Significant Difference In Functional Outcome Research Articles

Reconstruction for Salvage Laryngectomy With Limited Pharyngectomy

Closure technique for optimization of postoperative and functional outcomes following salvage laryngectomy remains an area of debate among head and neck surgeons. To investigate the association of salvage laryngectomy closure technique with early postoperative and functional outcomes. This retrospective cohort study included patients from 17 academic, tertiary care centers who underwent total laryngectomy with no or limited pharyngectomy after completing a course of definitive radiotherapy or chemoradiotherapy with curative intent between January 2011 and December 2016. Patients with defects not amenable to primary closure were excluded. Data were analyzed from February 14, 2021, to January 29, 2024. Total laryngectomy with and without limited pharyngectomy, reconstructed by primary mucosal closure (PC), regional closure (RC), or free tissue transfer (FTT). Patients were stratified on the basis of the pharyngeal closure technique. Perioperative and long-term functional outcomes were evaluated with bivariate analyses. A multivariable regression model adjusted for historical risk factors for pharyngocutaneous fistula (PCF) was used to assess risk associated with closure technique. Relative risks (RRs) with 95% CIs were determined. The study included 309 patients (256 [82.8%] male; mean age, 64.7 [range, 58.0-72.0] years). Defects were reconstructed as follows: FTT (161 patients [52.1%]), RC (64 [20.7%]), and PC (84 [27.2%]). A PCF was noted in 36 of 161 patients in the FTT group (22.4%), 25 of 64 in the RC group (39.1%), and 29 of 84 in the PC group (34.5%). On multivariable analysis, patients undergoing PC or RC had a higher risk of PCF compared with those undergoing FTT (PC: RR, 2.2 [95% CI, 1.1-4.4]; RC: RR, 2.5 [95% CI, 1.3-4.8]). Undergoing FTT was associated with a clinically meaningful reduction in risk of PCF (RR, 0.6; 95% CI, 0.4-0.9; number needed to treat, 7). Subgroup analysis comparing inset techniques for the RC group showed a higher risk of PCF associated with PC (RR, 1.8; 95% CI, 1.1-3.0) and predominately pectoralis myofascial flap with onlay technique (RR, 1.9; 95% CI, 1.2-3.2), but there was no association of pectoralis myocutaneous flap with cutaneous paddle interposition with PCF (RR, 1.2; 95% CI, 0.5-2.8) compared with FTT with cutaneous inset. There were no clinically significant differences in functional outcomes between the groups. In this study of patients with limited pharyngeal defects, interpositional fasciocutaneous closure technique was associated with reduced risk of PCF in the salvage setting, which is most commonly achieved by FTT in academic practices. Closure technique was not associated with functional outcomes at 1 and 2 years postoperatively.

Outcomes of different surgical procedures for optic disc pit: a meta-analysis

Objective To assess the surgical outcomes of pars plana vitrectomy (PPV) in conjunction with various adjuvant procedures for optic disc pit maculopathy (ODPM). Methods We conducted a literature search to identify clinical studies and case series of surgically treated OPM patients. (1) greater than two patients, (2) surgical treatment and (3) reporting of pre and postoperative visual acuity data were inclusion criteria. We excluded review articles and studies unavailable in the English language. One-way analysis of variance, Pearson’s chi-squared test and straightforward linear regression were used to analyze the results. Results A total of 838 studies were initially identified as potentially relevant studies. After removing duplicates and screening titles and abstracts, the eligibility of 86 full-text articles was evaluated. There were 50 studies included in the meta-analysis. We identified the following commonly reported techniques: juxtapapillary laser alone, PPV alone or with juxtapapillary laser (PPV/JPL), internal limiting membrane peeling (PPV/ILMP), both ILMP and JPL (PPV/ILMP/JPL), inner retinal fenestration (PPV/IRF), autologous platelet concentrate (PPV/APC), macular buckling alone or with PPV, PPV with ocriplasmin (PPV/OCR) and PPV with autologous scleral flap. All groups showed an improvement in best-corrected visual acuity compared with baseline, with no significant differences between groups. The average OPM resolution rate for all groups was 70% (range: 56–100%), and the average resolution duration was 9.1 months. Central macular thickness was diminished in the PPV, PPV/JPL, and PPV/ILMP groups, but there were no significant differences between groups. There was no effect on the outcomes. Analyses of linear regression revealed significant correlations between preoperative best-corrected visual acuity and the aforementioned outcome measures. The rate of complete anatomic success and visual improvement following PPV is ∼85%. Anatomic and visual success rates for PPV alone are 89% and 100%, respectively, according to subgroup analysis. Gas tamponade, laser and ILMP during vitrectomy are less promising, whereas PPV with ILM flap stuffing may yield better results than cases without it. Conclusion We did not find a significant difference in functional outcomes between the various surgical procedures used to treat OPM. Based on the available evidence, PPV is effective for ODPM, while gas tamponade, laser and ILMP should be used with caution. This study is limited by its reliance on retrospective studies and publication bias towards positive outcomes.

