VAS Pain Score Research Articles

The effect of cervical length on procedure time and VAS pain score in office hysteroscopy

This study aimed to investigate the effect of cervical length on procedure time and VAS pain scores during office hysteroscopy. A cross-sectional study was conducted on 50 patients who underwent office hysteroscopy for various indications such as abnormal uterine bleeding and infertility. Exclusion criteria included active vaginal infection, previous cervical surgery, and chronic pelvic pain. Cervical length was measured via transvaginal ultrasound prior to the procedure. Procedure time and VAS pain scores were recorded and analyzed. Patients with a retroverted uterus had higher post-procedure VAS scores (7.6 ± 0.8) compared to those with an anteverted uterus (4.9 ± 1.9, p < 0.001). Cervical length was found to be a significant predictor of both procedure time (β = 5.711, p < 0.001) and VAS pain score change (β = 0.167, p < 0.001). Procedure time was significantly longer in patients with increased cervical length (R2 = 79.6%, p < 0.001). Additionally, an anteverted uterus was associated with a shorter procedure time (118.2 ± 49.2 s) compared to a retroverted uterus (142.7 ± 46.8 s, p < 0.001). Cervical length was a significant predictor of VAS pain scores (β = 0.167, p < 0.001), with each millimeter increase leading to a 0.167-unit rise. While univariate analysis showed a negative association between age and VAS scores (β = -0.299, p = 0.035), this was not significant in the multivariate model (p = 0.586). Cervical length also significantly prolonged procedure time (β = 5.711, R2 = 79.6%, p < 0.001). Cervical length is a significant factor influencing both the duration and pain experienced during office hysteroscopy. Consideration of cervical length can improve patient comfort and procedural efficiency in clinical practice.

Interposition Arthroplasty with Meniscal Allograft for the Treatment of Sternoclavicular Joint Pathology; The SC Calamari Technique.

Painful degeneration of the sternoclavicular joint refractory to nonoperative treatment has historically been managed with resection of the degenerative segment of the medial clavicle. Although this has produced good results with improvement in symptoms, recurrent pain necessitating revision surgery is not an infrequently encountered outcome. To reduce the occurrence of recurrent postoperative pain, a novel technique to reconstruct the intra-articular disc at the time of medial clavicle resection was developed. 10 patients whom underwent medial clavicle excision and interposition arthroplasty with a lateral meniscus allograft were retrospectively reviewed. Functional results were based on VAS pain scores and subjective shoulder scores. VAS pain score improved from 7.5 (5-10) preoperatively to 1.2 (0-2; p = .005, W-value = 0) postoperatively, with an average improvement of 6.3. The mean preoperative SSV score improved from 54.5 (25-70) preoperatively to 88.5% (80-95%; p = .005; W-value = 0) postoperatively, with a mean increase of 34 percentage points. No patients experienced a complication and or recurrence of pain at most recent follow-up. Minimal excision of the medial clavicle and interposition arthroplasty with lateral meniscal allograft successfully reduces pain and restores stability and function for the treatment of painful degeneration of the SC joint.

Modified single-incision MIS-TLIF with expandable tubular assistance for degenerative lumbar spine diseases

