Transient Femoral Nerve Research Articles

Mid-term clinical and radiographic outcome of metal-on-metal hip resurfacing through an anterolateral approach.

The aim of this retrospective study was to evaluate the medium-term clinical and radiographic results of current generation metal-on-metal resurfacing prostheses performed through anterolateral approach. Fifty-seven hips in 52 patients underwent resurfacing arthroplasty. Two patients died from unrelated causes, leaving 55 hips in 35 males (3 bilateral) and 15 females (2 bilateral), with a mean age at surgery of 56.2years (range, 27-70years). Clinical and radiographic assessment was carried out preoperatively and at follow-up in all the survived cases. The cumulative survival rate was determined according to the method of Kaplan-Meier. At a mean follow-up of 5.2years (range, 1.8-9.1years), 2 HRs of the same female patient were revised because of early loosening of the acetabular component. Deep venous thrombosis and transient femoral nerve palsy occurred both in 1 case. No specific complications of HR were observed. Average Harris hip score improved significantly from 59.8 points (range, 30.4-90.6) preoperatively to 93.7 points (range, 53-100) at the latest examination. Neck narrowing showed an average of 3.27%, but it never exceeded 10%. Nonprogressive acetabular radiolucencies and osteolysis were detected both in 2 hips. A high rate of patients (32, 60.4%) developed heterotopic ossifications, although low-grade in most cases (27, 84.4%). The cumulative survival rate at 9.1years with revision for any reason as the end point was 93.0%. The early clinical and radiographic results of modern metal-on-metal hip resurfacing performed through an anterolateral approach are promising, but longer-term follow-up studies are necessary.

Upper extremity neuromonitoring changes are more common than lower extremity during spinal fusion for Scheuermann's kyphosis.

The purpose of this study is to determine the incidence of intraoperative neuromonitoring (IONM) changes and postoperative neurologic deficit in patients with Scheuermann's Kyphosis (SK) undergoing posterior spinal fusion (PSF). Single-center, retrospective chart review of the clinical, surgical and IONM data (somatosensory evoked potential (SSEP) and neurogenic motor evoked potential (NMEP) or transcranial motor evoked potential (TcMEP)) from patients with SK undergoing PSF at our center from 1993 to 2021. One hundred and four SK patients (mean 16.4 ± 1.9years) underwent PSF with correction of kyphosis from mean 79.4 ± 10.8° to 35.4 ± 13.9°. MEP data were obtained using either NMEP in 34.6% of patients) or TcMEP in 65.4% of patients. Only 3.8% of cases had lower extremity (LE) IONM changes during surgery, with no postoperative neurologic deficits in those patients. IONM changes occurred more frequently in the upper extremities (UE) with 14 (13.4%) patients having changes in UE SSEPs. Patients with UE IONM changes had significantly longer surgical times (p = 0.0096) and higher number of levels fused (p = 0.003) compared to patients without changes. Their weight, but not BMI, was also significantly higher (p = 0.036). These UE IONM changes resolved with arm repositioning in all but one patient who had a postoperative UE neurapraxia that resolved by 6weeks. There was 1 postoperative transient femoral nerve palsy without IONM changes thought to be due to patient positioning. The incidence of critical LE IONM changes during PSF for SK is 3.4%, which is similar to that reported in AIS. UE IONM changes are significantly more common at 13.4%, revealing that these patients are vulnerable to malpositioning of the arms during surgery.

