Postoperative Radiographic Parameters Research Articles

Comparison of Robot-Assisted Percutaneous Cannulated Screws Versus Open Reduction and Internal Fixation in Calcaneal Fractures.

Accurate placement of the screws is challenging in percutaneous cannulated screw fixation of calcaneal fractures, and robot-assisted (RA) surgery enhances the accuracy. We investigated the outcome of percutaneous cannulated screw fixation of Sander's type II and III calcaneal fractures. This retrospective study analyzed clinical data of 26 patients with fresh closed calcaneal fractures (28 fractures) who were admitted to our center from January 2022 to July 2022. All fractures were divided into the RA group and the open reduction and internal fixation (ORIF) group according to the surgeries performed. RA surgery was performed by closed reduction or open reduction combined with a tarsal sinus approach. Age, sex, operation time, preoperative waiting time, length of postoperative hospital stay, wound complications, and American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS) at 3 months postoperatively were compared. Preoperative and postoperative radiographic parameters (calcaneal length, width, height, Böhler angle, and fixation rate of the sustentaculum tali) were documented. The chi-square test, one-way analysis of variance, and Wilcoxon test were used for the comparison of categorical, normally distributed, and nonnormally distributed continuous variables, respectively. The calcaneal width, height, and Böhler angle were significantly corrected postoperatively in both groups. The postoperative calcaneal lengths in both groups were also corrected. However, no significant difference was found. No significant differences in calcaneal length, width, height, and Böhler angle were observed between the two groups. The operation time (p < 0.001), preoperative waiting time (p < 0.001), and length of postoperative hospital stay (p=0.003) in the RA surgery group were significantly shorter than those in the ORIF group. The fixation rate of the sustentaculum tali (p < 0.001) in the RA surgery group was significantly superior to that in the ORIF group. All wound complications occurred in the ORIF group. All fractures healed within 3 months. The AOFAS scores at 3 months postoperatively were not significantly different. RA percutaneous screw fixation of the calcaneal fracture is a safe, effective, rapid, and minimally invasive surgical option for surgeons.

Clinical effect of Corail femoral prosthesis with different offset in total hip arthroplasty

To explore the early clinical efficacy of primary total hip arthroplasty(THA) with Corail standard stems (KS type) and high offset stems (KHO type), by analyzing the postoperative radiographic parameters of different offset of femoral components with Corail stem which has a neck-shaft angle of 135 ° in unilateral primary THA, by comparing the measurement results on both sides and analyzing the reconstruction of the postoperative femoral offset and the hip joint function recovery. A retrospective analysis was made of 186 patients with unilateral hip joint lesions who underwent the first total hip arthroplasty with Johnson & Johnson Corail prostheses from January 2015 to June 2017. According to the use of femoral prostheses with different eccentricities during the operation, the patients were divided into high eccentricity group and standard eccentricity group. In the high eccentricity group, there were 52 cases of Corail high eccentricity prosthesis(KHO type), including 20 females and 32 males;aged 21 to 71 years old with an average of(50.6±13.2) years;body mass index(BMI) was (26.0±4.1) kg/m2. The standard eccentricity group included 134 Corail standard femoral stem prostheses(KS type), 57 females and 77 males;aged 18 to 77 years old with an average of (47.3±14.0) years;BMI was (25.3±3.5) kg/m2. The abduction arm, femoral eccentricity, acetabular eccentricity and the length difference of lower limbs were measured on the postoperatively positive X-ray film of the hip joint. Harris score and related complications were recorded before and after the operation, and the stability of the prosthesis was analyzed. There were significant differences in femoral eccentricity, joint eccentricity and abduction arm between the affected side and the healthy side in the high eccentricity group(P<0.05). There were significant differences in femoral eccentricity and acetabular eccentricity between the affected side and the healthy side in the standard eccentricity group(P<0.05). There were significant differences in combined eccentricity, abduction arm and length of lower limbs between two groups(P<0.05). In the high eccentricity group, the abduction arm of the affected hip joint was positively correlated with the femoral eccentricity, acetabular eccentricity and joint eccentricity(r=0.633, P<0.001;r=0.384, P=0.005;r=0.690, P<0.001). The same results were also obtained in the healthy side(r=0.688, P<0.001;r=0.574, P<0.001;r=0.765, P<0.001). In the standard eccentricity group, the abduction arm of the affected hip joint was positively correlated with the femoral eccentricity, acetabular eccentricity and combined eccentricity(r=0.734, P<0.001;r=0.418, P<0.001;r=0.749, P<0.001). The same results were also obtained in the healthy side(r=0.775, P<0.001;r=0.397, P<0.001;r=0.773, P<0.001). The difference of the length of both lower limbs was significantly correlated with the difference of bilateral joint eccentricity and bilateral abduction arm (r=0.376, P=0.006;r=-0.346, P=0.012). There was no significant correlation between the difference of the length of both lower limbs and the difference of bilateral joint eccentricity and bilateral abduction arm (r=-0.009, P=0.919;r=-0.036, P=0.682). There was no significant difference in Harris score between two groups at the last follow-up(P>0.05). At the last follow-up, Trendelenburg was negative in all patients in both groups, and the prostheses were stable. Both Corail standard stem and high offset stem may be effectively reconstruct the femoral offset, reconstruct the anatomical structure and biomechanics of the hip joint, and maintain the length of lower limbs and the stability of the hip joint in the unilateral primary total hip arthroplasty. Although the offset of the femur was not reconstructed normally in some cases, the stability of the components and postoperative function were not affected.

