Radiographic Outcomes Research Articles

4-year clinical outcomes of anterior acetabular wall reconstruction and cup revision for treatment of anterior acetabular wall defects with iliopsoas tendinopathy following total hip arthroplasty.

To assess clinical and radiographic outcomes of anterior acetabular wall reconstruction and cup revision in patients with anterior acetabular wall defects and associated iliopsoas tendinopathy (IPT) following total hip arthroplasty (THA). 7 patients with IPT (defined as groin pain that increased with active hip flexion) and pre-revision computed tomography (CT) scans showing anterior acetabular wall defects and cup-iliopsoas impingement were included. During cup revision, an autologous biconvex iliac crest graft was harvested and placed over the anterior acetabular wall defect before press-fitting a revision cup. Cup inclination and anteversion, axial and sagittal cup overhang, and iliopsoas muscle strength (0-5) were evaluated pre- and post-revision. Forgotten joint score (FJS; 0-100), Oxford hip score (OHS; 0-48), hip pain (0-10), satisfaction (0-10), graft osseointegration and resorption were evaluated post-revision. Pre-revision cup inclination was 43.7 ± 9.4°, anteversion was 30.4 ± 10.5°, axial overhang was 6.6 ± 7.9 mm, and sagittal overhang was 14.2 ± 4.8 mm. Immediate post-revision cup anteversion was 33.0 ± 7.9°, inclination was 45.3 ± 5.1°, while there was no axial or sagittal overhang. At 60.3 ± 5.6 (52-70) months follow-up, 6 of 7 patients were available for assessment (1 patient had died). Iliopsoas muscle strength increased from 3.9 ± 0.7 to 4.6 ± 0.9, FJS was 77.5 ± 32.8, OHS was 40.3 ± 12.8, hip pain on VAS was 0.2 ± 0.4 at rest and 2.3 ± 2.6 during activities. Patient satisfaction with surgery was 8.3 ± 2.3, but 1 patient was dissatisfied and reported persistent hip pain. Last follow-up CT scans were available for 4 of 7 patients, with 3 showing osseointegrated grafts and no graft resorption. Anterior acetabular wall reconstruction and cup revision resulted in satisfactory clinical outcomes at a minimum follow-up of 4 years in 5 of 7 cases. Most patients fully recovered their iliopsoas muscle strength, had minimal to no pain, excellent FJS, and an osseointegrated acetabular wall graft.

A Prospective Randomised Clinical Trial Evaluating Pulpotomy in Primary Molars With Three Bioceramic Calcium Silicate Cements: 24 Month Follow-Up.

In recent times, bioceramic calcium silicates have gained attention due to high success rates with pulpotomy in primary teeth. To evaluate and compare the clinical and radiographic outcomes of three different bioceramic calcium silicate cements in vital deciduous teeth treated with pulpotomies over a period of 24 months. Children aged 4-9 years, with deep dentinal caries (ICDAS 4-6) in primary molars, having no history of spontaneous pain or signs of non-vitality were included in the study. Following clinical and radiographic evaluation 117 primary molars diagnosed as having reversible pulpitis received pulpotomy treatment, after randomly being assigned into three groups based on the bioceramic calcium silicate medicament used: a pre-mixed syringe-loaded MTA putty (NeoPUTTY); a traditional powder-liquid hand mix MTA material (NeoMTA Plus), and a precapsulated, trituration mixed material (Biodentine). Clinical and radiographic evaluation was done at 6, 12, 18 and 24 months. The cumulative clinical and radiographic success for NeoPUTTY was 92%, NeoMTA Plus 97% and for Biodentine 95% and 89%, respectively, after 24 months follow-up. The clinical and radiographic success rates of all three bioceramic calcium silicate cements were found to be high, with no significant differences over a period of 24 months. Clinical trial registration number: CTRI/2021/03/031655.

