Preoperative Angle Research Articles

Cervical spine fractures in ankylosing spondylitis patients: an analysis of the presentation and clinical results of 110 surgically managed patients in two spine centers.

In this work, a two-center study was performed to study the clinical presentation of cervical spine fractures in ankylosing spondylitis (AS) patients and assess the surgical management of these fractures. A retrospective analysis of prospectively collected data in two level-1 spine surgery centers was performed. Both spine centers have a standard database for all admitted patients. Inclusion criteria were surgically treated AS with cervical spine fracture diagnosis (from C1 to Th3) and postoperative follow-up minimum of 12months. One hundred ten patients (105 male/5 female) were included. The mean age was 62 ± 10years. The mean time between trauma and surgery was 49 ± 42days. There was a history of mild trauma in 72 patients (65.4%). The clinical presentation was a pain in all patients. Twenty-seven (24.6%) had a neurological deficit at admission. The most common fracture level was C6/7 in 63 patients (57.23%). The VAS was 7 ± 1, and NDI was 34 ± 8 in the preoperative assessment. The mean preoperative kyphosis angle was 48 ± 26° between C2 and C7. Positioning and preparing of the patients on the operation table took a mean of 57 ± 28min. The surgical approach was dorsal in 59 patients (53.6%), combined in 45 patients (40.9%), and ventral in 6 patients (6,5%). The mean number of the fixed levels was 6 ± 2 levels. Intraoperative complications occurred in 9 patients (8.2%). Postoperative Cobb angle improved to a mean of 17 ± 9 degrees. Neurological improvement occurred in 20/27 patients. In 12 patients, the recovery was complete. The mean postoperative follow-up was 46 ± 18months. VAS improved to 3 ± 1, and NDI improved to 14 ± 6 at the last postoperative visit. The improvement was clinically significant (p = 0.01 and 0.00, respectively). High suspicion of cervical spine fractures is necessary for patients with AS. CT and MRI images are necessary to rule out cervical spine fractures in AS patients, especially to detect occult fractures. Surgical treatment is safe, and the posterior approach with long-segment fusion is the approach of choice in this group of patients.

Results of Unilateral Lateral Rectus Recession Surgery in 15 - 30 PD Intermittent Exotropia.

To evaluate the surgical outcomes of unilateral lateral rectus muscle recession (ULR) with low surgical dosage in patients with intermittent exotropia (IXT) of 15 - 30 prism dioptres (PD). We retrospectively analysed 92 eyes of 92 patients who underwent ULR surgery with the diagnosis of IXT of 15 - 30 PD at distance fixation between January 2017 and June 2019. ULR surgery of 6.5 mm was performed for exotropia of 15 - 20 PD, 7.5 mm for that of 20 - 25 PD, and 8.5 mm for that of 25 - 30 PD and postoperative results were evaluated at the 1st week, 1st month, 6th month, and the 2nd year. Orthophoria or IXT less than 10 PD was accepted as successful. The mean preoperative deviation angle at distance was 22.3 ± 4.4 PD. Mean postoperative deviation angles at distance were 2.5 ± 1.7, 3.9 ± 2.4, 6.5 ± 3.0, and 8.7 ± 3.1 at 1 week, 1 month, 6 months, and 2 years, respectively. The surgical success rate of ULR was 100, 96.7, 84.7, and 77.1% at the 1st week, 1st month, 6th month, and the 2nd year, respectively. In the long-term results, there were no complications such as lateral gaze incomitance, overcorrection, or deterioration in stereopsis. Using the ULR technique, we were able to obtain effective surgical results in IXT with less surgical dosage and without any serious complications. ULR surgery can be used as an effective method in patients with IXT of 15 - 30 PD.

Evaluation of Higher Order Aberrations and Anterior Segment Parameters Changes After Implantable Collamer Lens Implantation for High Myopia.

