Radiological Outcomes Research Articles

Optimal Timeline and Hematoma Size Parameters for Middle Meningeal Artery Embolization in Acute-On-Chronic Subdural Hematomas

Background and Purpose Chronic subdural hematomas (cSDH) are subdural collection of blood for which the current treatment option remains as surgical evacuation due to recurring focal inflammation and angiogenesis. An adjunctive therapeutic intervention is endovascular embolization of the middle meningeal artery (MMA) to cease the prolific cycle of angiogenesis. Few investigations have been made into the indications of this treatment modality regarding the intervention timeline and hematoma size for non-surgical candidates with acute-on-chronic subdural hematomas. Methods We examined the clinical outcomes of 19 patients with 31 acute-on-chronic SDHs undergone MMA embolization and highlighted preliminary trends in radiological and morbidity outcomes. Results Primary outcomes identified a 57.6% success rate for MMA embolization of acute-on-chronic SDHs defined as significantly reduced hematoma size (i.e. >50%) without recurring bleeds, peri-procedural complications, post-procedural neurological deficits, and need for post-procedural surgical evacuation. Subgroup analysis demonstrated a success rate of 90.9% in patients undergone embolization after a minimum 3-week delay from initial CT head study compared to 33.3% with early intervention as well as a success rate of 75% in patients presenting with a large (i.e. >10 mm) SDH compared to 30% for small SDH. Conclusion Our preliminary data in this retrospective cohort study demonstrates significantly improved outcomes of MMA embolization in patients presenting with large (>10 mm) acute-on-chronic SDHs and in patients undergone embolization after >3 weeks from initial CT head and symptomatic presentation.

Primary Total Knee Arthroplasty for Treating Osteoarthritic Knees with Neglected Patellar Dislocation.

Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary total knee arthroplasty (TKA) can serve as an effective treatment option. This study aimed to present the clinical and radiological outcomes achieved using our surgical technique. Materials and Methods: A retrospective review of 12 knees in 8 patients with neglected patellar dislocation and end-stage OA who underwent primary TKA was conducted. The surgical procedure involved conventional TKA techniques (e.g., medial parapatellar arthrotomy) and additional procedures specific to the individual pathologies of neglected patellar dislocation (e.g., lateral release, medial plication, and quadriceps lengthening). Clinical outcomes, including patient-reported outcome measures (PROMs) (Knee Society Scores and the Western Ontario and McMaster Universities Osteoarthritis Index) and knee range of motion (ROM), were assessed preoperatively and two years postoperatively. Radiological measures including mechanical femorotibial angle and patellar tilt angle were assessed preoperatively and until the last follow-up examinations. Any complications were also reviewed. Results: There were significant improvements in all PROMs, knee ROM, and radiological outcomes, including mechanical femorotibial angle and patellar tilt angle (all p < 0.05). At a mean follow-up of 68 months, no major complications requiring revision surgery, including patellar dislocation, were reported. Conclusions: Primary TKA is an effective procedure for correcting various pathologies associated with neglected patellar dislocation in end-stage OA without necessitating additional bony procedures. Satisfactory clinical and radiological outcomes can be expected using pathology-specific procedures.

Preoperative Factors on Loss of Range of Motion after Posterior Cervical Foraminotomy.