ObjectiveEvaluating the clinical value of the modified single-incision posterior median approach with expandable tubular assistance for lumbar interbody fusion in managing degenerative lumbar spine diseases.MethodA retrospective analysis was conducted on 121 patients with single-level degenerative lumbar spine disease treated in our spine surgery department from January 2017 to December 2021. Of these, 72 patients underwent a modified single-incision posterior median approach with expandable tubular assistance lumbar interbody fusion (single-incision MIS-TLIF group), while 49 patients received the classic open posterior median incision P-TLIF (open surgery group). We collected basic demographic data including age, gender, BMI, and surgical level. Surgical-related indicators such as operation time, intraoperative blood loss, postoperative drainage, length of hospital stay, hospital costs, and complication rates were compared between the two groups. Laboratory results [whole blood C-reactive protein (CRP), serum creatine kinase (CK)] and clinical outcomes [VAS scores for low back and leg pain, Oswestry Disability Index (ODI), excellent and good rate according to the modified MacNab criteria, and interbody fusion rate according to the Brantigan criteria] were also evaluated.ResultThere were no significant differences in the basic demographics between the two groups. The operation time, postoperative hospital stay, and hospital costs were also similar between the groups. However, significant differences were observed in intraoperative blood loss, postoperative drainage, and complication rates. On postoperative days 1 and 3, whole blood CRP and CK levels showed marked differences between the groups. At 3, 6, and 12 months postoperatively, the single-incision MIS-TLIF group had lower ODI scores and VAS scores for back pain compared to the open surgery group. The excellent and good rate according to the MacNab criteria was higher in the single-incision MIS-TLIF group. There were no significant differences in leg pain VAS scores and interbody fusion rates at 12 months postoperatively between the groups.ConclusionThe modified single-incision posterior median approach with expandable tubular assistance lumbar interbody fusion is highly effective in treating degenerative lumbar spine diseases. It results in less postoperative pain, faster recovery, and significant improvement in postoperative functional outcomes, making it a valuable treatment option.

Comparison of warm sitz bath and electronic bidet with a lower-force water flow for postoperative management after hemorrhoidectomy (BIDLOW)

AimElectronic bidets can be a substitute for sitz baths, but no study has examined the use of electronic bidets to manage anal problems.MethodsA randomized, controlled, single-blind, multicenter, parallel group trial was performed. Patients who underwent hemorrhoidectomy were randomly assigned (1:1) to use the electronic bidet or warm sitz baths for 7 days after hemorrhoidectomy. The primary endpoint was the difference in the anal pain VAS score for 7 days posthemorrhoidectomy.ResultsPatients were assigned to the electronic bidet (51) or sitz bath (50) groups. Twenty-six patients dropped out after randomization, and the final analysis included 34 patients in the electronic bidet group and 41 in the sitz bath group. The VAS score for anal pain 7 days posthemorrhoidectomy did not differ between the electronic bidet and sitz bath groups (38.3 ± 21.9 vs. 42.0 ± 21.1, p = 0.453). The upper limit of the 95% confidence interval of the VAS score in the electronic bidet group (81.22) was greater than the margin of noninferiority (46.20).ConclusionThe VAS scores after hemorrhoidectomy did not differ between the electronic bidet and sitz bath groups, but the noninferiority of the electronic bidet to sitz baths for anal pain 7 days posthemorrhoidectomy was not verified.Trial RegistrationThe trial was registered on ClinicalTrials.gov (Registration number: NCT02353156, date: 02/02/2015).

Nerve Capping Using Renerve® Synthetic Collagen Conduits for Hand Amputation Neuroma Pain.

Background: Amputated neuromas, a common consequence of peripheral nerve injury, can cause significant pain and may impair daily life. Herein, we conducted a retrospective study on patients who underwent a nerve-capping technique using the bioabsorbable nerve conduit Renerve®, with a minimum follow-up period of 6 months. Methods: We conducted a retrospective study to assess patients with amputation neuromas of the finger or palm who underwent surgical treatment using the capping technique with the Renerve® conduit between October 2018 and September 2022. The data on demographics, operative details, pre- and postoperative evaluations (visual analogue scale [VAS] pain scores and Tinel sign) and complications were analysed. Results: Seven patients (seven nerves) with a median age of 51 years (three men and four women) were assessed. The median follow-up duration was 15 months. Renerve® conduits of varying sizes (1.0-2.3 mm) and lengths (15-25 mm) were used. The median duration until surgery was 195 days. After the procedure, VAS pain scores significantly decreased from a baseline of 53.1 mm to 5.7 mm at the 6-month follow-up. Tinel sign persisted in four patients, and no postoperative complications occurred. Conclusions: Our study demonstrates the clinical usefulness of the Renerve® conduit as a nerve-capping technique for amputation neuroma. Considering the limited availability of real-world data on Renerve® conduits for nerve capping, our findings provide valuable insights for clinical practitioners. Level of Evidence: Level IV (Therapeutic).