To evaluate changes in higher order aberrations (HOAs) induced by implantable collamer lens (ICL) implantation in correction of high myopia and to compare the anterior segment parameters before and after surgery. Also, to correlate these parameters with HOAs, the best corrected visual acuity (BCVA) and intraocular pressure (IOP). This prospective interventional cohort case series study included 40 eyes with high myopia that underwent ICL V4c implantation. They were evaluated pre-operatively and post-operatively at 1st and 3rd month HOAs using Scheimpflug Sirius Camera. The anterior segment parameters were evaluated by optical biometry. Correlations between HOAs, BCVA and anterior segment parameters were evaluated. The mean pre-operative BCVA was 0.67 ± 0.17, while post-operative BCVA was 0.74 ± 0.16 (p-value < 0.001). The spherical equivalent was -13.66 ± 2.23 pre-operatively, while post-operatively it was -0.77 ± 0.65 (p-value < 0.001). The mean pre-operative root mean square (RMS) of HOAs was 0.62 ± 0.11 µm, while mean post-operative RMS in the 1st month was 0.82 ± 0.29 µm (p-value < 0.001). At 3rd month, it was 0.63 ± 0.17 µm (p-value = 0.685). The mean pre-operative anterior chamber depth (ACD) was 3.66 ± 0.26 mm. It decreased in the post-operative 1st month to 3.46 ± 0.30 mm, while in 3rd month 3.45 ± 0.24 mm (p-value < 0.001, < 0.001) respectively. The mean pre-operative anterior chamber angle (ACA) 45.98 ± 8.39 o while, the mean ACA was 31.65 ± 4.14, 31.03 ± 3.74 post-operatively (p-value < 0.001, < 0.001) respectively. There was significant increase in IOP (p-value < 0.001). ICL implantation is safe and effective in correction of high myopia, as HOAs increase at first month post-operatively then, return to the pre-operative level by 3rd month. However, anterior segment parameters show significant changes which may need longer follow up.

PD31-07 PATIENT REPORTED OUTCOMES AFTER ROBOTIC ASSISTED LAPAROSCOPIC EXTRAVASCULAR RENAL VEIN STENT PLACEMENT FOR NUTCRACKER SYNDROME

You have accessJournal of UrologyCME1 Apr 2023PD31-07 PATIENT REPORTED OUTCOMES AFTER ROBOTIC ASSISTED LAPAROSCOPIC EXTRAVASCULAR RENAL VEIN STENT PLACEMENT FOR NUTCRACKER SYNDROME Jacques Farhi, Hal Kominsky, Mohannad Awad, and Jeffrey Cadeddu Jacques FarhiJacques Farhi More articles by this author , Hal KominskyHal Kominsky More articles by this author , Mohannad AwadMohannad Awad More articles by this author , and Jeffrey CadedduJeffrey Cadeddu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nutcracker phenomenon is the compression of the left renal vein between the superior mesenteric artery (SMA) and the abdominal aorta. Nutcracker syndrome refers to the presence of nutcracker phenomenon with symptoms including hematuria, intermittent left flank pain, early satiety, nausea, vomiting, pelvic congestion syndrome, and dyspareunia. Treatment of nutcracker syndrome includes weight gain, vascular transposition, renal autotransplant, nephrectomy, endovascular renal vein stent placement, or extravascular renal vein stent placement. Between 2016 and 2022, we performed 18 robotic assisted laparoscopic extravascular renal vein stent placement. We sought to assess patient reported outcomes of robotic assisted laparoscopic extravascular renal vein stent placement by a high-volume robotic surgeon at a single institution. METHODS: We performed a single-center retrospective review of 18 patients with a minimum 3 month follow up. Symptoms were assessed utilizing a questionnaire conducted with a five-point Likert scale at 3 months. Five on the Likert scale was severe while a one was none. Primary study outcomes compared pre-operative patient reported symptom scores versus post-operative patient reported symptom scores. RESULTS: 12 out of 18 patients responded to the survey. Average age of the cohort was 36. Average BMI was 19.4. There was only one male. Mean operative time was 136 minutes and mean estimated blood loss was 12. Mean pre-operative SMA angle was 19 and mean post operative SMA angle was 36. Patients reported that flank pain, abdominal pain, nausea, headaches, back pain, pelvic pain, and early satiety improved (p<0.05) (Figure 1). 8 respondents would strongly recommend the surgery for nutcracker syndrome. CONCLUSIONS: Robotic assisted laparoscopic extravascular renal vein stent placement demonstrates an effective treatment for nutcracker syndrome. Patients reported improved symptoms at 3 months post operatively across multiple domains. Further studies need to be conducted to assess long-term durability of robotic assisted laparoscopic extravascular renal vein stent placement. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e903 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacques Farhi More articles by this author Hal Kominsky More articles by this author Mohannad Awad More articles by this author Jeffrey Cadeddu More articles by this author Expand All Advertisement PDF downloadLoading ...

Radiographic Outcomes of Titanium Augment vs Bone Graft in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity.

Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction and, in theory, also increases the longitudinal arch by plantarflexion of the first ray through tensioning the peroneus longus for patients with stage IIB adult acquired flatfoot deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus, which is then filled with autograft, allograft, or a porous metal wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes following LCL for stage IIB AAFD. We conducted a retrospective review of all patients who underwent LCL from October 2008 until October 2018. Preoperative weightbearing radiographs, initial postoperative radiographs, and 1-year weightbearing radiographs were reviewed. The following radiographic measurements were recorded: incongruency angle, talonavicular coverage angle (TNCA), talar-first metatarsal angle (T-1MT), and calcaneal pitch. A total of 44 patients were included in our study. The mean age of the cohort was 54 (range, 18-74). The study cohort was divided into 2 groups. There were 17 (38.7%) patients who received a titanium metal wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (59 vs 47 years old, P = .006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (32 vs 27 degrees, P = .013). There were no significant differences in postoperative TNCA, incongruency angle, or calcaneal pitch at 6 months or 1 year. At 6 months and 1 year, no radiographic differences were found between autograft/allograft bone substitutes vs titanium wedge in LCL. Level III, retrospective cohort study.

356 Intraoperative Robotic Planning Software is Accurate at Predicting Postoperative Lumbar Lordosis After Anterior Column Reconstruction

INTRODUCTION: Re-establishment of lumbar lordosis with spine deformity surgery is considered a pre-requisite for long term positive results with less biomechanical loading on the adjacent segments, reducing the likelihood of developing adjacent segment disease. The pre-operative planning softwares of robotic systems now allow the surgeon to plan a patient-specific surgical plan and are also able to predict the degree of lumbar lordosis following the instrumentation surgery based on pre-operative imaging by using vertebral segmentation. METHODS: We conducted a retrospective review of patients aged 18 or older who underwent pedicle screw spinal instrumentation using the Mazor X Robot (Medtronic Inc., Minneapolis, MN, USA), performed by one surgeon over a five-year period. The robotic guidance software (Mazor X-Align, Medtronic Inc., Minneapolis, MN, USA) was used to calculate the predicted lumbar lordosis based on pre-operative imaging. Wilcoxon Rank test was used to compare the predicted angles to the observed lumbar lordosis on post-operative radiographs. RESULTS: A total of 15 patients (46.6% female) with a mean age of 61.5 ± 10.9 years were identified, who underwent posterior lumbo-sacral spinal fusion with the robotic system using both percutaneous and open approach. Instrumentation was done across a mean of 3.27 levels per case and 11 patients (73.3%) underwent anterior column reconstruction prior to posterior fixation without the need for an intra-operative CT spin. There was no statistical difference between the predicted and the actual post-operative lumbar lordosis (p-value: 0.334) while there was a significant statistical difference between the pre-operative and post-operative angles (p-value: 0.02). CONCLUSIONS: Our study suggests that the intraoperative robotic planning software of the Mazor X system is accurate at predicting postoperative lumbar lordosis which can be useful and help guide surgical decision making and planning.

Prediction of Post-Operative Clinical Parameters in Posterior Scoliosis Surgery Through An Adaptive Neuro-Fuzzy Interface System

Background and Objective: Postoperative clinical indices should be estimated accurately in scoliosis correction surgeries, which have been analyzed in various studies such as experimental (in vitro or in vivo) trials through different modeling methods (finite element or multibody analysis). These costly and time-consuming methods can only be conducted on a large number of scoliotic patients. An adaptive neuro-fuzzy interface system (ANFIS) is used in this study to estimate the postoperative cobb and thoracic kyphosis angles in adolescent idiopathic scoliosis patients undergoing posterior scoliosis correction surgeries. Methods: Four groups of 55 patients with distinct preoperative clinical indices (thoracic cobb and pelvic incidence) were considered the ANFIS inputs, whereas postoperative thoracic cobb and kyphosis angles were used as the outputs. For robustness evaluation, the predicted values of postoperative angles were compared with measurements by calculating the root mean square errors and clinical correction deviation indices (the relative deviation of postoperative predicted angles from the real angles). Results: The least root mean square errors (3.0º and 6.3° for the main thoracic cobb and thoracic kyphosis estimations, respectively) were recorded in the group with the main thoracic cobb, pelvic incidence, thoracic kyphosis, and T1 spinopelvic inclination used as inputs. The clinical correction deviation indices were calculated 0.0086 and 0.0641 for cobb angles in two cases and 0.0534 and 0.2879 for thoracic kyphosis in two other cases. Conclusion: Greater differences between preoperative and postoperative cobb angles compared with those of thoracic kyphosis decreased the root-mean-square errors and clinical deviation indices but improved accuracy

The effectiveness of penile curvature treatment by cavernous body rotation and plication of the tunica albuginea

