1%) had been removed. The prosthesis survival was 94.9% (95% CI, 89.1%-100%). With any reoperation as the endpoint of follow-up, the clinical success rate was 88.1% (95% CI, 79.4%-96.9%). The mean postoperative visual analog scale score, AOFAS ankle-hindfoot score, and Ankle Osteoarthritis Scale pain and disability score improved significantly ( P < .001). The ankle range of motion also improved from preoperative 33.4 ± 16.6 to 40.3 ± 15.5 postoperatively ( P < .001); however, there was no statistically significant change in plantarflexion ( P = .243). Radiolucent areas and osteolysis were found in 28 (47.5%) and 27 (45.8%) patients, respectively. Heterotopic ossification was observed in 13 patients (22.0%). In this series, early clinical and radiographic outcomes of this prosthesis were promising. We believe the early radiolucent lines were probably due to the gap at the implant and bone interface, and they disappeared at the time of osseous integration. However, longer follow-up is necessary to determine the long-term durability and survivorship of this implant, particularly given the high incidence of postoperative osteolysis. Level IV, case series.

Surgical Treatment of Confirmed Intraosseous Lipoma of the Calcaneus: A Case Series

Intraosseous lipoma of the calcaneus is a benign lesion formed by mature adipose tissue. When the lesion is symptomatic, the most frequent presentation is localized pain and soft tissue swelling. Because these lesions can regress spontaneously, conservative treatment methods are recommended. Operative excision is mostly required for painful lesions and pathologic fractures. The data from 14 patients with calcaneal intraosseous lipoma, who had undergone surgery in our clinic, were evaluated retrospectively. Using Milgram’s classification system, 9 lesions were classified as stage 1, 4 as stage 2, and 1 as stage 3. All lesions were occupying 100% of intracalcaneal cross-section in the coronal plane and >30% in the sagittal plane of magnetic resonance imaging sections. The mean preoperative visual analog scale score was 5.29 ± 1.14 (range 4 to 7), and the mean postoperative visual analog scale score at the last follow-up visit was 1.14 ± 0.36 (range 1 to 2), which was significantly better (p < .01). The mean Maryland foot score at the last follow-up visit was 97.71 ± 2.02 (range 95 to 100). The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score was 97.86 ± 2.11 (range 94 to 100) at the last follow-up visit. The differences between the pre- and postoperative values were statistically significant (p < .01). No recurrence had been detected within a median follow-up period of 84 months. Operative management of symptomatic lesions related to intraosseous lipoma of the calcaneus provides better results compared with the preoperative state.

Hysterectomy and salphingoopherectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery(NOTES): Turkish surgeons' initial experience

BackgroundThe aim of this study was to evaluate the feasibility, safety, and early postoperative outcomes of hysterectomies and salpingo-oophorectomies using transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Materials and methodsThe women undergoing vNOTES hysterectomies and salpingo-oophorectomies at a tertiary referral medical center between April 2016 and April 2017 were retrospectively analyzed. In all of the vNOTES procedures, a handmade glove port system comprised of a glove-wound retractor NOTES port was used. ResultsThirteen patients underwent gynecological procedures with benign indications via vNOTES. Of the 13 operations, 6 of the patients had salpingo-oophorectomies and 7 had hysterectomies, and all of the surgeries were performed by the same surgeon (Dr. Ahmet Kale). No conversion to a conventional laparoscopy or even a laparotomy was needed in any of the procedures. The mean operation time was 73.14 min in the hysterectomy patients and 40.8 min in the salpingo-oophorectomy patients. The mean drop in the hemoglobin (Hb) level was 1.4 g/dl in the hysterectomy patients and 1.6 g/dl in the salpingo-oophorectomy patients. For these patients undergoing vNOTES, the mean postoperative visual analog scale (VAS) pain score at 6 h was 4.38 and at 24 h it was 0.62. There were no intraoperative complications in any of the cases. The mean length of the hospital stay was 1.8 days in the hysterectomy patients and 1.5 days in the salpingo-oophorectomy patients. ConclusionThe vNOTES procedure overcomes the surgical and technical difficulties of conventional vaginal surgery by incorporating the advantages of endoscopic surgery. Moreover, vNOTES uses inexpensive, reusable, handmade conventional laparoscopic instruments and avoids those problems related to abdominal wall incisions and trocar-related complications. Overall, this procedure results in high patient satisfaction, cosmetic advantages, and decreased postoperative pain.