Stapled Haemorrhoidectomy Compared with Milligan-Morgan Excision for the Treatment of Prolapsing Haemorrhoids: A Prospective Study

Background: Haemorrhoids, a common rectal and anal pathology, present with symptoms such as pain, bleeding, and prolapse caused by oedematous vascular formations in the anal canal. The conventional Milligan-Morgan haemorrhoidectomy (MMH) and stapled haemorrhoidopexy (Stapled Haemorrhoidectomy, PPH) are frequently used surgical techniques for prolapsing haemorrhoids. Aim: To compare Stapled Haemorrhoidectomy and Milligan-Morgan Haemorrhoidectomy in treating prolapsing haemorrhoids. Methodology: This prospective comparative cross-sectional study analyzed early postoperative outcomes in 60 patients undergoing either PPH or MMH. The study was conducted at Jinnah Hospital, Lahore. Data were collected for six months’ duration from January 2024 to June 2024 using a Likert scale questionnaire adapted from Khan et al. (2009). Descriptive statistics summarized continuous variables like operative time, VAS pain scores, and hospital stay, while categorical variables were analyzed using frequency distributions and the Chi-square test to assess associations between complications and procedure type. Findings and Conclusion: Stapled Haemorrhoidectomy showed significant advantages over MMH, including shorter operative time, reduced postoperative pain, and shorter hospital stays. It was also associated with fewer complications such as postoperative bleeding, urinary retention, infection, and anal stenosis. These findings align with previous studies, confirming that Stapled Haemorrhoidectomy offers better recovery and lower complication rates, making it a preferred option in healthcare settings

Effect of subanesthetic dose of esketamine on early postoperative depression in elderly patients with Sarcopenia

ObjectiveTo explore the effects of subanesthetic dose of esketamine on serum inflammatory factor levels and depressive mood in elderly patients with sarcopenia postoperatively.MethodsThis study retrospectively included 102 elderly patients who underwent elective total knee arthroplasty from April 2023 to June 2024 with skeletal muscle mass index (SMI) meeting the diagnostic criteria for sarcopenia (male SMI < 42.6 cm2/m2, female SMI < 30.6 cm2/m2). They were divided into two groups according to whether esketamine was used: esketamine group (ESK group, n = 51) and control group (CON group, n = 51). The Hamilton Depression Scale (HAMD) scores of the patients in the two groups were completed on preoperative day 1, postoperative day 1 and day 7, and serum ceramide (Cer), NOD-like receptor thermoprotein structural domain-related protein 3 (NLRP3) and interleukin-6 (IL-6) were detected. The length of hospital stay, time to first ambulation and pain VAS scores of 4 h, 8 h and 24 h after surgery were recorded. The incidence of adverse reactions was recorded in the postoperative period of 48 h.ResultsThere were no significant differences in HAMD scores, Cer, NLRP3 and IL-6 levels between the two groups preoperatively (P > 0.05). Compared with CON group, HAMD score, Cer, NLRP3 and IL-6 levels, and pain VAS scores (postoperative 4 h and 8 h) were significantly decreased in ESK group at postoperative day 1 and day 7 (P < 0.05). In addition, the number of postoperative remedial analgesia and length of hospital stay in the ESK group were significantly shorter than those in the CON group (P < 0.05). HAMD scores and levels of Cer, IL-6 and NLRP3 were higher at postoperative day 1 and day 7 than those preoperatively in both two groups (P < 0.05), and there was no statistically significant difference in the incidence of adverse reactions at postoperative 48 h between the two groups.ConclusionsThe subanesthetic dose of esketamine can effectively reduce the serum Cer, NLRP3 and IL-6 levels after knee arthroplasty in elderly patients with sarcopenia, and may improve the patients’ depression in the early postoperative period.

Is WALANT Really Necessary in Outpatient Surgery?