BackgroundThere are several approaches to the surgical treatment of the penile curvature conditionally divided into three large groups: tunica albuginea plication (TAP), corpus cavernosum rotation (CR), and transplantation of various materials. The study aims to compare the effectiveness of TAP and CR techniques in the treatment of penile curvature. There was a prospective randomized study of the effectiveness of surgical treatment of patients with an established diagnosis of the penile curvature from 2017 to 2020 in Irkutsk, Russian Federation. The final analysis of the results included 22 cases.ResultsThe analysis of the comparative intergroup effectiveness of the treatment performed based on the criteria established in the study showed good treatment results in 8 (88.8%) patients in the CR group and 9 (69.2%) patients in the TAP group (p = 0.577). The other patients obtained satisfactory results. There were no negative outcomes. Simple logistic regression analysis showed that the preoperative flexion angle > 60 degrees (OR 2.7; 95% CI 0.12; 5.28; p = 0.040) was significant in predicting the complaints of penile shortening during TAP. Both methods are safe, effective, and bring minimal risk of complications.ConclusionThus, the effectiveness of both treatment methods is comparable. However, TAP surgery is not recommended for patients with an initial curvature of more than 60 degrees.

Comparison of the effect of total knee arthroplasty and high tibial osteotomy on coronal pelvic and ankle–hindfoot alignment

BackgroundTotal knee arthroplasty (TKA) and high tibial osteotomy (HTO) are different procedures on the continuous spectrum of osteoarthritic knee treatments. TKA aims for neutral alignment and HTO aims for slight valgus. Methods2:2:2:1 propensity score matching yielded 100, 100, 100, and 50 patients with unilateral TKA, bilateral TKA, unilateral HTO, and bilateral HTO, respectively. Radiological evaluations of pelvis, knee, ankle, and hindfoot were performed. The important factors affecting the alignment change of the adjacent joints were identified, and subgroup analyses were performed using the identified parameters. The clinical outcomes were also compared. ResultsThe coronal alignments of the adjacent joints were corrected to the neutral position after TKA and HTO. The tibiotalar tilt angle (TTTA) was a common factor that affected changes in the ankle and hindfoot alignment. Patients with larger preoperative TTTA showed larger changes in TTTA in both TKA and HTO groups (P < 0.001). Patients with larger preoperative hindfoot alignment angle (HAA) showed larger changes in tibial plafond inclination, talar inclination, and HAA in both TKA and HTO groups (P < 0.001). TKA groups showed negative pelvic tilt values in the horizontal plane, and HTO groups showed a larger weight-bearing line ratio. ConclusionEven more severe deformities including adjacent joints were observed in TKA patients, both TKA and HTO patients showed improved alignment of the adjacent joints. However, HTO patients showed closer normal alignment than patients who underwent TKA. The preoperative TTTA and HAA were important factors for restoration of ankle and hindfoot alignment after knee surgery.

The Lumbosacral Fractional Curve vs Maximum Coronal Cobb Angle in Adult Spinal Deformity Patients with Coronal Malalignment: Which Matters More?

Retrospective cohort study. In patients undergoing adult spinal deformity (ASD) surgery we sought to: 1) report preoperative and postoperative lumbosacral fractional (LSF) curve and maximum coronal Cobb angles and 2) determine their impact on radiographic, clinical, and patient-reported outcomes (PROs). A single-institution cohort study was undertaken. The LSF curve was the cobb angle between the sacrum and most tilted lower lumbar vertebra. Coronal/sagittal vertical axis (CVA/SVA) were collected. Patients were compared between 4 groups: 1) Neutral Alignment (NA); 2) coronal malalignment only (CM); 3) Sagittal malalignment only (SM); and 4) Combined-Coronal-Sagittal-Malalignment (CCSM). Outcomes including postoperative CM, postoperative coronal vertical axis, complications, readmissions, reoperation, and PROs. A total of 243 patients underwent ASD surgery with mean total instrumented levels of 13.5. Mean LSF curve was 12.1±9.9°(0.2-62.3) and mean max Cobb angle was 43.0±26.5° (0.0-134.3). The largest mean LSF curves were seen in patients with CM (14.6°) and CCSM (13.1°) compared to NA (12.1°) and SM (9.5°) (p=0.100). A higher LSF curve was seen in patients with fusion to the sacrum and instrumentation to the pelvis (p=0.009), and a higher LSF curve was associated with more TLIFs (p=0.031). Postoperatively, more TLIFs were associated with greater amount of LSF curve correction (p<0.001). Comparing the LSF and the max Cob angle among Qiu types, the highest mean max Cobb angle was in Qiu Type B patients (p=0.025), whereas the highest mean LSF curve was in Qiu Type C patients (p=0.037). Moreover, 82.7% of patients had a LSF curve opposite the max Cobb angle. The LSF curve was larger than the max Cobb angle in 22/243 (9.1%) patients, and most of these 22 patients were Qiu Type A (59.1%). Regarding correction, the max Cobb angle achieved more correction than the LSF curve, judged by the percent improved from preop (54.5% Cobb vs. 46.5% LSF, p=0.025) in patients with max cobb>20° and LSF curve >5°. The LSF curve underwent greater correction in Qiu Type C patients (9.2°) compared to Type A (5.7°) and Type B (5.1°) (p=0.023); however, the max Cobb angle was similarly corrected among Qiu Types: Type A 21.8°, Type B 24.6°, and Type C 25.4° (p=0.602). Minimal differences were seen comparing the preop/postop/change in LSF curve and max Cobb angle regarding postop CM, postop CVA, complications, readmissions, reoperation, and PROs. The LSF curve was highest in patients with CM, CCSM, and Qiu Type C curves. Most patients had a LSF curve opposite the max Cobb angle. The max Cobb angle was more often corrected than the LSF curve. The LSF curve underwent greater correction among Qiu Type C patients, whereas the max Cobb angle was similarly corrected among all Qiu Types. No clear trend was seen regarding postoperative complications and PROs between the LSF curve and max Cobb angle.