Efficacy of Anterior Cervical Discectomy and Fusion for Female Patients with Hirayama Disease

To compare the preoperative and postoperative hand function and radiographic parameters in female patients with HD. Consecutive female patients with HD undergoing anterior cervical discectomy and fusion were followed-up. The postoperative hand functional data were obtained from the last follow-up, while the postoperative radiographic data were obtained from the examinations in 3- or 6-month follow-up after surgical treatments. The preoperative and postoperative data of hand functional and radiographic assessments were collected and compared between them. Logistic regression analysis was used to clear potential risk factors for surgical treatment. In all, 15 female patients with HD were included in the follow-up study over 9 years. Significant differences were found in total scores (P<0.001) and all five dimensions, including function (P=0.003), activities of daily life (P=0.002), work (P=0.003), satisfaction (P=0.002), appearance (P=0.005), and HD-specific hand symptoms (P=0.001) in hand functional assessment. The comparison of C2-7 Cobb angle was statistically different (P=0.042) in radiographic assessments. The course of illness was of marginal significance (P=0.065) with curative effect of surgical treatment in logistic regression analysis. Anterior cervical discectomy and fusion was an effective way to treat female patients with HD, and the course of illness may be correlated with the efficacy of surgery. For some female patients with HD with a clear diagnosis, early surgical treatment is worthy of clinical consideration.

Can immediate postoperative radiographs predict outcomes in pediatric clubfoot?

The goal of treatment for pediatric idiopathic clubfoot is to enable the patient to comfortably walk on his or her soles without pain. However, currently accepted treatment protocols are not always successful. Based on the abnormal bone alignment reported in this disease, some studies have noted a correlation between radiographic characteristics and outcome, but this correlation remains debated. To assess the correlation between immediately postoperative radiographic parameters and functional outcomes and to identify which best predicts functional outcome. To predict the outcome and prevent early failure of the Ponseti's method, we used a simple radiographic method to predict outcome. Our study included newborns with idiopathic clubfoot treated with Ponseti's protocol from November 2018 to August 2022. After Achilles tenotomy and a long leg cast were applied, the surgeon obtained a single lateral radiograph. Radiographic parameters included the tibiocalcaneal angle (TiCal), talocalcaneal angle (TaCal), talofirst metatarsal angle (Ta1st) and tibiotalar angle (TiTa). During the follow-up period, the Dimeglio score and functional score were examined 1 year after surgery. Additionally, recurring events were reported. The correlation between functional score and radiographic characteristics was analyzed using sample and multiple logistic regression, and the optimal predictor was also identified. In total, 54 feet received approximately 8 manipulations of casting and Achilles tenotomy at a mean age of 149 days. The average TiCal, TaCal, Ta1st, and TiTa angles were 75.24, 28.96, 7.61, and 107.31 degrees, respectively. After 12 mo of follow up, we found 66% excellent-to-good and 33.3% fair-to-poor functional outcomes. The Dimeglio score significantly worsened in the poor outcome group (P value < 0.001). Tical and TaCal showed significant differences between each functional outcome (P value < 0.05), and the TiCal strongly correlated with outcome, with a smaller angle indicating a better outcome, each 1 degree decrease improved the functional outcome by 10 percent. The diagnostic test revealed that a TiCal angle of 70 degrees predicts an inferior functional outcome. The TiCal, derived from lateral radiographs immediately after Achilles tenotomy, can predict functional outcome at 1 year postoperatively, justifying its use for screening patients who need very close follow-up.

Focusing on the amount of immediate changes in spinopelvic radiographic parameters to predict the amount of mid-term improvement of quality of life in adult degenerative scoliosis patients with surgery

