Radiographic Outcomes Of Patients Research Articles

Do Intact Collateral Ligaments Play a Role in the Overall Clinical and Radiological Results of Rotating Hinge Knee Arthroplasties?

Rotating hinge knee arthroplasty (RHKA) implants are often utilized as a salvage procedure in cases where bone stock is compromised. The aim of this retrospective study was to investigate whether residual collateral ligament integrity affects functional and radiographic outcomes in patients undergoing revision surgery with RHKA. Patients treated with RHKA between 2011 and 2021 were eligible. Inclusion criteria were patients who had undergone an RHKA as a revision or a primary procedure, had complete radiological and clinical data, and had a minimum follow-up of two years. Patients who died before the second-year follow-up visit, those who had missing clinical and/or radiological data, and those who did not want to participate were excluded. There were 79 knees that were included. Patients were evaluated with standing radiographs and two-dimensional multi-acquisition variable-resonance imaging combination selective (MAVRIC) magnetic resonance imaging (MRI) sequences to assess ligament integrity. Range of motion (ROM), Visual Analog Scale (VAS), Knee Society Scores (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded. The mean age was 66 years (range, 39 to 79), and the mean follow-up was 54.6 months (approximately 4.5 years). The integrity of the collateral was successfully determined by the MRI scans and patients were divided into three groups: those who had both collateral ligaments (n = 53), isolated MCL damage (n = 14), and those who had both collateral ligaments damaged (n = 12). No significant difference was observed between the groups with regard to both radiological data and clinical scores (P > 0.05). KSS, KSS-F, and WOMAC function scores at the last follow-up were significantly higher in patients treated for secondary osteoarthritis (complex primaries). No significant difference in functional outcomes was detected in patients treated with RHKA, independent of collateral ligament integrity, at an average of 54 months postoperatively. When an RHKA is indicated as the first treatment option, results are more satisfactory in comparison to revision cases.

Calcaneal lengthening osteotomy using ipsilateral fibular graft in the treatment of flexible flatfoot deformity: preliminary results.

Flexible flatfoot deformity is quite common among adolescents. This study aimed to report the preliminary results of calcaneal lengthening osteotomy using a fibular bone graft. This single-center, retrospective study included 28 patients (28feet) with symptomatic flexible flatfoot deformity. The deformity was corrected with calcaneal lengthening osteotomy using an ipsilateral fibular graft. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score at the final follow-up was selected as the primary outcome measure. Radiographic outcomes included the anteroposterior talo-first metatarsal (AP talo-MT1) angle, the lateral talo-first metatarsal (LAT talo-MT1) angle, the lateral calcaneal pitch (LCP), and the Goldberg scoring system (GSS) for fibular graft incorporation. The visual analogue scale (VAS) was used to assess pain over the ipsilateral fibula donor site. The AOFAS ankle hindfootscore improved from a mean of 53.7 ± 22.4 to a mean of 81.1 ± 19.8, the AP talo-MT1 angle improved from a mean of 24.1° ± 15.6 to a mean of 12.9° ± 7.3, the LAT talo-MT1 angle improved from a mean of 22.3° ± 3.2 to a mean of 7.9° ± 2.3, and the LCP improved from a mean of 10.1° ± 7 to a mean of 24.4° ± 9.1. The GSS was seven points in all patients, which indicated complete radiographic union with an excellent reorganization of the fibular bone graft. The VAS for pain over the ipsilateral fibula donor site was zero at the final follow-up. The fibular bone autograft achieved excellent incorporation when used in calcaneal lengthening osteotomy with good improvement in the clinical and radiographic outcomes in patients with symptomatic flexible flatfoot deformity. III, Therapeutic study.

Clinical and Radiographic Results in Thoracic Hyperkyphosis Surgical Treatment Considering the Optimal Distal Fusion Area.

Introduction: The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of patients who underwent posterior correction and fusion for thoracic hyperkyphosis, with a focus on determining the optimal distal fusion level. Methods: From 2006 to 2012, 26 patients with a median age of 16.8 years (range 14-25), diagnosed with either idiopathic hyperkyphosis or Scheuermann's kyphosis, underwent posterior fusion and Ponte osteotomies at two medical centers. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at the final follow-up and included assessments of fusion extension, Cobb angle, sagittal balance, and the presence of junctional kyphosis or discopathy. Results: The median follow-up period was 12.3 years (range 11-17). Good clinical outcomes were observed in 24 patients, with no cases of hardware failure. The distal fusion area included the first lordotic vertebra in 17 patients, the sagittal stable vertebra in four patients, and both in five patients. Cobb angle correction was maintained at 50% at the final follow-up (p > 0.05). Significant sagittal balance correction was achieved in 87% of patients immediately postoperatively and was maintained at the final follow-up (p > 0.05). Junctional kyphosis occurred in two patients whose fusion area included only the first lordotic vertebra. Conclusions: Including at least the first lordotic vertebra in the fusion area is crucial for preventing junctional kyphosis. Extending the fusion to the stable vertebra can reduce the incidence of distal junctional kyphosis, especially in symptomatic young adult patients, potentially avoiding the need for revision surgery.

