Radiological Complications Research Articles

Non-vascularized coracoid process autograft for glenoid reconstruction in revision shoulder arthroplasty.

To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty. This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score. Fifteen patients (9 males, 6 females; mean age 66.9years, range 38-85) were included. At a mean follow-up of 20.9months (range 12-56months), 93.3% achieved complete graft integration. One case of partial lysis without baseplate loosening was noted. Regarding range of motion, the mean forward elevation was 130° (range 90°-170°), external rotation at the side 25° (range 10°-40°), external rotation in 90° of abduction 45° (range 10°-80°), and internal rotation 52° (range 10-80°). The mean VAS for pain was 1.1 (range 0-8), mean SSV 67.3% (range 40-90%), mean ASES score 85.5 (range 65-98.3), mean Absolute Constant score 58.6 (range 21-83), and mean Ponderate Constant score 77.5% (range 28.8-110.7%). No neurological injuries were reported. Utilizing a non-vascularized coracoid graft during shoulder arthroplasty revision is a safe, reproducible, and time-efficient technique that demonstrated satisfactory osseointegration, implant stability, good functional results, and a low complication rate.

Challenging the Controversy Surrounding Percutaneous Brachial Artery Access Related Complications: A Systematic Review and Meta-Analysis.

Endovascular therapy has become increasingly preferred in the diagnosis and treatment of various conditions. The choice of arterial access usually depends on the type of procedure being performed with most via the common femoral artery and increasingly via the radial artery. Percutaneous access via the brachial artery has however been approached with caution due to the perceived increased risk for development of complications. Percutaneous brachial artery access (pBAA) has insufficient evidence when compared to femoral and radial access, with no large-scale studies available. The objective of this study is to review the literature and report the clinical and radiological complications associated with pBAA. EMBASE, EMCARE, CINAHL and Medline were searched for existing data on the complications associated with pBAA. Systematic review and meta-analysis were carried out on the data of 31 studies. The results of this systematic review and meta-analysis indicates that the probability of post procedural haematoma was 4.76%, haemorrhage 1.43%, perforation 1.11% pseudoaneurysm 1.06%, spasm 0.9%, thrombus 0.55%, neuropathy 0.53%, occlusion 0.51%, ischaemia 0.37% and infection 0.24 %. Non-target vessel puncture, stenosis and stroke had a 0% incidence among the assessed population. This study provides evidence to support clinical decision making when it comes to the utility of pBAA in endovascular diagnosis or therapy. The results demonstrate that pBAA is relatively safe with a low incidence of serious complications and thereby provide the clinician with the option of an alternate access point when planning treatment.

Long term results with medpor® reconstruction of the anterior skull base at a single institute

Objectives To evaluate a technique of multi-layered CSF repair following endonasal anterior skull base surgery using medpor graft. Design Retrospective review of consecutive case series from a single centre. Subjects 68 cases of repair of CSF leaks utilising medpor identified from a larger prospectively maintained database of endonasal endoscopic procedures at our centre. Methods Retrospective review of a database of consecutive anterior skull base cases from 2016–2022, and further data collection from electronic hospital records. Results During follow up there were 7 cases of post-op CSF leak (10.3%). There were no radiological complications, and no cases of medpor removal or extrusion. Rates of infection were low, there were 3 (4.4%) cases of confirmed bacterial meningitis within our cohort. The mean length of stay was 4.7 days (median 3 days), with 16 cases discharged on the first post-operative day. Conclusions Our experience of using medpor in anterior skull base reconstruction demonstrates that medpor is a readily available, easily handled, and reliable graft option with relatively low rates of infection and post-op CSF leak. Its use reduces the use of autologous graft materials and the associated donor site morbidity. Our long term follow up data further demonstrates the safety and efficacy of this technique.