Does septic arthritis after anterior cruciate ligament reconstruction lead to poor outcomes? A systematic review and meta-analysis of observational studies

BackgroundSeptic arthritis is a rare but devastating complication after anterior cruciate ligament reconstruction (ACLR). While early treatment can prevent significant graft complications, outcomes are often inferior to those in uncomplicated ACLR. Furthermore, whether to retain or remove the graft after infection remains debatable. Therefore, we sought to compare the outcomes of septic arthritis post ACLR with uncomplicated ACLR and evaluate graft retention versus removal in infected patients.MethodsWe conducted a systematic review and meta-analysis in which PubMed, Embase, and Cochrane Library databases were searched. Clinical studies were included if they compared patient-reported, clinician-reported, or radiographic outcomes (minimum follow-up of 12 months) between patients with post-ACLR septic arthritis and those with uncomplicated ACLR or that compared graft retention and removal in patients with post-ACLR septic arthritis.ResultsThirteen studies were retrieved. Patients with post-ACLR septic arthritis reported inferior Lysholm Knee Scoring Scale scores (mean difference (MD) 7.53; 95% confidence interval (CI) 3.20–11.86; P = 0.0006), Tegner Activity Scale scores (MD, 1.42; 95% CI 1.07–1.76; P < .00001), and return to sports rates (53% versus 76%, respectively) to those of patients with uncomplicated ACLR. Patients with post-ACLR septic arthritis and those with uncomplicated ACLR did not differ in terms of the pooled estimate of various clinician-reported outcomes, such as the objective International Knee Documentation Committee score, anterior–posterior laxity, pivot shift, and Lachman test results. Furthermore, no significant difference was noted between the aforementioned patient groups regarding osteoarthritis (detected radiographically). Graft retention led to better patient- and clinician-reported outcomes than graft removal.ConclusionsDespite similar clinician-reported outcomes and osteoarthritis rates, patients with post-ACLR septic arthritis reported worse outcomes than those with uncomplicated ACLR. Graft retention leads to improved patient- and clinician-reported outcomes compared with the outcomes of graft removal. Our findings may help develop realistic expectations and management strategies for this rare complication.

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.

Standalone Anterior Lumbar Interbody Fusion Without Supplementary Posterior Fixation Is Effective for Treatment of Symptomatic Grade 1 Isthmic Spondylolisthesis.

There is a paucity of data examining anterior lumbar interbody fusion (ALIF) with pedicle-screw fixation (ALIF-PSF) or without (standalone, sa-ALIF) for the treatment of low-grade isthmic spondylolisthesis (IS). Treating pathology with sa-ALIF reduces costs, operative times, and posterior access morbidity. This study aimed to investigate the clinical and radiographic outcomes of sa-ALIF for the management of low-grade IS compared with an ALIF-PSF cohort. Retrospective analysis of prospectively collected data. Consecutive patients from 1 senior spine surgeon performing sa-ALIF or ALIF-PSF for management of low-grade IS. Patient-reported outcome measures (PROMs) were collected at baseline, then postoperatively at 6 weeks, 6 months, 12 months, and a final follow-up timepoint. Computed tomography was conducted at 6 months, 12 months, or until interbody fusion was confirmed. Two cohorts comprised 51 patients (sa-ALIF 22 and ALIF-PSF 29). Both cohorts' PROMs improved from baseline to 12 months postoperatively. There were no significant differences (P = 0.05) in PROMs between the 2 cohorts at 6 months postoperatively, 12 months postoperatively, or at a final follow-up timepoint. There were no significant differences in mean fusion rates 12 months postoperatively (sa-ALIF 82% and ALIF-PSF 88%). Compared with preoperative measurements in sa-ALIF and ALIF-PSF cohorts, listhesis and segmental lordosis showed no significant changes, while disc height significantly increased (P = 0.0001). There were no significant differences in disc L5/S1 radiographic measurements between the cohorts at 12 months. There were 12 complications (sa-ALIF 2 and ALIF-PSF 10). Only 1 patient in the ALIF-PSF cohort required revision surgery. In appropriately selected patients with normal bone density, sacral slope <40°, and a body mass index <35, sa-ALIF is a safe and effective treatment option for grade I IS. The additional morbidity and cost of PSF may not be justified given the satisfactory clinical and radiographic outcomes of sa-ALIF for grade I IS. Clinically, this research continues to suggest that sa-ALIF is a safe and effective method of treatment for low grade IS.