Improved clinical and radiographic outcomes with expandable cages in transforaminal lumbar interbody fusion: a propensity-matched cohort analysis.

The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts. An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters. A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up. Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.

Comparing the Exactech Equinoxe Reverse TSA for Fracture versus Degenerative Conditions: Five-Year Minimum Follow-Up

Reverse total shoulder arthroplasty (rTSA) has become the operative treatment of choice for acute proximal humerus fractures in the elderly population, but little data exists on the long-term outcomes or how they compare to rTSA done for degenerative conditions. The purpose of this study is to compare the clinical and radiographic outcomes of patients undergoing rTSA for acute fracture versus degenerative conditions with a minimum 5-year follow-up. Data was extracted from an international registry of patients with the Exactech Equinoxe rTSA implant from 2007-2018. Patients with a minimum follow-up of 5 years were then split into fracture and degenerative cohorts and matched 1:3 based on age, sex, and follow-up duration. Clinical and radiographic outcomes were compared between the cohorts including range of motion (ROM), patient-reported outcome measures (PROM), VAS pain score, complication and revision rates, implant characteristics, and scapular notching. This data was analyzed using Welch's t-test, Fisher's exact test, or Wilcoxon rank sum test. There were 384 total patients included in the study, with 96 fractures and 288 degenerative. At a mean follow-up of 6.4 years, the degenerative cohort had significant improvements in all PROMs and ROM, compared to their preoperative status. At the latest follow-up, the mean ASES score was 83 and the mean VAS pain score was 1.1 for both cohorts. Patients with degenerative indications had greater forward elevation which did not meet the minimally clinically important difference and greater internal rotation which did not meet the substantial clinical benefit threshold. Patient satisfaction was very high for both cohorts, with 97% in the degenerative cohort and 91% in the fracture cohort satisfied with the procedure (p=0.276). Complication and revision rates were similar between the two cohorts. Patients in the fracture cohort had a larger glenosphere diameter (p=0.045) and greater combined liner/tray offset (p=0.05). Patients in the elective cohort more frequently required an augmented baseplate (p<0.001). Scapular notching was 11% in the degenerative cohort and 9% in the fracture cohort (p=0.82). This study demonstrates no significant differences in the clinical or radiographic outcomes at a minimum of 5 years follow-up for patients undergoing rTSA for acute fracture versus degenerative conditions. Patients undergoing rTSA for either indication have similar rates of complications, revisions, and scapular notching, with high patient satisfaction. Patients undergoing rTSA for an acute fracture can expect similar results to those undergoing rTSA for degenerative conditions at minimum 5-year follow-up.

Comparative analysis of two double-plate fixation techniques for intercondylar fractures of the distal humerus

This study was aimed to compare the clinical and radiographic outcomes of patients with intercondylar fractures of the humerus treated with orthogonal and parallel plating methods via precontoured plates. This was a retrospective comparative study conducted on 50 adult patients with intercondylar humerus fractures that were surgically treated over an eleven-year period. The patients were divided into two groups: Group A underwent internal fixation via parallel plating, whereas Group B received orthogonal plating. Clinical outcomes were evaluated via the Mayo Elbow Performance Score (MEPS), and the radiographic assessments included time to consolidation, pseudoarthrosis, malunion and hardware removal. Both groups presented similar demographic and preoperative characteristics. The functional outcomes assessed by the MEPS were not significantly different between the groups. Radiographically, comparable healing times and rates of complications, including pseudoarthrosis, malunion and hardware removal, were observed. The study findings suggest that both orthogonal and parallel plating methods yield comparable clinical and radiographic outcomes in the treatment of intercondylar humerus fractures. These results underscore the effectiveness of both techniques and emphasize the importance of further research to elucidate the optimal plating method for specific fracture patterns.