Absence of scapular notching in lateralized reverse shoulder arthroplasty: a mid-term clinical and radiological evaluation

BackgroundLateralized reverse shoulder arthroplasty (LRSA) has been conceived to improve clinical and functional outcomes and reduce complication rates and scapular notching in comparison with medialized implant. The purpose of this study was to evaluate the mid-term clinical and radiological outcomes, the survival rate, and the health-related quality of life in a prospective series of patients who underwent LRSA, and to identify the possible predictors of clinical outcomes. MethodsWe conducted a retrospective study on prospectively collected data of 29 patients who underwent LRSA. Thirteen (45%) patients suffered from primary osteoarthritis (OA), 12 (41%) patients suffered from cuff tear arthropathy (CTA), and 4 (14%) patients suffered from secondary OA due to fracture sequelae. Each patient was evaluated preoperatively and at follow-up by radiological and computed tomography (CT) and by assessing the range of motion (ROM), the Constant-Murley Score (CMS), and the Short Form 12 (SF-12). ResultsAfter a mean follow-up of 52.3±17.4 (range, 24-101) months, a statistically significant recovery of the forward flexion, abduction, and external rotation ROM as well as the CMS and SF-12 physical component values was reported. Higher postoperative functional outcomes were noted in patients suffering from primary OA in comparison with patients suffering from CTA or secondary OA. No cases of scapular notching (0%) and just one case (3.4%) of grade 1 heterotopic ossification were observed. ConclusionsSatisfactory clinical and radiological outcomes of LRSA can be expected after a mean 52.3-month follow-up, with no cases of scapular notching and exceptionally low rates of radiological complications.

Anterior cervical corpectomy and fusion-derived adjacent segment disease managed via channel-repairing anterior endoscopic transcorporeal cervical discectomy: a case report

BackgroundManagement of anterior cervical corpectomy and fusion (ACCF)-derived adjacent segment disease (ASD) represented a challenge facing the surgeons.MethodsA 41-year man diagnosed as C3-4 level ASD derived from C5-level ACCF surgery 13 years ago was admitted to the hospital for numbness and pain in the right shoulder and upper limb. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) was performed, and pre- and postoperative clinical and imaging data were collected.ResultsThe operation was completed within 70 min, and no clinical or radiological complication was reported. The visual analog scale (VAS) score decreased from preoperative 5 points to postoperative 1 point. Numbness was relieved postoperatively and disappeared completely at postoperative 3 months. Imaging data indicated sufficient spinal cord decompression, good channel repairing and cervical alignment.ConclusionsChannel-repairing PEATCD was successfully performed to treat ACCF-derived ASD, nevertheless, the long-term efficacy remained tracing and further clinical trials were needed to validate its efficacy.

Radiographic and complication evaluation of 2 different bioresorbable pins in hallux valgus corrective surgery.

Osteotomies to correct hallux valgus are usually secured using metal implants. Their main disadvantage is the need for a repeat surgery for removal of implanted material. Bioresorbable implants would make it possible to overcome this complication. Few studies analyse the results of using bioresorbable pins. The primary objective of this study is to compare hallux valgus correction radiographic results with the use of two types of bioresorbable pins. The secondary objectives are to screen for possible complications related to the use of these bioresorbable pins. This is a descriptive, retrospective, single-centre study carried out between May 2018 and May 2022 in the orthopaedic surgery department of the Centre Chirurgical Emile Gallé at the CHRU in Nancy (France). The study involved 105 hallux valgus (98 patients) operated on by open double metatarsal and phalangeal osteotomy. Osteotomies were stabilised with resorbable polylactic acid (PLLA) pins (Arthrex® TRIM-IT® drill pin) in 57 cases (53 patients), and with resorbable polylactic acid-polyglycolic acid copolymer (PGLA) pins (Bioretec® ActivaPins®) in 48 cases (45 patients). The efficacy of hallux valgus correction was analysed in terms of changes in preoperative and postoperative radiographic parameters at 1 and 6 months on a weight-bearing foot. Descriptive statistics were used to describe the demographic and radiological parameters of each group. The mean age was 59.7 years (range 25-81 years) in the PLLA group and 56 years (range 23-78 years) in the PGLA group. The mean preoperative HVA was 30° (range 15-63°) in the PLLA group and 30.8° (range 15-57°) in the PGLA group. The mean preoperative IMA was 14.4° (range 7-30°) in the PLLA group and 13.8° (range 7-20°) in the PGLA group. There was a statistically significant correction of hallux valgus in the PLLA (p=5.24 X 10-15 ) and PGLA (p=3.56 X 10-13 ) groups. The mean correction for the hallux valgus angle was 13° in the PLLA group and 12° in the PGLA group. There was no statistically significant difference in hallux valgus correction between the PLLA and PGLA groups, particularly in terms of hallux valgus severity. There was no radiological or clinical complication in the groups related to bioresorbable pins. The use of bioresorbable pins allows effective stabilisation of osteotomies to correct hallux valgus. There was no significant difference in correction between PLLA and PGLA implants, regardless of the severity of the hallux valgus. We did not observe any obvious clinical or radiological complications related to their use. The use of bioresorbable osteosynthesis material in forefoot surgery seems to offer interesting advantages, providing patients with safer and less invasive treatment solutions.

