Postoperative Functional Scores Research Articles

Clinical Outcomes of Osteochondritis Dissecans Lesions of the Capitellum Treated with Arthroscopy with a Mean Follow-Up of 8.3 Years.

While numerous studies exist evaluating the short-term clinical outcomes for patients who have undergone elbow arthroscopy for osteochondritis dissecans (OCD) of the capitellum, the literature on minimum 2-year clinical outcomes for a large cohort of patients is limited. /Hypothesis: We hypothesized that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved postoperative subjective functional and pain scores, and with acceptable return to play for these patients. A retrospective analysis from a prospectively collected surgical database was performed to identify all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Inclusion criteria for this study included the diagnosis of OCD of the capitellum treated arthroscopically with minimum 2-year follow-up. Exclusion criteria included any prior surgical treatment on the ipsilateral elbow, missing operative reports, and patients with any portions of the surgical procedure performed open. Follow-up was performed by telephone using multiple patient-reported outcome questionnaires: American Shoulder and Elbow Surgeons - Elbow (ASES-e), Andrews/Carson, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), and our institution-specific return-to-play questionnaire. After the inclusion and exclusion criteria were applied to our surgical database, 107 eligible patients were identified. Of these, 90 were successfully contacted for a follow-up rate of 84%. The mean age was 15.2 years and mean follow-up time was 8.3 years. Eleven patients had a subsequent revision procedure for a 12% failure rate in these patients. ASES-e pain was an average of 4.0 out of a max pain scale of 100, ASES-e function was an average of 34.5 out of a maximum of 36, and surgical satisfaction was an average of 9.1 out of 10. The average Andrews/Carson score was 87.1 out of 100 and the average KJOC score for overhead athletes was 83.5 out of 100. Additionally, out of the 87 patients evaluated who played sports at the time of their arthroscopy, 81 (93%) returned to play. This study demonstrated an excellent return-to-play rate and satisfactory subjective questionnaire scores with a 12% failure rate following arthroscopy for OCD of the capitellum with a minimum 2-year follow-up.

The effect of vascular risk factors on the efficacy of endolymphatic sac decompression surgery for Meniere's disease: a retrospective cohort study.

This study aimed to investigate the effect of vascular risk factors on the outcomes of endolymphatic sac decompression (ESD) surgery in patients with Meniere's disease. The study included 56 patients with Meniere's disease, who had undergone unilateral ESD surgery. The patients' vascular risk factors were assessed based on the preoperative 10-year atherosclerotic cardiovascular diseases risk classification. Those with no or low risk were defined as the low-risk group, while those with medium, high, or very high risk were defined as the high-risk group. The correlation between the vascular risk factors and ESD efficacy was evaluated by the comparison of vertigo control grade between the two groups. The functional disability score was also assessed to investigate whether ESD improved the quality of life in Meniere's disease patients with vascular risk factors. After ESD, 78.95 and 81.08% of patients from the low-risk and high-risk groups, respectively, demonstrated at least grade B vertigo control; no statistically significant difference was observed (p = 0.96). The postoperative functional disability scores in both groups were significantly lower compared with those before surgery (p < 0.01), with a median decrease of two (1, 2) points in both groups. No statistically significant difference between the two groups was observed (p = 0.65). Vascular risk factors have little effect on the efficacy of ESD in patients with Meniere's disease. Patients with one or more vascular risk factors can still experience a not poor vertigo control and improved quality of life after ESD.

Rotator cuff repairs with all-suture tape anchors: no difference in outcomes between with or without all-suture tape anchors.

This study aimed at comparing the outcomes of medium- to large-sized rotator cuff repairs performed using the suture bridge technique either with or without tape-like sutures, and single row techniques with conventional sutures. A total of 135 eligible patients with medium to large rotator cuff tears were identified and analyzed retrospectively, from 2017 to 2019. Only repairs using all-suture anchors were included in the study. Patients were divided into the following three groups: single-row (SR) repair (N = 50), standard double-row suture bridge (DRSB) repair with conventional sutures (N = 35), and DRSB with tape-like sutures (N = 50). The average postoperative follow-up period was 26.3 ± 9.8months (range, 18-37). DRSB with tapes had the highest re-tear rate of 16% (8/50), but there was no significant difference with the re-tear rates observed in SR (8%, 4/50) and DRSB with conventional sutures (11.4%, 4/35) (n.s.). DRSB with tapes demonstrated higher rate of type 2 re-tears (10%) compared to type 1 re-tears (6%), but the other two groups showed either similar or higher rates of type 1 re-tears compared to that of type 2. Post-operative functional scores of the three groups improved significantly (all p < 0.05), but the differences between the groups were not statistically significant. No clinical difference in functional outcomes and re-tear rates were observed in DRSB with tapes when compared with SR and DRSB using the conventional sutures. Tape-like DRSB suture which was expected to be superior by its biomechanical advantage was clinically non-superior to conventional DRSB suture. There were no significant differences in VAS scores and UCLA scores. Level III.