Medial Tibial Condylar Valgus Osteotomy improve clinical outcomes and effectively corrects significant Tibial varus deformities without compromising joint line obliquity or patellar heigh

BackgroundTibial condylar valgus osteotomy (TCVO), or Chiba osteotomy, is a recognized procedure for treating advanced knee osteoarthritis in middle-aged individuals. Although its effectiveness is established, limited literature exists on its outcomes for specific conditions such as post-traumatic deformities, Blount disease (BD), and Pagoda-like proximal tibia varus deformities. HypothesisWe hypothesized that TCVO could improve both clinical and radiographic outcomes in patients with severe varus deformities, correcting lower-limb variances while preserving joint line obliquity (JLO) and patellar height in substantial varus deformities. Patients and methodsThis study included 33 patients who underwent TCVO, with etiologies including post-traumatic (26 patients, 78.8%), Blount disease (4 patients, 12.1%), and Pagoda deformities (3 patients, 9.1%). The average age was 32.5 years (standard deviation = 12.8 years). Techniques for deformity correction varied, including Patient Specific Instrumentation (PSI) for 10 patients (30.3%) and locking plate fixation for 13 patients (39.4%). We assessed several radiological parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), Caton-Deschamps index (CDI), and proximal posterior tibial angle (PPTA). Patient-reported outcomes, including the Knee injury and Osteoarthritis Outcome Score (KOOS) and simple knee value (SKV), were recorded both pre-operatively and two years post-operatively. ResultsStatistically significant improvements were observed in clinical scores and alignment changes two years post-operatively, including increases in HKA (from 166.1 to 178.4, p < .0001) and MPTA (from 72.4 to 85.1, p < .0001), and a decrease in JLO (from 9.8 to 3.2, p < .0001). No significant changes were noted in JLCA, PPTA, and CDI, with the patellar height remaining stable post-operatively. The achieved corrections closely matched the pre-operative plans. ConclusionTCVO offers significant improvements in radiological and clinical parameters for patients with substantial tibial varus deformities, effectively maintaining JLO and patellar height. Optimal outcomes from TCVO are dependent on careful patient selection and precise execution of surgical techniques. Level of evidenceIII.

Minimally Invasive Distal Metatarsal Diaphyseal Osteotomy (MIS-DMDO) for the Prevention and Treatment of Chronic Plantar Diabetic Foot Ulcers.

Diabetic foot is one of the major complications of diabetes, affecting 15% of patients with diabetes. This study aims to evaluate and compare the clinical and radiographic outcomes of patients with diabetes affected by forefoot plantar preulcerative or ulcerative lesions who have undergone minimally invasive distal metatarsal diaphyseal osteotomy (MIS-DMDO) to assess its efficacy in the prevention and treatment of chronic plantar diabetic foot ulcers (CPDFUs). The study included 60 patients, 38 with preulcers and 22 with ulcers, with at least 2 years of clinical and radiologic follow-up. Clinical outcomes were assessed using the European Foot and Ankle Society (EFAS) score, the Foot Function Index (FFI), and the Manchester-Oxford Foot Questionnaire (MOXFQ). The radiographic evaluation was performed according to the Maestro criteria. Both groups improved in clinical and radiologic outcomes when comparing baseline measurements to those at the final follow-up. There were no statistical differences between preulcer and ulcer groups in terms of both clinical and radiologic outcomes, with the only exception being FFI, which was lower in the preulcerative group. In multivariate analysis, gender and glycated hemoglobin (HbA1c) were predictors of better outcomes. Specifically, FFI and MOXFQ (P < .05) exhibited larger improvements in females, while Maestro 1 and 2 were better in patients with lower HbA1c (P < .05). All patients were considered healed at the final follow-up. Carefully performed minimally invasive distal metatarsal diaphyseal osteotomy can be an effective approach to the care of impending or chronically present plantar diabetic foot ulcers.

Long-term Outcomes of Partial Meniscectomy for Degenerative Medial Meniscus Posterior Root Tears.