Midterm Comparative Analysis of Short Femoral Stem Survivorship in Dorr Type A Femurs.

Proximal-distal mismatch has emerged as a prominent concern in Dorr type A femoral morphology, prompting the exploration of short stems as promising alternatives to conventional stems. This study aimed to evaluate clinical and radiographic outcomes of total hip arthroplasty (THA) using short femoral stems in Dorr type A proximal femoral morphology with a minimum follow-up of 5 years. Patients with short femoral stems in Dorr type A between 2011 and 2017 were included. Patients with the Short Modular Femoral (SMF) stem and Metha stem were recruited and patients with a shortened tapered stem (Tri-Lock BPS) were matched by propensity score matching based on age, sex, body mass index, calcar to canal ratio, and diagnosis. Patient-reported outcomes and the presence of thigh pain were assessed at 5 years postoperatively. Revision rate, complication rate, and radiographic outcomes were also assessed and compared. Twenty-two cases (81%) in the SMF stem and 43 cases (65%) in the Metha stem had more than 5 years of follow-up data available. The SMF stem showed a higher failure rate than the other 2 groups, with 18% requiring revision surgery in the SMF stem compared to 4.6% in the Metha stem, and 2.3% in the Tri-Lock BPS. The SMF stem showed considerable complications such as stem position change and lateral cortical hypertrophy with inferior clinical outcomes than the other 2 stem groups. When the Metha stem and the Tri-Lock BPS groups were compared, more intraoperative fractures were observed in the Metha stem, whereas stress shielding and anterior thigh pain were significantly more prevalent in the Tri-Lock BPS. The SMF stem might be less reliable than previously reported, showing a high failure rate and increased radiologic complications. Thus, its use for THA in Dorr Type A femurs needs caution. On the other hand, the Metha stem showed comparable outcomes to the shortened tapered Tri-Lock BPS.

Dijital Çıkarma Anjiyografisinde Komplikasyonlar: İlk Üç Yıllık Deneyim

Purpose: In this study, we describe the complications we encountered during digital subtraction angiographies (DSA) in our initial three years of experience and evaluate the risk factors in our patient population.
 Materials and methods: A series of 507 patients with different pathological processes were diagnosed via digital subtraction angiography (DSA) in our institution from April 2019 through May 2022 and were retrospectively evaluated. During the angiography, the date of the procedure, patient age, gender, comorbidities, catheter types, number of catheters used, and all procedure-related complications were recorded, even if they did not cause any neurological sequelae. Complications were categorized as neurological, non-neurological, or local.
 Results: Our study included a total of 507 patients. Of these, 256 (50.5%) were male, and 251 (49.5%) were female. The mean age of patients was 49.2 years (range 5-91). The most preexisting comorbidity in patients was hypertension (22.5%). Of 507 patients, a total of 10 patients had either a neurological complication, radiological complication, or angio-site-related complication, and the overall rate of complications was 0.02%. In 6 patients with neurological complications, 3 (0.6%) had permanent neurological deficits, and 3 (0.6%) had transient deficits. In 4 patients with non-neurological complications, asymptomatic vasospasms were encountered in two cases; internal carotid artery (ICA) dissection was experienced in one case, and scrotal hematoma was observed in one case. 
 Conclusion: Complications following DSA are rare but must be minimized with knowledge of the characteristics of the patients and determining the proper indication. Although the risk is low, complications such as thromboembolism can cause permanent neurological deficits and even death.