Background and Objectives: Posterior cervical foraminotomy (PCF) aims to resolve cervical radiculopathy while preserving range of motion (ROM). However, its effectiveness in maintaining ROM is uncertain. This study investigates the changes in ROM after PCF and identifies preoperative factors that influence ROM reduction post surgery. Materials and Methods: This retrospective cohort study included patients treated at our hospital from August 2016 to September 2021. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI). Radiological outcomes included the segmental angle (SA), cervical angle (CA), C2-C7 SVA, Pfirrmann grade, extent of facetectomy, foraminal stenosis, and ROM. Patients were categorized into two groups based on segmental ROM changes: decreased (Group D) and maintained (Group M). Radiological and clinical outcomes were compared between the groups. Univariate and multivariate regression analyses were performed to identify risk factors for ROM loss after PCF. Results: 76 patients were included: 34 in Group D and 42 in Group M, with no demographic differences. Preoperatively, Group D had significantly larger flexion segmental and cervical angles than Group M (segmental, p < 0.001; cervical, p = 0.001). Group D also had a higher Pfirrmann grade (p = 0.014) and more bony bridge formations (p = 0.004). While no significant differences were observed in arm pain VAS and NDI scores, Group D exhibited worse neck pain VAS at the last follow-up (p = 0.03). Univariate linear regression indicated that preoperative segmental ROM (p < 0.001, B = 0.82) and bony bridge formation (p = 0.046, B = 5.33) were significant predictors of ROM loss post PCF. Conclusions: Patients with higher preoperative flexion angles and Pfirrmann grades at the operative level are at an increased risk for ROM loss and neck pain and often exhibit bony bridge formation. Accounting for these factors can improve surgical planning and patient outcomes.

Effect of magnesium supplementation on diaphyseal tibia fractures: a pilot study

Background: This study aimed to assess and compare the efficacy of magnesium supplementation in patients with long diaphyseal tibia fractures who have undergone surgical management with intramedullary interlocking nailing. Methods: In a prospective, randomized trial, thirty patients were included, with half receiving magnesium (420 mg/day) along with calcium (500 mg/day) supplementation for 3 months alongside surgical treatment. Radiological outcomes were evaluated through postoperative X-rays using the radiographic union scale for tibia fractures (RUST) scoring system at 6 and 12 weeks. Results: A significant difference was observed between the two groups. Patients receiving magnesium supplementation exhibited a notable improvement in RUST score, indicating an accelerated bone healing process. Conclusions: This study demonstrates the efficacy of magnesium supplementation in achieving superior radiologic outcomes compared to patients who did not receive such supplementation. The findings suggest that adjuvant magnesium supplementation could be a viable therapeutic option to enhance bone healing outcomes in individuals with tibia diaphyseal fractures.

Dynamic tightrope fixation for the correction of the 1,2 intermetatarsal angle in hallux valgus surgery

Introduction Hallux valgus is a common foot deformity that causes forefoot widening, difficulty fitting shoes, bunion pain, and transfer metatarsalgia. Studies have shown that correcting the 1,2 intermetatarsal angle (IMA) can significantly reduce forefoot width and improve symptoms. This study aims to review the radiological and functional outcomes of hallux valgus reconstruction with IMA closure using mini-tightrope suture buttons. Methods A case series of 52 consecutive patients who underwent minimally invasive surgical reconstruction of hallux valgus deformity utilising the dynamic tightrope fixation was included. All patients had &gt;1 year follow-up with interim assessments at baseline, 3 months, 6 months, and 1 year. Primary outcomes included IMA in weight-bearing feet X-rays, and secondary outcomes included the hallux valgus angle (HVA) and clinical function via the Foot and Ankle Outcome Score. Results Based on radiological analysis, the 1,2 IMA and the HVA significantly improved. Clinical function also showed significant improvement in symptoms, pain, activities of daily living, and quality of life subsection. No major intra-operative complications occurred in this series; however, ∼5% of the patients required revision surgery due to a recurrence of the hallux valgus or overcorrection into hallux varus. Conclusion Dynamic tightrope fixation is a simple surgical technique that effectively corrects the 1,2 IMA during hallux valgus surgery.

Pituitary apoplexy: a comprehensive analysis of 93 cases across functioning and non-functioning pituitary adenomas from a single-center.