Treatment of Distal Radius Fractures in Elderly Patients:
 A Review

Background. Distal radius fractures (DRF) are one of the most common injuries in the elderly population. Their incidence increases steadily, with epidemiologists predicting further growth. Despite its growing prevalence, the efficacy of surgical treatment for this pathology in elderly patients remains debatable.
 Aim — to determine the optimal method for treating distal radius fractures in the elderly population basing on a comparative analysis of the literature data on various treatment methods, including conservative and surgical ones.
 Methods. A search was performed in PubMed/MEDLINE, Scopus, Google Scholar, and eLIBRARY databases according to the following keywords, their derivatives and combinations in the titles and abstracts: treatment, distal radius fracture, elderly. Initial analysis for meeting the inclusion criteria was performed on the article titles and abstracts, followed by analysis of the full-text articles. The sources with unavailable full-text versions were excluded from the analysis.
 Results. Current epidemiological data were studied, specific aspects of physical examination of elderly patients with distal radius fractures were described, the main treatment methods were determined. The main treatment method remains the conservative one: closed reduction and immobilisation. Open reduction and internal fixation with a volar locking plate has become the leading surgical treatment method in recent decades, replacing such methods as closed reduction and fixation with wires or external fixation. At early follow-up, elderly patients operated on with volar locking plate show better functional results than those who received conservative treatment. However, at long-term follow-up, most studies show no significant differences in functional outcomes after surgical and conservative treatment, despite the differences in radiological data in favour of surgical treatment.
 Conclusion. For the majority of elderly patients, conservative treatment may be the optimal treatment option. Surgical intervention using a volar locking plate may be justified for certain groups of elderly patients, as this method may accelerate rehabilitation after injury.

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome.

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons.The objective of this study was tocompare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modifiedPutti-Platt surgery. Functional outcomes were assessed at sixmonths using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age:23.93±5.88 years) undergoing shoulder procedures.Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

Surgical treatment of pituitary neuroendocrine tumors with coexisting intracranial lesions: A case series and review of the literature.

Pituitary neuroendocrine tumors (PitNETs) are a diverse group of benign neoplasms that account for a significant proportion of intracranial tumors (13%). The coexistence of PitNET with other intracranial lesions, such as meningiomas and intracranial aneurysms, has been constantly reported in the literature; yet, the pathophysiological mechanisms remain unknown, and the appropriate management is controversial. This study aims to describe the clinical characteristics, surgical treatment, and outcomes of patients with PitNET with coexisting intracranial lesions in a single healthcare center. A retrospective analysis was conducted on 12 patients who underwent surgical treatment for PitNET and another intracranial lesion at our single tertiary referral center over 15 years from January 2008 to May 2023. Among these coexisting lesions, aneurysms were the most commonly found (41.67%), followed by meningiomas (33.33%). Surgical intervention for both lesions was performed in a single-stage procedure for most cases (75%), employing transcranial, endoscopic endonasal, and combined approaches. We found low preoperative Karnofsky Performance Scale scores in three patients, with significant differences in functional outcomes. These findings contribute to the limited knowledge about PitNET coexisting with other intracranial lesions and emphasize the importance of patient-tailored, multidisciplinary management in these unusual scenarios.

