Short-term Functional Improvement Research Articles

Core training for pain management and functional improvement in patients with patellofemoral pain syndrome: a systematic review and meta-analysis.

To investigate the effects of core strengthening exercises on pain, mobility, and lower extremity muscle strength in patients with Patellofemoral Pain Syndrome (PFP). Six databases were searched from inception until August 11, 2023. Pain, function and muscle strength related outcomes were extracted and the quality of the studies was assessed using the PEDro scale and the level of evidence was assessed using the GRADE. Nineteen studies involving 1138 patients were included. Very low-grade evidence supported the short-term pain-relieving effect of core training (SMD = -0.60 95% CI [-0.95, -0.25]), high-grade evidence supported the short-term functional improvement effects of core training (WMD = 3.61 95% CI [1.44, 5.78]), which was similarly significant within 3-12 months of follow-up. The results of the subgroup analyses suggested that hip-knee training was most advantageous in relieving pain and enhancing motor function. Although training that includes trunk core is clearly superior to knee strengthening alone, the effectiveness of hip-knee training, which is also a core training program for pain and function, is more pronounced. The available evidence supports that hip-knee training is the most valuable treatment option for patients with PFP.

Prognostic impact of cancer history in patients undergoing transcatheter mitral valve repair

BackgroundHistory of cancer is common in patients undergoing transcatheter mitral valve repair (TMVR).ObjectivesAim was to examine the impact of cancer history on outcomes after TMVR.MethodsIn patients of a monocentric prospective registry of TMVR history of cancer was retrospectively assessed from records. Associations with 6-week functional outcomes and clinical outcomes during a median follow-up period of 594 days were examined.ResultsOf 661 patients (mean age 79 years; age-range 37–101 years; 56.1% men), 21.6% had a history of cancer with active disease in 4.1%. Compared with non-cancer patients, cancer patients had a similar procedural success rate (reduction of mitral regurgitation to grade 2 or lower 91.6% vs. 88%; p = 0.517) and similar relevant improvement in 6-min walking distance, NYHA class, Minnesota Living with Heart Failure Questionnaire score and Short Form 36 scores. 1-year survival (83% vs. 82%; p = 0.813) and 1-year survival free of heart failure decompensation (75% vs. 76%; p = 0.871) were comparable between cancer and non-cancer patients. Patients with an active cancer disease showed significantly higher mortality compared with patients having a history of cancer (hazard ratio 2.05 [95% CI 1.11–3.82; p = 0.023]) but similar mortality at landmark analysis of 1 year.ConclusionTMVR can be performed with equal efficacy in patients with and without cancer and symptomatic mitral regurgitation. Cancer patients show comparable clinical outcome and short-term functional improvement as non-cancer patients. However, longterm mortality was increased in patients with active cancer underlining the importance of patient selection within the heart-team evaluation.Graphical abstract

Effect of joint immobilization using extension splint immediately after total knee arthroplasty on post-operative knee function and pain: a randomized clinical trial.

Investigate the effect of semirigid extension bracing after total knee arthroplasty (TKA) on articular pain and function. The present randomized clinical trial included 72 patients undergoing unilateral primary TKA. Patients in the case group received eight days of post-operative semirigid extension-locked knee bracing, whereas controls did not. The outcomes assessed preoperatively and on the first, ninth, 30th day, and oneyear post-operatively included the knee society score (KSS), functional KSS (FKSS), VAS pain score, amount of postoperative opiate painkiller usage (tablet oxycodone 5mg), and knee ROM. The case group had a significantly lower flexion ROM on postoperative day nine compared to the control group (95.3° vs. 100.8°, p=0.03), while it became significantly higher 1 month (114.1° vs. 104.7°, p=0.03) and one year post-operative (128.0° vs. 120.5°, p=0.002). Also, FKSS was significantly higher in the case group than in the controls in the onemonth post-operative assessment (37.0 vs. 32.6, p=0.009) but not in the oneyear post-operative assessment. The case group patients had a significantly lower pain than the controls on days one (5.8 vs. 7.2, p=0.02) and nine post-operative (4.1 vs. 5.2, p=0.048), but not at later assessments. The amount of onemonth post-operative opium (oxycodone) consumption was significantly lower in the brace group (12.4 vs. 14.1 tablets, p=0.03). The KSS were not significantly different between the groups after the surgery. Extension-locked splinting immediately after TKA is a noninvasive, non-pharmacological, and inexpensive intervention with possible promising effects on knee ROM, short-term functional improvement, and acute post-operative pain management.