IntroductionSurgery is still an effective treatment option for adult degenerative scoliosis (ADS), but how to predict patients’ significant amount of the improvement in quality of life remains unclear. The previous studies included an inhomogeneous population. This study aimed to report the results about concentrating on the amount of immediate changes in spinopelvic radiographic parameters to predict the amount of mid-term improvement in quality of life in ADS patients.Materials and methodsPre-operative and immediately post-operative radiographic parameters included Cobb angle, coronal vertical axis (CVA), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI) and LL/PI matching (PI–LL). Quality of life scores were evaluated pre-operatively and at the final follow-up using Oswestry Disability Index (ODI) and visual analogue scale (VAS). The amount of immediate changes in spinopelvic radiographic parameters (Δ) and the amount of mid-term improvement in quality of life (Δ) were defined, respectively.ResultsPatients showed significant change in radiographic parameters, ODI and VAS pre- and post-surgery, except CVA and PI. Univariate analysis showed a significant correlation between ΔTK, ΔLL, ΔCVA and the amount of mid-term improvement in quality of life, but multivariate analysis did not get a significant result. Univariate and multivariate analyses showed that ΔSVA was still a significant predictor of ΔVAS and ΔODI. The changes in the other radiographic parameters were not significant. The equations were developed by linear regression: ΔODI = 0.162 × ΔSVA − 21.592, ΔVAS = 0.034 × ΔSVA − 2.828. In the ROC curve for ΔSVA in the detection of a strong ΔODI or ΔVAS, the cut-off value of ΔSVA was − 19.855 mm and − 15.405 mm, respectively.ConclusionsThis study shows that ΔSVA can predict the amount of mid-term improvement in quality of life in ADS patients. The changes in the other radiographic parameters were not significant. Two equations were yielded to estimate ΔODI and ΔVAS. ΔSVA has respective cut-off value to predict ΔODI and ΔVAS.

Comparison of customized 3D-printed prosthesis and screw-rod-cage system reconstruction following resection of periacetabular tumors.

Background and purposeVarious operative methods are used for reconstructing pelvic girdle after resection of primary malignant periacetabular tumor has been reported. The objective of this study was to evaluate the accuracy, effectiveness, and safety of customized three dimensional-printed prosthesis (3DP) in the reconstruction of bone defects compared with conventional reconstruction using the screw-rod-cage system.MethodsA retrospective case–control analysis of 40 patients who underwent pelvic tumor resection and reconstruction with a customized 3D-printed prosthesis (3DP), or screw-rod-cage system (SRCS) between January 2010 and December 2019 was performed. The minimum follow-up time for patients alive was 2 years. Blood loss, operation time, complications, surgical margin, local recurrence, distant metastases, status at time of latest follow-up, MSTS-93 score, Harris hip score, and postoperative radiographic parameters were recorded. Moreover, overall survival, tumor-free survival, and prosthesis survival rates in both groups were compared.ResultsCustomized 3DP reconstruction was performed in 15 patients, and SRCS reconstruction was done in 25 patients. The group of patients treated with customized 3DP reconstruction had significantly shorter operation time (323.7 ± 83.7 vs. 393.6 ± 98.8 min; P = 0.028) and more precise (all P < 0.05) radiographic reconstruction parameters than patients in the SRCS group. Fewer complications (P = 0.026), better MSTS score (P = 0.030), and better Harris hip score (P = 0.016) were achieved in the 3DP group. Furthermore, the survival rate of prosthesis was also significantly better in the 3DP group (P = 0.039). However, blood loss, surgical margin, local recurrence, distant metastases, and status at time of latest follow-up had no significant difference between two groups.ConclusionCompared with the screw-rod-cage system reconstruction, the customized 3D-printed prosthesis reconstruction is equally safe and effective, but it is more accurate and time-saving and is associated with fewer complications.

Comparison of Radiographic and Clinical Outcomes of First Tarsometatarsal Arthrodesis with the Lapiplasty System vs Cross-Screw Fixation

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Hallux valgus (HV) is recognized as a triplanar deformity comprising axial abduction, sagittal hypermobility, and coronal pronation of the first metatarsal. A first tarsometatarsal (TMT) arthrodesis may be used to address all three planes of deformity. The Lapiplasty system (Treace Medical Concepts, Inc., Ponte Vedra, FL) was developed to reproducibly address triplanar deformity. However, the Lapiplasty system is costlier than other fixation constructs. Because healthcare is increasingly value-focused, we sought to determine if the more expensive Lapiplasty system improved radiographic outcomes or decreased complication rates over standard cross-screw fixation. We hypothesized that HV patients undergoing first TMT arthrodesis with the Lapiplasty system would have equivalent radiographic correction and similar complication rates when compared to patients treated with cross-screw fixation. Methods: In this multi-center, IRB-approved retrospective study, consecutive series of patients who underwent 1st TMT arthrodesis for HV, either with cross-screw fixation at Institution A, or Lapiplasty at Institution B, were identified by registry search. Inclusion criteria included age over 18 and preoperative and minimum 6-month postoperative weight-bearing AP and lateral radiographs. Exclusion criteria included primary conditions other than hallux valgus and previous first ray surgeries or ipsilateral arthrodeses. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and tibial sesamoid position (TSP) were measured preoperatively and at final follow-up, and clinic notes were reviewed to identify complications and reoperations. To compare cohorts, Mann-Whitney U tests and Fisher's Exact tests were applied for continuous and discrete variables, respectively. To examine preoperative-postoperative changes, Wilcoxon signed rank tests were used. Multivariable regressions tested the effect of fixation constructs on postoperative radiographic parameters, adjusted for preoperative radiographic measurements, age, sex, and BMI. Results: 65 patients were included in each group, with 121 (93.8%) female patients, mean (SD) age 54.7 (14.8), BMI 25.8 (5.2), and radiographic follow-up time 8.9 (6.7) months. The Lapiplasty cohort had greater BMI (26.8 vs. 24.7, P = .048), and there were no significant differences between groups in age, sex distribution, and radiographic follow-up time. Radiographic measurement data is displayed in Table 1. After adjusting for age, sex, BMI, preoperative HVA, and preoperative IMA, fixation with Lapiplasty was significantly associated with lower postoperative IMA (b=-2.03, 95% CI = [-2.78, -1.37], P &lt; .001) and lower postoperative HVA (b= -7.48; 95% CI = [-9.69, -5.26]; P &lt; .001), but not postoperative sesamoid position. There were no significant differences between cohorts in the incidence of complications or reoperations. Conclusion: We found that use of the Lapiplasty system was associated with better radiographic hallux valgus correction, as evidenced by lower postoperative HVAs and IMAs, compared to standard technique with crossing screws. The clinical significance of these findings is unclear, as complication and reoperation rates were similar between groups. Future research assessing longer- term outcomes, patient-reported outcome data, and cost-benefit analysis will be necessary to further compare techniques and fixation systems.