P102 FEMORAL NERVE PALSY POST OPEN INGUINAL HERNIA REPAIR - CASE REPORT AND LITERATURE REVIEW

Abstract Aim and Introduction “Inguinal hernia repair is one of the most common surgical procedures performed worldwide. Postoperative pain control is very important and recently nerve block has gained popularity as an alternative to opioid use. Transient femoral nerve palsy (TNFP) is a potential complication of ilioinguinal nerve block, but it is extremely rare with only a few cases reported. We discuss a case of TNFP post-left inguinal hernia repair to highlight this rare complication.” Material and Methods “Case Report: A 17-year-old male with clinically and radiologically confirmed left inguinal hernia underwent open mesh repair (Lichtenstein repair). At the end of the procedure, he had ilioinguinal and iliohypogastric nerve block (10ml, 0.5% bupivacaine). In the recovery room, he developed numbness of his anteromedial aspect of his left thigh with weakness of hip flexion and paralysis of quadriceps with an inability to extend his knee. He was reviewed by the anaesthetic team and was admitted overnight. His symptoms resolved spontaneously within 18 hours. He was subsequently discharged and followed up in the surgical OPD 2 weeks, 6 weeks and 6 months later and there were no residual neurological symptoms.” Results and Conclusion “TNFP post open hernia repair is very rare. Mechanisms of femoral nerve injury include suturing, stapling, scar tissue entrapment or direct compression. Careful attention is needed to the technique of local anaesthesia post-operatively (avoid deep infiltration, lowest volume and concentration used, ultrasound use) to avoid potential morbidity if this complication is not recognised.”

Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: a meta-analysis.

PurposeTo investigate the success rate of the Tübingen hip flexion splint (THFS) for the treatment of developmental dysplasia of the hip (DDH), of different severity as per the Graf classification, among infants younger than six months of age. The type and incidence rate of complications associated with THFS treatment were also evaluated.MethodsThe following databases were searched using keywords and limited for age less than six months: PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, between inception and July 2020. Articles were screened and extracted by two researchers, and the quality of the included literature was evaluated (methodological index for non-randomized studies criteria). R studio 1.3 was used for statistical analysis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsAfter screening, eight articles were included in the analysis, contributing 1211 hips (875 patients). The overall success rate of THFS treatment is 91% (95% confidence interval (CI) 0.82 to 0.95). The success rate by Graf type is as follows: type-II, 98% (95% CI 0.94 to 1.00); type-III, 96% (95% CI 0.88 to 1.00); and type-IV, 32% (95% CI 0.18 to 0.47). Complications (24/1211, 2%) included transient femoral nerve palsy (n = 1); avascular necrosis of the femoral head (n = 9) and residual acetabular dysplasia (n = 14).ConclusionTHFS treatment is successful for Graf type-II and –III, but low for type-IV, with a low rate of complication. THFS may be an effective treatment option for DDH among infants less than six months of age. However, those with Graf type-IV require close monitoring.Level of EvidenceIII

Simplified arthroscopic lavage of pediatric septic hip: case series.

Septic arthritis of the pediatric hip is a surgical emergency that requires adequate lavage to decompress the hip, reduce degradative cartilage insult, and prevent coxarthrosis. In this report, we describe a simplified arthroscopic technique that may be performed using a single portal based on fluoroscopy and surface landmarks and without regular use of traction. We present results of a series of patients who underwent the simplified arthroscopic method for the management of pediatric septic hip. Data were obtained by a retrospective chart review of 13 consecutive patients (14 hips) with pediatric septic hip treated with arthroscopic lavage from 2010 to 2015. Age at the time of surgery ranged from 3 months to 8 years with three patients less than 1 year old. Ten hips (71%) returned for a routine follow-up with an average follow-up of 22 months. All 14 hips (100%) had complete resolution of symptoms. Two hips (14%) needed revision surgery due to inadequate response after the first lavage. One hip (7%) had transient femoral nerve palsy. Hip arthroscopy is an attractive and effective option for the management of pediatric septic hip. The limited equipment required and the ease of performing our simplified technique may broaden the application to the general orthopedist for the treatment of pediatric septic hip.

AB159. Femoral nerve palsy post open inguinal hernia repair—case report and literature review

Background: Inguinal hernia repair is one of the most common surgical procedures performed worldwide. Postoperative pain control is very important and recently nerve block has gained popularity as an alternative to opioid use. Transient femoral nerve palsy (TNFP) is a potential complication of ilioinguinal nerve block but it is extremely rare with only a few cases reported. We discuss a case of TNFP post-left inguinal hernia repair to highlight this rare complication.

The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty.