Oblique Lumbar Interbody Fusion Combined With Anterolateral Fixation and Cement Augmentation for the Treatment of Degenerative Lumbar Diseases in the Elderly Population: A Retrospective Study.

Cage subsidence is a common complication of oblique lumbar interbody fusion (OLIF), particularly in elderly patients with osteoporosis or osteopenia. While bilateral pedicle screw fixation (BPS) is effective in reducing subsidence, it is associated with longer operative times, increased blood loss, and greater tissue trauma. In contrast, anterolateral fixation (AF) is less invasive but linked to higher subsidence rates. Ensuring both minimal invasiveness and adequate stability in OLIF-assisted fixation remains a significant challenge. This study aimed to evaluate the efficacy of combining AF with cement augmentation (AF + CA) in reducing cage subsidence and improving clinical outcomes compared with AF and BPS. A retrospective analysis was conducted on 138 elderly patients with degenerative lumbar diseases treated with OLIF. Patients were divided into three groups: AF + CA (32 patients), AF (32 patients), and BPS (74 patients). Clinical and radiographic outcomes were compared among the groups, and logistic regression analyses were performed to identify risk factors for cage subsidence after OLIF. At 1 year postoperatively, the disc height of the AF + CA group was significantly greater than that of the AF group. The cage subsidence rate in the AF + CA group was 24.3%, significantly lower than that in the AF group (48.8%, p < 0.05) and comparable to the BPS group (30.4%). Survivorship curve analysis showed better outcomes in reducing cage subsidence in theAF + CA group compared with the AF group, with no significant difference between the AF + CA and BPS groups. Compared with the AF + CA and BPS groups, the AF group had significantly higher grades and severity of cage subsidence. Fusion rates at 1 year were 91.9% in the AF + CA group, 90.2% in the AF group, and 95.1% in the BPS group, with no significant differences. The AF + CA group had significantly shorter operative times, less intraoperative blood loss, lower VAS scores at 3 days and 1 year postoperatively, and lower ODI scores at 3 days and 3 months compared with the BPS group. Multivariate regression analysis revealed that AF was a significant risk factor for cage subsidence, with an odds ratio of 3.399 compared with AF + CA. AF + CA effectively reduces cage subsidence in OLIF surgeries, offering results comparable to BPS while providing advantages such as shorter surgical time, reduced blood loss, and improved early postoperative outcomes. AF + CA is a viable alternative, especially for elderly patients with comorbidities who may not tolerate the longer operative durations or greater blood loss associated with BPS.

Humeral Stem Design in Reverse Total Shoulder Arthroplasty.

There have been tremendous modifications to the humeral component since Paul Grammont first introduced the reverse total shoulder arthroplasty in 1985. The purpose of this article is to review historical design features and their drawbacks and to summarize the clinical outcomes of modern designs. Decreasing the neck-shaft angle and increasing humeral lateralization have helped address problems of scapular notching and limited internal and external rotation that were common with traditional designs. Advancements in proximal porous coatings have also facilitated the development of short-stem and stemless implants, which decreases the need for cement fixation and allows preservation of bone stock. Moreover, a reduction in stem length with smaller metaphyseal and diaphyseal filling ratios may limit stress shielding. Current humeral implants have an aseptic loosening rate less than 1%. Despite promising results, many of these new humeral design features do not have long-term data and continued surveillance of their performance is necessary. The humeral stem design significantly influences clinical and radiographic outcomes. Surgeons should be mindful of these design variables to increase impingement-free range of motion, minimize scapular notching, reduce stress shielding, and improve implant survivorship.

Impact of postoperative cauda equina clumping on recovery after biportal endoscopic decompression for severe lumbar stenosis.