Clinical Outcomes and Complications of Corrective Fusion Surgery Down to L4, L5, and the Pelvis for Adult Scoliosis in Patients Younger than 50 Years.

Corrective fusion for adult scoliosis often requires fusion from the thoracic spine to the lower lumbar spine or pelvis. However, it is often difficult to determine the lowest instrumented vertebrae (LIV), especially in younger patients. The purpose of this study was to summarize the clinical outcomes and revision surgery rates after corrective fusion for adult scoliosis at different LIV levels in patients under 50 years of age. We retrospectively analyzed 25 patients with adult scoliosis (mean age, 38 years; mean follow-up, 65 months) who underwent corrective fusion from the thoracic spine to L4, L5, or pelvis between 2010 and 2018. Preoperative and at least 2 years' postoperative radiographic parameters, patient-reported outcomes (Scoliosis Research Society-22r [SRS-22r]), mechanical complications, and revision surgery were investigated, and comparisons were made between two groups: the L4 and L5 (L) group (n=14) and the pelvic group (n=11). Both groups showed a significant improvement in the SRS-22r domains of Self-image and Subtotal postoperatively compared with the baseline (P<0.05). The incidence of rod fracture was significantly higher in the pelvic group (5 patients, 45%) than in the L group (0 patients, 0%) (P=0.001). In addition, revision surgery was performed five times in 4 patients (36%) in the pelvic group compared with 0 in the L group (P=0.068). In the L group, clinical outcomes improved in the medium term, with no patients requiring revision surgery. In the pelvic group, the rod fracture rate was higher, but the clinical outcomes improved.

Predicting the Magnitude of Distal Junctional Kyphosis Following Cervical Deformity Correction.

Retrospective review of a cervical deformity database. This study aimed to develop a model that can predict the postoperative distal junctional kyphosis angle (DJKA) using preoperative and postoperative radiographic measurements. Distal junctional kyphosis (DJK) is a complication following cervical deformity correction that can reduce of patient quality of life and functional status. Although researchers have identified the risk factors for DJK, no model has been proposed to predict the magnitude of DJK. The DJKA was defined as the Cobb angle from the lower instrumented vertebra (LIV) to LIV-2 with traditional DJK having a DJKA change >10°. Models were trained using 66.6% of the randomly selected patients and validated in the remaining 33.3%. Preoperative and postoperative radiographic parameters associated with DJK were identified and ranked using a conditional variable importance table. Linear regression models were developed using the factors most strongly associated with postoperative DJKA. A total of 131 patients were included with a mean follow-up duration of 14±8 months. The mean postoperative DJKA was 14.6±14° and occurred in 35% of the patients. No significant differences between the training and validation cohort were observed. The variables most associated with postoperative DJK were: preoperative DJKA (DJKApre), postoperative C2-LIV, and change in cervical lordosis (∆CL). The model identified the following equation as predictive of DJKA: DJKA=9.365+(0.123×∆CL)-(0.315×∆C2-LIV)-(0.054×DJKApre). The predicted and actual postoperative DJKA values were highly correlated ( R =0.871, R2 =0.759, P <0.001). The variables that most increased the DJKA were the preoperative DJKA, postoperative alignment within the construct, and change in cervical lordosis. Future studies can build upon the model developed to be applied in a clinical setting when planning for cervical deformity correction.

Patellofemoral Joint after Opening Wedge High Tibial Osteotomy: A Comparative Study of Uniplane versus Biplane Osteotomies.