Either one- or two-stage revision arthroplasties can be used for the treatment of chronic periprosthetic joint infection (PJI) after total hip arthroplasty (THA). We report our results following two-stage revision surgery performed through the direct anterior approach (DAA) interval using a custom-made articulating spacer. Between 2009 and 2014, 49 patients (49 consecutive procedures) had surgery through either a DAA or extended DAA approach. Each patient received perioperative intravenous administration of antibiotics. A custom-made spacer was implanted after explanting cup and stem and following extensive debridement. Broad-spectrum antibiotics were administered during the immediate perioperative period and then adjusted according to the infecting organism. Complication rates and eradication rates were observed. WOMAC patient assessments were administered preoperatively and one-year postoperatively. Of the 49 study patients, five had a recurrence of the infection after the second-stage revision, five had a proximal periprosthetic fracture during the first stage procedure and one patient had a transient femoral nerve palsy that resolved fully within the first postoperative year. 30 different microorganisms were identified on intraoperative specimens. The average time between first and second stage procedure was 65.7days (range 21-132days). Eradication of infection was defined as healed wound without fistula, no drainage, no recurrence of the infection, no subsequent surgical intervention for persistent or perioperative infection after second stage revision and no long-term (> 6months) antimicrobial suppression therapy. Eradication rate of infection in our study was 89.8%. Postoperative WOMAC scores improved significantly CONCLUSION: The preliminary clinical results for the custom-made spacer technique implanted through the DAA are promising. Therefore, we believe the DAA can be used safely as a standard operative approach for two-stage revision procedures.

Extension of the Direct Anterior Approach for the Treatment of Periprosthetic Femoral Fractures

BackgroundPeriprosthetic femoral fractures (PFFs) after total hip arthroplasty are devastating complications often resulting in functional limitations and increased mortality. The use of the direct anterior approach (DAA) is becoming more popular, and the number of revisions done through this interval is increasing. The DAA interval can be expanded to treat PFFs. This retrospective case series assessed outcomes of PFF patients treated with the extension of the DAA interval. MethodsThe study contained 40 patients (40 hips). Mean patient age was 74.3 years (range, 55.1-92.2 years). Mean follow-up time was 50.4 months (range, 20-98.2 months). Fractures were classified as Vancouver B2 (n = 36) and B3 (n = 4). ResultsMedian cut-to-close time was 152 minutes (interquartile range: 80-279). There were five complications (12.5%): 2 deaths, 1 transient femoral nerve palsy, 1 fissure distal to the stem, and 1 hematoma. ConclusionExpansion of the DAA interval to treat PFF showed similar results compared with other surgical approaches in terms of mortality, complications, fracture healing, and dislocation rate. These results indicate that femoral revision for PFF in the DAA interval is a safe and reliable procedure compared with other surgical approaches for the treatment of Vancouver B2 and B3 periprosthetic fractures.

Lateral lumbar interbody fusion in the elderly: a 10-year experience.

OBJECTIVEElderly patients, often presenting with multiple medical comorbidities, are touted to be at an increased risk of peri- and postoperative complications following spine surgery. Various minimally invasive surgical techniques have been developed and employed to treat an array of spinal conditions while minimizing complications. Lateral lumbar interbody fusion (LLIF) is one such approach. The authors describe clinical outcomes in patients over the age of 70 years following stand-alone LLIF.METHODSA retrospective query of a prospectively maintained database was performed for patients over the age of 70 years who underwent stand-alone LLIF. Patients with posterior segmental fixation and/or fusion were excluded. The preoperative and postoperative values for the Oswestry Disability Index (ODI) were analyzed to compare outcomes after intervention. Femoral neck t-scores were acquired from bone density scans and correlated with the incidence of graft subsidence.RESULTSAmong the study cohort of 55 patients, the median age at the time of surgery was 74 years (range 70-87 years). Seventeen patients had at least 3 medical comorbidities at surgery. Twenty-three patients underwent a 1-level, 14 a 2-level, and 18 patients a 3-level or greater stand-alone lateral fusion. The median estimated blood loss was 25 ml (range 5-280 ml). No statistically significant relationship was detected between volume of blood loss and the number of operative levels. The median length of hospital stay was 2 days (range 1-4 days). No statistically significant relationship was observed between the length of hospital stay and age at the time of surgery. There was one intraoperative death secondary to cardiac arrest, with a mortality rate of 1.8%. One patient developed a transient femoral nerve injury. Five patients with symptomatic graft subsidence subsequently underwent posterior instrumentation. A lower femoral neck t-score < -1.0 correlated with a higher incidence of graft subsidence (p = 0.006). The mean ODI score 1 year postoperatively of 31.1 was significantly (p = 0.003) less than the mean preoperative ODI score of 46.2.CONCLUSIONSStand-alone LLIF can be safely and effectively performed in the elderly population. Careful evaluation of preoperative bone density parameters should be employed to minimize risk of subsidence and need for additional surgery. Despite an association with increased comorbidities, age alone should not be a deterrent when considering stand-alone LLIF in the elderly population.