Pituitary apoplexy (PA) is a rare clinical syndrome due to acute/subacute pituitary hemorrhage and/or infarction; data on PA in functioning pituitary adenoma (FPA) is scarce. A retrospective record-review of details of PA in non-functioning (NFPA) and FPA managed at tertiary endocrine center. 93 patients [56 males; 33.3% FPA: 5 acromegaly, 14 prolactinoma, and 12 Cushing's Disease (CD)] diagnosed with PA were included. Median age was 40 years, with younger age of presentation in FPA. Type A (acute) [49.5%] and headache (78.5%) were the commonest presentations, with PA being the initial manifestation in 98.4% of NFPA. Median (range) Pituitary Apoplexy Score (PAS) was 2 (0-8). Median tumor diameter was 2.5cm, with larger tumors in FPA (3.2cm vs. 2.3cm). 29 (46.7%) NFPA-PA and 14 (45.2%) FPA-PA patients [71% prolactinoma, 33% in CD, and none in acromegaly] were conservatively managed. In the NFPA cohort, those managed surgically had significantly higher PAS (4 vs. 1) and larger tumor size (2.6 vs. 1.8cm); however, both arms had comparable recovery of neuro-visual, radiological, and hormonal outcomes. In FPA cohort, CD and acromegaly required definitive treatment, whereas prolactinomas were effectively managed (clinical and biochemical recovery) with oral cabergoline and glucocorticoids. Matching PAS cohorts (to overcome allocation bias for management approach) in macroadenomas (excluding prolactinoma) showed comparable neuro-deficit and hormonal recovery between surgical and conservative approaches. PA in FPA has distinct features and management issues. Carefully selected patients (PAS guided) in NFPA with PA for conservative management have comparable outcomes to surgery.

Cannulated compression screws with cable technique leads to a dramatic reduction in patella fracture fixation complications compared to tension band wiring.

The aim of this study was to compare the clinical, radiological and functional outcomes between cannulated compression screw with cable construct (CS) and tension band wiring (TBW) in transverse patella fractures. A retrospective study was conducted on patients surgically treated for AO/OTA 34C1 or 34C2 transverse patella fractures with CS or TBW technique between January 2019 and January 2023. Clinical outcomes included complications related to the implant, wound and fracture at 6 months and 1 year, time to achieving full weight bearing status and early perioperative clinical outcomes. Radiological outcomes included the time to fracture heals and delayed union. Functional outcome measures using the Oxford Knee Scale, 36-short form questionnaire and the Bartlett Anterior Knee Score were assessed. 73 patients were treated with CS (n = 33) or TBW (n = 40). TBW had higher complication rates: 25.0% (n = 10) required implant removal, 12.5% (n = 5) had wire breakage, 12.5% (n = 5) experienced fracture displacement while 52.5% (n = 21) experienced implant migration. In contrast, no CS patients had implant removals, wire breakage or fracture displacement and 3.0% (n = 1) experienced implant migration. At 1day post-operatively, 87.9% (n = 29) CS group patients were able to ambulate as compared to the 55.0% (n = 22) of TBW patients. Furthermore, CS patients ambulated further distances at 11.8 ± 10.6m than the TBW group (6.4 ± 7.4m). The CS group (25.9 ± 24.6 days) also achieved full weight bearing status faster than the TBW group (43.6 ± 39.4 days). The time taken for the fracture to heal and functional outcomes were comparable among the two groups. The CS technique demonstrated lower complications, in particular, no CS patient had implant removals, wire migration or fracture displacement. Additionally, CS technique showed a faster return to ambulation and time to achieving full weight bearing status.

Comparative analysis of the quality of the cement mantle in hip hemiarthroplasty after femoral neck fracture between three different surgical approaches: a single-center retrospective observational study.