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures.

There is currently no consensus on proximal humerus fractures with an initial deformity in the coronal plane who are better off with plates or nails, so we designed this study. To compare the effect of the initial deformity in the coronal plane of proximal humerus fractures on postoperative outcomes, we compare the maintenance of reduction in procedures utilizing plates and nails, and analyzed the subsequent occurrence of complications to explore whether the initial deformity should dictate the fixation approach. The clinical data of patients with proximal humerus fractures who were hospitalized and underwent surgical treatment in our hospital from January 2016 to December 2020 were reviewed. Postoperative functional scores (American Shoulder and Elbow Surgeons, ASES; Constant-Murley Score, CMS), Neck-shaft angle (NSA), Quality of fracture reduction, Deltoid Tuberosity Index (DTI), and complications were compared among cases with initial varus, normal, or valgus deformities. We included 131 patients, 56 males and 75 females, with a mean age of 60.89 ± 5.53 years (range 50-76) and a mean follow-up duration of 16.63 ± 6.78months (range 12-48). Of these, 29 cases had initial varus displacement, 71 had a normal NSA, and 31 had initial valgus displacement. Seventy-five were treated with a locking plate and 56 with a nail. After open reduction and internal fixation, the NSA was restored to normal (-135°) in all patients in all groups (P > 0.05). There was a significant difference in NSA changes at the last follow-up; 2.93° ± 2.12° in the varus group, 1.77° ± 1.18° in the normal group, and 2.32° ± 1.64° in the valgus group, with the highest change occurring in the varus group. There was no significant difference in the range of motion or functional scores including ASES and CMS among the three groups (P > 0.05). The complication rate of 20.7% in the varus group was significantly higher than the complication rates of 12.7% in the normal and 12.9% in the valgus groups (P < 0.05). While proximal humerus fractures with initial coronal displacement (varus, normal, and valgus) show similar postoperative functional outcomes, varus fractures have a higher rate of complications. The nail provides better maintenance of reduction than the locking plate, especially in varus fractures.

Short-term efficacy analysis and comprehensive evaluation of laparoscopy for patients with rectal cancer-a prospective multi-center study

ObjectiveTo compare the short-term efficacy indicators of laparoscopic technique and open surgery in patients with rectal cancer surgery, and to further evaluate the safety and efficacy of laparoscopic rectal cancer surgery.MethodsThis study adopted a prospective multicenter, open-label, non-randomized concurrent control method to analyze patients who received rectal cancer surgery from 10 colorectal tumor centers across the country from January 2017 to December 2018. The two groups of patients received laparoscopic-assisted surgery and conventional open surgery respectively. All surgeons were selected according to relevant standards and participated in the two groups of operations at the same time. Comprehensive evaluation and analysis of the operation and postoperative recovery, postoperative pathological results, survival information, postoperative related functional scores and other indicators.ResultsIn the open surgery group, the proportion of tumors with a maximum diameter of more than 5 cm was higher (χ2 = 0.089, P = 0.018), and the proportion of T4 was higher (χ2 = 0.478, P < 0.001). In the laparoscopic group, the proportion of more than 12 harvested lymph nodes was higher (χ2 = 0.248, P < 0.001). There were no significant differences in the length of postoperative hospital stay, intraoperative blood loss, time to first flatus after operation, time to first out of bed, time to first liquid diet, and preservation rate of anal sphincter between the two groups, but in the laparoscopic surgery group the operation time was shorter (t = 6.750, P < 0.001) and postoperative pain was less (t = 0.896, 0.63, 0.964, and 0.989 on postoperative days 1, 2, and 3, respectively, all P < 0.001). The incidence of grade 2–4 adverse complication in the two groups was 12.5% and 14.6%, respectively, with no statistical difference (χ2 = 0.061, P = 0.105), but the incidence of incision infection was lower in the laparoscopy group (χ2 = 0.19, P < 0.001). There was no significant difference in 3-year disease-free survival between the two groups (HR = 1.089, 95% CI = 0.962–1.232, P = 0.170). Multivariate analysis suggested that intraoperative blood loss, T stage, N stage, nerve invasion, and postoperative sepsis were independent prognostic factors for disease-free survival. Wexner score, IPSS score and LARS score were not statistically different between the two groups.ConclusionThe pathological results and short-term outcomes of laparoscopic surgery for rectal cancer are comparable to those of conventional open surgery, and laparoscopic surgery is safe and feasible for rectal cancer patients.