Enhanced recovery and same-day discharge after brain tumor surgery under general anesthesia: initial experience with Hospital-at-Home-based postoperative follow-up.

The objective of this study was to describe the outcomes of outpatient oncological neurosurgery (OON) in a European clinical setting and to compare them with the conventional inpatient protocol. Patients who had undergone OON (either tumor removal or biopsy) at the authors' center since 2019 were analyzed. A matched cohort of patients was selected from patients undergoing tumor surgery in the same period. Collected data included patient demographics, postoperative progress, specific location of the target lesion, and the procedure performed. There were 18 patients in the case group and 59 patients in the control group. The outpatient surgeries had a same-day discharge rate of 89%, and all ambulatory patients successfully completed the Enhanced Recovery After Surgery program within 6.24 hours of the procedure. All ambulatory patients underwent Hospital-at-Home postoperative follow-up for an average of 4.12 days. Radiological complications were present in 11% of the case group and 8% of the control group. Postoperative neurological deficit occurred in 6% of the same-day discharge group and 3% of the control group. Among the patients in the control group, 3% suffered from postoperative seizures, whereas no seizures were observed in the case group. These differences were not statistically significant. General anesthesia-related complications were not observed in any of the patients. The authors' findings demonstrate that Enhanced Recovery After Surgery protocols and same-day discharge craniotomy for tumor resection and image-guided biopsy under general anesthesia, when patients are carefully selected, can be safely performed with excellent outcomes in a European clinical setting. The OON program proved to be a viable alternative to conventional hospitalization, showing comparable safety records and offering advantages in terms of patient recovery.

Usage of xenogeneic bone intentionally left exposed to the oral environment after immediate implant placement: a case report with six-year follow-up

Objective: This clinical case report aims to demonstrate a successful treatment using an alternative technique for flapless immediate implant placement by letting the xenogeneic bone graft exposed to the oral environment. Case report: A flapless immediate implant placement into the fresh mandibular first molar socket was done. The alveolar gap was filled by deproteinized bovine bone mineral (DBBM) up to the level of the gingival margin, and the biomaterial was intentionally left exposed and maintained only by the cover screw. A definitive restoration was placed six months after the implant insertion. This patient exhibited no clinical or radiologic complications throughout the six-year follow-up period. Conclusion: The DBBM exposed to the oral environment showed stability and caused no sign of infection and clinical complications. Throughout the follow-up time, the patient presented a favorable peri-implant phenotype, with a wide keratinized mucosa width, stable peri-implant buccal bone, as well as the maintenance of crestal bone. Although the exposed biomaterial may be more susceptible to displacement, this approach showed satisfactory performance regarding uneventful healing, esthetics, and function, in a six-year follow-up. However, randomized clinical trials to evaluate the clinical predictability and soft and hard tissues healing profile are needed.

The volume of the thalamus and hippocampus in a right-handed female episodic migraine group