Billroth-II modified with hinged anti-peristaltic afferent loop versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A propensity-score match analysis

BackgroundThis study aimed to evaluate the effectiveness of modified Billroth-II with a hinged anti-peristaltic afferent loop by comparing it with the Roux-en-Y method. MethodsWe retrospectively analyzed 344 patients with gastric cancer who underwent distal gastrectomy between 2016 and 2021. Propensity score matching was conducted to balance baseline characteristics. ResultsAfter propensity score matching, there were 117 patients in each group. The Billroth-II group was significantly better regarding operating time (184.7 vs 225.3 minutes), postoperative hospital stays (7.9 vs 9.2 days), and time to semi-solid diet tolerance (2.8 vs 3.8 days). The Billroth-II group demonstrated comparable results with the Roux-en-Y group in weight loss, hemoglobin changes, reflux esophagitis, food residue, and gastritis severity. Presentation of bile in gastric remnant was significantly higher in the Billroth-II group (42.9% vs 10.3%). ConclusionThere were no significant differences in functional outcomes between Billroth-II and Roux-en-Y reconstructions. The Billroth-II was superior to Roux-en-Y in operating time, hospital stays, and time to semi-solid diet tolerance. The Billroth-II could be considered an acceptable alternative reconstruction after distal gastrectomy.

Comparison between transradial and transfemoral mechanical thrombectomy for ICA and M1 occlusions: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

BackgroundThe role for the transradial approach for mechanical thrombectomy is controversial. We sought to compare transradial and transfemoral mechanical thrombectomy in a large multicenter database of acute ischemic stroke.MethodsThe prospectively...

Impact of sustentaculum tali screw positioning on radiographic and functional outcomes in calcaneal fractures

BackgroundTo investigate whether accurate placement of sustentaculum tali screws have the impacts on the clinical efficacy of calcaneal fractures.MethodsA retrospective analysis of 72 cases (73 feet) of calcaneal fractures from September 2015 to September 2019 treated with open reduction and internal fixation with sustentaculum tali screws was conducted. Patients were divided into the sustentaculum tali fixation group (ST group) and the sustentaculum fragment fixation group (STF group) according to the location of the sustentaculum tali screw placement. The functional outcomes at preoperative, 7 days and 1 year postoperative were collected and analyzed.ResultsIn the ST group (40 feet), the Gissane's angle altered from (109.89 ± 12.13)° to (121.23 ± 9.34)° and (119.08 ± 8.31)° at 7 days and 1 year postoperative, respectively. For Böhler’s angles altered from (11.44 ± 5.94)°, to (31.39 ± 7.54)°, and (30.61 ± 7.94)° at 7 days and 1 year postoperative, respectively. In the STF group (33 feet), Gissane’s angle altered from (110.47 ± 14.45)°, to (122.08 ± 8.84)°, and (120.67 ± 9.07)° and Böhler’s angle altered from (11.32 ± 6.77)°, to (28.82 ± 8.52)°, and (28.25 ± 9.13)° (P < 0.001). However, there was no statistically significant difference in functional outcomes at 1 week after surgery and 1 year after surgery (P > 0.05). The AOFAS scores at the final follow-up of the two groups: ST group (88.95 ± 6.16) and STF group (89.78 ± 8.76); VAS scores, ST group (0.83 ± 0.98) and STF group (1.03 ± 1.59), all differences were not statistically significant (P > 0.05).ConclusionThe position of sustentaculum tali screws has no significant difference on the short-term clinical outcome in patients with calcaneal fractures, while reliable fixation of screws to sustentaculum tali fragment can achieve similar clinical outcome.Level of evidence V.

Evaluating outcome associations with race after mechanical thrombectomy: an analysis of the NVQI-QOD acute ischemic stroke registry

BackgroundMechanical thrombectomy has become the standard of care for acute ischemic stroke due to large vessel occlusions. Racial differences in outcomes after mechanical thrombectomy for acute ischemic stroke have not...