Transient femoral nerve neuropathy secondary to haematoma after medial thigh lift

We report an unusual and rare complication of transient femoral nerve neuropathy secondary to a large haematoma after medial thigh lift surgery. This has never been previously reported in the literature in association with this procedure. It is prudent to raise awareness that such a significant complication, although rare, can occur even with such a benign procedure, and that it is readily reversible with prompt recognition and early treatment.

Transient obturator nerve block with fascia iliaca compartment block following local infiltration for open inguinal herniorrhaphy

BackgroundIlioinguinal nerve block is effective for analgesia after open inguinal herniorrhaphy. However, transient femoral nerve palsy can happen after the block. The ambulatory patients sometimes cannot discharge from the hospital with the motor deficiency. Here is described a case of fascia iliaca compartment block with complete obturator nerve block after surgical infiltration analgesia for open inguinal herniorrhaphy.Case presentationAn ambulatory open inguinal herniorrhaphy was performed for a 63-year-old male under general anesthesia. The mixture of short-/long-acting local anesthetics was injected by the surgeon into the subcutaneous tissue, between the Camper’s and Scarpa’s fasciae, into the inguinal canal, and between the internal oblique and transversus abdominis muscles. The patient could not adduct his ipsilateral hip joint at all 1 h after emergence. The flexion of the hip joint was weakened two more hours later, and numbness of the lateral thigh emerged. The complications completely resolved 7 h after surgery.ConclusionsSurgical infiltration analgesia as well as percutaneous ilioinguinal nerve block can cause both fascia iliaca plane block and obturator nerve block. Analgesia regimen should be carefully built for ambulatory surgery.

Do Postoperative Results Differ in a Randomized Trial Between a Direct Anterior and a Direct Lateral Approach in THA?

The direct lateral approach to THA provides good exposure and is associated with a low risk of dislocations, but can result in damage to the abductor muscles. The direct anterior approach does not incise muscle, and so recovery after surgery may be faster, but it has been associated with complications (including fractures and nerve injuries), and it involves a learning curve for surgeons who are unfamiliar with it. Few randomized trials have compared these approaches with respect to objective endpoints as well as validated outcome scores. The purpose of this study was to compare the direct anterior approach with the direct lateral approach to THA with respect to (1) patient-reported and validated outcomes scores; (2) frequency and persistence of abductor weakness, as demonstrated by the Trendelenburg test; and (3) major complications such as infection, dislocation, reoperation, or neurovascular injury. We performed a randomized controlled trial recruiting patients from January 2012 to June 2013. One hundred sixty-four patients with end-stage osteoarthritis were included and randomized to either the direct anterior or direct lateral approach. Before surgery and at 3, 6, 12, and 24 months, a physiotherapist recorded the Harris hip score (HHS), 6-minute walk distance (6MWD), and performed the Trendelenburg test directly after the 6MWD. The patients completed the Oxford Hip Score (OHS) and the EQ-5D. The groups were not different at baseline with respect to demographic data and preoperative scores. Both groups received the same pre- and postoperative regimes. Assessors were blinded to the approach used. One hundred fifty-four patients (94%) completed the 2-year followup; five patients from each group were lost to followup. There were few statistical differences and no clinically important differences in terms of validated or patient-reported outcomes scores (including the HHS, 6MWD, OHS, or EQ-5D) between the direct anterior and the lateral approach at any time point. A higher proportion of patients had a persistently positive Trendelenburg test 24 months after surgery in the lateral approach than the direct anterior approach (16% [12 of 75] versus 1% [one of 79]; odds ratio, 15; p = 0.001). Irrespective of approach, those with a positive Trendelenburg test had statistically and clinically important worse HHS, OHS, and EQ-5D scores than those with a negative Trendelenburg test. There were four major nerve injuries in the direct anterior group (three transient femoral nerve injuries, resolved by 3 months after surgery, and one tibial nerve injury with symptoms that persist 24 months after surgery) and none in the lateral approach. Based on our findings, no case for superiority of one approach over the other can be made, except for the reduction in postoperative Trendelenburg test-positive patients using the direct anterior approach compared with when using the direct lateral approach. Irrespective of approach, patients with a positive Trendelenburg test had clinically worse scores than those with a negative test, indicating the importance of ensuring good abductor function when performing THA. The direct anterior approach was associated with nerve injuries that were not seen in the group treated with the lateral approach. Level I, therapeutic study.