Achieving the initial stability of implants is necessary for hip hemiarthroplasty (HHA), especially in elderly patients, and this can be achieved with a cement mantle of quality. The direct anterior approach (DAA) for HHA lately has shown positive results. However, evidence is lacking of HHA in elderly patients with osteoporosis after femoral neck fracture (FNF). This study compares differences in cement mantle quality after HHA, its complications, radiological outcomes and functional status in elderly patients with FNF intervened through different approaches. A non-interventional, retrospective case-control study was conducted. 150 cases were selected based on the surgical approach (DAA, DLA and PLA) in a 1:1:1 proportion between 2018 and 2019. Under 75years old suspicion or confirmation of a pathological fracture were excluded. Antibiotic-loaded cement was utilized. Cement preparation involved vacuum centrifugation and standard instructions for preparation canal and filling, and prosthesis placement were followed. No statistically significant differences in cement mantle quality, radiological outcomes, and the majority of the postoperative complications and functional status considering the surgical approach (p > 0.05). However, the DAA was associated significantly with shorter hospital stays (8.3days vs 11.3 and 13days for DLA and PLA) a decrease in postoperative blood transfusion (22% vs 34% and 53%), and lower rate of loss of walking (8% vs 20% and 28.6%). The DAA for HHA in patients with FNF provides a high-quality cement mantle, similar to other approaches. Also, the DAA shows advantages like shorter hospital stays and lower transfusion rates in elderly patients.

Orbital Myeloma and Plasmacytoma: An Australian Study.

The purpose of this study was to provide Australian data on the clinical and radiological features and outcomes in patients with orbital plasmacytomas. Multicentre retrospective review of orbital plasmacytoma and orbital involvement in multiple myeloma (MM) from 2005 to 2022 in Australia. Twenty-one participants were identified. The median age was 62 years (range 34-88 years), and 11 (52%) were females. Eighteen (84%) had a known diagnosis of MM prior to their orbital presentation, with all patients eventually being diagnosed with systemic MM. Thirteen (72%) were receiving active treatment for systemic myeloma on presentation, while 3 (17%) were in remission. All but 1 had unilateral orbital involvement (n = 20, 95%). Common presenting symptoms and signs were decreased visual acuity (n = 13, 62%), proptosis (n = 11, 52%), limited motility (n = 15, 71%), and optic neuropathy (n = 5, 24%). Radiologically, 15 (71%) involved the superotemporal orbit, 7 (33%) inferotemporal orbit, and 16 (76%) involved ≥1 extraocular muscle. Sixteen (76%) were biopsied and confirmed orbital plasmacytoma on histopathology. Treatment modalities included intravenous and oral steroids (n = 7, 33%), chemotherapy (n = 9, 43%), radiotherapy (n = 13, 62%), stem cell transplant (n = 3, 14%), and surgical debulking and decompression (n = 3, 14%). Mortality was high, with 15 (71%) having MM-related mortality. This is the largest cohort of Australian data on orbital plasmacytomas. Most patients have a diagnosis of systemic MM at presentation. It is crucial to recognize and treat these patients early due to a poor systemic prognosis.

Long head of biceps tendon autograft is effective in the management of large to massive rotator cuff tear: a systematic review.

The aim of this systematic review is to review the functional, clinical and radiological outcomes of patients undergoing large to massive rotator cuff repair with long head of biceps tendon (LHBT) autograft, as well as compare these to standard arthroscopic cuff repair. A review of the online Medline database was conducted on 20 October 2022 according to PRISMA guidelines and registered prospectively on the PROSPERO database. Clinical studies assessing patients with large to massive rotator cuff tears undergoing LHBT autograft repair were included. All studies reported on functional outcomes, range of movement (ROM) and radiological re-tear rates. The Methodological Index for Non-Randomised Studies (MINORS) tool was used to appraise all studies. The search strategy identified ten studies for inclusion including a total of 594 patients. Five studies were comparable (346 patients), assessing LHBT autograft repair against arthroscopic rotator cuff repair without autograft. A variety of techniques of LHBT autograft were used across all studies, including bridging and augmentation styles. Radiographic comparison showed lower re-tear rates in the LHBT autograft group with two studies demonstrating statistically significant results. Pain scores, functional outcomes and ROM were significantly improved post-operatively in all studies for LHBT autograft patients, with no significant difference when compared to standard arthroscopic repair. LHBT autograft looks to significantly improve functional scoring and range of motion in patients with large to massive rotator cuff tears. When compared to standard arthroscopic cuff repair, LHBT autograft appears to significantly reduce the re-tear rate. Further randomised studies are needed to assess the efficacy of this technique.