ObjectiveTo the best of our knowledge, there has been no comparative study of changes in radiographic parameters in the sagittal plane between biplane opening wedge high tibial osteotomy (OWHTO) with plate fixation and uniplane OWHTO with spacer implantation. The aim of the study was to compare sagittal radiographs between the procedures of biplane and uniplane OWHTOs in patients with genu varum and to investigate the impact on the patellofemoral joint.MethodsA retrospective study of 71 patients (58.0 ± 5.0 years of age, 58 females and 13 males) with varus‐aligned medial compartment knee osteoarthritis treated with OWHTO was performed during the period from January 2016 to February 2019. Thirty‐three patients underwent biplane osteotomy with plate fixation (biplane group), and 38 patients underwent uniplane osteotomy with absorbable wedged spacer fixation (uniplane group). Independent t tests were used to compare the two groups according to the preoperative and postoperative radiographic parameters of hip‐knee‐ankle (HKA) angle, posterior tibial slope (PTS), tibial tubercle prominence (TTP), Caton–Deschamps (CD) index, and Blackburne–Peel (BP) index. During the last follow‐up assessment, patients were asked to rate their patellofemoral joint status using the Samsung Medical Center (SMC) patellofemoral (PF) scoring system. The visual analog scale (VAS) was also used to rate knee joint pain when walking.ResultsThere was no significant difference between the two groups in any of the demographic, clinical, or radiological characteristics at baseline (p > 0.05). Comparisons of postoperative sagittal radiographic parameters between patients in the uniplane group and patients in the biplane group showed significant differences in the PTS (13.4° vs 16.6°, t = 4.465, p < 0.001), TTP (9.0 mm vs 4.2 mm, t = 7.950, p < 0.001), and CD index (0.81 vs 0.70, t = 4.035, p < 0.001). At the final follow‐up assessment (minimum, 2 years), the SMC PF function score was significantly lower in patients in the uniplane group than in patients in the biplane group (27.8 vs. 32.1, t = 2.458, p = 0.016), but there were no significant differences in the SMC PF pain score or VAS score (p > 0.05).ConclusionThe essential difference in the postoperative sagittal radiographic changes between biplane and uniplane OWHTO was the tibial tubercle prominence, indicating the posterior displacement of the tibial tubercle. Uniplane OWHTO may yield better function of the patellofemoral joint compared to biplane OWHTO.

Six Commonly Used Postoperative Radiographic Alignment Parameters Do Not Predict Clinical Outcome Scores after Unrestricted Caliper-Verified Kinematically Aligned TKA.

Background: Unrestricted caliper-verified kinematically aligned (KA) TKA restores patient’s prearthritic coronal and sagittal alignments, which have a wide range containing outliers that concern the surgeon practicing mechanical alignment (MA). Therefore, knowing which radiographic parameters are associated with dissatisfaction could help a surgeon decide whether to rely on them as criteria for revising an unhappy patient with a primary KA TKA using MA principles. Hence, we determined whether the femoral mechanical angle (FMA), hip–knee–ankle angle (HKAA), tibial mechanical angle (TMA), tibial slope angle (TSA), and the indicators of patellofemoral tracking, including patella tilt angle (PTA) and the lateral undercoverage of the trochlear resection (LUCTR), are associated with clinical outcome scores. Methods: Forty-three patients with a CT scan and skyline radiograph after a KA TKA with PCL retention and medial stabilized design were analyzed. Linear regression determined the strength of the association between the FMA, HKA angle, PTS, PTA, and LUCTR and the forgotten joint score (FJS), Oxford knee score (OKS), and KOOS Jr score obtained at a mean of 23 months. Results: There was no correlation between the FMA (range 2° varus to −10° valgus), HKAA (range 10° varus to −9° valgus), TMA (range 10° varus to −0° valgus), TSA (range 14° posterior to −4° anterior), PTA (range, −10° medial to 14° lateral), and the LUCTR resection (range 2 to 9 mm) and the FJS (median 83), the OKS (median 44), and the KOOS Jr (median 85) (r = 0.000 to 0.079). Conclusions: Surgeons should be cautious about using postoperative FMA, HKAA, TMA, TSA, PTA, and LUCTR values within the present study’s reported ranges to explain success and dissatisfaction after KA TKA.

Concave apical translation with simultaneous convex apical derotation technique in adolescent idiopathic scoliosis Surgery: A technical note and case series

ObjectiveThere is still a debate regarding the efficacy of pedicle screws in adolescent idiopathic scoliosis (AIS) surgery. As well as the implant being used, the surgeon factor and the correction technique are also important for correction quality. The purpose of this study was to introduce the concave apical translation with simultaneous convex apical derotation technique (CATCAD) using polyaxial pedicle screws and report the radiographical outcomes. Material and MethodsConsecutive AIS patients who had been scheduled for surgery were enrolled in the study. The preoperative and postoperative radiographic parameters included Cobb angle, apical vertebral translation (AVT), thoracic kyphosis (TK) and apical vertebral rotation (AVR). Coronal plane parameters were measured in plain radiography. Sagittal and axial plane parameters were measured in computed tomography scan (CT scan). Implant density was calculated. ResultsTwenty patients were included in the study. All were female with a mean age of 14.9 years. Eighteen patients were either Lenke 1 (45.0 %) or Lenke 2 (45.0 %). The remaining patients were Lenke 3 and 4 (10.0 %). There was an improvement of postoperative radiographic parameters. The mean of AVR corrections were −1.8 ± 2.8° (10.0 %) and −4.5 ± 2.8° (24.0 %) for lower apical screw density (LAD) group and higher apical screw density (HAD) group, respectively (p-value = 0.024). ConclusionCATCAD technique can achieve the 3D correction in AIS surgery. With this correction technique, the AVR correction seem higher if the high apical screw density implant is used.