Comparison of quality of life, symptom and functional outcomes following surgical treatment for colorectal neoplasia.

Colorectal surgical procedures can have a significant impact on quality-of-life (QoL), functional and symptom outcomes. This retrospective study conducted in a tertiary care center evaluated the influence of four colorectal surgical procedures on patient-reported outcome measures (PROMs). 512 patients undergoing colorectal neoplasia surgery between June 2015 and December 2017 were identified via the Cabrini Monash Colorectal Neoplasia database. Primary outcomes measured were the mean changes in PROMs following surgery utilizing the International Consortium of Health Outcome Measures colorectal cancer (CRC) PROMs. 242 patients from 483 eligible patients responded (50% participation rate). Responders and non-responders were comparable in median age (72 vs. 70 years), gender (48% vs. 52% male), time from surgery (<1 and >1 year), overall stage at diagnosis and type of surgery. Respondents underwent either a right hemicolectomy, ultra-low anterior resection, abdominoperineal resection or a transanal endoscopic microsurgery/transanal minimally invasive surgery. Right hemicolectomy patients reported the best post-operative function and reduced symptoms, significantly better (P < 0.01) than ultra-low anterior resection patients who reported the worst outcomes in multiple areas (body image, embarrassment, flatulence, diarrhoea, stool frequency). Furthermore, patients undergoing an abdominoperineal resection reported the worst scores for body image, urinary frequency, urinary incontinence, buttock pain, faecal incontinence and male impotence. The differences in PROMs in CRC surgical procedures is demonstrable. The worst post-operative functional and symptom scores were reported after either an ultra-low anterior resection or an abdominoperineal resection. Implementation of PROMs will identify and aid early patient referral to allied health and support services.

Early clinical and radiological outcomes of the new porous titanium shell in combination with locking screw in revision total hip arthroplasty

IntroductionExtensive acetabular bone loss and poor bone quality are two key challenges often encountered in revision total hip arthroplasty. A new 3D-printed porous acetabular shell has been made available with the option to insert multiple variable-angle locking screws. We sought to evaluate the early clinical and radiological outcomes of this construct.MethodsA retrospective review of patients operated by two surgeons was performed in a single institution. Fifty-nine revision hip arthroplasties were performed in 55 patients (34 female; mean age 68.8 ± 12.3 years) for Paprosky defects I (n = 21), IIA/B (n = 22), IIC (n = 9), III (n = 7) between February 2018 and January 2022 using the novel porous titanium acetabular shell and multiple variable angle locking screws. Postoperative clinical and radiographic outcomes were locally maintained. Patient-reported outcome measures collected included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score, and the 12-item Short Form Survey.ResultsAfter a mean follow-up of 25.7 ± 13.9 months, two cases of shell migration were noted. One patient had a failed constrained mechanism and received revision to a cemented dual mobility liner. No other acetabular shells showed any evidence of radiographic loosening at the final follow-up. Preoperatively, 21 defects were classified as Paprosky grade I, 19 grade IIA, 3 grade IIB, 9 IIC, 4 grade IIIA, and 3 IIIB. The mean postoperative WOMAC function score was 84 (SD 17), WOMAC (stiffness) 83 (SD 15), WOMAC (pain) 85 (SD 15), and WOMAC (global) 85 (SD 17). The mean postoperative OHS was 83 (SD 15), and mean SF-12 physical score was 44 (SD 11).ConclusionThe additional augmentation of porous metal acetabular shells with multiple variable-angle locking screws provides reliable initial fixation with good clinical and radiological outcomes in the short term. Further studies are needed to establish the medium- and long-term outcomes.Level of evidenceIV.

Comparison of All-Polyethylene Tibial Versus Metal-Backed Tibial Component in Total Knee Replacement Surgery