EP551 - Assessment of Surgical Management for Mild and Moderate Acute Gallstone Pancreatitis in Accordance with AUGIS Guidelines: A Clinical Audit

Abstract Aim Acute Gallstone Pancreatitis (AGSP) presents as a surgical emergency with diverse clinical outcomes. The guidelines from the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) recommend inpatient laparoscopic cholecystectomy (LC) during the index admission or within two weeks for surgically fit patients in cases of mild to moderate AGSP. This study examines the surgical management of AGSP, evaluating adherence to AUGIS guidelines. Methods All patients admitted to a single surgical unit who had MRCP for AGPS from September 2020 to September 2022 were included. Electronic case notes were reviewed for demographics, comorbidities, radiological results, whether they had LC and reasons for not proceeding to LC. Severity of AGSP were graded using CT severity index. Those with severe AGSP were excluded. Results 116 patients were identified; one was excluded. Median age was 59 years (IQR 46-73) and 79 (68.9%) were female. Median length of stay was 5.8 days (IQR 3.7-8.2). 19 (16.5%) patients had inpatient LC, 42 (36.5%) had outpatient LC, 4 (3.5%) patients declined LC, 10 (8.7%) patients were not surgically fit and in 40 (34.8%) patients there was no documentation of why LC not carried out. The median Charlson Comorbidity Index for patients where there was no documentations for not proceeding with LC was 4.5 (IQR 2.3-5.8). Conclusion Our study highlights suboptimal compliance with national guideline. It is essential that patients with AGSP undergo inpatient LC or receive prompt outpatient LC to mitigate the risk of recurrent AGSP. Thorough documentation becomes imperative in cases where LC is not scheduled.

FP3.2 - Pre-Treatment Neutrophil–Lymphocyte/ Lymphocyte-Monocyte Ratios: Are They Useful Prognostic Biomarkers In Locally Advanced Rectal Cancers?

Abstract Aim Examining the relationship &amp; outcome between pre operative Neutrophil:Lymphocyte Ratio, Neutrophil:Monocyte Ratio &amp; Lymphocyte:Monocyte Ratio in a cohort of locally advanced complex pelvic tumours, involving the rectum, where the patients underwent resection with curative intent. Methods The retrospective data collected from 2013 to 2022. Cases where rectum resection was not involved were excluded. The Kaplan-Meier curve was employed to estimate the survival function, with overall survival defined as the duration from the date of the first surgery to the date of death from any cause. The final data input point was last attendance at the hospital or the date of death. Disease-free survival was calculated and disease recurrence was determined based on a combination of radiological, histopathological, and/or endoscopic results. Results The data encompassed 72 cases. The male-to-female ratio was 1:0.85. Kaplan-Meier curves were used to calculate over-all disease free survival. Our results from Neut:Lymph ratio did not show any significant correlation in overall survival and disease free survival. For Neut:Monocytes ratio, all cases in our cohort had high ratio but this comparison was not published elsewhere for our comparison. Finally, for Lymph:Monocytes, when compared to Gawiński’s data, our disease free survival was found to be significant at p&amp;lt;0.0425 suggesting that the likelihood of recurrence is high. Our overall survival did not have any significant findings. Conclusions In all cancer cases, the neutrophil-to-monocyte ratio consistently showed high averages, raising the question of whether this ratio could potentially serve as a more effective biomarker. The analysis remains a work in progress with further variables to compare.