Medium to long term functional and radiographic outcomes in patients with Madelung's deformity treated by isolated or combined radioulnar osteotomy

IntroductionMadelung's deformity is a rare congenital condition of the wrist that can cause pain, aesthetic concerns, reduced range of motion and grip strength. Currently, there is no consensus on the optimal age for surgery or whether operative procedures can be isolated or combined depending on the extent of the deformity. The main objective of our study was to analyze the postoperative functional clinical results at a minimum of 3-years follow-up in patients operated on for Madelung's deformity. The secondary objectives were (1) comparison of preoperative and postoperative radiographic parameters, and (2) to assess whether certain preoperative radiographic parameters influence the choice of surgical procedure. HypothesisThe surgery offered at our center achieves clinical and radiological result necessary for long-term activities of daily living, and varies according to the severity of the distal radial deformity. Patients and methodsWe carried out a retrospective observational monocentric study including patients operated on between 2004 and 2016. Clinical (VAS, mobility), functional (PRWE score), and radiographic assessments were performed before and after the last follow-up. ResultsThe study included 11 patients (12 wrists) with a mean age of 17±7.3 years and a mean follow-up of 8.1 years (4–12.3). The mean VAS was 2.3 (0–6) and the mean PRWE score was 37 (0–108). The mean flexion-extension arc was 134° and that of pronation and supination was 142°. The mean grip strength was 25.8±11.8kg. Four out of 6 radiographic criteria were significantly improved. An isolated radial osteotomy or combined radioulnar osteotomy was performed when the sagittal radial tilt was greater than 30° and protrusion of the lunate greater than 5mm, otherwise below these values, an isolated ulnar osteotomy was performed. DiscussionOur center offers surgical management of Madelung's deformity by osteotomy which improves the majority of postoperative radiographic parameters and gives satisfactory clinical and radiographic results after a mean follow-up of 8.1 years. The surgery is influenced by the severity of the distal radial deformity, including protrusion of the lunate and sagittal radial tilt. Level of evidenceIV, Retrospective study.

Surgical outcome of scoliosis in patients with Marfan syndrome.

To evaluate clinical and radiographic outcomes after surgical scoliosis correction and posterior instrumented fusion in SMF patients. A single-center medical database was reviewed to identify MF patients who presented with scoliosis from 2000 to 2015. Patients who underwent spinal fusion surgery were included. Demographic, operative and clinical data were reviewed, and the preoperative, postoperative, and latest follow-up radiographic parameters were compared. Twelve patients were identified (2 males, 10 females) with an average age at surgery of 14.4 ± 2.6years. Comorbidities were found in 84.6%. Most patients (90.9%) presented with a right thoracic curve. The average preoperative Cobb angle was 75.6 ± 15.5 degrees. Posterior instrumented spinal fusion was performed in all patients (1 hook/pedicular screw and 11 pedicle screws only). The average follow-up period was 6.8 ± 3.1years. The mean postoperative Cobb angle after surgery and at the final follow-up was 33.4 ± 18.0 degrees and 35.5 ± 18.4 degrees, respectively. There was a statistically significant difference among the preoperative and postoperative Cobb angles (p < 0.001), but no significant difference among the sagittal angles. Two perioperative complications including superficial wound infection and broken rods were observed. Posterior scoliosis correction and instrumented spinal fusion resulted in a satisfactory outcome in MF patients. Perioperative complications are not uncommon; however, no neurological complication or spinal decompensation was observed in this study. IV.

Modified Scarf Osteotomy with Medial Capsular Interposition Combined with Metatarsal Shortening Offset Osteotomy: A Comparison of Patients with Noninflammatory Arthritis and Rheumatoid Arthritis of the Foot.