Introduction: Total knee replacement (TKR) is the most successful procedure in Orthopedics. The selection of an ideal implant relies on better survivorship, restoration of functional activities and cost-effectiveness. This study compared the effectiveness of all-polyethylene (AP) versus metal-backed tibial (MTB) implant in TKR patients in terms of objective and subjective patient related outcomes. Objectives: To compare the effectiveness of all-polyethylene tibial implants versus metal-backed tibial implants in total knee replacement patients in terms of improvement in the American Knee Society Score (AKSS). Methodology: It was a nonrandomized controlled trial done in the Orthopaedic Department of the Sharif Medical City Hospital, Lahore, after approval by the institutional ethical committee. Fifty patients of grade IV knee joint osteoarthritis for greater than six months were included by nonprobability convenient sampling technique. The patients were allocated equally into standard treatment and intervention groups; patients underwent TKR with MTB implants in the standard group and AP implants in the intervention group after taking informed written consent. The AKSS score was calculated pre-operatively, 3 months and 6 months after surgery by the team member not involved in surgical planning. Results: A statistically significant improvement was observed in pre-operative to post-operative knee scores (p-value = 0.004) and functional scores (p-value = 0.001) with TKR. When the means of knee scores were compared between AP and MTB implants, there was no significant difference between the two groups between pre-operative and post-operative knee scores and functional scores. Practical implication Conclusion: There is no significant difference in knee score between the all-polyethylene and metal-backed implants regarding pain and functional status. All-polyethylene implants are a better substitute for MTB implants due to their cost-effectiveness, particularly in countries with financial constraints. The most practical implication of the current study is health economics. In a developing country with a low per capita income, expensive implants can be swapped with low cost implants to bring the cost of the procedure down. Keywords: All-polyethylene tibial, Metal-backed tibial, Total knee replacement, American Knee Society Score, AKSS.

Bankart repair with subscapularis augmentation: A case control study.

To examine the effect on functional shoulder scores of Bankart repair with arthroscopic subscapularis tendon augmentation applied to cases of anterior shoulder instability with < 25% glenoid defect and ligament-labral failure. A total of 83 patients underwent Bankart repair with subscapularis tendon augmentation between 2015 and 2021. The range of movement of the patients was measured by 2 doctors using a goniometer. The Constant Murley score, American Shoulder and Elbow Surgeons score, Rowe score, and the University of California at Los Angeles scores were recorded preoperatively and postoperatively. Statistically significant increases were determined in the postoperative functional scores compared to the preoperative values as mean 41.4 ± 2.08 unit increase in the Constant Murley score, mean 41.4 ± 1.8 unit increase in the American Shoulder and Elbow Surgeons score, mean 13.8 ± 1.45 unit increase in the University of California at Los Angeles and mean 49.3 ± 7.45 unit increase in the Rowe score (P = .001; P < .01). Compared with the preoperative evaluation, there was found to be a postoperative statistically significant unit decrease of 10.2 ± 1.47 in the external rotation measurement (P = .001; P < .01). The number of dislocations was determined to have a negative correlation with the internal rotation measurements (r = -0.305; P = .005; P < .01), and a weak negative statistically significant relationship with external rotation measurements (r = -0.329; P = .002; P < .01). Unlike other techniques, as this repair technique includes both the tendon and the capsule as a single piece, it was seen to be a sufficient and reliable technique that is easy-to apply.

Oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative disease of the lumbar spine: a systematic review and meta-analysis

This meta-analysis compared the efficacy of oblique lumbar interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative diseases. A computer search for the published literature on OLIF and MIS-TLIF for the treatment of lumbar degenerative diseases in the PubMed, Web of Science, Embase, CINAHL, MEDLINE, Cochrane Library, and other databases was performed, from which 522 related articles were retrieved and 13 were finally included. Two reviewers independently extracted data from the included studies and analyzed them using RevMan 5.4. The quality of the studies was assessed using the Cochrane systematic analysis and the Newcastle–Ottawa scale. Meta-analysis showed that the blood loss [95% confidence intervals (CI) (− 121.01, − 54.56), P<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P<0.001$$\\end{document}], hospital stay [95% CI (− 1.98, − 0.85), P<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P<0.001$$\\end{document}], postoperative fusion rate [95%CI (1.04, 3.60), P=0.04\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.04$$\\end{document}], postoperative disc height [95% CI (0.50, 3.63), P=0.01\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.01$$\\end{document}], and postoperative foraminal height [95% CI (0.96, 4.13), P=0.002\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.002$$\\end{document}] were all better in the OLIF group; however, the complication rates were significantly lower in the MIS-TLIF group [95% CI (1.01, 2.06), P=0.04\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.04$$\\end{document}]. However, there were no significant differences between the two in terms of surgery time, patient satisfaction, or postoperative functional scores. The OLIF group had the advantages of lower blood loss, a shorter hospital stay, a higher postoperative fusion rate, and better recovery of the disc and foraminal heights, whereas MIS-TLIF had a relatively lower complication rate.

Postoperative residual vertical deviation affects quality of life in Asian patients with thyroid-associated ophthalmopathy (Graves ophthalmopathy).