The effectiveness of intravenous zoledronic acid in elderly patients with osteoporosis after rotator cuff repair: a retrospective study

The aim of this study was to investigate the effect of zoledronic acid (ZA) on postoperative healing and functional rehabilitation in osteoporotic patients with rotator cuff (RC) injury. 96 Patients were divided into three groups according to bone mineral density and ZA use (Group A: normal BMD; Group B: osteoporosis and intravenous ZA use; Group C: osteoporosis, without ZA use). Radiologic, functional and Serological outcomes were evaluated 6 months after surgery. The functional scores in all groups exhibited significant improvement 6 months after surgery. Inter-group comparison showed that Constant Shoulder joint function Score (CSS) of group A not significantly differing from that of group B, the other indicators were significantly better than those of group B and C. There were no significant differences in shoulder forward flexion, abductive Range of Motion between group B and C. Other indicators of group B were significantly improved compared to group C. The retear rate in group C (30.3%, 10/33) was higher than group A (6.1%, 2/33) and group B (13.3%, 4/30). In conclusion, the application of ZA can significantly reduce the rate of RC retear in elderly patients with osteoporosis after surgery, which is significant for postoperative shoulder joint functional rehabilitation.

The clinical utility of autologous tumor lysate-loaded dendritic cell vaccination for patients with glioma: A systematic review and meta-analysis.

Dendritic cell (DC) vaccines show promise for glioma treatment, but optimal use remains uncertain. This meta-analysis examined DC vaccine efficacy and safety for gliomas. This systematic review and meta-analysis study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. From the date of inception to October 23, 2023, electronic databases PubMed, Embase, Web of Science, and Scopus have been thoroughly evaluated. A total of 12 studies with 998 patients and a mean age ranging from 40.2 to 56 years were included. Across 12 articles, DC vaccine 6-month overall survival (OS) was 100% [95% confidence interval {95%CI}: 100%-100%]. Respectively, 12-month OS reported 75% [95%CI: 65%-85%] but declined to 32% [95%CI: 20%-43%] for 24-month OS. 6- and 12-month progression-free survival reached 49% [95%CI: 21%-77%] and 19% [95%CI:8%-30%]. Studying radiological outcomes shows that complete response and partial response rates were 13% [95%CI: 17%-42%], and 26% [95%CI: 10%-42%], though stable disease reached 33% [95%CI: 15%-51%], suggesting predominant antineoplastic effects. The progressive disease rate also was 24% [95%CI: 9%-57%]. In gliomas, DC vaccinations show a temporary efficacy; stability is more prevalent than regression. Impacts favor decreased resistance to early disease. Enhancing efficacy remains critical. Early therapy can be enhanced by appropriate supplementary therapy integration.

Head and Neck Paragangliomas: 16-year Single-center Experience and Mini Review on Diagnosis, Treatment, and Follow-up.

To investigate head and neck paraganglioma cases treated at a tertiary center from 2007 to 2023. The research includes a thorough examination of published studies that have focused on long-term outcomes. The additional goal is to contribute to the existing knowledge on head and neck paraganglioma, with a particular emphasis on refining diagnostic algorithms, treatment selection, and follow-up procedures. A total of 44 patients were retrospectively analyzed, and 39 were included. Demographic information, symptoms, radiological examination results, types, stages, and postoperative complications were recorded. A review was conducted to select articles that reported single-center experiences with large cohorts, long follow-ups, and different treatment modalities since 2010. The mean age of the patients was 54 years, and the female/male ratio was 3.55:1. Among the 39 cases examined, 18 and 19 were identified as cervical paraganglioma and 19 as temporal bone paraganglioma. All patients initially underwent surgical resection. The mean follow-up duration was 5.42 years. Four residual cases and two recurrences were identified postoperatively, and a Gamma Knife was used as additional treatment. Subsequently, 17 articles were selected and summarized, and then a flowchart was prepared showing the possible options for diagnosis, treatment, and follow-up. Preoperative staging is essential for surgical planning and predicting potential intraoperative complications. Based on our findings and review of the articles, we have prepared a flowchart that includes all possibilities depending on the tumor stage to help in the diagnosis, treatment, and follow-up of head and neck paragangliomas.

Immobilisation in a collar and cuff with high elbow flexion is a safe and effective treatment option to reduce and immobilise Gartland type II supracondylar fractures.