This study determined the prevalence of cauda equina clumping among patients with Schizas grade C or higher central stenosis after decompression and compared the radiographic and clinical outcomes between patients with and without clumping. We conducted a single-center retrospective cohort study involving 98 patients who underwent biportal endoscopic spine surgery between January 2019 and June 2022. Based on postoperative magnetic resonance imaging findings, the patients were divided into the clumping (n = 40) and non-clumping (n = 58) groups. Clinical outcomes were assessed using the visual analog scale for back and leg pain, Oswestry Disability Index (ODI), and EuroQol 5-Dimension (EQ-5D-5L) questionnaire at 1, 3, 6, and 12 months postoperatively. Radiographic evaluations included measuring the cross-sectional area of the dural sac preoperatively and 1 month postoperatively using the PACS software. Postoperative cauda equina clumping was observed in 40.8% of the patients. Despite an average dural sac expansion of approximately 270%, the clumping group exhibited significantly higher radiating pain at 3 and 6 months (p < 0.05) than the non-clumping group. The ODI and EQ-5D scores were worse in the clumping group at 3 months (p < 0.05). At 12 months postoperatively, differences in clinical outcomes between the two groups were not significant. Patients in the clumping group required longer duration of postoperative medication than those in the non-clumping group (p = 0.024). Post-decompression cauda equina clumping is commonly observed in patients with severe lumbar stenosis and impacts intermediate-term clinical recovery. Although long-term outcomes at 1 year are similar, tailored postoperative care is essential for patients exhibiting clumping to effectively manage prolonged symptoms.

Short-Term Outcomes of a Novel Non-Screw Based Expandable Posterior Interbody Fusion Cage

BackgroundLumbar interbody fusion is a well-established surgical technique for treating various lumbar degenerative pathologies. Expandable cages have been introduced to allow for insertion via the confined access and to improve disc height restoration, though concerns about the stability of the screw-based cages in the expanded state remains a concern. This study aims to evaluate the short-term clinical and radiographic outcomes of a novel non-screw based expandable TLIF cage. MethodsAdult patients who underwent posterior spinal fusion and were implanted the X-PAC TLIF-cage for degenerative lumbar conditions between September 2021 and April 2023 were retrospectively reviewed. Radiographic outcomes, including anterior disc height (ADH), posterior disc height (PDH), and segmental lordosis, were measured preoperatively, postoperatively, and at ≥6-month follow-up. Cage subsidence at follow-up was assessed according to the Marchi classification, along with cage collapse and complications requiring revision surgery. Radiographic outcomes were compared between timepoints using Wilcoxon signed-rank tests and paired t-test depending on distribution. ResultsThe study included 131 patients, implanted with 160 expandable cages. Significant increases in ADH and PDH were observed postoperatively and maintained at follow-up (ADH: 9.8 mm ± 5.4 versus 12.7 mm ± 4.0, and PDH: 3.1 mm (1.3 – 4.9) versus 5.0 mm (3.6 – 6.9) respectively, p < 0.001). Segmental lordosis showed an initial postoperative increase but was not significantly sustained at the 6-month follow-up. Cage subsidence was seen in 9.3% of cases, with no severe subsidence or complete cage collapse. Revision surgery was required in 6.1% of patients, none due to cage-related issues. ConclusionThe novel non-screw-based expandable cage effectively restored and maintained disc height with a low incidence of complications, suggesting it as a safe and effective alternative for lumbar interbody fusion. Further long-term studies are needed to confirm its efficacy and safety.

Analysis of clinical and radiographic outcomes at least 5 years after coronectomy for deeply impacted mandibular third molars

ObjectiveCoronectomy is an alternative to traditional mandibular third molar extraction when the inferior alveolar nerve (IAN) is closely associated with the roots of these molars. Given the paucity of research on the long-term outcomes after coronectomy, we conducted this study to evaluate clinical and radiographic outcomes at least 5 years post-coronectomy. MethodsThis retrospective study enrolled all patients with impacted mandibular third molars treated with coronectomy at our institution who were willing to return for follow-up evaluation 5 years or more after their original procedure. Patient data were obtained retrospectively from hospital records and during oral examinations at the follow-up study appointment. We assessed the following postoperative clinical outcomes: injury to the IAN, root migration distance, root exposure in the oral cavity, non-healing sockets, pain or sensitivity in the coronectomy area, and the presence of periapical pathology. ResultsOf the 196 patients invited to participate, 66 patients (male, 32%; female, 68%) who underwent a total of 75 coronectomies were included in this study. No persistent hypoesthesia of the lower lip were reported during follow-up. Two patients required reoperation because of root eruption into the oral cavity. Approximately two-thirds of residual roots migrated from their position on preoperative radiographs; the mean migration distance was 3.2 ± 1.3 mm. Two patients (2.6%) had pain in the soft tissues around the coronectomy site. ConclusionOur findings confirm that coronectomy is an effective treatment option for preventing IAN injury when the nerve is in close proximity to the roots of these molars.