Introduction: The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has revolutionized outpatient hand surgery, enabling procedures such as carpal tunnel release and trigger finger release without a tourniquet. Its benefits include patient cooperation during surgery, especially for tendon repairs. However, WALANT has limitations, including a steep learning curve, longer operative preparation time, and risks such as digital ischemia and adrenaline-induced cardiac ischemia. This study evaluates the safety and effectiveness of local anesthesia with a tourniquet for short-duration outpatient hand surgeries. Materials and Methods: This case series included 300 patients undergoing carpal tunnel or trigger finger release between February 2023 and March 2024. Local anesthesia with lidocaine was administered, and a tourniquet was applied to the proximal arm. Demographic data, operative time, and pain levels during tourniquet use (measured by VAS) were recorded. Results: The average surgical time was 12 min. Most procedures involved carpal tunnel release. The average VAS pain score was 3.73, with older patients and longer surgeries reporting higher discomfort. Tourniquet release was required in only 1% of cases due to discomfort. Conclusions: For short outpatient hand surgeries, local anesthesia with a tourniquet is a safe, effective alternative to WALANT, challenging its routine use and highlighting the need for tailored anesthetic approaches.

Is Platelet-rich Plasma Effective in Treating Achilles Tendinopathy? A Meta-analysis of Randomized Clinical Trials.

Several meta-analyses have evaluated the use of platelet-rich plasma (PRP) in the treatment of Achilles tendinopathy. Although they generally did not find PRP to be effective, an updated meta-analysis containing all the available, high-quality randomized trial evidence that addresses the methodological shortcomings identified in earlier meta-analyses needs to be performed. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in improving (1) pain and function as assessed using the Victorian Institute of Sports Assessment-Achilles (VISA-A) score 3 months, 6 months, and 1 year after treatment and (2) VAS pain scores 3 months after treatment in patients with chronic Achilles tendinopathy. We conducted a systematic search of PubMed, Scopus, Embase, and Cochrane CENTRAL from their inception until June 2024, focusing on randomized clinical trials (RCTs) comparing PRP with placebo or other treatments for Achilles tendinopathy. Our search identified 1289 studies, of which 1262 were excluded after removing duplicates and screening titles and abstracts, leaving 27 studies for detailed review. Six RCTs met the inclusion criteria, encompassing 422 patients, with a predominance of participants who were men. Publication bias was suggested by funnel plot asymmetry, which suggested that, if anything, the results may have overstated the apparent benefit of PRP treatment. Risk of bias was evaluated using the Cochrane Risk of Bias tool for randomized trials, revealing an overall low or unclear risk of bias. The primary outcomes were pain relief and functional improvement, assessed using the VAS, scored 0 to 10, with higher scores representing more severe pain, and VISA-A score, scored 0 to 100, with higher scores representing better pain and function. Heterogeneity was assessed using the Cochran Q test and I2 statistics, and a random-effects model was applied due to substantial heterogeneity. Statistical analyses were performed using Review Manager 5.4 and RStudio, version 764. We found no benefit in terms of VISA-A scores favoring PRP over placebo at 3 months (mean difference 1.7 [95% confidence interval (CI) -1.8 to 5.2]; p = 0.34), 6 months (mean difference 0.5 [95% CI [-8.5 to 9.3]; p = 0.92), or 1 year (mean difference -7.9 [95% CI -27.3 to 11.6]; p = 0.43). PRP did not improve VAS pain scores at 3 months (mean difference -0.22 [95% CI -0.56 to 0.12]; p = 0.21). Sensitivity analyses confirmed these findings. PRP showed no difference compared with stromal vascular fraction and was less effective in the short term compared with high-volume injection. Until future high-quality RCTs show a clear clinical benefit, PRP should not be used to treat Achilles tendinopathy. Our analysis found that PRP does not improve pain or function compared with placebo, and potential publication bias suggests that the apparent benefits may be inflated. Surgeons should be cautious when considering PRP for this condition, and future research should focus on larger trials with standardized protocols to provide more definitive guidance. Level II, therapeutic study.