Care-needs Certification in the National Long-Term Care Insurance is Useful for Assessment of Premorbid Function in Older Japanese Patients with Stroke

ObjectiveTo investigate the effects of premorbid long-term care insurance (LTCI) care-need certification on functional improvement during acute hospitalization in older patients with stroke. MethodsIn this single-center prospective cohort study, we assessed LTCI care-needs certification and the modified Rankin Scale (mRS) at the premorbid stage, on admission, and at hospital discharge in older patients with stroke. We also assessed adverse events during hospitalization. The main outcome was the presence of functional improvement during hospitalization (mRS on admission < mRS at discharge). Multivariate analysis was performed to investigate the relationship between functional improvement and premorbid LTCI care-need certification. ResultsIn total, 246 older patients with stroke were enrolled in this study. There was a significant independent association between premorbid LTCI care-needs certification (care level 1 = odds ratio [OR]: 0.26, 95% CI: 0.10–0.72, p = 0.01; Care level 2 = OR: 0.27, 95% CI: 0.10–0.73, p = 0.01; care level 3–5 = OR: 0.21, 95% CI: 0.08–0.56, p = 0.002; Not applicable = reference) and functional improvement. ConclusionsPremorbid LTCI care-need certification is associated with short-term functional improvement in older patients with stroke. Assessment of premorbid LTCI care-needs certification is valid for predicting functional improvement in older patients with stroke.

Risk Factors for Poor Outcomes Following Minimally Invasive Discectomy: A Post Hoc Subgroup Analysis of 2-Year Follow-up Prospective Data.

ObjectiveA post hoc subgroup analysis of prospectively collected data from a randomized controlled trial was conducted to identify risk factors related to poor outcomes in patients who underwent minimally invasive discectomy. MethodsPatients were divided into satisfied and dissatisfied subgroups based on Oswestry Disability Index (ODI), visual analogue scale (VAS) back pain score (VAS-back) and leg pain score (VAS-leg) at short-term and midterm follow-up according to the patient acceptable symptom state threshold. Demographic characteristics, radiographic parameters, and clinical outcomes between the satisfied and dissatisfied subgroups were compared using univariate and multivariate analysis. ResultsA total of 222 patients (92.1%) completed 2-year follow-up, and the postoperative ODI, VAS-back, and VAS-leg were significantly improved after surgery as compared to preoperatively. Multivariate analysis indicated older age (p=0.026), lateral recess stenosis (p=0.046), and lower baseline ODI (p=0.027) were related to poor short-term functional improvement. Higher baseline VAS-back (p=0.048) was associated with poor short-term relief of back pain, while absence of decreased sensation (p=0.019) and far-lateral disc herniation (p=0.004) were associated with poorer short-term relief of leg pain. Lumbar facet joint osteoarthritis was identified as a risk factor for poor functional improvement (p=0.003) and relief of back pain (p=0.031). Disc protrusion (p=0.036) predicted poorer relief of back pain at midterm follow-up. ConclusionIn this study, several factors were identified to be predictive of poor surgical outcomes following minimally invasive discectomy. (ClinicalTrials.gov number: NCT01997086).

Sphinkeeper Procedure for Treating Severe Faecal Incontinence-A Prospective Cohort Study.