Previous studies have demonstrated that medial meniscus posterior root tear (MMPRT) repair is superior to debridement in terms of patient-reported outcomes, rates of conversion to total knee arthroplasty (TKA), and long-term costs. Despite the known poor midterm outcomes, there is a paucity of long-term results of partial meniscectomy for degenerative MMPRTs. To 1) evaluate long-term patient-reported and radiographic outcomes of patients who underwent partial medial meniscectomy (PMM) for MMPRTs, and 2) determine the rate of and risk factors for conversion to total knee TKA. Case series; Level of evidence, 4. A previously identified cohort of 26 patients treated with partial meniscectomy for isolated MMPRTs between 2005 and 2013 was prospectively followed for long-term outcomes at a minimum 10-year follow-up. Patients were evaluated for International Knee Documentation Committee (IKDC) outcome score, reoperation, and conversion to TKA. Failure was defined as conversion to arthroplasty or a severely abnormal IKDC subjective score <75.4. This study included 26 patients (10 men, 16 women; mean age, 54 ± 8.7 years [range, 38-71 years] at diagnosis; body mass index, 32.9 ± 5.5) who were followed for a mean of 14.0 ± 3.6 years (range, 10.1-19.6 years). At the final follow-up, 1 patient was deceased and 18 (72%) of the remaining 25 patients had progressed to TKA, with 1 (4%) patient undergoing repeat meniscectomy. The 6 (24%) patients who had not progressed to TKA or revision surgery reported a mean IKDC score of 57 ± 23. Nineteen patients underwent subsequent surgery and 5 demonstrated severely abnormal IKDC scores resulting in a clinical failure rate of 96% (24 of the 25 living patients) at a mean 14-year follow-up. PMM for medial meniscus posterior horn root tears demonstrated 72% progression to TKA and 96% failure according to subjective clinical outcomes at a minimum 10-year follow-up.

Clinical and radiographic evaluation of implant-supported single-unit crowns with cantilever extensions: A systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to analyze the clinical and radiographic outcomes of patients rehabilitated using a single implant supporting a crown with a cantilever extension or two implants supporting two single crowns. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines, a systematic review of relevant literature published from 2000 was conducted in the Cochrane Library, Scopus, and MEDLINE databases. Moreover, a manual search was performed. A meta-analysis of the resulting data was carried out. Peri-implant marginal bone level, probing pocket depth, prevalence of technical and mechanical complications, implant survival rate, and prosthesis survival rate were assessed. The meta-analysis showed a non-statistically significant change in the peri-implant marginal bone level and probing pocket depth in the cantilever group and revealed a non-significant prevalence of technical complications, showing a 27% rate in the cantilever group. The analysis of the prosthesis survival rate in the cantilever group showed a mean survival rate of 99% while the comparison of the implant survival between the two groups revealed an odds ratio of 0.50. The use of a single implant supporting a crown with a cantilever extension does not result in lower implant survival rate if compared with two implants supporting two single crowns. Moreover, a high prosthesis survival rate was observed in the cantilever group even if the high prevalence of complications should be carefully considered by the clinician.

Impact of Teriparatide and Denosumab on Clinical and Radiographic Outcomes in Osteoporotic Vertebral Compression Fractures.

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are prevalent among the elderly, often leading to significant pain, morbidity, and mortality. Effective management of underlying osteoporosis is essential to prevent subsequent fractures. This study aimed to compare the clinical and radiographic outcomes of teriparatide and denosumab treatments in patients with OVCFs to determine their relative effectiveness in improving patient outcomes. Materials and Methods: This retrospective study included 78 patients diagnosed with an acute thoracolumbar OVCF who received either teriparatide (35 patients) or denosumab (43 patients) within three months of a fracture. Clinical outcomes were assessed using the visual analog scale (VAS) for back pain, Oswestry disability index (ODI), and EQ-5D quality of life scores at baseline, 6 months, and 12 months. Bone mineral density (BMD) and radiographic outcomes were evaluated initially and at 12 months post-treatment. Results: Both treatment groups demonstrated significant improvements in VAS, ODI, and EQ-5D scores over 12 months. No significant differences were observed between the teriparatide and denosumab groups in terms of clinical outcomes or radiographic measurements at any time point. Fracture union and BMD improvements were similarly observed in both groups. The teriparatide group had a lower baseline BMD, but this did not affect the overall outcomes. Conclusions: Both teriparatide and denosumab are effective in improving clinical and radiographic outcomes in patients with OVCFs. Despite concerns about denosumab's potential to hinder fracture healing, our study found no significant differences between the two treatments. These findings support the use of denosumab for early treatment of OVCFs to prevent subsequent fractures without compromising fracture healing. Further prospective studies are needed to confirm these results.