Clinical and Radiographic Outcome of Open Reduction and Internal Fixation of 3- and 4-Part Proximal Humerus Fractures Augmented with Impaction Bone Grafting and A Magnesium-Based Bone Filler

BackgroundOpen reduction and internal fixation (ORIF) of proximal humerus fractures (PHF) is a challenging operation with high rates of loss of reduction, screw cut out, avascular necrosis, and subsequent unplanned reoperation. Augmentation of the repair with synthetic bone fillers and other alternatives has shown promise in decreasing adverse outcomes. Our aim is to report radiographic and clinical outcome of impaction grafting with cancellous allograft chips and injection of magnesium-based bone filler for ORIF augmentation of PHFs. MethodsAll patients that underwent ORIF for a 3- or 4-part PHF with the standardized protocol with a minimum of 6 months radiographic follow-up by a single surgeon (VE) were included. Radiographs were taken at standardized time points up to 6 months, followed by a final radiographic follow-up, to define radiographic healing or failure. Patient-reported outcome measures (PROMs) were collected at final follow-up. Patient characteristics, complications, reoperations and radiographic measures of reduction quality were also recorded. Results17 patients were identified with a mean 34.1 months of radiographic follow-up. Median Penn Shoulder Score was 89 (IQR 19), American Shoulder and Elbow Surgeons score was 92 (25), Veterans-Rand 12 (VR-12) Mental Component Score was 53.9 (11.9), VR-12 Physical Component Score was 51.6 (12.8), and Single Assessment Numerical Assessment was 85 (18.5).14 patients (82.3%) had routine radiographic healing. Two patients (11.8%) developed avascular necrosis (AVN) with screw cutout. Two patients (11.8%) had reoperation including one hardware removal and one conversion to reverse total shoulder arthroplasty for a subsequent rotator cuff tear. No signs of glenohumeral arthritis were present in 12/17 patients (70.6%), and no signs of cuff tear arthropathy were noted in 13/17 patients (76%). Seven out of nine (78%) patients who worked prior to injury returned to work at a mean of 14.7 weeks postoperatively. ConclusionAugmentation of 3- and 4-part proximal humeral fractures with a standardized protocol utilizing cancellous chips and a synthetic magnesium-based bone filler results in a high rate of maintenance of fracture reduction, radiographic healing, and satisfactory patient outcomes. Further comparative data is needed to evaluate the efficacy of this technique compared to alternative methods of augmentation.

Zenker’s Per-Oral Endoscopic Myotomy (Z-POEM): The Ideal First Line Therapy for Treatment of Zenker’s Diverticulum

Zenker's diverticulum is a mucosal herniation at the pharyngoesophageal junction. While open surgical myotomy is the conventional treatment, robust evidence on third-space flexible endoscopic myotomy is lacking. We assessed safety, effectiveness and patient-reported outcomes of per-oral endoscopic myotomy (Z-POEM) in the largest reported single-centre experience with this technique. Retrospective cohort study was performed of consecutive patients undergoing Z-POEM in a tertiary hospital thoracic surgery practice from 2018-2024. Data collected included demographics, comorbidities, clinical and radiographic (pre/post-operative esophagram) outcomes, and validated patient-reported quality-of-life outcomes (Dakkak and Eckardt scores). Descriptive analyses were used to describe the population, outcomes, and complications. Aggregate and individual-patient symptom trajectories were charted over time. Fifty-seven patients (57.9% female, n=33) with a mean age of 74 years underwent Z-POEM. Median diverticulum size was 2 cm (IQR 2-3). All patients reported subjective symptom improvement and showed complete resolution of obstructed barium flow on postoperative esophagrams. At median follow-up of 9 months, all Z-POEM patients reported clinically-important improvements in objective symptom scores, with symptom trajectories showing rapid and durable improvement up to 5 years postoperatively. Four patients (7%) experienced complications. Majority of the cohort (66.7%) was unsuitable for rigid stapled myotomy, mainly due to short diverticulum or limited neck/mouth movement. No patients required repeat myotomy. We demonstrate significant and sustained relief of patient-reported outcomes/symptoms following Z-POEM, including for small diverticuli, with low complication rates. Its safety and versatility has made it the new standard of care locally; Z-POEM can be adopted by third-space endoscopy-trained thoracic surgeons.