(1) Background: The Sphinkeeper implantation for faecal incontinence (FI) is a novel surgical procedure with limited data on its clinical efficacy. Therefore, we aimed to assess the functional outcome following Sphinkeeper surgery in patients with refractory FI. (2) Methods: Between 2018 and 2020, eleven consecutive patients (9 female) with FI met the inclusion criteria and were enrolled for surgery. Functional outcome and quality of life were evaluated by standard questionnaires pre- and post-surgery. Migration of protheses was demonstrated by 3D endoanal ultrasound. The median follow-up time was eight months (range 3–18 months). (3) Results: The median age was 75 years (range 46–89 years) with a median BMI of 27.4 (range 21.2–30.1). The median number of implanted prostheses per intervention was nine (range 9–10). We found no intraoperative or early postoperative complications. After two months, two prostheses in one patient had to be removed due to pain at the perianal skin site. The median St. Mark’s incontinence score decreased significantly from 22 to 13 points (p = 0.008). The SF-12 showed a significant improvement (35.9 versus 46.3) after surgery (p = 0.028). A migration of at least one prosthesis was observed in ten patients (91%). Six (60%) prostheses were found at the same level in another ten patients. (4) Conclusion: Sphinkeeper implantation is a promising surgical technique for patients with severe FI. The complication rate is low, and short-term functional improvement can be achieved even in severe forms of FI. Migration of implants commonly occurs.

Dry Needling for the Treatment of Musculoskeletal Ailments With Trigger Points

Background: Dry needling is an increasingly popular technique for relieving musculoskeletal pain, through targeting myofascial trigger points. Existing evidence indicates that dry needling is effective in short-term management of pain, with research showing efficacy in improving functional outcomes when compared to other treatments. Indications: Myofascial trigger points may result in range of motion limitations and muscle weakness. Noninvasive treatments for musculoskeletal pain associated with myofascial trigger points, such as stretching or warm compresses, may not provide significant benefit for patients. Dry needling is a minimally invasive technique that provides significant short-term functional improvement and analgesia for musculoskeletal pain associated with myofascial trigger points, seen with reductions in visual analog scale (VAS) pain scores and decreased need for pharmacologic therapies. Technique Description: This video demonstrates dry needling at the tensor fascia latae, extensor carpi radialis longus, and gastrocnemius muscles. Myofascial trigger points and important anatomical landmarks are identified and labeled. A needle is inserted into the region of the myofascial trigger point to a depth of 10 to 100 mm and remains in situ for about 10 to 20 seconds with the use of a piston technique, although this time varies dependent upon patient response. Results: Dry needling may significantly decrease pain and improve functional outcomes in patients with short-term musculoskeletal ailments. Randomized controlled trials have examined dry needling for fibromyalgia, mechanical neck pain, myofascial pain, and following total knee arthroplasty, with these finding significant reductions in pain scores in short-term follow-up. A randomized single-blind placebo-controlled trial found dry needling with exercise to be more effective than sham dry-needling and exercise. Dry needling may provide improved long-term analgesia but also results in increased pain during the procedure and increased soreness afterwards. Pain relief may not last beyond 6 months, although little research investigating long-term outcomes has been performed. Discussion/Conclusion: The usage of dry needling in clinical settings is increasing, as it has shown strong efficacy in providing short-term pain relief and ability to improve functional outcomes. Dry needling is a simple, minimally invasive technique that is easily and quickly learned by physical therapists and may provide great benefits to patients.

Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: a systematic review.

Is patient education effective as a standalone intervention or combined with other interventions for people with knee osteoarthritis? Systematic review of randomised controlled trials. MEDLINE, EMBASE, SPORTDiscus, CINAHL and Web of Science were searched from inception to April 2020. The Cochrane Risk of Bias tool was used for included studies, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to interpret certainty of results. People with knee osteoarthritis. Any patient education intervention compared with any non-pharmacological comparator. Primary outcomes were self-reported pain and function. Twenty-nine trials involving 4,107 participants were included, informing low to very-low certainty evidence. Nineteen of 28 (68%) pooled comparisons were not statistically significant. Patient education was superior to usual care for pain (SMD-0.35, 95% CI -0.56 to-0.14) and function in the short term (-0.31, 95% CI-0.62 to0.00), but inferior to exercise therapy for pain in the short term (0.77, 95% CI 0.07 to 1.47). Combining patient education with exercise therapy produced superior outcomes compared with patient education alone for pain in the short term (0.44, 95% CI 0.19 to 0.69) and function in the short (0.81, 95% CI 0.54 to 1.08) and medium term (0.39, 95% CI 0.15 to 0.62). When using the Western Ontario and McMaster Universities Osteoarthritis Index for these comparisons, clinically important differences indicated that patient education was inferior to exercise therapy for pain in the short term (MD 1.56, 95% CI 0.14 to 2.98) and the combination of patient education and exercise therapy for function in the short term (8.94, 95% CI 6.05 to 11.82). Although patient education produced statistically superior short-term pain and function outcomes compared with usual care, differences were small and may not be clinically important. Patient education should not be provided as a standalone treatment and should be combined with exercise therapy to provide statistically superior and clinically important short-term improvements in function compared with education alone. PROSPERO CRD42019122004.