Medial meniscus posterior root tears with advanced osteoarthritis or subchondral insufficiency fracture are good indications for unicompartmental knee arthroplasty at a minimum 2-year follow-up

IntroductionThe outcomes of unicompartmental knee arthroplasty (UKA) in the presence and absence of medial meniscus posterior root tears (MMPRTs) have not been compared. This study compared the characteristics and clinical outcomes of patients undergoing UKA with and without MMPRTs.Materials and methodsThis study analyzed 68 patients. The presence or absence of MMPRTs was evaluated using preoperative magnetic resonance imaging. Patient characteristics, clinical scores before surgery and at the final evaluation, and imaging findings were compared between patients with and without MMPRTs. Multiple regression analysis was conducted on postoperative visual analog scale (VAS)-pain scores.ResultsMMPRTs were present in 64.7% (44/68) of patients. Patients with MMPRTs were significantly younger (67.8 ± 8.2 vs. 75.0 ± 7.1 years, p < 0.001) and had a shorter duration from the development of symptoms to the time of surgery than those without (6.8 ± 8.4 vs. 36.1 ± 38.9 months, p < 0.001). Component placement or lower-limb alignment did not significantly differ between the groups. Preoperative clinical scores were not significantly different between the groups; however, patients with MMPRTs showed significantly better postoperative VAS-pain scores than those without (10.0 ± 9.0 vs. 28.2 ± 26.0 points, p = 0.026). Multiple regression analysis of postoperative VAS-pain scores revealed the significant effect of duration from the development of symptoms to the time of surgery (p = 0.038).ConclusionsPatients undergoing UKA with MMPRTs were younger with less radiographic osteoarthritic changes compared to those without MMPRTs, and their postoperative VAS-pain scores were significantly superior. The duration from the development of symptoms to the time of surgery significantly influenced postoperative pain in patients undergoing UKA.

Optimizing total hip arthroplasty: the gripper table mounted system for enhanced soft tissue preservation and postoperative outcomes.

In total hip arthroplasty (THA), soft tissue retraction is crucial, but traditional methods may cause damage. This study addresses the issue by introducing the Gripper Table Mounted System, a pulley-based retraction system. The research compares THA outcomes with and without the Gripper system, whether reducing soft tissue damage and postoperative pain. The Gripper, with its unique design, aims to minimize tissue damage during surgery. The study conducted a retrospective analysis of 180 patients (180 hips) who underwent THA via an antero-lateral approach with the Gripper System or conventional retraction methods. Primary outcomes included gluteus medius cross-sectional area and hip abductor muscle strength. Secondary outcomes were pain VAS, intraoperative bleeding, operative time, laboratory data, and WOMAC score. The study compared outcomes between those using the Gripper System (Gripper + group, n = 58) and those without (Gripper - group, n = 122). Both groups exhibited no significant differences in demographics or operative parameters. Gripper + group showed enhanced recovery in gluteus medius cross-sectional area and hip abductor muscle strength, with significant analgesia at various postoperative time points. No complications were noted in either group. The Gripper system proved effective in early analgesia, swift recovery of hip strength, and preserving muscle area. Its single-use, sterile, and compact design offers advantages over traditional retractor holders or human assistance, potentially reducing soft tissue damage and postoperative pain. This study concluded the Gripper system's value in reducing pain and restoring strength in THA. Therapeutic Level III. The University Hospital Medical Information Network (UMIN) registration number UMIN000052948.

A randomized double-blind noninferiority clinical multicenter trial on oral moxifloxacin versus placebo in the outpatient treatment of uncomplicated acute appendicitis: APPAC IV study protocol.