To evaluate the treatment effect of strabismus surgery for Graves ophthalmopathy in an ethnic Chinese population. A prospective clinical study. Thirty-one patients with Graves ophthalmopathy who had undergone strabismus surgery at National Taiwan University Hospital between 2012 and 2013 were consecutively recruited. The subjective outcome was evaluated using the Graves' Ophthalmopathy Quality-of-Life (GO-QoL) questionnaire, and the ocular deviation was measured preoperatively and postoperatively by use of a prism cover test. The GO-QoL scores for visual functioning and appearance improved significantly after surgery (preoperative scores 32.6 ± 19.9 and 43.8 ± 26.4, postoperative scores 55.2 ± 24.4 and 54.1 ± 27.6, respectively; P < .05). Motor success was achieved in 61.3% of the patients, and their postoperative visual scores were higher (61.5 ± 22.5) than the scores of those who experienced motor failure (45.3 ± 26.8, P = .048). The postoperative visual function scores showed a negative correlation with the residual vertical deviation (R2 = 0.546, P = .040). A higher increase in GO-QoL visual scores and a lower residual vertical deviation in downgaze were achieved among patients without previous decompression surgery. Our surgical methods resulted in a motor success rate of 76.5% for the correction of vertical deviation. GO-QoL scores and ocular deviation improved significantly after strabismus surgery. Precise correction of vertical deviation was of greater importance than horizontal deviation for visual function scores. Our surgical methods were effective for the correction of vertical deviation in Graves ophthalmopathy.

The comparison of the Effect of double reverse traction repositor (DRTR) and traction table assisted Anterograde Intramedullary nail in treatment of femoral shaft fractures

ObjectiveThe objective of this study was to compare the clinical efficacy of DRTR (Double Reverse Traction Repositor, DRTR)and traction table in the treatment of femoral shaft fractures with the aid of AN-IMN (Antegrade intramedullary nailing).Patients and MethodsIn this study, patients with femoral shaft fractures admitted to the Department of Orthopedics at Zhaoqing First People’s Hospital from May 2018 to October 2022 were recruited. All patients were treated with anterograde intramedullary nailing, with 23 patients in the DRTR-assisted group and 21 patients in the traction table-assisted group. The demographic characteristics, fracture classification, intraoperative data, postoperative data, and prognostic indicators of the two groups were recorded and analyzed retrospectively. All procedures were performed by the same team of experienced physicians.ResultsAll the patients in the two groups were followed up for more than 12 months. Both traction methods could provide stable traction for the operator during AN-IMN, and there was no significant difference in demographic characteristics and fracture classification. The intraoperative fluoroscopy times and opening reduction rate of the DRTR group were lower than those of the traction table group (P < 0.05), and the postoperative Harris Hip Score, as well as the Lyshol Lysholm knee function Score of the DRTR group, were significantly higher than the traction table group members (P < 0.05). Postoperative complications such as perineal soft tissue injury and lateral femoral cutaneous nerve injury occurred in the traction table group, but not in the DRTR group.ConclusionDRTR can safely and effectively provide continuous and stable traction in the femoral shaft fractures surgery, and outperforms the traction table in the number of intraoperative fluoroscopy, opening reduction rate, reduction of complications, and postoperative joint function score.

Association Between Preoperative Multidimensional Psychological Distress and Physical Function After Surgery for Sports-Related Injury.

Psychological distress after orthopaedic surgery can lead to worse outcomes, including higher levels of disability and pain and lower quality of life. The 10-item Optimal Screening for Prediction for Referral and Outcome-Yellow Flag (OSPRO-YF) survey screens for multiple psychological constructs relevant to recovery from orthopaedic injury and may be useful to preoperatively identify patients who may require further psychological assessment and possible intervention after surgery. To determine the association between the OSPRO-YF and physiological patient-reported outcomes (PROs). It was hypothesized that higher OSPRO-YF scores (indicating worse psychological distress) would be associated with worse PRO scores at time of return to sport. Case series; Level of evidence, 4. This study evaluated 107 patients at a single, academic health center who were assessed at a sports orthopaedics clinic and ultimately treated surgically for injuries to the knee, shoulder, foot, or ankle. Preoperatively, patients completed the OSPRO-YF survey as well as the following PRO measures: Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, numeric rating scale for pain; American Shoulder and Elbow Surgeons standardized shoulder assessment form for patients with shoulder injuries, the International Knee Documentation Committee score (for patients with knee injuries), and the Foot and Ankle Ability Measure (FAAM; for patients with foot or ankle injuries). At the time of anticipated full recovery and/or return to sport, patients again completed the same PRO surveys. Multivariable regression was used to evaluate the association between total OSPRO-YF score at baseline and PRO scores at the time of functional recovery. The baseline OSPRO-YF score predicted postoperative PROMIS Physical Function and FAAM Sports scores only. A 1-unit increase in the OSPRO-YF was associated with a 0.55-point reduction in PROMIS Physical Function (95% CI, -1.05 to -0.04; P = .033) indicating worse outcomes. Among patients who underwent ankle surgery, a 1-unit increase in OSPRO-YF was associated with a 6.45-point reduction in FAAM Sports (95% CI, -12.0 to -0.87; P = .023). The study findings demonstrated that the OSPRO-YF survey predicts certain long-term PRO scores at the time of expected return to sport, independent of baseline scores.