Short-term clinical and radiographic outcomes with modular long stem for revision reverse total shoulder arthroplasty

BackgroundWhen performing reverse total shoulder arthroplasty with compromised proximal bone fixation, surgeons must consider using specialized stems with a distal press-fit design. In this study, the authors report on the clinical and radiographic outcomes of patients who underwent surgical management with modular diaphyseal press-fit stems. MethodsIn 2017-2021, patients who underwent revision reverse total shoulder arthroplasty reconstruction with diaphyseal press-fit stems (Aequalis Adjustable Stem [AS] or Aequalis Flex Revive Stem [RS]; Stryker, Kalamazoo, MI, USA) with minimum 1-year follow-up were identified. Patients with complex proximal humerus and scapula fractures, neurological injuries, and custom humeral replacements were excluded. Demographics and clinical follow-up data including range of motion, Visual Analog Scale (VAS), Simple Shoulder Test (SST), American Shoulder Elbow Surgeons (ASES) Score, and Single Assessment Numeric Evaluation were retrospectively reviewed. Postoperative radiographs were reviewed for aseptic humeral loosening, periprosthetic instability, stress shielding, periprosthetic fractures, and humeral stem failure. ResultsSixty-five patients (29 AS and 36 RS) had mean follow-up of 25 months (standard deviation ± 16). Mean anterior elevation improved from 57° ± 39 preoperative to 121° ± 31 postoperatively. Mean external rotation improved from 3° ± 17 to 34° ± 16. Mean internal rotation improved from 4° ± 13 to 35° ± 26. Mean VAS improved from 6.7 ± 2.2 to 2.9 ± 1.5. Mean SST improved from 13% ± 13% to 65% ± 22%. Mean ASES score improved from 19 ± 13 to 60 ± 18. Mean Single Assessment Numeric Evaluation improved from 25% ± 18% to 71% ± 17%. There were statistically significant differences in mean postoperative VAS (P = .0017), SST (P = .025), and ASES score (P = .0228) in favor of the RS group. There were no other notable differences between groups. The most common complications were aseptic humeral stem loosening (24% vs. 3%, P = .018) and periprosthetic instability (10% vs. 6%, P = .649) for the AS and RS cohorts, respectively. There was no statistically significant difference between surgical revision rates between the AS and RS cohorts (24% vs. 8%, respectively. P = .096). DiscussionDiaphyseal press-fit modular humeral stem can provide a viable surgical alternative in compromised proximal humeral bone. At short-term follow-up, the clinical and radiographic outcomes are comparable to other stem designs. Further studies are necessary to identify risks and causes of failure associated with modular diaphyseal press-fit stems.

Poster 296: Comparing Outcomes of Osteochondral Allograft Transplantation of the Knee Preserved by the Missouri Osteochondral Preservation System to Standard Preservation Methods

Objectives: Osteochondral allograft (OCA) transplantation is an established surgical intervention for full-thickness chondral defects. Standard Preservation (SP) protocols currently allow for osteochondral allografts to be stored for a maximum of 28 days after procurement. The Missouri Osteochondral Allograft Preservation System allows for grafts to be stored for at least 60 days after procurement. The purpose of this study is to compare clinical and radiographic outcomes in patients that have undergone OCA transplantation utilizing Missouri Osteochondral Allograft Preservation System (MOPS) to standard preservation protocols. Methods: Retrospective review identified all patients who underwent OCA transplantation between 2012 and 2018. Patients without appropriate follow-up, postoperative outcomes, or necessary imaging were excluded. All patients had at least 2-year follow-up data. Patient demographics, outcomes, and graft information were compared between patients who received grafts preserved by MOPS and standard preservation as previously defined. Results: Sixty-four patients were included. Twenty-five were in the MOPS group and 39 in the SP group. Members of the MOPS group were younger at the time of surgery than those in the SP group (28.6 ± 10.7 years in MOPS vs. 36.7 ± 10.9 in SP group, P = 0.005). Seventy-six grafts were analyzed with 39 grafts in the MOPS group and 37 in the SP group. Grafts in the MOPS group were stored longer (average 50.03 days) than grafts in the SP group (average 23.18 days) (P &lt; 0.001). No difference between groups was found in complications or reoperation rates. Outcomes between the 2 groups showed no statistical differences for complications or revisions as well as similar Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement, International Knee Documentation Committee scores, 12-item psychosocial safety climate scores, and 12-item mental health component summary scores. Conclusions: Grafts preserved using the MOPS were stored for more than double the length of time than grafts preserved with standard preservation techniques. There was no difference in postoperative outcomes following OCA transplantation regardless of preservation method used.

Cost-Effectiveness and Clinical Outcomes of Lateral Lumbar Interbody Fusion With Tricalcium Phosphate and Iliac Bone Graft Compared With Posterior Lumbar Interbody Fusion With Local Bone Graft in Single-Level Lumbar Spinal Fusion Surgery in Thailand.