What Are the Functional, Radiographic, and Survivorship Outcomes of a Modified Cup-cage Technique for Pelvic Discontinuity?

What Are the Functional, Radiographic, and Survivorship Outcomes of a Modified Cup-cage Technique for Pelvic Discontinuity?

Translated article] Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: Clinical and functional outcomes

Achieving stability in total knee arthroplasty (TKA) is crucial for long-term implant survival. In cases of severe deformity or ligament laxity, constrained implants may be required. Traditionally, increasing constraint involved intramedullary stems. However, there are intermediary alternatives, including employing a constrained polyethylene insert without stems, thereby avoiding complications related to them. The study aims to evaluate our experience with a non-modular constrained (NMC) implant in primary TKA. We conducted a retrospective review of the clinical and radiographic outcomes of 108 non-stemmed primary TKAs performed at our institution between 2013 and 2021 in patients with at least 10° deformity or 10 mm ligament laxity. Data included demographics, preoperative and postoperative deformities, clinical outcomes and revision rates. A total of 103 patients (108 knees) with a mean age of 74 were followed up for a minimum of 2 years. The mean postoperative range of motion was 105°/0°. The median Oxford Knee Score, Knee Society Score and Knee Society Function Score were 43.5, 92 and 90, respectively. 17 knees had varus deformity (mean tibiofemoral angle of 2.7°), and 87 knees had excessive valgus deformity (mean tibiofemoral angle of 15.1°). The remaining 4 knees had a neutral alignment. The mean postoperative tibiofemoral angle was 6.8°. The overall revision rate was 6.5% (7 patients): 3 deep periprosthetic infections, 2 patellar dislocations, 1 stiffness and 1 aseptic loosening. Our experience demonstrates favorable mid-term outcomes with the NMC implant, providing a safe alternative to stemmed implants in primary TKA, particularly in cases of severe deformity or ligament laxity.

A 10-Year Follow-Up of Reconstructive Treatment of Peri-Implantitis Using Mineralized Dehydrated Allograft and Resorbable Membrane: A Retrospective Case Series.

To evaluate the 10-year clinical and radiographic outcomes of peri-implantitis intrabony defects treated with mineralized dehydrated bone allograft (MDBA) and resorbable membrane in patients undergoing a regular supportive peri-implant/periodontal therapy (STP). The original study participants were 34 (34 defects). After mechanical debridement and chemical decontamination of implant surfaces, intrabony defects were filled with MDBA and covered by a resorbable membrane. Patients were enrolled in a maintenance program with a recall interval of 6 months. The primary outcome was the absence of additional marginal peri-implant bone loss ≥ 1.0 mm after surgery. The composite outcome was no additional marginal peri-implant bone loss ≥ 1.0 mm and the absence of probing depth (PD) ≥ 5 mm, bleeding on probing and suppuration. Of the original 34 implants, 20 completed the 10-year follow-up, and three failed. Related to the primary outcome, the mean peri-implant marginal bone level changed from 4.78 mm (SD 1.84) at baseline to 3.10 mm (SD 1.73) after surgery and 3.71 mm (SD 1.78) at the follow-up end point. According to the composite outcome for disease resolution, 19 of the 34 original implants were successfully treated at the 10-year follow-up with a statistically significant difference between 1 (31/34 implants) and 5 years (20/34 implants) (p = 0.003) and 1 and 10 years (p = 0.001) but not between 5 and 10 years (p = 1.000). Ten years after the reconstructive treatment, followed by regular SPT, the cumulative successful treatment rate, according to the primary and the composite outcomes, was 58% (20/34 implants) and 53% (19/34) implants, respectively.