Does platelet-rich plasma enhance fusion in transforaminal lumbar interbody fusion? A prospective clinico-radiological comparative study

Abstract Background: Several animal studies have shown that platelet-rich plasma (PRP) is effective in enhancing bone fusion. However, the role and efficacy of PRP in spinal fusion surgery remain uncertain. The objective was to evaluate the efficacy of PRP in bone fusion and to compare the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) with and without PRP. Materials and Methods: This prospective study was done on 50 patients who underwent TLIF surgery for various spinal pathologies. Patients were divided into the control group (underwent TLIF with interbody cage and local bone grafts alone) and the study group (underwent TLIF with interbody cage, local bone grafts, and PRP). Functional outcome was evaluated using visual analog score (VAS) and Oswestry disability index (ODI). Radiological outcome was assessed by Bridwell’s grading system for fusion on computed tomography scan at the end of 2 years. Results: The average bone fusion rate was significantly higher in the PRP group compared to the control group; however, the average duration of fusion was not statistically significant. There was no difference in VAS and ODI at 1 and 2 years. There was also no significant difference in lower back pain, leg pain, and numbness in both groups at the end of 1 year. Conclusion: Although there is no statistically significant difference in functional outcome between both groups, local application of PRP along with autologous bone grafts increases bone fusion rates with good clinical and radiological outcomes.

Functional Outcome of Distal Femoral Fractures using NEER Scoring Managed by Distal Femoral Locking Plate versus Retrograde Intramedullary Nail: A Cross-sectional Study

Introduction: Distal femur fractures are a group of fractures that have been a topic of debate for the past decade, were traditionally treated mainly using conservative methods. However, with advancements in surgical techniques and implants, operative intervention has now become the preferred treatment approach. There are various methods for treating distal femur fractures and the present study compares the treatment of distal femoral fracture using distal femur nailing versus the use of locking plate. Aim: To compare the functional outcomes of stabilising distal femur fractures using locking compression plating versus retrograde nailing and to evaluate the merits and drawbacks of each procedure. Materials and Methods: A cross-sectional comparative study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, over a one-year period from (January 2021 to January 2022. Total 46 patients with distal femur fractures were included, with six lost to follow-up. Two groups were divided in which total 20 patients underwent distal femoral nailing, while 20 were treated with distal femoral locking plates. Functional outcomes were assessed using the NEER Score, aiming for perfect restoration of the articular surface, stable fixation, full knee range of motion, and good functional results. Data were entered into a Microsoft Excel spreadsheet for statistical analysis using Statistical Packages for Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA). Numerical variables were summarised as mean and standard deviation, while categorical variables were presented as counts and percentages. A p-value of ≤0.05 was considered statistically significant. Results: The study population consisted of 70% males with a mean age of approximately 55 years. Road traffic accidents were the most common mode of injury. The mean time for radiological union in the nailing group was 14.05 weeks, significantly shorter than the 16 weeks in the plating group. The mean range of knee flexion was 111° in the nailing group and 114.5° in the plating group. The average NEER score was 84.10 for the plating group and 83.30 for the nailing group. There was no statistically significant difference in functional outcomes between the two groups. Conclusion: Both retrograde intramedullary nailing and the use of locking compression plates can be considered as suitable treatment options. Early weight-bearing can be initiated with retrograde nailing. No significant difference was observed in terms of outcome, fracture healing, or NEER score. The time taken for radiological union of fractures using both techniques was comparable. Proper operative planning, execution, and adherence to a strict rehabilitation protocol play crucial roles in the overall patient outcome.