Outcomes of total knee arthroplasty in a patient with poliomyelitis and distal femur malunited fracture

Severe deformity of the distal femur due to malunited fracture in a poliomyelitis patient is a rare entity. No reports are available in the literature about the results of total knee arthroplasty (TKA) in such cases. We report a 4-year follow-up of TKA in a 52-year-old woman who had postpoliomyelitis syndrome with malunited distal femur fracture associated with severe deformity and degenerative arthritis. TKA in poliomyelitis patients could reveal a good short-term functional improvement. We aim to demonstrate that even with the presence of deformity from previous trauma in polio cases, TKA would improve functional abilities. However, long-term follow-up is needed for similar cases.

Functional and MRI Outcomes of Superior Capsule Reconstruction with Acellular Dermal Matrix

Superior capsular reconstruction (SCR) is an emerging treatment option for irreparable massive rotator cuff tears (MRCT). The initial description utilized fascia lata autograft, but acellular dermal matrix (ADM) has become the graft of choice in the USA. Several reports have demonstrated excellent short-term functional improvement and patient satisfaction, but there is limited data correlating imaging studies of graft integrity to functional outcome. The purpose of this study was to determine if functional outcome after SCR is dependent on dermal allograft integrity on post-operative MRI.

The Influence of Body Mass Index on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Five-Year Results in 140 Patients

Background: Significant short-term improvements in function and pain after arthroscopic management of femoroacetabular impingement syndrome (FAIS) have been demonstrated regardless of mass index (BMI). No studies have reported the influence of obesity on mid- to long-term outcomes. Purpose: To evaluate the effect of BMI class on 5-year patient outcomes after arthroscopic treatment of FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a prospective database was performed to identify patients who underwent arthroscopic treatment for FAIS. A matched-pair analysis for age and sex was performed in a 1:1:2:3 fashion for morbidly obese (BMI ≥35), obese (BMI = 30-34.9), overweight (BMI = 25-29.9), and normal weight (BMI = 18.5-24.9) patients, respectively. Patient characteristics, imaging, Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports Subscale (HOS-SS) scores, modified Harris Hip Score (mHHS), and pain scores were recorded preoperatively, with the same outcome scores recorded at 5 years postoperatively, along with satisfaction scores. Standardized modern hip arthroscopy, with labral repair, acetabuloplasty, femoroplasty, and capsular plication followed by formalized rehabilitation, was performed for all patients. Absolute outcomes along with change in outcomes were assessed between BMI groups. A between-group analysis was also conducted evaluating achievement of the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) for any outcome score. A multivariable analysis was additionally included to evaluate outcomes adjusting for known confounding variables. Results: A total of 140 patients with mean follow-up of 62.1 ± 6.5 months were identified: 20 morbidly obese, 20 obese, 40 overweight, and 60 normal weight. There were significant improvements for HOS-ADL, HOS-SS, and mHHS scores in the normal (all P < .0001) and overweight groups (all P < .0001), mHHS in the obese group (P = .0275), and no significant improvement in functional scores in the morbidly obese group (P > .05). Compared with normal controls, multivariable analysis, adjusting for confounders, showed similar improvement in HOS-ADL for patients in the overweight and obese groups, HOS-SS for patients in the overweight group, and mHHS for patients in the overweight and obese groups (all P > .05). All groups showed significant improvement in pain scores (all P < .01) that were not significantly different between groups in multivariable analysis (all P > .05). Obese BMI was associated with a 54.9-point decrease in 5-year HOS-SS, and morbidly obese BMI was associated with a 27.3, 35.0, and 23.7-point decrease in 5-year HOS-ADL, HOS-SS, and mHHS, respectively (all P < .05). Regarding surgical benefit in comparison with normal weight patients, patients in the overweight and obese groups were as likely to achieve MCID (reciprocal odds ratio [ROR]: 1.5 and 1.2, respectively, both P > .05), but patients in the morbidly obese group were not. All groups were significantly less likely than the normal weight group to achieve PASS (ROR: overweight 5.2, obese 14.1, morbidly obese 13.0; all P < .05) and SCB (ROR: overweight 3.9, obese 7.8, morbidly obese 20.3; all P < .05). Conclusion: There were significant improvements in at least 1 outcome score across all BMI groups with arthroscopic treatment of FAIS. While the normal weight patients demonstrated universal improvement in all patient-reported outcomes and significantly greater likelihood of achieving PASS and SCB, the higher BMI groups still demonstrated significant improvement in function and pain, except for the morbidly obese group. Patients with morbid obesity demonstrated long-term pain improvement, although they did not experience functional improvement.