MP73-17 WHOLE GLAND ABLATION USING HIGH-INTENSITY FOCUSED ULTRASOUND VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE-MATCHED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP73-17 WHOLE GLAND ABLATION USING HIGH-INTENSITY FOCUSED ULTRASOUND VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE-MATCHED STUDY Jin Noh, Gyoohwan Jung, Hae Sung Lee, Jun Hyun Nam, Jung Kwon Kim, Sangchul Lee, Seong Jin Jeong, Jong Jin Oh, Seok-Soo Byun, Sung Kyu Hong, and Hakmin Lee Jin NohJin Noh More articles by this author , Gyoohwan JungGyoohwan Jung More articles by this author , Hae Sung LeeHae Sung Lee More articles by this author , Jun Hyun NamJun Hyun Nam More articles by this author , Jung Kwon KimJung Kwon Kim More articles by this author , Sangchul LeeSangchul Lee More articles by this author , Seong Jin JeongSeong Jin Jeong More articles by this author , Jong Jin OhJong Jin Oh More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , and Hakmin LeeHakmin Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We compared the clinical outcomes of robot-assisted radical prostatectomy (RARP) and whole gland ablation (WGA) using high-intensity focused ultrasound (HIFU) in localized prostate cancer. METHODS: We analyzed 3,806 patients who had undergone RARP and WGA using HIFU. According to the propensity score for each treatment, 84 patients after WGA were matched to 3,722 patients after RARP at a 1:4 ratio using the nearest neighbor method. RESULTS: The matched cohort comprised 420 subjects (RARP, 336; PGA, 84), with a median follow-up period of 26 months. Treatment failures were identified in 16.7% and 15.5% of patients in the WGA and RARP groups, respectively. Kaplan-Meier analyses revealed no significantly failure-free (p=0.999) and salvage-free survival (p=0.548) in the RARP group than in the WGA group. There was no significant difference in the postoperative urinary symptom score (p=0.630), but the postoperative erectile function score in group of preoperative international index of erectile function (IIEF)≥17 was significantly higher in the WGA group (p=0.030). The rate of urinary incontinence (any pad) was lower in the WGA group than that in the RARP group (10.7% vs 20.2%, p=0.057). Postoperative complications were more frequent in the WGA group (p<0.001); however, there was no significant difference in high-grade complications (≥3) (p=0.201). CONCLUSIONS: WGA using HIFU showed statistically similar oncological outcomes compared with RARP for failure-free survival and salvage-free survival. However, functional outcomes regarding erectile function in selective group and postoperative incontinence were more favorable in the WGA group. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1042 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin Noh More articles by this author Gyoohwan Jung More articles by this author Hae Sung Lee More articles by this author Jun Hyun Nam More articles by this author Jung Kwon Kim More articles by this author Sangchul Lee More articles by this author Seong Jin Jeong More articles by this author Jong Jin Oh More articles by this author Seok-Soo Byun More articles by this author Sung Kyu Hong More articles by this author Hakmin Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

The Barn Doors Greenstick Fracture-A New 3D Geometry for Common Osteotomies in Rhinoplasty: The First 50 Patients with 1-Year Follow-up.

The "barn doors greenstick fracture" is a new concept that includes three contiguous greenstick fractures: one in the central compartment of the nasal dorsum (nasal bones) and two on the lateral walls of the bony nasal pyramid. The present study aimed to describe this new concept and to report the first esthetical and functional outcomes. This prospective, interventional, and longitudinal study was performed on 50 consecutive patients undergoing primary rhinoplasty by spare roof technique B. The validated Portuguese version of the Utrecht questionnaire (UQ) for outcome assessment in esthetic rhinoplasty was utilized. Each patient answered the questionnaire online before surgery and 3 and 12 months after surgery. In addition, a visual analog scale (VAS) was used to score nasal patency for both sides. The patients also answered three questions (yes or no): (1) "Do you feel any step on your nasal dorsum?" if yes: (2) "Is that step visible?" (3) "Does it bother you?"A statistically significant improvement in UQ scores postsurgery was found, demonstrating a high satisfaction index in this patient population. Additionally, the preoperative and postoperative mean functional VAS scores showed a significant and consistent improvement on both sides (right and left). Twelve months after surgery, a step at the nasal dorsum was felt by 10% of the patients, but it was visible just in 4%, which were two females with thin skin.The barn doors greenstick concept provides a new approach to achieve a real and sustainable smooth transition in the dorsal and lateral walls. The association of the two lateral greensticks and the already described subdorsal osteotomy allows a real greenstick segment in the most critical esthetic region of the bony vault-the root of the nasal pyramid.