This study aimed to report the proportion of children requiring subsequent surgical intervention, rate of complications and radiologic outcomes following collar and cuff immobilisation with high elbow flexion (>90°) for Gartland type II supracondylar fractures. A retrospective case series of consecutive patients aged <18 years with Gartland type II fractures treated at a level 1 trauma centre from December 2020 to April 2023 was conducted. The need for surgical intervention and complications were recorded from electronic clinical notes. The initial, post-immobilisation and final Baumann's angle and lateral humeral-capitellar angle (LHCA) were measured and compared. In total, 42 patients were included in this study. Thirty-four were treated definitively in a collar and cuff with a mean elbow flexion of 109.4°. Two patients underwent closed reduction and Kirschner wire fixation. No patient required subsequent corrective osteotomy. There were no cases of recorded complications. Immobilisation in a collar and cuff with >90° elbow flexion was associated with a significant improvement in the mean LHCA (initial 80.9° vs final 65.6°, p < 0.001). There was no significant change in the LHCA post immobilisation in a collar and cuff until final radiographic follow-up (post immobilisation 68.3° vs final 65.6°, p=0.274). Immobilisation in a collar and cuff with high elbow flexion is a safe and effective nonoperative treatment method to reduce and immobilise Gartland type II supracondylar fractures. Surgical treatment could be reserved for cases with unsatisfactory alignment or early loss of reduction following attempted nonoperative treatment.

Effects of anti-osteoporosis treatment in elderly patients with osteoporosis and lumbar discectomy and fusion.

The effect of anti-osteoporosis treatment in elderly patients with osteoporosis and lumbar discectomy and fusion (LIF) for lumbar degenerative diseases is not well known. This study aimed to evaluate the effect of perioperative anti-osteoporosis treatment in the patients with osteoporosis and LIF. From January to December 2022, patients were divided into three groups according to the inclusive criteria: the normal group (Group A), the osteopenia group (Group B) and the osteoporosis group (Group C). Quantitative computed tomography (QCT), height of the intervertebral space (HIS), segmental sagittal angle (SSA), visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were compared between the groups at the follow-up time. The serum Ca2 + , osteocalcin (OC), propeptide of type I procollagen (PINP) C-terminal cross-linking telopeptide of type I collagen (β-CTX) and 25-OH vitamin D (25-OH VD) levels were compared between the groups at the time of follow-up. Interbody fusion was graded on the X-ray and CT images at the follow-up time. There were 165 patients in this study. There were significant differences in the mean age, mean score, HIS and SSA between the groups at the different follow-up times. There were significant differences in the concentrations of serum Ca2 + , OC, β-CTX, 25-OH VD and PINP at the sixth month after surgery between the groups. There were significant differences in the concentrations of serum Ca2 + , β-CTX and 25-OH VD between the pre-surgery and at six months after surgery in Group B and β-CTX and 25-OH VD in Group C. There was a significant difference in the degree of fusion between Group B and C (χ2= 5.6243, P< 0.05). In elderly patients with LIF and osteoporosis, anti-osteoporosis therapy could reduce bone resorption and thus facilitate fusion. Anti-osteoporosis medication tends to enhance radiological, functional, and fusion short-term outcomes.

Functional Outcome in Obese Patients Undergoing Image-Based Cruciate Retaining Robotic-Assisted Total Knee Arthroplasty Using the Subvastus Approach: A Short-Term Study.