Transient Femoral Nerve Palsy Following Ilioinguinal Nerve Block for Inguinal Hernioplasty.

Background:Elective inguinal hernia repair in young fit patients is preferably done under ilioinguinal nerve block anesthesia in the ambulatory setting to improve throughput, save cost, and increase patient satisfaction. A rare complication of ilioinguinal nerve block is transient femoral nerve palsy (TFNP).Objectives:The aim of this study is to examine the incidence of TFNP among adults undergoing ambulatory inguinal hernia repair under ilioinguinal nerve block.Patients and Methods:Patients 18 years and older in the American Society of Anesthetists classes I and II who underwent ambulatory inguinal hernia repair over a 3-year period under ilioinguinal nerve block only were assessed for evidence of TFNP. All patients had power on the ipsilateral limb checked 30 min before and 1 h after the procedure. TFNP was considered present if there was sensory loss over the anterior aspect of the thigh, weakness of extension at the knee joint, or reduction in power of the ipsilateral limb.Results:One hundred and twelve patients were involved in the study; 90 (80.3%) males and 22 (19.6%) females with the mean age of 45.7 years. All had normal power (Grade 5) in the ipsilateral limb before instituting the nerve block. Postoperatively, 3 (2.6%) patients had grade 4 and recovered normal power over a 2–6-h period and were subsequently discharged.Conclusion:TFNP is a rare complication of ilioinguinal nerve block which delays patient discharge postambulatory hernioplasty.

Femoral Nerve Palsy Following Landmark Based Ilioinguinal-Iliohypogastric Nerve Block: Case Report and Safety Review

Inguinal hernia repair is one of the most commonly performed procedures in the United States. Ilioinguinal-iliohypogastric nerve blocks are commonly performed for postoperative pain control. Transient femoral nerve palsy is a recognized complication of this block. A 75-year-old male underwent an uncomplicated Lichtenstein repair of an incarcerated right inguinal hernia. An ilioinguinal-iliohypogastric nerve block was performed at the conclusion. Postoperatively, he reported symptomatology of femoral nerve palsy, with full resolution within 8 h. Femoral nerve palsy occurs when anesthetic is infiltrated into the transverse abdominis muscle, allowing for diffusion toward the femoral nerve along contiguous planes of the transverse abdominis-iliacus fascia. Incidence can be as high as 5%. Literature favors ultrasound to landmark-based approaches for improved efficacy and reduced complications. Postoperative protocols for femoral nerve palsy can be implemented with minimal effect on nursing workflow to improve patient safety from the effects of this complication. J Med Cases. 2017;8(5):155-158 doi: https://doi.org/10.14740/jmc2809w

Femoral Nerve Palsy Following Landmark Based Ilioinguinal-Iliohypogastric Nerve Block: Case Report and Safety Review

Inguinal hernia repair is one of the most commonly performed procedures in the United States. Ilioinguinal-iliohypogastric nerve blocks are commonly performed for postoperative pain control. Transient femoral nerve palsy is a recognized complication of this block. A 75-year-old male underwent an uncomplicated Lichtenstein repair of an incarcerated right inguinal hernia. An ilioinguinal-iliohypogastric nerve block was performed at the conclusion. Postoperatively, he reported symptomatology of femoral nerve palsy, with full resolution within 8 h. Femoral nerve palsy occurs when anesthetic is infiltrated into the transverse abdominis muscle, allowing for diffusion toward the femoral nerve along contiguous planes of the transverse abdominis-iliacus fascia. Incidence can be as high as 5%. Literature favors ultrasound to landmark-based approaches for improved efficacy and reduced complications. Postoperative protocols for femoral nerve palsy can be implemented with minimal effect on nursing workflow to improve patient safety from the effects of this complication. J Med Cases. 2017;8(5):155-158 doi: https://doi.org/10.14740/jmc2809w

Arthroscopic Treatment of Septic Arthritis in Very Young Children.