Functional and MRI outcomes of Superior Capsule Reconstruction with Acellular Dermal Matrix

Objectives:Superior capsular reconstruction (SCR) is an emerging treatment option for irreparable massive rotator cuff tears (MRCT). The initial description utilized fascia lata autograft, but acellular dermal matrix (ADM) has become the graft of choice in the United States. Several reports have demonstrated excellent short-term functional improvement and patient satisfaction, but there is limited data correlating imaging studies of graft integrity to functional outcome. The purpose of this study was to determine if functional outcome after SCR is dependent on dermal allograft integrity on post-operative MRI.Methods:Inclusion criteria were patients who underwent an SCR by one of 5 fellowship-trained surgeons at a single institution for the indication of pain attributable to irreparable MRCT that failed non-operative treatment. Exclusion criteria included arthritis, prior infection, revision SCR, and less than 6 months follow-up. Pre- operative data including age, gender, prior surgery, Hamada grade, and Goutallier stage were recorded. Intra-operative data including surgical findings and concomitant procedures were recorded. Pre- and post-operative acromiohumeral distance (AHD), American Shoulder and Elbow Surgeons (ASES), Oxford, visual analogue scale (VAS) and post-operative SANE score were recorded. In 90% of cases, a 3 mm ADM was used and in 10% of cases, a 6 mm ADM was used (doubled over 3 mm graft). All grafts were fixed by a double-row, trans-osseous equivalent technique on the tuberosity and with a mean of 3 anchors on the glenoid. Patients were routinely offered to undergo an MRI postoperatively regardless of symptoms.Results:53 patients met our inclusion criteria. Mean age was 60.1+7.9 years (range 34 to 77). 68% were male; 34% had at least one prior procedure; 58% had a concomitant procedure; 57% were Hamada 1, 38% Hamada 2, and 5% Hamada 3. Pre-op Goutallier stage was 3.7% grade 0, 17% grade 1, 40% grade 2; 26% grade 3; 13% grade 4. The mean clinical follow-up was 15+7.8 months (range 6-42 months). 81% of patients underwent an MRI post-operatively. The mean time for MRI was 14+7 months (range 6 -40). MRI revealed that 38% had a completely intact graft, 33% had a tear from the glenoid, 12% had a mid-substance tear, 14% tear from the tuberosity, and 2% had complete graft absence. There was a significant improvement in ASES (37.7 to 79.5, P<0.0001), Oxford (26.3 to 44, P<0.0001), and VAS (7 vs 2.3, P<0.0001). There was no difference between pre-op and post-op AHD (7.3 mm vs 6.9mm, P=0.57). There was no association between pre-operative AHD (P=0.9), Goutallier stage (P=0.43), Hamada grade (P=0.49) with post-operative ASES scores. There was a significant correlation between graft integrity with final outcome. There was no difference in post-operative ASES score when the graft was completely intact or torn from the glenoid (P=0.39), but graft tear from the tuberosity resulted in a significantly lower ASES score (P=0.013).Conclusions:In patients who undergo SCR for MRCT, there is significant improvement in ASES, Oxford, and VAS. This improvement is seen in patients who have an intact graft, as well as those where the graft is torn from the glenoid, but not those torn from the tuberosity. This supports the concept of the graft functioning as a ”biologic tuberoplasy” preventing bone-to-bone contact between the tuberosity and acromion. Preoperative AHD, Goutallier, Hamada, gender, or age did not have an association with post-operative ASES scores.