Cephalomedullary Nails for Isolated Subtrochanteric Femur Fractures: Age-Related Variations in Fracture Pattern and Perioperative Factors Do Not Affect Clinical and Radiographic Outcomes

Cephalomedullary Nails for Isolated Subtrochanteric Femur Fractures: Age-Related Variations in Fracture Pattern and Perioperative Factors Do Not Affect Clinical and Radiographic Outcomes

Application of 3D printing technology in preoperative planning and treatment of proximal humerus fractures: a retrospective study

BackgroundThe application of 3D printing technology in preoperative planning and treatment of these fractures has shown promise in improving surgical efficiency, trauma, and patient outcomes. This study aims to demonstrate the advantages of applying 3D printing technology to the treatment of proximal humeral fractures by comparing cases selected for 3D printing with a control group (conventional surgery group), in order to further promote the application of 3D technology in a broader range of trauma treatments.MethodsThis study conducted the clinical data of 51 patients with proximal humeral fractures. Inclusion criteria encompassed patients diagnosed with Neer II and III type proximal humerus fractures. Among them, 24 patients underwent traditional surgery, while 27 patients underwent surgery with 3D printing technology support. Intraoperative parameters, functional outcomes, radiographic results at 6 months, and pain scores were collected and analyzed.ResultsThe 3D printing group demonstrated significantly reduced total surgery time compared to the traditional surgery group (P < 0.05). Implant placement accuracy was significantly higher in the 3D printing group compared to the traditional surgery group (P < 0.05). Functional outcomes at 6 months favored the 3D printing group, with higher Constant-Murley Score and lower Disability of the Arm, Shoulder, and Hand (DASH) Score compared to the traditional surgery group (P < 0.05). Additionally, the 3D printing group showed a significantly lower prevalence of heterotopic ossification compared to the traditional surgery group (P < 0.05). Preoperative and early postoperative pain scores were significantly lower in the 3D printing group compared to the traditional surgery group (P < 0.05).ConclusionThe integration of 3D printing technology into the preoperative planning and treatment of complex proximal humerus fractures demonstrated significant advantages in surgical efficiency, functional outcomes, radiographic prognosis, and pain management.

Clinical and radiographic evaluation of non-surgical therapy with and without ozone gel application in controlled type 2 diabetic patients with periodontitis: a randomized controlled clinical trial

BackgroundThe current study aimed to assess the clinical and radiographic outcomes of the effect of subgingival application of ozonated gel as an adjunct to scaling and root planing (SRP) in diabetic patients with stage III periodontitis.MethodsTwenty-four patients with type II diabetes mellitus (DM) were randomized into two groups, with 12 patients in each group. Group I served as the intervention group, receiving both SRP and ozone gel application (SRP + Ozone), while Group II served as the control group, undergoing SRP alone. Clinical attachment level was evaluated as primary outcome, with secondary outcomes including probing pocket depth, full mouth plaque score, full mouth bleeding score, dentinal hypersensitivity, radiographic linear defect depth, radiographic defect angle, and periodontal ligament widening space assessed at 3 and 6 months.ResultsThe results revealed statistically significant intragroup differences between the two groups (p < 0.05). In contrast, intergroup differences revealed no statistically significant difference across the various time intervals (p > 0.05). The reduction in PD in the SRP + Ozone group at three months was statistically significant (p = 0.04). The SRP + Ozone group showed a significant radiographic improvement compared to the SRP group. The Visual Analogue Scale (VAS) also demonstrated statistically significant differences between the two groups. Glycated hemoglobin (HbA1c) significantly decreased after 6 months, with no significant signifcant differences between groups (p > 0.05).ConclusionsOzone gel is suggested to be a promising potential natural adjunctive therapy for diabetic patients to enhance periodontal health, with no reported adverse effects.Trial registrationID: NCT05538078, Date of Registration: 09/09/2022. (https://register.clinicaltrials.gov/prs/app/action/DownloadReceipt?uid=U0006D54&ts=3&sid=S000CGX4&cx=g1wreh).

When is staging complex adult spinal deformity advantageous? Identifying subsets of patients who benefit from staged interventions.