The chevron bunionectomy for moderate to severe hallux valgus deformity: Effects of procedural factors on hallux valgus correction

BackgroundEffects of procedural factors on chevron bunionectomy outcomes were studied. MethodsIncluded were 109 feet with distal chevron osteotomy and preoperative intermetatarsal angle (IMA) greater than 15 degrees. IMA and hallux valgus angles (HVA), release type, fixation, second-digit procedures, and risk factors were evaluated. ResultsEighty-three percent (91/109 feet) had satisfactory outcomes; nine had moderate pain. From preoperative, IMA improved 7.2 and HVA 20.5 degrees. Risk factors or second-digit procedures had no effect. Lateral release improved IMA (p < 0.01), with no difference between open lateral and transarticular release; 86% percent (64/74) were satisfied with open lateral release compared with 83% (19/23) and 66% (8/12) with no release and transarticular release, respectively. Fixation did not affect outcomes. ConclusionChevron bunionectomy corrected IMA and HVA to normal with few complications. Lateral release increased IMA correction. Transarticular release had lower satisfaction than open lateral release or no release. Level of EvidenceLevel III, retrospective

Laminoplasty is relevant for degenerative cervical spondylolisthesis when there is little risk of postoperative excessive kyphosis during neck flexion

BackgroundElderly patients with degenerative cervical myelopathy frequently have severe symptoms due to spondylolisthesis. The effectiveness of laminoplasty for degenerative cervical spondylolisthesis (DCS) is an important question. ObjectiveThe aim of this study is to elucidate factors associated with the outcome of laminoplasty for DCS. MethodEighty-nine patients with cervical spondylotic myelopathy (CSM) who underwent laminoplasty without instrumented posterior fusion were enrolled. Positive spondylolisthesis was defined as more than 2 mm during neck flexion or extension, from this, 46 DCS cases and 43 non-DCS cases were classified.Radiological parameters, including cervical alignment, balance, range of motion, and slippage along with the Japanese Orthopedic Association (JOA) score, were obtained before and 1 year after surgery. Factors associated with good surgical outcomes for DCS were analyzed using multivariate logistic analysis. ResultsThere were no significant differences in background and preoperative JOA score, but the DCS group recovery rate was significantly less (42% vs 53%). Multivariate logistic analysis revealed only the postoperative C2-7 angle during neck flexion was associated with a favorable outcome for DCS (P = 0.0039, Odds ratio: 1.49, 95% CI: 1.14–1.94). Multivariate regression analysis positively correlated the preoperative C2-7 angle in neutral and during flexion with the postoperative C2-7 angle during flexion. ConclusionThe major factor related to poor outcome was the magnitude of postoperative kyphotic C2-7 angle during neck flexion. Slippage was not directly related to outcome and postoperative cervical alignment. Caution is recommended for surgeons performing laminoplasty on patients with risk factors for postoperative excessive kyphotic C2-7 angle during flexion.