Impact of Frailty on Outcomes in Patients Undergoing Percutaneous Mitral Valve Repair

ObjectivesThe aim of this study was to describe the impact of frailty in patients undergoing percutaneous mitral valve repair (PMVR). BackgroundFrailty is common in elderly patients and those with comorbidities and is associated with adverse prognosis. MethodsFrailty according to the Fried criteria was assessed in consecutive patients admitted for PMVR. Associations of frailty with 6-week (device success, changes in 6-min walking distance and Minnesota Living With Heart Failure Questionnaire and Short Form 36 physical and mental component scores, and improvement ≥1 New York Heart Association functional class) and long-term outcomes during a median follow-up period of 429 days were examined. ResultsOf 213 patients admitted for PMVR (median age 78 years; age range 50 to 95 years; 57.3% men), 45.5% were classified as frail. Compared with nonfrail patients, frail patients had a similar device success rate (81.4% vs. 84.5%; p = 0.56) and improvement in 6-min walking distance, New York Heart Association functional class, and Short Form-36 scores but a more pronounced improvement in Minnesota Living With Heart Failure Questionnaire score (mean change −15.9 vs. −11.2 points; p = 0.002). Mortality at 6 weeks was significantly higher in frail (8.3%) compared with nonfrail (1.7%) patients (p = 0.03). Hazards of death (hazard ratio: 3.06; 95% confidence interval: 1.54 to 6.07; p = 0.001) and death or heart failure decompensation (hazard ratio: 2.03; 95% confidence interval: 1.22 to 3.39; p = 0.007) were significantly increased in frail patients during long-term follow-up, which did not change relevantly after adjustment for European System for Cardiac Operative Risk Evaluation score and N-terminal pro–brain natriuretic peptide level. ConclusionsPMVR can be performed with equal efficacy and is associated with at least similar short-term functional improvement in frail patients. These results support the continued use of PMVR in frail elderly patients with the goal of palliation of heart failure symptoms and improvement in quality of life.

Effectiveness of four dynamic treatment strategies in patients with anticitrullinated protein antibody-negative rheumatoid arthritis: a randomised trial

ObjectiveTo determine the most effective treatment strategy among anticitrullinated protein antibodies (ACPA)-negative patients with early rheumatoid arthritis.MethodsIn the BeSt study, 184 ACPA-negative patients were randomised to: (1) sequential monotherapy, (2)...

Pulmonary Hypertension in Patients with Chronic Fibrosing Idiopathic Interstitial Pneumonias.

BackgroundPulmonary hypertension (PH) is a common finding in patients with chronic fibrosing idiopathic interstitial pneumonias (IIP). Little is known about the response to pulmonary vasodilator therapy in this patient population. COMPERA is an international registry that prospectively captures data from patients with various forms of PH receiving pulmonary vasodilator therapies.MethodsWe retrieved data from COMPERA to compare patient characteristics, treatment patterns, response to therapy and survival in newly diagnosed patients with idiopathic pulmonary arterial hypertension (IPAH) and PH associated with IIP (PH-IIP).ResultsCompared to patients with IPAH (n = 798), patients with PH-IIP (n = 151) were older and predominantly males. Patients with PH-IIP were treated predominantly with phosphodiesterase-5 inhibitors (88% at entry, 87% after 1 year). From baseline to the first follow-up visit, the median improvement in 6MWD was 30 m in patients with IPAH and 24.5 m in patients with PH-IIP (p = 0.457 for the difference between both groups). Improvements in NYHA functional class were observed in 22.4% and 29.5% of these patients, respectively (p = 0.179 for the difference between both groups). Survival rates were significantly worse in PH-IIP than in IPAH (3-year survival 34.0 versus 68.6%; p<0.001). Total lung capacity, NYHA class IV, and mixed-venous oxygen saturation were independent predictors of survival in patients with PH-IIP.ConclusionsPatients with PH-IIP have a dismal prognosis. Our results suggest that pulmonary vasodilator therapy may be associated with short-term functional improvement in some of these patients but it is unclear whether this treatment affects survival.Trial Registrationclinicaltrials.gov NCT01347216

Early clinical and radiographical results of keel-less and shallow keel cervical disc replacement.