Nowadays, minimally invasive lateral lumbar interbody fusion (LLIF) is used to treat degenerative lumbar spine disease. Many studies have proven that LLIF results in less soft tissue destruction and rapid recovery compared with open posterior lumbar interbody fusion (PLIF). Our recent cost-utility study demonstrated that LLIF was not cost-effective according to the Thai willingness-to-pay threshold, primarily due to the utilization of an expensive bone substitute: bone morphogenetic protein 2. Therefore, this study was designed to use less expensive tricalcium phosphate combined with iliac bone graft (TCP + IBG) as a bone substitute and compare cost-utility analysis and clinical outcomes of PLIF in Thailand. All clinical and radiographic outcomes of patients who underwent single-level LLIF using TCP + IBG and PLIF were retrospectively collected. Preoperative and 2-year follow-up quality of life from EuroQol-5 Dimensions-5 Levels and health care cost were reviewed. A cost-utility analysis was conducted using a Markov model with a lifetime horizon and a societal perspective. All enrolled patients were categorized into an LLIF group (n = 30) and a PLIF group (n = 50). All radiographic results (lumbar lordosis, foraminal height, and disc height) were improved at 2 years of follow-up in both groups (P < 0.001); however, the LLIF group had a dramatic significant improvement in all radiographic parameters compared with the PLIF group (P < 0.05). The fusion rate for LLIF (83.3%) and PLIF (84%) was similar and had no statistical significance. All health-related quality of life (Oswestry Disability Index, utility, and EuroQol Visual Analog Scale) significantly improved compared with preoperative scores (P < 0.001), but there were no significant differences between the LLIF and PLIF groups (P > 0.05). The total lifetime cost of LLIF was less than that of PLIF (15,355 vs 16,500 USD). Compared with PLIF, LLIF was cost-effective according to the Thai willingness-to-pay threshold, with a net monetary benefit of 539.76 USD. LLIF with TCP + IBG demonstrated excellent radiographic and comparable clinical health-related outcomes compared with PLIF. In economic evaluation, the total lifetime cost was lower in LLIF with TCP + IBG than in PLIF. Furthermore, LLIF with TCP + IBG was cost-effective compared with PLIF according to the context of Thailand. LLIF with less expensive TCP + IBG as bone graft results in better clinical and radiographic outcomes, less lifetime cost, and cost-effectiveness compared with PLIF. This suggests that LLIF with TCP + IBG could be utilized in lower- and middle-income countries for treating patients with degenerative disc disease.

Staged Versus Same-Day Surgery in Circumferential Minimally Invasive Deformity Correction.

We sought to compare long-term clinical and radiographic outcomes in patients who underwent staged vs same-day circumferential minimally invasive surgery (cMIS) for adult spinal deformity (ASD). We reviewed staged and same-day cMIS ASD cases in a prospective multi-institution database to compare preoperative and 2-year clinical and radiographic parameters between cohorts. A total of 85 patients with a 2-year follow-up were identified (27 staged, 58 same-day). Staged patients had more extensive surgeries and greater hospital length of stay (all P < .001). There were no significant differences in preoperative or 2-year postoperative clinical metrics between cohorts. Patients in the staged cohort also had greater preoperative coronal deformity and thus experienced greater reduction in coronal deformity at 2 years (all P < .01). Patients undergoing staged or same-day cMIS correction had similar outcomes at 2 years postoperatively. Staged cMIS ASD correction may be more appropriate in patients with greater deformity, higher frailty, and who require longer, more extensive surgeries.

Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusions Using a Titanium Cage with a Biomimetic Surface.

We analyzed clinical and radiographic outcomes in patients undergoing anterior lumbar interbody fusions (ALIFs) using a new biomimetic titanium fusion cage (Titan nanoLOCK interbody, Medtronic, Minneapolis, Minnesota, United States). This specialized cage employs precise nanotechnology to stimulate inherent biochemical and cellular osteogenic reactions to the implant, aiming to amplify the rate of fusion. To our knowledge, this is the only study to assess early clinical and radiographic results in ALIFs. We conducted a retrospective review of data for patients who underwent single or multilevel ALIF using this implant between October 2016 and April 2021. Indications for treatment were spondylolisthesis, postlaminectomy syndrome, or spinal deformity. Clinical and radiographic outcome data for these patients were collected and assessed. A total of 84 patients were included. The mean clinical follow-up was 36.6 ± 14 months. At 6 months, solid fusion was seen in 97.6% of patients. At 12 months, solid fusion was seen in 98.8% of patients. Significant improvements were seen in patient-reported outcome measures (PROMs; visual analog scale and Oswestry Disability Index) at 6 and 12 months compared with the preoperative scores (p < 0.001). One patient required reoperation for broken pedicle screws 2 days after the ALIF. None of the patients required readmission within 90 days of surgery. No patients experienced an infection. ALIF using a new titanium interbody fusion implant with a biomimetic surface technology demonstrated high fusion rates (97.6%) as early as 6 months. There was significant improvement in PROMs at 6 and 12 months.