Introduction Knee osteoarthritis (OA) is a prevalent degenerative joint disease that significantly affects quality of life, especially among obese and morbidly obese individuals. Total knee arthroplasty (TKA) is an effective treatment for end-stage OA, but it presents unique challenges in obese patients. The mini-subvastus approach (SA) and robotic-assisted TKA (RA-TKA) are emerging techniques that may address these challenges. This study evaluates the clinical and radiological outcomes of cruciate-retaining (CR) RA-TKA using the mini-subvastus approach in obese and morbidly obese patients. Methods This study included 114 obese patients (215 knees) with primary OA who underwent CR RA-TKA (Maxx Meril CR knee, USA) using the Cuvis Joint® robotic system. Patients had a BMI of ≥30 kg/m² (n=101) and morbid obesity with a BMI ≥40 kg/m² (n=13). Preoperative planning involved CT scans and the J-planner for optimal implant size and positioning. Surgery was performed without tourniquets, and patients were mobilized postoperatively. Clinical outcomes were assessed using visual analog scale (VAS) scores and the American Knee Society Score (AKSS) at three and six months. Results The study included 85 females and 29 males with an average age of 61.8 years. Satisfactory knee exposure was achieved in all cases using SA, with no major complications such as wound infections, deep vein thrombosis, or component misalignment. Intraoperative challenges were managed effectively, including two cases of medial collateral ligament avulsion and one partial patellar tendon avulsion. Postoperative VAS scores showed significant pain reduction from pre-op (6.54) to post-op day 3 (1.3). AKSS improved from a pre-op average of 33.9 to 70.7 at three months and 80.9 at six months. Most patients (80%) achieved exceptional range of motion (ROM) ≥120° at six months. Discussion The mini-subvastus approach in RA-TKA offers several advantages, including reduced postoperative pain, faster recovery, and improved quadriceps strength, even in obese patients. The use of robotic assistance ensures accurate component positioning and alignment, mitigating the challenges typically associated with obese patients undergoing TKA. Conclusion The study demonstrates the feasibility and effectiveness of CR RA-TKA using the mini-subvastus approach in obese and morbidly obese patients. This technique provides adequate exposure, reduces pain, and promotes early mobilization and recovery with satisfactory clinical and radiological outcomes. The findings support the potential for wider adoption of this approach in managing knee OA in obese populations, though further studies with longer follow-up are warranted.

A Prospective Study to Analyse the Functional and Radiological Outcome of Intertrochanteric Femur Fractures Treated with Cemented Bipolar Hemiarthroplasty

A Prospective Study to Analyse the Functional and Radiological Outcome of Intertrochanteric Femur Fractures Treated with Cemented Bipolar Hemiarthroplasty

Total Hip Arthroplasty for Osteonecrosis of the Femoral Head: A Mid-term Follow-Up in Patients From Northern India.

Osteonecrosis of femoral head (ONFH) is a disabling condition of the hip joint with multifactorial etiology and is associated with genetic predilection and exposure to certain risk factors most commonly being chronic alcohol or steroid intake. Total hip arthroplasty (THA) remains the gold standard for end-stage femoral head osteonecrosis. The outcome after the surgery is mainly affected by age, activity levels and other factors that affect the development of ONFH. Through this study we aimed to evaluate the clinical and radiological outcomes in the patients who have undergone uncemented THA for ONFH. We included 111 uncemented THA on 84 patients with ONFH done by a single surgeon in our institution. The patients were followed up postoperatively and were evaluated based on their functional outcome using Harris hip scores (HHS) and the radiological outcome by serial radiographs on every follow-up. The mean preoperative HHSwas 49.30 which showed significant improvement inthe final follow-up to96.17. The mean acetabular inclination and anteversion at final follow-up radiographs were 47.70 and 18.67 degrees respectively. Fifteen patients had complications which included post-operative surgical site infection (three), hip pain (six) and thigh pain (six). Complications like osteolysis, poly wear and femoral subsidence were recorded in a total of six patients at the final follow-up. Three patients underwent revision THA due to increased femoral subsidence, accelerated poly wear, and aseptic loosening due to osteolysis. Our current observational study, which included 84 patients and 111 hips affected by osteonecrosis of the femoral head, examined the outcomes of total hip arthroplasty using metal on ultra-high molecular weight polyethylene liners. The results showed excellent clinical and radiological outcomes at a mean follow-up period of 4.8 years, particularly in younger patients with a mean age of 37.05 years.