Background/aimMigraine is a disabling headache with clinical and radiological complications. The aim of this study was to investigate the volume of the thalamus and hippocampus in migraineurs, the role of white matter lesions (WMLs), and the migraine characteristics in volume changes.MethodsBrain MRIs of 161 right-handed female episodic migraine patients and 40 right-handed, age-related, healthy women were performed. Left and right thalamus segmentation was performed on the 3D MPRAGE images using the Freesurfer 5.3 image analysis suite. Hippocampal subfield segmentation was based on a novel statistical atlas built primarily upon ultra-high-resolution ex vivo MRI data.ResultsThe left hippocampus had a smaller and the left thalamus had a larger total volume than the right one in both the control (p < 0.001) and migraine groups (p <0.001). Patients with white matter lesions (L+) showed smaller right thalamus and right hippocampal tail volumes than patients without lesions (L–) (p = 0.002 and p = 0.015, respectively) and controls (p = 0.039 and p = 0.025, respectively). For the right hippocampal body, we found significantly smaller volume in L+ patients when compared to L– patients (p = 0.018) and a similar trend when compared to the control group (p = 0.064). Patients without aura (A–) showed a larger right hippocampus (p = 0.029), right hippocampal body (p = 0.012), and tail volumes (p = 0.011) than patients with aura (A+). Inverse correlations were found between attack frequency and the volumes of the left and right hippocampal tails (p = 0.018 and p = 0.008, respectively).ConclusionThese findings indicate that WMLs may influence the volume of the right thalamus and hippocampus, while migraine aura and attack frequency may lead to volume changes in different parts of the hippocampi in migraine patients. These data support the necessity of effective migraine management to limit subcortical volume loss in migraineurs.

Complication Pattern After Percutaneous Cement Discoplasty: Identification of Factors Influencing Reoperation and Length of Hospital Stay

Percutaneous cement discoplasty (PCD) was introduced to treat symptomatic vertical instability of the lumbar spine in a minimally invasive way. The aim of the present study was to analyse the complication pattern after PCD and to identify factors that predict the chance of cement leakage, reoperation and length of hospital stay (LOS). 344 patients were treated with PCD within the study period. Clinical features and complications were analysed by applying descriptive statistics, while perioperative factors predictive of cement leakage, reoperation and LOS were identified by regression models. Cement leakage rate was 30.4 % in the total cohort, however only fifth of them were symptomatic. Cement leakage itself did not have a significant influence on clinical outcome. Other complications and non-surgical adverse events were registered only in 2.0% of cases. Age, BMI, low viscosity cement, lower level of surgeon's experience and the number of operated levels were identified as risk factors of cement leakage (p<0.01, c-index=0.807). Type of procedure, Charlson comorbidity score, reoperation and non-surgical adverse events significantly increased the LOS (p<0.01). Cement leakage, early surgical practice and high BMI were risk factors for reoperation (p<0.01, c-index=0.72). In summary, PCD is a relatively safe and effective procedure for treating spinal instability due to advanced stage disc degeneration characterized by vacuum phenomenon. Cement leakage is not uncommon but only a radiologic complication without clinical consequences in most cases. On the other hand, it can increase the LOS and it is a significant risk factor for reoperation.

Predictors for hemorrhagic transformation and cerebral edema in stroke patients with first-pass complete recanalization.

Predictors of radiological complications attributable to reperfusion injury remain unknown when baseline setting is optimal for endovascular treatment and procedural setting is the best in stroke patients with large vessel occlusion (LVO). To identify clinical and radiological/procedural predictors for hemorrhagic transformation (HT) and cerebral edema (CED) at 24 hr in patients obtaining complete recanalization in one pass of thrombectomy for ischemic stroke ⩽ 6 h from symptom onset with intra-cranial anterior circulation LVO and ASPECTS ⩾ 6. We conducted a cohort study on prospectively collected data from 1400 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. HT was reported in 248 (18%) patients and early CED was reported in 260 (19.2%) patients. In the logistic regression model including predictors from a first model with clinical variables and from a second model with radiological/procedural variables, diabetes mellitus (odds ratio (OR) = 1.832, 95% confidence interval (CI) = 1.201-2.795), higher National Institutes of Health Stroke Scale (NIHSS) (OR = 1.076, 95% CI = 1.044-1.110), lower Alberta Stroke Program Early CT (ASPECTS) (OR = 0.815, 95% CI = 0.694-0.957), and longer onset-to-groin time (OR = 1.005, 95% CI = 1.002-1.007) were predictors of HT, whereas general anesthesia was inversely associated with HT (OR = 0.540, 95% CI = 0.355-0.820). Higher NIHSS (OR = 1.049, 95% CI = 1.021-1.077), lower ASPECTS (OR = 0.700, 95% CI = 0.613-0.801), intravenous thrombolysis (OR = 1.464, 95% CI = 1.061-2.020), longer onset-to-groin time (OR = 1.002, 95% CI = 1.001-1.005), and longer procedure time (OR = 1.009, 95% CI = 1.004-1.015) were predictors of early CED. After repeating a fourth logistic regression model including also good collaterals, the same variables remained predictors for HT and/or early CED, except diabetes mellitus and thrombolysis, while good collaterals were inversely associated with early CED (OR = 0.385, 95% CI = 0.248-0.599). Higher NIHSS, lower ASPECTS, and longer onset-to-groin time were predictors for both HT and early CED. General anesthesia and good collaterals were inversely associated with HT and early CED, respectively. Longer procedure time was predictor of early CED.