The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery. Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts. Backstep logistic regression and conditional inference tree analysis were used to identify variable thresholds associated with study-specific definitions of an optimal outcome in each cohort, defined as no intraoperative or surgery-related in-hospital adverse event. There were 439 patients with complex ASD in the dataset (mean age 64.0 ± 9.3 years, 68% female, mean BMI 28.7 ± 5.5 kg/m2). Overall, 58.8% of patients were in the same-day group, while 41.2% were in the staged group. Demographically, cohorts were not significantly different (p > 0.05), but staged patients were more frail per total Edmonton Frail Scale score (p = 0.043). Staged patients also reported greater numeric rating scale scores for back pain than same-day patients (p = 0.002). Cohorts were comparable in magnitude of planned correction of C7-S1 sagittal vertical axis, pelvic incidence-lumbar lordosis (PI-LL) mismatch, and T4-12 kyphosis (all p > 0.05). Controlling for baseline age, frailty, and number of levels fused, staged patients reported significantly higher PROMIS Discretionary Social Activities scores by 6 weeks (p = 0.029). Radiographic outcomes by 6 weeks were comparable between cohorts, in terms of both magnitude of change from baseline and overall result (all p > 0.05). Same-day patients were significantly more likely to experience in-hospital complications (p = 0.013). When considering frailty thresholds for staging, only a Charlson Comorbidity Index ≤ 1.0 was associated with optimal outcome in same-day patients, while Edmonton Frail Scale score ≥ 7 (p = 0.036), ≥ 9 levels fused (p = 0.016), and baseline PI-LL mismatch ≥ 15.3° (p = 0.028) were associated with optimal outcome for staged patients. Yet, staging alone was not significantly associated with an optimal outcome perioperatively (p = 0.056). While staged and same-day combined-approach surgeries yield comparable radiographic and patient-reported outcomes, certain subsets of complex ASD patients may benefit from staged surgery despite the invariably increased hospital length of stay. Individuals with increased frailty, moderate to severe PI-LL mismatch, and increased anticipated number of levels fused may experience a lower risk of perioperative adverse events if they undergo a staged procedure. Clinical trial registration no.: NCT04194138 (ClinicalTrials.gov).

Reverse Shoulder Arthroplasty in the Setting of Massive Proximal Humeral Bone Loss: A Systematic Review

Massive proximal humeral bone loss (PHBL) poses a technical challenge during reverse shoulder arthroplasty (RSA). Surgical treatment strategies include allograft-prosthetic composite (APC) reconstructions, endoprostheses, and other reverse shoulder arthroplasty constructs, however, there is a paucity of literature summarizing the outcomes and complications unique to this complex patient population. This study aimed to systematically review the literature to evaluate (1) patient-reported outcome measures (PROMs), (2) functional outcomes, and (3) complications according to surgical treatment strategy for patients with massive PHBL who undergo primary or revision shoulder arthroplasty. A systematic review of the PubMed/MEDLINE, Embase, and Cochrane databases was performed to identify studies reporting clinical outcomes and complications of reverse shoulder arthroplasty in patients with significant PHBL. Methodological quality was assessed for included studies. PROMs, radiographic outcomes, and postoperative functional outcomes were collected. Eleven studies evaluating clinical outcomes and complications of reverse shoulder arthroplasty in the setting of PHBL comprising 277 patients were included for review. The mean age was 66 years (range, 60-79 years). American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS), and range of motion (ROM) were the most common outcomes collected, and patients exhibited significant improvements in mean scores postoperatively. Of the types of prostheses reported, there were 155 reverse shoulder arthroplasty (RSA) with allograft-prosthetic composite (APC) reconstructions, 48 proximal humeral replacement (PHR) endoprostheses, 41 RSA, 15 custom RSA, and 2 RSA with fibular strut allografts. The overall pooled complication rate was 30.1% (82/272) with revision/reoperation as the most common complication at 21% (57/272). The overall complication rate for RSA-APC reconstructions was 51% (79/155). The overall complication rate for PHR endoprostheses was 64.6% (31/48). Revision/reoperation rates were the most complication for both RSA-APC and PHR endoprostheses with rates of 20% and 31.3%, respectively. Treatment by APC reconstruction is the most common surgical technique described in the setting of massive PHBL. While shoulder arthroplasty can yield acceptable results for patients with substantial PHBL, such patients are at increased risk for complications and revision surgery.