Efficacy of Lumbar Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy in Individuals with Spine Surgery: A Retrospective Comparative Study

Introduction: Transforaminal epidural steroid injections (TFESI) have demonstrated their efficacy in both short-term and long-term treatment of radicular pain with their targets being the anterolateral epidural space and dorsal root ganglion. Although the evidence for transforaminal injections in treating radiculitis secondary to discherniation and lumbar stenosis is strong, evidence is limited regarding its effect on axial pain and in patients with failed back surgery syndrome (FBSS). Methodology: 61 patients were registered in this retrospective comparative study who underwent lumbar TFESI for lumbosacral radiculopathy from March 2021 to March 2022. All patients were assessed for difference in pain relief, disability and functional outcome at baseline and at the time of follow up using NRS, ODI &amp; PROMIS. As a secondary objective the patients were divided into two groups those with previous history of spine surgery (Group A) and non-operated patients (Group B) to Compare the mean levels of pain relief, functional outcome and disability in spine surgery patients compared to non-operated patients. After Ethical committee approval and informed consent from patient baseline scores (NRS, ODI &amp; PROMIS) were accessed from the MRD and follow up scores were obtained by sending a questionnaire across to the patient by email. The average follow up time was 1 year and 4 months (Mean). Results and Observations: A minimum clinically important difference (MCID) of &gt;2.0 was selected for the change in NRS to further determine the proportion of responders who experienced a clinically significant reduction of pain. Success in achieving MCID is defined by ≥3 t score change for all PROMIS instruments. Success in achieving MCID for ODI is defined as at least 30% score change at follow up from baseline score. There is no significant difference in pain relief, disability improvement, functional outcome as assessed by NRS, ODI &amp; PROMIS between the two groups. In this study the success in achieving MCID for NRS was 70% in Group A and 63% in group B and overall 67% indicating that total 41 patients (67%) had significant reduction in NRS after TFESI. In this study success of achieving MCID for ODI was 38.7% among Group A which was comparable to 23.3% among Group B and the difference was not statistically significant. The overall success of achieving MCID for ODI was total 19 patients (31.1%) indicating only 31% patients had significant improvement in disability post TFESI. There is no significant difference in functional outcome as assessed by PROMIS instruments between the two groups. For PROMIS PF, PI, SD the success of achieving MCID was greater than 70% overall and for both the groups. Conclusion: There is no doubt regarding the efficacy and therapeutic effect of TFESI in axial lumbosacral pain/radicular pain in non-operated patients. This study demonstrates the success rate of TFESI in spine surgery patients (FBSS) as well by utilizing PROMIS as an outcome measure and by use of a control group demonstrating improved Physical Function, less pain interference &amp; improved sleep.

Bankart Repair Versus Bristow-Latarjet Procedure in Treating Anterior Shoulder Dislocation: A Systematic Review

Introduction: Anterior shoulder dislocation affects an estimated 11/100,000 individuals annually, primarily involving the inferior glenohumeral ligament and causing recurrent instability. Surgical approaches like anatomical labral repair and the Bristow-Latarjet procedure are common for managing these issues. This systematic review aimed to compare the clinical and functional outcomes of Bankart repair and the Bristow-Latarjet procedure in treating anterior shoulder dislocation. Methods: Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Google Scholar, Science Direct, and the Cochrane Library, resulting in 154 studies. From these, 4 studies were selected: two retrospective cohorts, one prospective cohort, and one case-control, encompassing 414 patients. Among them, 257 patients underwent the Bristow-Latarjet procedure, while 157 received Bankart repair. Inclusion criteria covered English-language studies evaluating clinical outcomes such as SSV, WOSI, Rowe scores, movement loss, and arthropathy rates, with no demographic restrictions, while non-English studies were excluded. Quality evaluation employed classifications by the Oxford Center for Evidence-based Medicine, GRADE criteria, and AHRQ for assessing evidence strength, bias, and quality. Results: The systematic review selected 4 studies from the 154 identified, incorporating a total of 414 patients. Of these, 257 underwent the Bristow-Latarjet procedure, and 157 received Bankart repair. The studies comprised two retrospective cohorts, one prospective cohort, and one case-control study. Conclusion: The review revealed no significant difference in functional outcomes between Bankart repair and the Bristow-Latarjet procedure for anterior shoulder dislocation. The choice between these methods depends largely on surgeon preference and technological accessibility. However, more comprehensive, high-quality studies are needed to better guide the selection between these procedures. Keywords: Anterior shoulder dislocation; Glenohumeral ligament; Bankart repair; Bristow-Latarjet procedure.