Reverse shoulder arthroplasty for patients with cuff tear arthropathy: do clinical outcomes differ by inlay vs. onlay design?

The influence of position of the humeral tray (inlay or onlay) on clinical outcomes in reverse shoulder arthroplasty (RSA) is a topic of debate. The purpose of this study was to compare clinical and radiographic outcomes of patients with cuff tear arthropathy treated with RSA systems with inlay or onlay humeral tray design, similar neck-shaft angles, and lateralized glenospheres. This was a retrospective study of prospectively obtained data from 1 tertiary care center. We identified all patients who underwent primary RSA between 2009 and 2017 (N=511). We included 102 patients with diagnosed cuff tear arthropathy treated with RSA prostheses with a lateralized glenosphere and 135° neck-shaft angle (with either an inlay or onlay humeral tray design) who had a minimum of 2 years of follow-up (mean, 44months; range, 24-125months). Sixty-three patients (62%) had an inlay humeral tray (inlay group) and 39 (38%) had an onlay tray (onlay group). All patients underwent preoperative and postoperative evaluations, including measures of patient-reported outcomes (PROs), shoulder range of motion (ROM) testing, and radiographic imaging. Clinical relevance of changes in PROs and ROM was evaluated using published values for minimal clinically important differences. The 2 groups did not differ by demographic characteristics except for a higher proportion of women in the inlay group (75%) than in the onlay group (56%) (P=.04). Preoperative PROs and ROM were not significantly different between groups. At final follow-up, PROs and ROM were not different between groups in terms of statistical significance or clinical relevance. We found no significant differences in the rate of baseplate loosening (inlay, 3.2% vs. onlay, 5.1%, P=.63), revision surgery (inlay, 0% vs. onlay 5.1%, P=.07), acromial stress fracture (inlay, 3.2% vs. onlay, 5.1%, P=.63), prosthesis dislocation (inlay, 0% vs. onlay, 2.6%, P=.20), or scapular notching (inlay, 21% vs. onlay, 7.7%, P=.08). At 2-year minimum follow-up, the position of the humeral tray in RSA prostheses (either inlay or onlay) for cuff tear arthropathy was not associated with PROs, shoulder ROM, or rates of complications, including baseplate loosening, acromial stress fracture, and scapular notching.

Long-term clinical outcomes of hypofractionated stereotactic radiotherapy using the CyberKnife robotic radiosurgery system for jugular foramen schwannomas.

Jugular foramen schwannomas (JFSs) are rarely seen, benign tumors with slow growth. Today, management options for JFSs include observation, surgery, and radiation. However, the optimal treatment strategy remains controversial. Stereotactic radiosurgery serves as a minimally invasive alternative or adjuvant therapeutic regimen of microsurgery. Gamma Knife radiosurgery is suitable for patients with JFS who have small- and medium-sized tumors and normal cranial nerve (CN) function. Hypofractionated stereotactic radiotherapy (HSRT) offers a potential radiobiological advantage and may result in better preservation of normal structures compared to single-fraction stereotactic radiosurgery. The aim of the article was to review the clinical and radiographic outcomes of patients with JFS who were treated using HSRT. The authors retrospectively analyzed 74 patients with JFS who received HSRT between January 2009 and January 2020 in the authors' center. Among them, 53 patients were newly diagnosed with JFS, 19 patients had a previous history of microsurgical resection, and the other 2 patients underwent CyberKnife because of tumor recurrence after Gamma Knife radiosurgery. A total of 73 patients had preexisting CN symptoms and signs. The median tumor volume was 14.8 cm3 (range 0.5-41.2 cm3), and most of them (70.3%) were ≥ 10 cm3. The radiation dose regimen was prescribed depending on the tumor size, and more fractions were used in larger tumors. The median margin doses prescribed were 18.2 Gy/2 fractions, 21.0 Gy/3 fractions, and 21.6 Gy/4 fractions. The median follow-up was 103 months (range 18-158 months). After treatment, 42 (56.8%) patients had tumor regression, 27 (36.5%) patients had stable tumors, and 5 (6.8%) experienced tumor progression. Among them, MRI revealed that 1 patient had a complete response. Three patients received surgery at a median of 25 months because of tumor progression. One patient underwent ventriculoperitoneal shunt insertion for hydrocephalus that developed after HSRT independent of tumor progression. The 5-year progression-free survival rate was 93.2%. Preexisting cranial neuropathies improved in 46 patients, remained stable in 14, and worsened in 14. HSRT proved to be a safe and effective primary or adjuvant treatment strategy for JFSs, although 14 patients (18.9%) experienced some degree of delayed symptomatic deterioration posttreatment. This therapeutic option was demonstrated to provide both excellent tumor control and improvement in CN function.