Does capsular repair make a difference in the integrity and thickness of anterior capsule in the setting of borderline hip dysplasia

BackgroundHip joint capsular ligaments serve a fundamental role in balancing functional mobility and joint stability. However, few studies had focused on postoperative capsule changes in patients with borderline developmental dysplasia of the hip (BDDH).PurposeTo evaluate the integrity and thickness of anterior hip capsular thickness on pre and postoperative MRI in BDDH patients.Study designCase series study; Level of evidence III.MethodsA retrospective analysis was performed using data from BDDH patients who had arthroscopy between 2016 and 2019. Two groups were created and propensity-score matched based on whether the capsule was sutured. The study group comprised patients who have undergone routine capsule repair between 2018 and 2019. The control group includes BDDH patients with unrepaired capsulotomy between 2016 and 2018. Capsular integrity and thickness were measured on MRI before surgery and at least one year postoperatively. Furthermore, analysis was performed on correlations between the presence of a capsular defect and related factors.ResultsPropensity-score matching yielded 37 hips in the repair group and 37 hips in the non-repair group. There were no significant differences detected in age, sex, and BMI between the two groups. MRI detected capsular defects in 3 hips (8.1%) in the repair group and 10 hips (27.0%) in the non-repair group (p = 0.032). The defect was found to be along the interportal capsulotomy line in all capsular defect cases. Moreover, the postoperative anterior capsule thickness in the study group was significantly thinner compared with preoperative (2.9 ± 0.5 mm vs 3.7 ± 0.6 mm; p < 0.001), and no significant difference was detected in the control group. There were no statistically significant correlations between the presence of a defect capsule and demographic characteristics such as patient age, sex, BMI, preoperative alpha angle, or lateral center–edge angle (LCEA).ConclusionThe majority (91.9%) of the repaired hip capsules in BDDH patients remained closed compared with patients without repair (73.0%). The anterior capsule was significantly thinner in the zone of capsulotomy postoperative compared with preoperative in patients with unrepaired capsules. The presence of a defective capsule does not correlate with demographic factors.

Preoperative and Postoperative Clinical Factors in Predicting the Early Recurrence Risk of Intermittent Exotropia After Surgery

To identify preoperative and postoperative early recurrence risk in intermittent exotropia (IXT) patients after surgery. Prospective clinical cohort study. We included 210 basic-type IXT patients who underwent either the bilateral rectus recession or unilateral recession and resection procedure and had complete follow-up until recurrence or for more than 24 months postoperatively. The primary outcome was early recurrence, defined as postoperative exodeviation over 11 prism diopters at any time beyond postoperative month 1 and within 24 months. Survival was estimated by the Kaplan-Meier method. Preoperative and postoperative clinical characteristics were collected from patients, and preoperative and postoperative Cox proportional hazards regression analyses were performed. Preoperative model was fit with 9 preoperative clinical factors (sex, onset age of exotropia, duration of disease, spherical equivalent of the more myopic eye, preoperative distant exodeviation, near stereoacuity, distant stereoacuity, near control, and distant control). Postoperative model was fit by adding 2 factors relevant to surgery (surgery type and immediate postoperative deviation). Corresponding nomograms were constructed and evaluated using the concordance indexes (C-indexes) and calibration curves. Decision curve analysis (DCA) was used to determine the clinical utility. The recurrence rate was 8.10% for 6 months, 11.90% for 12 months, 17.14% for 18 months, and 27.14% for 24 months after surgery. Younger age at onset, larger preoperative angle, and less immediate postoperative overcorrection were found to increase the risk for recurrence. Although onset age and age at surgery were strongly correlated in this study, age at surgery was not significantly associated with IXT recurrence. The C-indexes for the preoperative and postoperative nomograms were 0.66 (95% CI: 0.60-0.73) and 0.74 (95% CI: 0.68, 0.79), respectively. Calibration plots between predicted and actual observed 6-, 12-, 18-, and 24-month overall survival using the 2 nomograms revealed high consistency. The DCA indicated that both models yielded great clinical benefits. By relatively accurate weighing of each risk factor, the nomograms offer good prediction for early recurrence in IXT patients and may help clinicians and individual patients make appropriate intervention plans.

Do Preoperative Supine Radiographs Predict Postoperative Residual Lumbar Curvatures in Adolescent Idiopathic Scoliosis? A Retrospective Cohort Study.

Retrospective comparative study. This study compares supine vs bending flexibility radiographs and evaluates their ability to predict residual postoperative lumbar curvature after selective thoracic fusion for Lenke 1 and 2 curves across different lumbar modifiers (A, B, and C) in adolescent idiopathic scoliosis (AIS). This was a retrospective review of AIS Lenke 1 and 2 patients who underwent posterior fusion. All patients had preoperative flexibility radiographs including side-bending and supine posteroanterior (PA) films, in addition to pre- and post-operative standing PA and lateral radiographs. We used SurgiMap 2.0 software for all radiographic measurements. Pearson correlations and linear regression models were developed in SAS. A total of 86 patients were included mean age 14.9years and follow-up 72.3 months. Preoperative supine lumbar Cobb angle and preoperative side-bending Cobb angles had similar, positive correlations with postoperative lumbar Cobb angle, r = .55 (P < .001) and r = .54 (P < .001), respectively. Three regression models were built to predict postoperative lumbar Cobb angles from preoperative information: Model S (R2 = .39) uses preoperative supine lumbar curve; Model B (R2 = .44) uses preoperative side-bending lumbar curve; Model SB (R2 = .49) uses both preoperative supine and side-bending lumbar curves. Model S and B performed just as well as Model SB. Either supine or side-bending radiographs alone may be used to estimate mean residual postoperative lumbar curvature after selective posterior thoracic fusion, but little is to be gained by taking both supine and side-bending radiographs.