Hip Arthroscopy for Femoroacetabular Impingement in a Military Population

Background: Femoroacetabular impingement (FAI) can lead to hip pain and early joint degeneration. There have been few reports to date on the outcomes of hip arthroscopy for the treatment of FAI in the military population. Purpose/Hypothesis: The purpose of this study was to compare patient demographics with postoperative outcomes after hip arthroscopy for symptomatic FAI and to identify preoperative risk factors for poor outcomes. The hypothesis was that certain preoperative patient characteristics will be predictive of poorer outcomes and that lower outcomes scores will be associated with a higher likelihood of medical separation from the military. Study Design: Case series; Level of evidence, 4. Methods: Retrospective chart review of active-duty and dependent patients older than 18 years who underwent hip arthroscopy for symptomatic FAI from 2009 to 2014 at a single institution. Results: A total of 469 (309 males and 160 females) surgeries were performed on 456 active-duty personnel and 13 dependent civilians, with a mean 2.5-year follow-up. Overall, 39% (n = 179) were able to return to duty (RTD), 18% (n = 82) were medically cleared to return to normal daily activities but did not remain on active duty, and 43% (n = 195) required referral to the Disability Evaluation System (DES). Increasing rank and male sex were positive predictors and Axis 1 psychiatric diagnosis, revision surgery, concomitant psoas tenotomy, multiple medical comorbidities, and complaints of generalized pelvic pain were negative predictors for returning to duty. US Marine Infantry and Special Forces showed improved RTD rates (50%-86%) compared with administrative, more sedentary, occupations (22%). On average, Single Alpha Numeric Evaluation (SANE) and visual analog scale (VAS) scores improved after surgery, with SANE scores improving 37 ± 28 points and VAS scores improving 2.6 ± 2.5 points. The mean postoperative SANE and VAS scores differed significantly between the RTD group and those not returning to duty; 87 and 1.2 points compared with 69 and 3.6 points, respectively (P < .0001). Conclusion: Hip arthroscopy for the treatment of symptomatic FAI effectively improves pain symptoms and self-reported overall function but shows a much lower than expected return to full, unrestricted active duty in the general active-duty military population. Underlying psychiatric diagnoses, female sex, and more sedentary occupations are associated with lower RTD rates. Furthermore, lower postoperative SANE and VAS scores are associated with lower RTD rates. Only the more active and elite components of the military study population showed RTD rates consistent with previously reported outcomes of return to competitive sports after hip arthroscopy for FAI.

Barbed snore surgery for concentric collapse at the velum: The Alianza technique

Recently, new conservative and non-resective surgical techniques, including palatopharyngeal surgical lifting and suspension (the ‘Roman blinds technique’) and modular barbed snore surgery (MBSS), have been successfully introduced for the treatment of obstructive sleep apnea syndrome (OSAS). This pilot longitudinal study describes our preliminary experience with the ‘Alianza technique’ (the simultaneous use of Roman blinds and MBSS) in mild to moderate OSAS patients with concentric pharyngeal collapse at the velum, previously documented by means of drug-induced sleep endoscopy.Effectiveness of the surgical procedure was assessed by means of the Epworth sleepiness scale (ESS), overnight polysomnography, and a 0–10 snoring visual analogue scale (VAS); tolerability was assessed by means of a 0–10 pain VAS.The final analysis relating to 19 patients (18 males; 94.8%), with a mean age of 43.8 ± 8.8 years, showed a statistically significant reduction in mean post-operative apnea-hypopnea indexes (22.3 ± 5.1 vs 7.0 ± 9.4 events/hour; p-value = 0.002) and mean ESS scores (11.3 ± 5.4 vs 3.9 ± 4.0; p-value < 0.001). There was also a significant decrease in mean post-operative snoring VAS scores (9.5 ± 0.7 vs 2.1 ± 1.7; p-value < 0.001). Surgery was well tolerated in most patients (mean pain VAS scores on day seven: 2.4 ± 1.4), and there were no major complications.In experienced hands, the Alianza can be considered an effective and safe technique for the treatment of mild to moderate OSAS.

A Prospective, Observational Trial Assessing the Efficacy of Abdominal Compression in Reducing Laparoscopic-Induced Shoulder Pain.

Postoperative shoulder pain is a condition associated with laparoscopic surgery and presumably attributed to residual carbon dioxide (CO2) in the abdomen. The intent of the current prospective, observational study was to assess the efficacy of abdominal compression in mitigating this painful complication. We recruited 30 patients who were treated with laparoscopic surgery for the management of gynecologic disease. All study participants underwent abdominal compression to evacuate the CO2 associated with their pneumoperitoneum. Postoperatively, the subjects' pain intensity was measured via the visual analogue scale at 12, 24, and 48 hours. The patients' mean postoperative visual analogue scale pain scores were the highest during the initial 12 hours (1.93), and thereafter, steadily declined at 24 hours (0.73) and 48 hours (0.70) ( P = .045). Furthermore, toxicity was reasonable, with only 20% of subjects who reported grade ≤2 nausea and vomiting. Abdominal compression is a relatively safe procedure that appears to sufficently evacuate residual CO2, thereby reducing the severity of laparoscopic surgery induced shoulder pain.