CUSTOM-MADE ACETABULAR REVISION ARTHROPLASTY FOR PELVIC DISCONTINUITY CAN RESULT IN STABLE CONSTRUCTS AND SIGNIFICANT IMPROVEMENT IN HEALTH-RELATED QUALITY OF LIFE: A PROSPECTIVE COHORT STUDY

Pelvic discontinuity (PD) is a detrimental complication following total hip arthroplasty (THA). The aim of this study was to assess the clinical and radiological results of patients with PD who were revised using a custom-made triflange acetabular component (CTAC).This is a single centre prospective study of patients with PD following THA who were treated with a CTAC. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Clinical and radiological complications, including reasons for revisions were registered. Trends over time are described and tested for significance and clinical relevance.18 females with 22 CTACs were included with a mean age of 73.5 years (SD 7.7). There were significant improvements between baseline and final follow-up in HOOS (p&lt;0.01), mOHS (p&lt;0.01), EQ-5D-3L utility (p&lt;0.01), EQ-5D-3L NRS (p&lt;0.01), VAS pain rest (p&lt;0.01), and VAS pain activity (p&lt;0.01). A minimal clinically important improvement in mOHS and the HOOS was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage.This is the first prospective assessment in clinical outcome of patients with PD who were treated with a CTAC. We have demonstrated that CTAC in patients with THA acetabular loosening and PD can result in stable constructs with no mechanical failures. Moreover, clinically relevant improvements in health-related quality of life at two years’ follow-up was observed.

Complications of reversible cerebral vasoconstriction syndrome in relation to age

IntroductionReversible cerebral vasoconstriction syndrome (RCVS) has a heterogenous clinical and radiological presentation. We investigated whether RCVS complications vary according to age.Patients and methodsIn a pooled French cohort of 345 patients with RCVS, we assessed (1) rates of clinical and radiological complications, and (2) the functional outcome at 3 months according to age as a continuous variable, and in young patients aged ≤ 49 years versus those aged ≥ 50 years. The Commission Nationale Informatique et Liberté and the local ethics committee approved this study (registration number: 202100733).ResultsThe risk for any focal deficit and for any brain lesion were independently associated with increasing age (OR 1.4, 95% CI 1.1–1.8; p = 0.014, and OR 1.6, 95% CI 1.2–2.1; p < 0.001, respectively). Subtypes of brain lesions independently associated with increasing age were subarachnoid haemorrhage (OR 1.7, 95% CI 1.3–2.3; p < 0.001) and intracerebral haemorrhage (OR 1.5, 95% CI 1.1–2.2; p = 0.023). Frequency of cervical artery dissections peaked at age 30–39, and young age was independently associated with cervical artery dissections (OR 13.6, 95% CI 2.4–76.6; p = 0.003). Age had no impact on the functional outcome, with a modified Rankin scale score of 0–1 in > 96% of patients.ConclusionAge seems to influence rates and types of complications of RCVS, with young age being associated with cervical artery dissections, and increasing age with haemorrhagic complications. If confirmed in larger prospective studies, recognition of age-specific patterns might help to guide clinical management and to identify complications in cases of RCVS and vice versa.