Total shoulder arthroplasty for glenohumeral arthritis associated with posterior glenoid bone loss: midterm results of an all-polyethylene, posteriorly augmented, stepped glenoid component

BackgroundThe purpose of this study is to report the minimum 5-year clinical and radiographic outcomes of patients undergoing anatomic total shoulder arthroplasty (aTSA) with a posteriorly augmented glenoid component. MethodsThirty-five shoulders with minimum 5-year follow-up underwent aTSA using a posteriorly augmented glenoid component for the treatment of glenohumeral osteoarthritis with posterior glenoid bone loss. Clinical outcomes included range of motion (ROM), Visual Analog Scale (VAS) for pain, and patient reported outcomes scores (PROS). Radiographs (XR) and computed tomography (CT) scans were obtained to assess glenoid morphology, retroversion, central peg osseous integration (CPOI) via Wirth score, Lazarus scores, and Yian scores. Postoperative outcomes were measured at minimum 2- and 5-year follow-up. Kaplan-Meier survival analysis was calculated. ResultsTwo patients experienced prosthetic instability requiring revision, leaving 33 shoulders with an average follow-up of 6.6 years. Average preoperative glenoid retroversion was 21.6˚. A significant improvement in pain, ROM, and PROS was noted at minimum 2-year and 5-year follow-up. Additionally, VAS pain, American Shoulder and Elbow Surgeons (ASES), and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores improved between minimum 2-year and 5-year follow-up. The average Lazarus and Yian scores at final follow-up were 0.73 and 2.6, respectively. There was an increase in Lazarus score and decrease in Wirth score between 2- and 5-year follow-up. A significant correlation was identified between VAS pain scores and both Lazarus and Wirth scores. Survivorship free from revision was 92% at 8.8 years postoperatively. ConclusionsMidterm results of aTSA with a posteriorly augmented, stepped glenoid component demonstrate sustained improvements in clinical outcomes with low rates of radiographic loosening. Continued improvement in pain and function, as well as a minor progression of radiographic osteolysis, may be expected between 2- and 5-year follow-up. Additionally, the severity of radiographic loosening correlates with subjective pain levels.

Correlation Between Radiological and Functional Outcomes Following Operative and Nonoperative Management of Acetabular Fractures: A Prospective Observational Study.

The management of acetabular fractures is a complicated orthopedic procedure that has been advancing with time. Newer radiological tools like CT scans help surgeons to identify and manage these fractures more attentively. The study was conducted to evaluate the clinical and radiographic outcomes in patients with acetabular fractures managed either conservatively or by open reduction and internal fixation. The study was done on 35 patients aged 18-60 years, with acetabular fractures treated either surgically or conservatively. Clinical scorings and radiological scoring were only taken and noted at three- and six-monthintervals using Matta's radiographic scoring and modified Merle d'Aubigne and Postel clinical hip scoring. Clinico-radiological variables and complications were compared between the two groups. The data obtained was subjected to statistical analyses using IBM Statistical Package of Social Sciences (SPSS) 2.0 version software (Chicago, IL, USA) at a level of significance being p<0.05. Out of a total of 35 patients, 19 were treated surgically and 16 conservatively. In patients belonging to the surgical treatment group, a maximum of 57.9% were aged 40-50 years, whereas the maximum patients (50%) of the conservative treatment group were aged <40 years, with male predominance in both groups. The type of fracture was recorded according to Judet and Letournel in both groups. Merle d'Aubigne's scoring and Matta's hip score were recorded at three and six months in both groups. A positive correlation was seen between radiological and functional outcomes at three and six months, which means that the higher the radiological scoring, the better the functional outcome of the patient managed either conservatively or surgically in the entire cohort. Our study revealed that surgically managed patients hadbetter functional and radiological outcomes than the patients who were conservatively managed at six months of follow-up. However, this is associated with more complications depending on fracture complexity and initial presentation of hip dislocation. The higher the radiological scoring, the better the functional outcome of the patient managed either conservatively or surgically in the entire cohort.