Long-term efficacy of penile rehabilitation with low-intensity extracorporeal shock wave therapy for sexual and erectile function recovery following robotic-assisted radical prostatectomy: a single-cohort pilot study.

The long-term efficacy of low-intensity extracorporeal shock wave therapy (LIESWT) for penile rehabilitation after robot-assisted radical prostatectomy (RARP) has not yet been reported. To assess the long-term efficacy of LIESWT for penile rehabilitation after RARP by evaluating the postoperative recovery of sexual and erectile functions following RARP. Patients who underwent RARP at our institution were categorized into 2 groups: those who received LIESWT and those who underwent penile rehabilitation with a phosphodiesterase type 5 inhibitor (PDE5i). The control group included patients who did not undergo penile rehabilitation. Potency and scores on the Expanded Prostate Cancer Index Composite for sexual function and 5-item International Index of Erectile Function (IIEF-5) were evaluated preoperatively and over 60months after RARP. The LIESWT group had significantly higher postoperative sexual function and total IIEF-5 scores and potency than the control group over the long term, and its results were not inferior to those of the PDE5i group. The LIESWT, PDE5i, and control groups comprised 16, 13, and 139 patients, respectively. As compared with the control group, the LIESWT group had significantly higher sexual function scores at 6, 12, and 60 months after surgery (P < .05) and total IIEF-5 scores at 24 and 60 months (P < .05). The LIESWT group also had a significantly higher potency rate than the control group at 60months (P < .05). For all time points after surgery, there were no significant differences between the LIESWT and PDE5i groups in terms of sexual function and total IIEF-5 scores and potency. LIESWT may be a new option for penile rehabilitation in patients with erectile dysfunction after RARP. This pilot study was performed at a single center and involved relatively few patients, which may have led to selection bias. Furthermore, the selection of this study for penile rehabilitation was not made randomly but by the patient's choice. Despite these limitations, our results provide evidence in support of LIESWT for penile rehabilitation after RARP because this is the first study to assess the long-term efficacy of LIESWT. LIESWT can improve sexual and erectile functions in patients with erectile dysfunction after RARP, and its efficacy can be maintained over a long period after surgery.

Patient-reported Outcomes of Revision Ankle Open Reduction Internal Fixation

Ankle fractures may require revision surgery for malunion or suboptimal joint congruence results after initial surgical or nonsurgical treatment. There is limited literature on the outcomes of patients undergoing such revision surgery for ankle fracture malunion. In this retrospective case series, we determined clinical and functional outcomes of revision ankle open reduction internal fixation (ORIF) for 7 patients with ankle fracture malunion through patient-reported and radiographic outcomes. Patient-reported Outcomes Measurement Information System physical function and pain interference scores prerevision and postrevision procedure were obtained from 7 patients treated from January 2017 to October 2020. Postoperative complications including persistent pain, infection, hardware removal, hardware failure, and conversion to ankle arthrodesis were analyzed. Seven patients who underwent revision ORIF surgery for ankle fracture malunion between January 2017 and October 2020 were included. The average age was 46.3 12.2 years old; 85.7% of the patients were female; 14.3% were male. The average amount of time between revision ORIF procedure and collection of postoperative Patient-Reported Outcomes Measurement Information System scores was 19.3±5.9 months. Each of the 7 patients showed an increase in physical function after revision surgery (average preoperative physical function score: 30.7; average postoperative physical function score: 48.9). All patients showed a decrease in pain after revision surgery (average preoperative pain interference score: 64.8; average postoperative pain interference score: 55.7). Of the 7 participants who underwent revision ORIF, a majority did not experience any complications at least 1 year postprocedure, including infection, reoperation, or hardware removal. One participant underwent hardware removal for persistent pain and developed overlying cellulitis. For patients with ankle fracture malunion without significant post-traumatic degenerative changes of the ankle joint, revision ankle ORIF can be an effective method for improving physical function, decreasing pain, and preserving ankle joint motion. Level of Evidence: Level IV—case series.

Early surgical outcomes and influencing factors of high tibial osteotomy.