Arthroscopic lavage is a well-established, minimally invasive treatment for septic arthritis (SA) in adults, but the use of arthroscopy in the pediatric population is typically restricted to sports injuries and deformity. Previous research on arthroscopic lavage of septic joints in the pediatric population has been limited to case reports and small case series of older children. As such, we aimed to evaluate the safety and efficacy of arthroscopic treatment of SA in various joints in very young children. Between 2011 and 2015, 24 children (aged 3 wk to 6 y) were treated for SA with arthroscopic lavage. A single portal was adequate for both inflow and outflow in most cases. A second portal was used in all knees and in other joints for synovectomy, when indicated. Drains were placed through the portal site and remained in place for 2 to 3 days. Antibiotics were managed by the infectious disease service. Nine hips, 9 knees, 4 ankles, and 2 shoulders were included. Portal placement, visualization, and adequate lavage were straight forward in all joints. There was 1 transient femoral nerve palsy and no other arthroscopy-associated complications (iatrogenic damage, difficult drain placement, or conversion to open). Two patients required repeat arthroscopic lavage for disease eradication, one of which required a second admission. A third patient underwent open irrigation following arthroscopic lavage with a resultant 1.125 average procedures per subject. At final follow-up (2 to 49 mo, average 16 mo), no recurrence of infection or decreased range of motion was noted. Arthroscopic lavage appears to be a safe, quick, and effective alternative to open arthrotomy for the treatment of SA in very young children. It is feasible in any large joint even in the infantile population, allowing for improved visualization and irrigation with little soft-tissue dissection and morbidity. Our relatively simple technique and positive results should encourage regular use of arthroscopic treatment of SA even in very young children. Level IV-case series.

Electrophysiological Study of Femoral Nerve Function After a Continuous Femoral Nerve Block for Anterior Cruciate Ligament Reconstruction: A Randomized, Controlled Single-Blind Trial

Background: A continuous femoral nerve block (CFNB) is an effective analgesic treatment after anterior cruciate ligament (ACL) reconstruction but may result in transient femoral nerve injuries and quadriceps muscle weakness, which in turn contribute to worsened functional outcomes. Purpose: To compare electrophysiological criteria of a femoral nerve injury as well as functional and pain-related outcomes after ACL reconstruction when analgesia was provided by a CFNB or intravenous patient-controlled analgesic of morphine (IV PCA). Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: A total of 74 patients scheduled for ACL reconstruction were randomized to receive a CFNB before surgery, followed by a ropivacaine infusion for 2 days and oxycodone, or IV PCA. The primary outcome was the rate of femoral nerve injuries at 4 weeks postoperatively, defined as a reduction of the compound muscle action potential (CMAP) area from the vastus medialis muscle after supramaximal femoral nerve stimulation at the groin, associated with an absent H-reflex of the femoral nerve and signs of vastus medialis muscle denervation. Secondary functional outcomes were quadriceps muscle strength, active flexion range, and distance walked, as measured on postoperative days 1 and 2. Secondary pain-related outcomes were IV morphine consumption and pain scores at rest and on movement in phase 1 recovery and on postoperative days 1 and 2. Results: No patients met the electrophysiological criteria of a femoral nerve injury. The mean CMAP area at 4 weeks was equivalent in both the CFNB and IV PCA groups (47 ± 16 mV·ms and 51 ± 13 mV·ms, respectively; P = .50). While no differences were detected in functional outcomes or pain scores, the consumption of an IV morphine equivalent was reduced by the administration of a CFNB in phase 1 recovery (6 ± 5 mg and 13 ± 7 mg, respectively; P = .0003), on postoperative day 1 (6 ± 7 mg and 19 ± 17 mg, respectively; P = .0005), and on postoperative day 2 (11 ± 10 mg and 19 ± 17 mg, respectively; P = .03) compared with an IV PCA. Conclusion: Despite prior contrary reports, a CFNB did not result in femoral nerve injuries or worsened functional outcomes after ACL reconstruction. The improvement of analgesia with a CFNB was only marginal and not clinically relevant beyond 24 hours. Registration: NCT01321138 (ClinicalTrials.gov identifier).