Background:Cervical disc replacements has been shown to be as effective as fusions in the treatment of radiculopathy or myelopathy due to disc prolapse. Newer implants were designed to reduce the difficulty of end-plate preparation. Since 2010, the authors have started using Discocerv (Alphatec Spine, Carlsbad, USA) a keel-less implant and Activ-C (B. Braun, Sheffield, UK), a shallow keel implant.Aim:The aim of this study was to compare the duration of surgery between cervical disc replacement and anterior cervical discectomy and fusion, and also to evaluate the functional outcome, complications, and radiographic outcome of cervical disc replacement.Results:Fifty patients were included (20 disc replacement and 30 fusion). This was a single surgeon retrospective study, with all surgery performed by the senior author (RT). The mean operation duration for single-level disc replacement was 2.6 h, and for single-level fusion was 2.4 h (P = 0.4684). For 2-levels surgery, the result was 3.5 h for 2-level hybrid surgery (one level disc replacement and one level fusion) and 3.4 h for fusion (P = 0.4489). Disc replacement resulted in preservation of an average of 67% of the angle of motion at the sagittal plane (FFflexion-extension). The average range of motion after disc replacement was 6.1°. The median clinical follow-up duration was 2 years (average 1.8 years). There was no incidence of major complications or significant neurovascular injury in this series of patients. A significant improvement in short form-36 scores was seen as early as 3 months postoperative (from 58 preoperative to 92 at 3 months). The improvement was sustained up to the fourth year of follow-up.Conclusion:Cervical arthroplasty with keel-less and shallow keel implants are safe and relatively easy to perform. The surgical time for disc replacement is not significantly longer than standard fusion surgery. There is reasonably good preservation of motion. The short-term functional improvement is good, and we await further long-term outcome results. The authors felt that cervical disc replacement will have an important role in the treatment of cervical degenerative disc disease in the future.

Variables asociadas a mejora funcional medida con el índice de Montebello en pacientes con fractura de cadera ingresados en una Unidad de Ortogeriatría

ObjectiveTo determine the variables associated with functional improvement and their relationship with the Montebello index (MI) in patients with hip fracture. MethodAn observational, descriptive study was carried out for 7 months in our orthogeriatrics unit. We analyzed sociodemographic (age, sex and institutionalization), functional (Barthel index), cognitive (Pfeiffer Questionnaire), comorbidity (Charlson index), surgical type, hip fracture and rehabilitation-related variables. The MI was used as the endpoint. Bivariate and multivariate analyses were performed. ResultsA total of 76 patients were analyzed, of which 83% were older than 80 years. Previous functional status showed mild dependency (mean Barthel index: 78.3 points) and mild comorbidity (mean CI: 1.20 points). The most common type of fracture was fracture of the femoral neck and the most frequent type of surgery was arthroplasty (53.9%). Early weight bearing was authorized in 88.1% of the patients. Functional gain at discharge measured by the MI was 0.42 (SD 0.26) and the mean functional gain after 3 months was 15 points. The effectiveness index was 1.47 (SD 1.20). In the bivariate analysis, the only variable significantly associated with a higher MI score was a lower PQ score. ConclusionThe main factor for the prediction of short-term functional improvement after hip fracture surgery in our oldest population was a low PQ score. The use of the MI in daily practice could help to improve analysis of functional results in orthogeriatrics units.