To investigate the influencing factors of functional recovery after high tibial osteotomy (HTO). A retrospective research was carried on 98 patients who underwent HTO between January 2018 and December 2020. In each case, the medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), femoral tibial angle (FTA), hip-knee-ankle (HKA), weight bearing line (WBL) ratio of the knee joint, opening gap, opening angle, American knee society knee score (KSS), US Hospital for Special Surgery (HSS) score, Lysholm score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured to determine postoperative function and influential factors of pain through logistic regression analysis. The follow-up time was between 18 and 42 months after operation with an average of 27.66 ± 12.9 per month. Overall functional scores were significantly improved. The influencing factors that may affect the postoperative effect of HTO include age and preoperative WBL ratio of the knee joint (WBL%). After incorporating these two factors into the multivariate logistic regression analysis, for every 1 unit increase in the preoperative WBL%, the probability of postoperative HSS being superior is 1.06 times higher than before [Exp(β): 1.062, 95% CI: 1.01-1.1, p = 0.018]. For every year increase in age, the probability of an excellent HSS score after surgery was 0.84 times higher than that before surgery [Exp(β): 0.843, 95% CI: 0.718-0.989, p = 0.036]. Preoperative WBL% ≥ 14.37 was 17.4 times more likely to be rated as excellent postoperative HSS than that <14.37 [Exp(β): 17.406, 95% CI: 1.621-186.927, p = 0.018]. The postoperative functional scores of the patients significantly improved. Patients with preoperative WBL% ≥ 14.37% had better function after surgery.

Tibiotalar and Tibiotalocalcaneal Arthrodesis with Paragon28 SilverbackTM Plating System in Patients with Severe Ankle and Hindfoot Deformity

The treatment of end-stage ankle osteoarthritis (OA) and associated hindfoot deformities remains a major challenge for orthopedic surgeons. Numerous techniques and surgical approaches have been proposed for tibiotalar (TT) and tibiotalocalcaneal (TTC) arthrodesis, from arthroscopic to open, as well as numerous devices proposed for internal fixation (retrograde intramedullary nails, cannulated screws, and plating systems). The aim of this study was to retrospectively analyze the results, with at least 18 months of follow-up, with SilverbackTM TT/TTC Plating System Paragon28 in a group of 20 patients with severe OA and hindfoot deformities (mainly secondary post-traumatic OA). The demographic characteristics and past medical history of the patients were collected and analyzed to identify the cause of the pathology. The degree of OA and deformity were quantified based on foot and ankle weight-bearing radiography and CT examination. Pre- and post-operative clinical and functional scores (ROM, VAS, AOFAS, FFI, and SF-36) and radiographic parameters (anterior distal tibial angle, tibiotalar angle, coronal tibiotalar angle, and hindfoot alignment angle) were evaluated. All of the patients showed clinical and radiographic fusion at an average of 14 weeks (range 12-48), with improvement in pain and functional scores, without major surgical complications and/or infections. Despite the limitations of our study, the results with this new plating system showed good results in terms of bone consolidation, post-operative complications, and improvement of pain and quality of life in patients with severe OA and deformities of the ankle and hindfoot.

Prior Meniscectomy in Patients Undergoing Primary Total Knee Arthroplasty is Associated With Worse Short-Term Outcomes

BackgroundPatients undergoing total knee arthroplasty (TKA) who have prior meniscectomy may have increased rates of postoperative infection, arthrofibrosis, and revision. However, aside from an increased risk of complications, it is unclear whether prior meniscectomy impacts functional outcomes after TKA. This study was conducted to compare functional outcomes following TKA in patients who did and did not have a prior meniscectomy. We hypothesized that patients who had a prior ipsilateral meniscectomy would have worse functional outcomes after undergoing TKA. MethodsA retrospective matched case-control study was conducted at a tertiary academic center. Patients who underwent both meniscectomy and TKA (cases) or TKA alone (controls) from 2013 to 2020 were identified from our institutional database using current procedural terminology codes. Cases were matched in a 1:3 ratio to controls using age, sex, race, body mass index, and a comorbidity index. Inclusion criteria comprised a minimum of 1-year follow-up for the Knee Injury and Osteoarthritis Outcome Score Junior (KOOS-JR). Exclusion criteria included patients undergoing revision TKA and patients who had a history of ligamentous knee surgery or fracture. T- and Chi-squared analyses were conducted, with significance threshold being P < .05. A total of 589 cases and 1,767 controls were included after matching. There were no significant differences in demographic variables. Cases underwent TKA after their meniscectomy at a mean of 2.9 years (range: 42 days to 16 years). ResultsWhile no significant difference existed for preoperative KOOS-JR scores (46.4 versus 46.4; P = .984), postoperative KOOS-JR scores were significantly lower in the case group (71.9 versus 75.3; P = .001). The case group also achieved the KOOS-JR minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) at significantly lower rates than the control group [(MCID: 71.0 versus 77.3%; P = .011) (PASS: 69.4 versus 76.7%; P = .001);]. ConclusionPatients who had a prior meniscectomy may experience lower postoperative functional outcome scores after TKA and had a lower rate of achieving the MCID and PASS for KOOS-JR. Patient expectations should be adjusted accordingly.