Abstract 13065: Comparative Efficacy of Endovascular Mechanical Thrombectomy With and Without Intravenous Thrombolysis in Acute Ischemic Stroke: A Meta-Analysis of Randomized Trials

Background: Current guidelines states that intravenous tissue plasminogen activator (tPA) should be administered to eligible acute ischemic stroke (AIS) patients even if endovascular mechanical thrombectomy (EMT) is being considered. However, there is still uncertainty regarding the superiority of EMT with tPA over direct EMT. Aim: This meta-analysis seeks to provide a comprehensive evaluation of the comparative effectiveness of EMT with and without tPA in treating AIS. Methods: We performed a systematic literature search using PubMed, EMBASE, Cochrane, Web of Science, and clincialtrials.gov. Relevant articles from inception until April 10th, 2023, were scrutinized. The primary outcome of interest was functional independence assessed by the modified Rankin Score between 0-2 at 90 days. Secondary outcomes included all-cause mortality within 90 days, successful recanalization defined as extended thrombolysis in cerebral infarction score of 2b to 3, and safety outcome, i.e., the occurrence of symptomatic intracranial hemorrhage (sICH). Results: Our analysis included 6 RCTs involving 2334 patients. The pooled analysis of the primary outcome revealed no significant difference between EMT with tPA and direct EMT [OR, 1.08 (95% CI, 0.87-1.34), p=0.41]. All-cause mortality [OR, 0.93 (95% CI, 0.74-1.16), p=0.42] and sICH [OR, 1.22 (95% CI, 0.91-1.62), p=0.14] also did not significantly differ between the two groups. However, the results for successful recanalization [OR, 1.35 (95% CI, 1.01-1.80), p=0.04] indicate that patients who underwent EMT with tPA had a 35% significantly higher likelihood of achieving successful recanalization. Conclusion: Our meta-analysis found no significant difference in functional outcome, all-cause mortality, or sICH between EMT with tPA and direct EMT. However, EMT with tPA was associated with a higher likelihood of successful recanalization, suggesting its potential benefit in improving recanalization rates in AIS.

Two-week versus four-week immobilization of stable distal radioulnar joint following surgical fixation of Galeazzi fracture-dislocations: A randomized controlled trial

BackgroundPostoperative immobilization protocols following surgical fixation of Galeazzi fracture-dislocations (GFD) in adults remain unresolved. This study aimed to compare outcomes of two different immobilization durations (two weeks versus four weeks) in terms of functional outcomes and complications. MethodsParticipants were prospectively and randomly enrolled in two-week versus four-week immobilization after plate fixation of GFD when the distal radioulnar joint (DRUJ) was reducible and stable postoperatively. Immobilization involved an above-elbow splint with the forearm in full supination. Demographic data, including age, gender, mechanism of injury, fracture characteristics, and treatment approach, were recorded. The primary outcome was the abbreviated version of the Disability of Arm, Shoulder, and Hand (DASH) scores at three months post-operation. Secondary outcomes included wrist range of motion, mean grip strength differences between injured and uninjured sides, and complications. ResultsA total of 54 participants were enrolled and randomized into two treatment groups. Demographics were similar between groups, with most participants being male, and the mean age was 35 years (range 18–65). Fractures were generally less than 10 cm. The mean DASH scores were slightly higher in the four-week immobilization group but not statistically significant (1.43 in the two-week immobilization group vs. 2.36 in the four-week immobilization group, p = 0.152). Range of motion and mean grip strength differences were similar between groups. Complication rates were also similar, with recurrent DRUJ dislocation occurring in two participants from each group. ConclusionThis study found no significant differences in functional outcomes and complications between two-week and four-week immobilization durations after plate fixation of GFD when the DRUJ was reducible and stable postoperatively. Level of evidenceTherapeutic Level I.

Salvage Cryoablation for Recurrent Prostate Cancer Following Primary External Beam Radiotherapy or Primary Cryotherapy: A Propensity Score Matched Analysis of Mid-term Oncologic and Functional Outcomes.