Patients who have noninflammatory arthritis of the feet may develop destructive changes on the first metatarsal head and painful dislocation of the metatarsophalangeal (MTP) joint of 1 or more lesser toes. This aim of this study was to compare feet with noninflammatory arthritis and those with rheumatoid arthritis (RA) with respect to the clinical and radiographic outcomes after treatment of these destructive deformities with a modified Scarf osteotomy with medial capsular interposition into the newly formed first MTP joint, combined with metatarsal shortening offset osteotomy. A retrospective observational study of 93 feet (31 with noninflammatory arthritis and 62 with RA) was performed. Hallux and lesser-toe scores on the Japanese Society for Surgery of the Foot (JSSF) scoring system, a self-administered foot evaluation questionnaire (SAFE-Q), and preoperative and postoperative radiographic parameters were evaluated. There were significant improvements at the time of the final follow-up in the mean scores on the hallux and lesser-toe scales of the JSSF system and in the SAFE-Q score. The postoperative JSSF lesser-toes function score was better for the feet with noninflammatory arthritis feet than the feet with RA. There was no significant difference in the hallux valgus angle (HVA) between 1 month postoperatively and the final follow-up for both groups. Furthermore, the HVA showed a strong correlation between the 1-month and final follow-up values. The combination of the modified Scarf osteotomy with medial capsular interposition and shortening metatarsal offset osteotomy was useful and safe in feet with noninflammatory arthritis. The HVA at 1 month after surgery is useful to predict the HVA within 5 years after surgery. The postoperative clinical score for the lesser toes was better in the feet with noninflammatory arthritis. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Progressive collapsing foot deformity treated by calcaneus osteotomy, flexor digitorum longus transfer, and peroneus brevis-to-longus tenodesis

Objective: This study presents the results of progressive collapsing foot deformity treatment with calcaneus osteotomy, flexor digitorum longus transfer, and peroneus brevis-to-longus transfer as an adjuvant in the correction of the deformity. Methods: The outcomes of 22 patients with posterior tibial tendon dysfunction who underwent calcaneal osteotomy and flexor digitorum longus transfer combined with peroneus brevis-to-longus transfer (tenodesis) were evaluated retrospectively. Results: According to the Visual Analog Scale, pain scores improved from a mean of 7.1 at baseline to 1.6 after a mean follow-up of 32 months. The mean AOFAS score was 45.3 points preoperatively and 86.3 points at follow-up. Comparison of preoperative and postoperative radiographic parameters was possible in 16 patients (73%), demonstrating significant improvements in Meary’s angle and calcaneal pitch. Conclusion: Based on these findings, we conclude that correction of progressive collapsing foot deformity through a combination of calcaneal osteotomy, flexor digitorum longus transfer, and peroneal tenodesis leads to improvement in clinical and radiographic parameters. Level of Evidence IV; Therapeutic Studies; Case Series.

Minimally Invasive versus Conventional Lumbar Interbody Fusion at L5–S1: A Retrospective Comparative Study

Objective: This study aimed to evaluate the radiologic and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and conventional posterior lumbar interbody fusion (PLIF) at the L5–S1.Methods: We retrospectively reviewed patients who underwent posterior lumbar fusion (MIS-TLIF and PLIF) at only the L5–S1 and were followed up for more than 12 months. Age, sex, body mass index (BMI), bone mineral density (BMD), diagnosis, comorbid conditions, fusion rate, perioperative results, and pre- and postoperative radiographic parameters at the L5–S1 level, pelvic parameters and degree of spondylolisthesis, and clinical results were analyzed.Results: A total of 102 patients (46 male, 56 female) with a mean age of 57.1 years were evaluated. Fifty and fifty-two patients underwent MIS-TLIF and PLIF surgeries, respectively. Radiologic parameters increased from their preoperative measures at the last follow-up study; similarly, there were no intergroup differences. The fusion rates in the MIS-TLIF and PLIF groups were 86% and 82.7%, respectively. The subsidence rates in the MIS-TLIF and PLIF groups were 6% and 3.8%, respectively. There was no intergroup difference in terms of fusion rate and subsidence. Clinical outcomes also gradually improved after surgery in both groups without intergroup differences.Conclusion: In L5–S1 posterior spinal surgery, there was no significant difference between MIS-TLIF and conventional PLIF. Considering the operation time and estimated blood loss, MIS-TLIF is more effective than PLIF surgery in terms of postoperative health care and economics.

Surgical therapy of peri-implantitis with adjunctive hydroxyapatite and enamel matrix derivative: a 1-year retrospective case series

This case series retrospectively investigated the one-year surgical outcome of regenerative peri-implantitis therapy using a hydroxyapatite (HA) bone substitute material in combination with enamel matrix derivate (EMD) and collagen membrane for guided bone regeneration (GBR). Data-sheets of patients were screened to detect patients who received identical regenerative peri-implantitis-therapy with surface decontamination and GBR applying HA, EMD and a collagen membrane under broad-spectrum antibiotic regime. For inclusion, information on pre- and postoperative clinical and radiographic parameters (probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUPP) and the radiological bone level (RBL)) had to be available for statistical analysis. Data of a total of 11 patients (20 implants) were extracted out of 202 (336). All implants were still in function after one year. Bone defects decreased by an average of 1.3 mm mesially and 0.9 mm distally, respectively. Mean PPD was reduced from 4.9 mm to 2.7 mm. BOP decreased from 90% to 20%. Suppuration decreased from 65% to 0%. Based on the success criteria applied, 15 of the 20 (75%) implants included were considered as successfully treated after 1 year. Regenerative peri-implantitis therapy according to the presented concept showed promising clinical and radiographic outcomes after one year. To estimate the beneficial effects of the combined use of HA, EMD and collagen membranes, further long-term investigations with a control group are needed.&#x0D; Accepted for publication: January 7, 2022&#x0D; Published online: January 12, 2022

Surgical therapy of peri-implantitis with adjunctive hydroxyapatite and enamel matrix derivative: a 1-year retrospective case series.