CT guided cryoablation for locally recurrent or metastatic bone and soft tissue tumor: initial experience.

BackgroundHistorically, local control of recurrent sarcomas has been limited to radiotherapy when surgical re-resection is not feasible. For metastatic carcinomas to the bone or soft tissue, radiotherapy and some interventional radiology treatment along with other systemic therapies have been widely advocated due to the possibility of disseminated disease. These techniques are effective in alleviating pain and achieving local control for some tumor types, but it has not been effective for prolonged local control of most tumors. Recently, cryoablation has been reported to have satisfactory results in lung and liver carcinoma treatment. In this study, we analyzed the clinical outcome of CT-guided cryoablation for malignant bone and soft tissue tumors to elucidate potential problems associated with this procedure.MethodsSince 2011, 11 CT-guided cryoablations in 9 patients were performed for locally recurrent or metastatic bone and soft tissue tumors (7 males and 2 females) at our institute. The patients’ average age was 74.8 years (range 61–86) and the median follow up period was 24.1 months (range 5–48). Histological diagnosis included renal cell carcinoma (n = 4), dedifferentiated liposarcoma (n = 2), myxofibrosarcoma (n = 2), chordoma (n = 1), hepatocellular carcinoma (n = 1), and thyroid carcinoma (n = 1). Cryoablation methods, clinical outcomes, complications, and oncological outcomes were analyzed.ResultsThere were 5 recurrent tumors and 6 metastatic tumors, and all cases had contraindication to either surgery, chemotherapy or radiotherapy. Two and 3 cycles of cryoablation were performed for bone and soft tissue tumors, respectively. The average length of the procedure was 101.1 min (range 63–187), and the average number of probes was 2.4 (range 2–3). Complications included 1 case of urinary retention in a patient with sacral chordoma who underwent prior carbon ion radiotherapy, 1 transient femoral nerve palsy, and 1 minor wound complication. At the final follow up, 4 patients showed no evidence of disease, 2 were alive with disease, and 3 died of disease.ConclusionsReports regarding CT-guided cryoablation for musculoskeletal tumors are rare and the clinical outcomes have not been extensively studied. In our case series, CT-guided cryoablation had analgesic efficacy and there were no cases of local recurrence post procedure during the follow-up period. Although collection of further data regarding use of this technique is necessary, our data suggest that cryoablation is a promising option in medically inoperable musculoskeletal tumors.

Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia.

Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.

Indications and Results of Hip Arthroscopy in 288 Consecutive Patients with a Minimum Follow-Up of 6 Months

Objectives:We present the indications and results of hip arthroscopy of a series of 288 consecutive patients with a minimum follow-up of 6 months (to 4 years).Methods:288 patients underwent hip arthroscopy between 2009 and 2013. Forty patients were lost in follow-up. For the clinical assessment of the remaining 248 patients, we used the modified Harris Hip Score (mHHS) pre-operatively and at 3, 6, 12, and 24 months post-operatively. We documented patients in respect to age (mean age was 36, range 16 to 68), sex (178 males, 70 females), indication for arthroscopy (159 femoroacetabular impingement-FAI, 37 osteoarthritis-OA, 15 diagnostic, 10 for osteonecrosis-AVN, 6 post-traumatic(fracture-dislocation), 15 for traumatic labral tear, 5 for synovial osteochondromatosis and one for post-op adhesions), the correlation of pre-operative imaging and arthroscopic findings, surgical time, use of image intensifier and complications. The patient was placed in lateral position in 105 cases and supine in 143 cases.Results:In the majority of patients, FAI was the primary diagnosis where the mHHS showed an improvement from 51 to 92 post-operatively. In 37, OA was the primary diagnosis; 16 required joint replacement within 14 months post arthroscopy. In OA, joint space less than 2 mm and presenceof bone edema of the femoral head in the pre-operative MRI were poor prognostic factors. In ten out of 15 patients diagnostic chondral injuries were present. Complications: One transient femoral nerve palsy, one superficial wound infection, two cases of instrument breakage within the joint which were successfully removed without sequelae and one inability to access safely the central compartment.Conclusion:The main indication for hip arthroscopy today is FAI. With proper indications, hip arthroscopy can significantly improve patient’s symptoms in most cases.