Local prostate cancer recurrence following radiotherapy (XRT) or cryoablation (CRYO) may be addressed with salvage cryotherapy (SCT), although little is known about how the primary treatment modality affects SCT results. Oncologic and functional outcomes of patients who underwent SCT after primary XRT (XRT-SCT) or cryoablation (CRYO-SCT)were studied. Data was collected using the Duke Prostate Cancer database and the Cryo On-Line Data (COLD) registry. The primary outcome was biochemical progression-free survival (BPFS). Urinary incontinence, rectourethral fistula, and erectile dysfunction were secondary outcomes. The Kaplan-Meier log-rank test and univariable/multivariable Cox proportional hazards (CPH) models were utilized to evaluate BPFS between groups. 419 XRT-SCT and 63 CRYO-SCT patients met inclusion criteria, that was reduced to 63 patients in each cohort after propensity matching. There was no difference in BPFS at 2 and 5 years both before (P=.5 and P=.7) and after matching (P=.6 and P=.3). On multivariable CPH, BPFS was comparable between treatment groups (CRYO-SCT, HR=1.1, [0.2-2.2]). On the same analysis, BPFS was lower in D'Amico high-risk (HR 3.2, P < .01) and intermediate-risk (HR 1.95, P < .05) categories compared to low-risk. There was no significant difference in functional outcomes between cohorts. Following primary cryotherapy, salvage cryoablation provides comparable intermediate oncological outcomes and functional outcomes compared to primary radiotherapy.

Medial patellofemoral ligament reconstruction appears to be a better treatment than repair, proximal realignment, or conservative management for primary patellar dislocation: A network meta-analysis.

The purpose of this study was to compare the functional outcomes and re-dislocation rates of medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, combined proximal realignment (CPR), and conservative management for primary patellar dislocation by conducting a systematic literature search of the available studies. The hypothesis was that MPFL repair and MPFL reconstruction would be better options for treating primary patellar dislocation. Randomized controlled trials or prospective studies of primary patellar dislocation treated with MPFL reconstruction, MPFL repair, CPR, or conservative management were identified from the MEDLINE, EMBASE, and the Cochrane Library databases through December 31, 2021. A total of 626 patients met the prespecified inclusion criteria. The methodological quality of each study was assessed using a risk of bias table, Detsky quality index, and Newcastle-Ottawa Scale. The end-point data collected included comparisons of the mean in functional scores on knee outcomes scales and the number of patients who experienced re-dislocation. A network meta-analysis of the relevant literature was performed to investigate which treatment showed better outcomes. In total, 10 trials were included in this study. There was no statistically significant difference in the subgroup analysis in terms of the functional outcomes among MPFL reconstruction, MPFL repair, CPR, and conservative management. However, MPFL reconstruction showed statistically significantly better outcomes than MPFL repair, CPR, or conservative management in terms of the re-dislocation rate. Additionally, surface under the cumulative ranking curve percentage showed that MPFL reconstruction had a lower probability of re-dislocation than MPFL repair even though there was no significant difference (0.24, 95% confidence interval: 0.02-2.91). Using a network meta-analysis, this meta-analysis showed that there was no significant difference in functional outcomes in a subgroup analysis. In re-dislocation subgroup analysis, MPFL repair and MPFL reconstruction produced significantly better results than other treatments. Also, surface under the cumulative ranking curve percentage showed that MPFL reconstruction had a lower probability of re-dislocation than MPFL repair.

Optimizing femoral component rotation in TKA: The role of posterior condylar angle and condylar twist angle