Axial Plane Rotation of the Talus in Progressive Collapsing Foot Deformity: A Weightbearing Computed Tomography Analysis.

Progressive collapsing foot deformity (PCFD) is recognized as a 3-dimensional deformity centered around the talus. Previous studies have described some features of talar motion in the ankle mortise in PCFD, such as sagging in the sagittal plane or valgus tilt in the coronal plane. However, axial plane alignment of the talus in the ankle mortise in PCFD has not been investigated extensively. The purpose of this study was to examine this axial plane alignment of PCFD vs controls using weightbearing computed tomography (WBCT) images and to determine if talar rotation in the axial plane is associated with increased abduction deformity, as well as to assess the medial ankle joint space narrowing in PCFD that may be associated with axial plane talar rotation. Multiplanar reconstructed WBCT images of 79 patients with PCFD and 35 control patients (39 scans) were retrospectively analyzed. The PCFD group was divided into 2 subgroups depending on preoperative talonavicular coverage angle (TNC): moderate abduction (TNC 20-40 degrees, n=57) and severe abduction (TNC >40 degrees, n=22). Using the transmalleolar (TM) axis as a reference, the axial alignment of the talus (TM-Tal), calcaneus (TM-Calc), and second metatarsal (TM-2MT) were calculated. Difference between TM-Tal and TM-Calc was calculated to examine talocalcaneal subluxation. A second method to assess talar rotation within the mortise utilized an angle between the lateral malleolus and the talus (LM-Tal) in the axial slices of WBCT. In addition, the prevalence of medial tibiotalar joint space narrowing was assessed. These parameters were compared between the control and PCFD groups, and between moderate and severe abduction groups. The talus was significantly more internally rotated with respect to the ankle TM axis and the lateral malleolus in PCFD patients compared to controls, and in the severe abduction group compared with the moderate abduction group, using both measurement methods. Axial calcaneal orientation did not differ between groups. There was significantly greater axial talocalcaneal subluxation in the PCFD group, and this was also greater in the severe abduction group. The prevalence of medial joint space narrowing was higher in PCFD patients. Our findings suggest that talar malrotation in the axial plane should be considered an underlying feature of abduction deformity in PCFD. The malrotation occurs in both the talonavicular and ankle joints. This rotational deformity should be corrected at the time of reconstructive surgery, especially in cases of severe abduction deformity. In addition, medial ankle joint narrowing was observed in PCFD patients, with a higher prevalence of medial ankle joint narrowing in those with severe abduction. Level III, case-control study.

Outcomes of Consecutive Exotropia Surgery at a Tertiary Eye Hospital in Saudi Arabia.

This study aimed to evaluate surgical outcomes, compare success rates, and identify potential risk factors for failure of various surgical procedures for consecutive exotropia. This retrospective cohort study was conducted at a tertiary eye hospital in Saudi Arabia and included patients with consecutive exotropia treated between 2007 and 2020. Patients with a follow-up of <3 months were excluded. The type of surgery performed was based on surgeon experience and factors, such as the angle of deviation, adduction limitation, and intraoperative findings. Successful outcome was defined as a deviation of ≤10 prism diopters (PD) at the last follow-up visit. A total of 59 patients were included in this study. Preoperatively, the mean near and distance deviations were 33 ± 14 PD and 32 ± 14 PD, respectively. Among the included patients, 27.1% underwent medial rectus advancement with or without resection, 28.8% underwent lateral rectus recession, and 44.1% underwent combined surgery. At 12 months postoperatively or the last follow-up visit, the overall success rate of distance-deviation correction and near-deviation correction were 80.6% and 67.8%, respectively. Success rates of different surgeries were not significantly different. The severity of amblyopia and number of muscles operated on did not influence the success rate. Medial rectus advancement and combined medial rectus advancement with lateral rectus recession were associated with better surgical outcomes than lateral rectus recession alone, although the difference was not statistically significant. The only factor that negatively affected the outcome was a high preoperative near angle of deviation.