This case series retrospectively investigated the one-year surgical outcome of regenerative peri-implantitis therapy using a hydroxyapatite (HA) bone substitute material in combination with enamel matrix derivate (EMD) and collagen membrane for guided bone regeneration (GBR). Data-sheets of patients were screened to detect patients who received identical regenerative peri implantitis-therapy with surface decontamination and GBR applying HA, EMD and a collagen membrane under broad- spectrum antibiotic regime. For inclusion, information on pre- and postoperative clinical and radiographic parameters (probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUPP) and the radiological bone level (RBL)) had to be available for statistical analysis. Data of a total of 11 patients (20 implants) were extracted out of 202 (336). All implants were still in function after one year. Bone defects decreased by an average of 1.3 mm mesially and 0.9 mm distally, respectively. Mean PPD was reduced from 4.9 mm to 2.7 mm. BOP decreased from 90% to 20%. Suppuration decreased from 65% to 0%. Based on the success criteria applied, 15 of the 20 (75%) implants included were considered as successfully treated after 1 year. Regenerative peri-implantitis therapy according to the presented concept showed promising clinical and radiographic outcomes after one year. To estimate the beneficial effects of the combined use of HA, EMD and collagen membranes, further long term investigations with a control group are needed.

The Influence of Concomitant Hammertoe Correction on Postoperative Outcomes in Patients Undergoing Hallux Valgus Correction

Category:Bunion; Lesser ToesIntroduction/Purpose:Patients with hallux valgus often develop secondary hammertoe deformities of the lesser toes. Chronic lateral deviation of the hallux leads to proximal interphalangeal joint flexion contracture, metatarsophalangeal joint subluxation and ultimately a cross-toe deformity. Operative management of bunions with hammertoe is more extensive since both the primary bunion deformity and the secondary defect have to be corrected simultaneously; however, it is unclear whether simultaneous bunion and hammertoe correction affects patient outcomes. The objective of this study was to compare postoperative patient reported outcomes using the patient-reported outcome measure information system (PROMIS) scores and radiographic outcomes between patients who underwent isolated bunion deformity correction and patients who underwent operative repair of hallux valgus with concomitant hammertoe correction.Methods:This retrospective cohort study included patients over the age of 18 who were treated operatively by 1 of 7 fellowship-trained foot and ankle surgeons for hallux valgus. Those with clinically symptomatic hammertoes were also corrected at the surgeon's discretion. All patients had minimum 1-year postoperative PROMIS scores and minimum 3-month postoperative radiographs. Preoperative, final postoperative and change in PROMIS scores from 6 domains (physical function, pain interference, pain intensity, global physical and mental health, and depression) were compared between the isolated bunion and bunion with hammertoe correction groups. Radiographic measurements compared between cohorts included hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal-articular angle (DMAA), and Meary's angle. Radiographic parameters were measured on anteroposterior (AP) and lateral weightbearing radiographs. Statistical analysis utilized targeted minimum-loss estimation (TMLE) to control for confounders (age, gender, BMI).Results:A total of 221 patients (134 with isolated bunion correction, 87 with concomitant hammertoe correction) with an average of 19.2 months follow-up were included in this study. Demographically, patients in the concomitant hammertoe cohort were older than the isolated bunion group (58.5 vs 53.1, p<0.01) and had a higher BMI (24.8 vs 58.5, p<0.05). Both cohorts demonstrated improvement in all PROMIS domains except for global mental health and depression. The isolated bunion cohort had significantly better improvements in pain interference and pain intensity when compared to the concomitant hammertoe group (p<0.01, p<0.05 respectively) (Table 1). The isolated bunion cohort had lower postoperative pain interference scores (p<.01). Radiographically, the concomitant hammertoe group had a higher preoperative HVA than the isolated bunion group (30 vs 27.6, p<.05). There were no statistically significant differences between the two cohorts in postoperative radiographic parameters, in addition to the probability of achieving normal postoperative radiographic measures.Conclusion:Patients undergoing simultaneous bunion and hammertoe correction experienced worse postoperative outcomes measured by PROMIS pain interference, had significantly less improvement in PROMIS pain interference and pain intensity scores, and had more severe preoperative radiographic deformity when compared to those who underwent isolated bunion correction. The relationship between hallux valgus and hammertoe development should be considered when counseling patients for surgery. Patients with hallux valgus who show early signs of hammertoe formation such as second toe elevation or pain under the second metatarsal head may benefit from earlier bunion correction before the hammertoe progresses to the point of needing surgical management.