PurposeFemoral component rotation (FCR) is crucial in total knee arthroplasty (TKA). Currently, the optimal method to select FCR is unknown due to patient anatomy variation. Addressing the variability of femoral component rotation is critical to optimizing TKA outcomes and patient satisfaction. In this study, we aimed to identify outlier frequency and evaluate malrotation risk reduction by setting anatomic limits for FCR selection. MethodsOne hundred patients with end-stage knee osteoarthritis requiring TKA were included and categorized as normal rotation, internal rotation outlier, and external rotation outlier based on their expected FCR calculated intraoperatively using the modified gap balancing technique with a tensioning device. The computed FCR was then referenced to their Posterior Condylar Angle (PCA) and Condylar Twist Angle (CTA). The postoperative FCR and 1, 2-, and 5-years functional scores were also measured. ResultsSeventy-one knees (71%) were within the limits of PCA and CTA. The combined outlier frequency is 29%. The mean computed FCRs are 4.4° (±1.5), −1° (±2.6), and 8.0° (±3.4) for the normal, internal rotation, and external rotation groups, respectively. Whereas after setting the limits, the postoperative FCRs are 3.1° (±1.5), 3.9° (±1.7), and 2.5° (±1.4) for the three groups, respectively. The relative risk reduction against malrotation was 65%. At 1, 2, and 5 years post-TKA, all groups showed significant functional improvement, with no significant differences in functional outcomes between the normal and outlier groups. ConclusionThe use of lower and upper limits for selecting the FCR based on CTA and PCA can be a valuable approach to reducing malrotation risk and achieving satisfactory functional outcomes in TKA. Addressing the individual patient's anatomic limits contributes to improved TKA outcomes and patient-specific component alignment, thus enhancing the overall success of the procedure.

Evaluation of the efficiency of transurethral enucleation with bipolar energy according to prostate volume for patients with benign prostate hyperplasia

BackgroundThis study evaluated the efficiency and safety of transurethral enucleation with bipolar energy (TUEB) using a spatula loop according to prostate volume. MethodsWe retrospectively evaluated 398 patients who underwent TUEB for benign prostatic hyperplasia at a single tertiary hospital between August 2018 and December 2022. The patients were divided into three groups according to estimated prostate volume (ePV): ≤40 mL (n = 67), 40–80 mL (n = 200), and ≥80 mL (n = 131). To compare the efficiency of TUEB, perioperative parameters including TUEB and enucleation efficiencies, were calculated as enucleated tissue weight per operation time and enucleated tissue weight per enucleation time, respectively. Preoperative and postoperative functional outcomes such as the International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, maximum flow rate (Qmax), and post-void residual urine volume (PVR), were also compared. ResultsThe IPSS total score, voiding sub-score, Qmax, and PVR improved after TUEB in all groups (all p < 0.05). The TUEB and enucleation efficiencies increased with increasing ePVs (all P < 0.001). When comparing the three prostate volume groups, there were no significant differences in functional outcomes within 12 months after TUEB (all-Bonferroni adjusted P > 0.017). A total of 57 patients experienced adverse events after TUEB, with no significant differences between the three groups (p = 0.507) ConclusionAs prostate volume increases, the perioperative efficiency of TUEB is enhanced. Meanwhile, small prostates did not show significant differences in the improvement of functional outcomes and complications in comparison with larger prostates.

A meta-analysis of closed reduction percutaneous pinning and open reduction with pin fixation of pediatric humeral lateral condylar fracture.

To compare the effectiveness and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation to treat the pediatric humeral lateral condylar fracture. Studies comparing closed reduction percutaneous pinning vs. open reduction with pin fixation for treating pediatric lateral humeral condyle fractures were found by searching Pubmed, Embase, the Cochrane Library, and Web of Science databases, including randomized/non-randomized controlled, retrospective case-control, and prospective cohort studies. Furthermore, quality evaluation and data retrieval were conducted after the literature review. A meta-analysis was performed using RevMan 5.4 software to compare both groups' outcome measures. This Meta-analysis incorporated eight studies with 856 cases. The Meta-analysis found no significant difference in functional outcomes, superficial infection, deep infection, poor fracture union, avascular necrosis of the humeral capitulum, or lateral spur formation between groups. However, the status of unaesthetic scars in the closed reduction percutaneous pinning group was superior. For pediatric humeral lateral condylar fracture surgical therapy, the efficacy and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation were not significantly different; closed reduction percutaneous pinning offered the benefit of eliminating unaesthetic scar. However, further high-quality research is required to verify the conclusions of this Meta-analysis. https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023392451.