A paradigm shift in pulmonary arterial hypertension management

At the end of 2013 clinicians managing pulmonary arterial hypertension (PAH) patients have many more treatment options available to them than they did two decades ago. Basic and clinical research continue to expand treatment options but, in a changing PAH environment, there is a need to move away from trials with primary end-points that merely demonstrate short-term improvements in function to large scale trials utilising robust end-points that reflect long-term morbidity and mortality [1]. The reviews in this issue of the European Respiratory Review discuss this evolution of study design and management of patients with PAH. The authors, all experts in the field of pulmonary hypertension, delivered the presentations upon which the articles are based at the 12th International Pulmonary Hypertension Forum in April 2013 in Hamburg, Germany. This annual platform for the exchange of knowledge and experience among clinicians and researchers was attended by over 1000 healthcare professionals from all over the world, highlighting the continuing interest in PAH. All oral therapies currently available for the management of PAH have been approved based on change in 6-min walk distance (6MWD) over a short 12–16-week study period [2–6]. The 6MWD is a simple, inexpensive, reproducible test that has allowed the rapid expansion of therapeutic options in PAH, and remains a valuable, clinically important measure of symptomatic improvement. However, in today's more advanced PAH field, its utility as a primary end-point has been challenged. In their review, Gaine and Simonneau [7] will discuss the limitations of the 6MWD, including its reduced sensitivity in patients with milder disease [8] and the reduced ability to detect a treatment …

English

Introduction People with long-term musculoskeletal conditions such as osteoarthritis are increasing in prevalence, are significantly more likely to be less active than adults without arthritis and are at increased risk of either having or developing further co- morbidity. More than half of adults with arthritis undertake minimal/little walking per week. Walking is popular and can substantially lower the risk of many chronic diseases. This review aims to summarise the available literature regarding the role of walking programmes for people with osteoarthritis. Materials and methods PUBMED and the Cochrane library searches were performed to locate articles. Key terms used in PUBMED searches included ‘walking program*’, ‘physical activit*’ and ‘osteoarthritis’ whilst Cochrane searches included the same search terms without truncation and also by browsing records under ‘osteoarthritis’. Searches were performed in English. Reference lists of identified articles were checked to identify further articles for the review. Results Seven studies were identified and included: three randomised clinical trials, two pilot or feasibility studies (one uncontrolled) and two quasi- experimental studies. The study characteristics, including participants, interventions, outcomes and summarised findings, are presented. The theoretical rationales, content and dosages showed wide variation. Compliance rates decreased over time. Attrition rates ranged from 10% to 47%. Conclusion Limited evidence currently suggests that walking programmes can safely improve pain and quality of life. Programmes improve function and quadriceps strength in the short term and may have a role in weight management. Short-term improvements in function may not be maintained in the longer term. Such programmes can offer an inexpensive, accessible, flexible treatment and self-management option; however many treatment parameters require further investigation.

Short-term outcome of coronary artery bypass graft surgery in end stage renal failure dialysis-dependent patients

Background Patients with end-stage renal disease (ESRD) requiring dialysis who undergo coronary artery bypass graft surgery (CABG) are at significant risk for perioperative morbidity and mortality. We describe our own experience in such high risk subgroup of patients. Methods Over four years period, a retrospective analysis of fifteen patients with dialysis-dependent renal failure who underwent coronary artery bypass grafting. Mean age was 55 ± 12 years. Except from one patient who was on peritoneal dialysis, all other patients were on regular hemodialysis. five patients were referred to cardiac surgery as their coronary artery disease was detected during routine coronary angiography before renal transplant. Results There was one postoperative death (in-hospital mortality, 6.6%). The patient who died was suffering from morbid obesity with severe LV dysfunction and poor target coronary artery vessels. Three patients underwent renal transplantation after CABG operation and another one patient was recently operated and is waiting for transplant. One patient was complicated with significant perioperative MI after having LAD endartrectomy and surgical reconstruction with LIMA; this was complicated with heart failure and moderate to severe MR. This patient had lost his chance for future renal transplant. One patient had cerebral hemorrhage 2 months after surgery and he recovered. Conclusions Cardiac operations in patients with end-stage renal disease may be performed with a fairly low perioperative risk and the perspective of short-term functional improvement and acceptable survival. However, careful selection is mandatory for better outcome.