Outcomes of Core Decompression and Bone Marrow Aspirate Concentrate Injection for Osteonecrosis of the Femoral Head

AbstractWithout intervention, 80% of hips with osteonecrosis (ON) will progress. Core decompression (CD) has shown favorable results (60–80% survivorship) in early stage ON, and recently, bone marrow aspirate concentration (BMAC) injection into the decompressed femoral head has been proposed to stimulate healing of the necrotic lesion and improve outcomes and survivorship. We reviewed the clinical and radiographic outcomes of 51 Steinberg stage 2 hips in 31 patients who underwent CD + BMAC for ON with a minimum of 1 year follow-up. We evaluated preoperative visual analog pain scores (VAS), Steinberg stage based on radiographs, and Kerboul angle as measured on magnetic resonance imaging. Clinical outcomes were reported as a change in VAS at final follow-up, hip and disability osteoarthritis score for joint replacements (HOOS, JR) score at final follow-up, advancement in Steinberg stage based on radiographs, or decision to proceed with total hip arthroplasty (THA). At an average of 27 months, VAS scores improved from 7 to 2.3 (p &lt; 0.001). In total, 38 of 51 hips (75%) had stable radiographs, while 13 of 51 hips (25%) progressed radiographically or proceeded to THA. The average HOOS JR score in patients at final follow-up was 87.5, indicating excellent hip function. Of the patients that went on to THA, all were preoperative Steinberg stage 2C and the preoperative Kerboul angle in this cohort was 241, compared with 163 in those hips that did not go on to THA (p &lt; 0.001). In preoperative hips that were Steinberg stage 2B or less, there was no advancement in the radiographic stage, whereas 67% of patients with preoperative stage 2C hips progressed (p &lt; 0.001). CD + BMAC significantly improves pain and helps prevent the progression of ON when performed on patients in whom ON is classified as Steinberg stage 2B or less or in whom the Kerboul angle is 180 or less. Level of evidence was level III.

POSITIONING OF ACETABULAR AND FEMORAL COMPONENT IN PRIMARY TOTAL HIP ARTHROPLASTY USING CT EVALUATED PATIENT NATIVE ANATOMY

In total hip arthroplasty, component orientation is an important task for stability. Acetabular and femoral component orientation is the key factor for outcome of total hip arthroplasty. The aim of this study is to assess the clinical and radiological effectiveness of positioning of acetabulum and femoral components in primary total hip replacement using CT evaluated patient native anatomy. Subjects of this study were 36 patients with nonunion neck of femur fractures or arthritic hip based on inclusion and exclusion criteria and treated with cemented or uncemented total hip arthroplasty. Pre operative CT scan with 3D reconstruction was done for all patients and the acetabular inclination and version was measured in coronal and axial planes. Femoral anteversion was measured in mid axial image. Transverse acetabular notch (TAN) and anterior acetabular notch (AAN) were identied intra operatively to reproduce the pre operative angles. Post operatively CT scan was done and all angles were measured as before. All patients were followed up and analyzed using Harris Hip Score. The mean preoperative Harris Hip Score is 34.5. The mean postoperative Harris Hip Score is 88.19. Mean acetabular cup inclination is 39.80°, Mean cup anteversion is 15.1° and mean femoral anteversion is 14.75°. No Dislocation was noted during follow up. No hips show clinical and radiological evidence of femoral and acetabular component loosening. All Postoperative CT measurements of angles are within the safe zone by Lewinnek et al. Preoperative CT guided parameters, intra operative anatomical landmarks (TAN&amp;AAN) and the digital protractor device can aid better positioning of the acetabular and femoral component of THA and is independent of the position of the patient. It also provides a precise planning for component placement resulting in less intra operative time thereby reducing the chances of infection and decreases the dislocation rate and wear and tear and improves the functional outcome

Associated correction of forefoot alignment with hindfoot fusion for pes planovalgus deformity

BackgroundThe present study aimed to investigate changes in hallux alignment after corrective surgery for adult-acquired flatfoot deformity (AAFD). Patients and methodsThe present study retrospectively investigated the changes of hallux alignment in 37 feet (33 patients) which were treated with double or triple arthrodesis of the hindfoot for AAFD between 2015 and 2021 and could be followed up to one year postoperatively. ResultsHallux valgus (HV) angle significantly decreased by a mean 4.1° among the whole 37 subjects and by a mean 6.6° among the 24 subjects who had a preoperative HV angle of 15° or more. Those who had HV correction (HV angle correction ≥ 5°) demonstrated more near-normal postoperative alignment of the medial longitudinal arch and hindfoot than those without HV correction. ConclusionsHindfoot fusion for AAFD could improve preoperative HV deformity to some degree. HV correction was associated with proper realignment of the midfoot and hindfoot. Level of evidenceLevel IV; retrospective case series