Post covid lung fibrosis (PCLF) or post covid lung sequelae (PCLS) in treated case of severe COVID-19 Pneumonia case in Intensive care unit with ventilatory support and home oxygen therapy for twelve weeks

Lung fibrosis is final radiological outcome of COVID-19 pneumonia documented in proportionately majority of cases. Post COVID lung fibrosis is considered as worrisome radiological complication observed during early phase of pandemic. Time trends of final radiological outcome has evolved over months with or without treatment with antifibrotics and steroids. Importantly, Post covid lung fibrosis resolved more than fifty percent cases in six months and nearly in all cases after one year. In this case report we have documented PCLF in 32-year male hospitalized for severe COVID-19 illness with acute hypoxic respiratory failure secondary to ARDS (acute respiratory distress syndrome). He required high flow nasal canula oxygen supplementation with noninvasive ventilatory support for three weeks. He responded to medical treatment such as injection remdesivir, methylprednisolone and low molecular weight heparin injection. He was discharged to home with advice for home oxygen therapy and medicines such as steroids and antifibrotics Nintedanib. He required oxygen for twelve weeks. His chest imaging done at one year shown residual post covid sequel without any cardiopulmonary and exercise performance impact.

Post COVID lung fibrosis (PCLF) or post COVID lung sequelae (PCLS): Which one is the right choice?

Lung is the primary target organ in COVID-19 disease with diverse clinical and radiological presentations and outcome. It has caused minimal to moderate lung disease in some patients and in some cases caused deadly acute respiratory distress syndrome (ARDS). COVID-19 disease caused lung damage by direct virus induced alveolar damage, cytokine induced alveolar and vascular damage and microvascular thrombosis resulting into acute hypoxic respiratory failure. COVID-19 pneumonia evolved over period of three weeks in cases with ARDS as natural course of illness. Usually, ARDS resolves by fibrosis or resolution as final outcome. Similarly, in COVID-19 recovered cases of advanced disease or those suffering from ARDS are having post COVID lung disease. Lung fibrosis is final radiological outcome of COVID-19 pneumonia documented in proportionately majority of cases. Post COVID lung fibrosis is considered as worrisome radiological complication observed during early phase of pandemic. Time trends of final radiological outcome has evolved over months with or without treatment with antifibrotics and steroids. Importantly, Post COVID lung fibrosis resolved more than fifty percent cases in six months and nearly in all cases after one year. Post COVID lung fibrosis is considered as ‘health issue of great concern’ initially in post pandemic phase of first wave, and due to its resolving nature over time period; now considered as ‘sigh with relief’ due to its reversible pathophysiology. Post COVID sequel is minimal residual effects of COVID-19 lung disease irrespective of disease severity in past. We recommend to use term post COVID sequel over post COVID lung fibrosis.

Nintedanib as an Antifibrotic in Post Covid Lung Fibrosis: Are we Really Overestimating?

Antifibrotics were exuberantly used to treat post covid lung complications. Lung is the primary target organ in COVID-19 disease with diverse clinical and radiological presentations and outcome. It has caused minimal to moderate lung disease in some patients and in some cases caused deadly acute respiratory distress syndrome (ARDS). COVID-19 disease caused lung damage by direct virus induced alveolar damage, cytokine induced alveolar and vascular damage and microvascular thrombosis resulting into acute hypoxic respiratory failure. COVID-19 pneumonia evolved over period of three weeks in cases with ARDS as natural course of illness. Usually, ARDS resolves by fibrosis or resolution as final outcome. Similarly, in COVID-19 recovered cases of advanced disease or those suffering from ARDS are having post covid lung disease. Lung fibrosis is final radiological outcome of COVID-19 pneumonia documented in proportionately majority of cases. Post COVID lung fibrosis is considered as worrisome radiological complication observed during early phase of pandemic. Antifibrotics such as Nintedanib and Pirfenidone were used to treat post covid lung complications such as fibrosis. Both drugs were shown good antifibrotic property in clinical trials for fibrotic lung disease and observed positive outcome in restoring lung parenchyma. Time trends of final radiological outcome has evolved over months with or without treatment with antifibrotics and steroids. Importantly, Post covid lung fibrosis resolved more than fifty percent cases in six months and nearly in all cases after one year. Thus, antifibrotics were used irrationally in fibrosing lung condition of reversible type. Actually, we have overestimated post covid lung fibrosis and overtreated with antifibrotics.

ONE- AND TWO-YEAR RESULTS OF A NOVEL CERAMIC-ON-CERAMIC HIP RESURFACING IMPLANT IN AUSTRALIA

Hip resurfacing arthroplasty (HRA) is a bone conserving alternative to total hip arthroplasty. We present the early 1 and 2-year clinical and radiographical follow-up of a novel ceramic-on-ceramic (CoC) HRA in a multi-centric Australian cohort.Patient undergoing HRA between September 2018 and April 2021 were prospectively included. Patient-reported outcome measures (PROMS) in the form of the Forgotten Joint Score (FJS), HOOS Jr, WOMAC, Oxford Hip Score (OHS) and UCLA Activity Score were collected preoperatively and at 1- and 2-years post-operation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis/loosening and heterotopic ossification formation.209 patients were identified of which 106 reached 2-year follow-up. Of these, 187 completed PROMS at 1 year and 90 at 2 years. There was significant improvement in HOOS (p&lt; 0.001) and OHS (p&lt; 0.001) between the pre-operative, 1-year and 2-years outcomes. Patients also reported improved pain (p&lt;0.001), function (p&lt;0.001) and reduced stiffness (p&lt;0.001) as measured by the WOMAC score. Patients had improved activity scores on the UCLA Active Score (p&lt;0.001) with 53% reporting return to impact activity at 2 years. FJS at 1 and 2-years were not significantly different (p=0.38). There was no migration, osteolysis or loosening of any of the implants. The mean acetabular cup inclination angle was 41.3° and the femoral component shaft angle was 137°. No fractures were reported over the 2-year follow-up with only 1 patient reporting a sciatic nerve palsy.There was early return to impact activities in more than half our patients at 2 years with no early clinical or radiological complications related to the implant. Longer term follow-up with increased patient numbers are required to restore surgeon confidence in HRA and expand the use of this novel product.In conclusion, CoC resurfacing at 2-years post-operation demonstrate promising results with satisfactory outcomes in all recorded PROMS.

Staged treatment of placenta accreta spectrum: A combined surgical and radiological approach.

Placenta accreta spectrum (PAS) is a rare but serious complication of pregnancy. The aim of this study was to determine maternal and neonatal outcomes following a combined surgical and interventional radiology (IR) approach to managing PAS, and the risks associated with this technique. Retrospective cohort study of all cases of PAS in a tertiary maternity centre between January 2001 and July 2020. Women who underwent caesarean hysterectomy for histologically confirmed PAS with a staged surgical and IR approach were compared with those who underwent caesarean hysterectomy without IR. Maternal, neonatal outcomes, surgical and radiological complications were assessed. Forty-six women were included in the study, and 30/46 (65.2%) underwent the staged surgical and IR approach. Women in the staged group had less overall blood loss (1794 mL vs 3713 mL; P < 0.001), less requirement for blood transfusion (40% vs 75%; P < 0.001), and a lower mean volume of packed red cells transfused (2.5 vs 6.1 units). Anaesthetic and operative times were longer for the staged group (468 vs 189 min: 272 vs 141 min P < 0.001), respectively. There were no differences in rates of neonatal or maternal complications between the two groups. This study demonstrates that a staged procedure combining surgery and IR for PAS results in a considerable reduction in blood loss, need for transfusion, and units of packed red cells transfused compared with surgery alone. The staged procedure required significantly longer anaesthetic and operative times; however, there were no differences in maternal and neonatal morbidity.