Antibiotic therapy is currently considered a safe and effective treatment alternative for computed tomography (CT)-confirmed uncomplicated acute appendicitis with recent studies reporting good results on both oral antibiotics only and outpatient management. Furthermore, there are promising pilot results on uncomplicated acute appendicitis management with symptomatic treatment (placebo). This trial aims to assess whether both antibiotics and hospitalization can be safely omitted from the treatment of uncomplicated acute appendicitis. The APPAC IV (APPendicitis Acuta IV) trial is a randomized, double-blind, multicenter noninferiority clinical trial comparing oral moxifloxacin with oral placebo in an outpatient setting with a discharge directly from the emergency room (ER). Adult patients (18-60 years) with CT-confirmed uncomplicated acute appendicitis (absence of appendicolith, abscess, perforation, tumor, appendiceal diameter ⩾15 mm on CT, or body temperature >38 °C) will be enrolled in nine Finnish hospitals. Primary outcome is treatment success at 30 days, that is, the resolution of acute appendicitis resulting in discharge from the hospital without appendectomy during the 30-day follow-up evaluated using a noninferiority design with a noninferiority margin of 6 percentage points. Noninferiority will be evaluated using one-sided 95% confidence interval of proportion difference between groups. Secondary endpoints include postintervention complications, recurrent appendicitis after the 30-day follow-up, duration of hospital stay, admission to hospital and reason for admission, readmissions to emergency department or hospitalization, VAS pain scores, quality of life, sick leave, and treatment costs. The follow-up after discharge from the ER includes a phone call at day 1, and at 3-4 days, 30 days, and 1, 3, 5, 10, and 20 years. Those eligible patients, who decline to undergo randomization, will be invited to participate in a concurrent observational cohort study with follow-up at 30 days, and 1 and 5 years. To our knowledge, APPAC IV trial is the first large randomized, double-blind, noninferiority multicenter clinical trial aiming to compare oral antibiotics and placebo for CT-diagnosed uncomplicated acute appendicitis in an outpatient setting. The study aims to bridge the major knowledge gap on whether antibiotics and hospitalization or both can be omitted in the treatment of uncomplicated acute appendicitis. The study protocol has been approved by the Clinical Trials Information System (CTIS) of the European Medicines Agency (EMA), study number: 2023-506213-21-00 and the trial has been registered in ClinicalTrials.gov, NCT06210269.

A123: The Study of Intervention Effect of Promoting and Inhibiting Kinesio Tape on Patellofemoral Pain Syndrome

Background/Purpose: The patellofemoral pain syndrome (PFPS), which might be caused by weakness and delayed activation of the vastus medialis obliquus (VMO), as well as tightness of the vastus lateralis (VL), gravely affects daily lives and exercises. Kinesio tape (KT) are often used to prevent and treat musculoskeletal diseases. Different application directions and tension levels can produce a promoting or inhibitory effect. If KT could improve the symptoms of PFPS through coordinating imbalanced muscles, it has positive significance. This study aimed to explore the effects of three KT application methods on PFPS and compare them with placebo, to explore possible psychological effects. Method: Fourteen participants with PFPS (7 males, 7 females, Mage = 20.71) were recruited from Beijing Sport University. A repeated-measures pre-test/post-test design was used in this study. Each participant completes all four methods (VMO facilitatory, VL inhibitory, VMO facilitatory &amp; VL inhibitory, white placebo tape) with a washout period of one week considered between each two methods. Before applications of KT, participants accept tests such as EMG (Delsys), proprioception (PK254), static balance (one foot standing test), and pain (VAS), and are immediately retested after applications. MATLAB 7.13 (MathWorks Inc., Natick, MA, USA) is used to analyze EMG data, and SPSS 25 (IBM Corp., Armonk, NY, USA) was used for statistical analysis, with P &lt; 0.05 set to determine statistical significance. Results: The results manifested that after using VMO facilitatory KT, the static balance is significantly improved (18.752 ± 29.693, P = 0.002), and the mean VL activity was significantly reduced (2.837 ± 1.532, p = 0.048). After applying VL inhibitory KT, there was a great improvement in proprioception (2.666 ± 2.272, p = 0.048) and an increase in the average activation level of VMO (0.300 ± 0.070, P = 0.036). All four methods greatly reduced the VAS score of pain (PVMO = 0.002, PVL = 0.001, PVMO &amp; VL = 0.001, Pplacebo = 0.005). The improvement effect of VMO facilitatory KT was significantly superior to the other three methods (PVMO-VL &lt; 0.001, PVMO-VMO &amp; VL &lt; 0.001, PVMO-placebo &lt; 0.001). There was no distinct difference in terms of the effect of the other three methods. The difference before and after any other indicator was not obvious. Conclusion: Consistent with previous literature, our study supported that KT can enhance functional levels and alleviate symptoms, which has practical significance for the prognosis of PFPS and early return to exercises. However, the comparison with placebo also displays that some of the effects of KT may be attributable to psychological effects, rather than physiological or mechanical mechanisms. Therefore, in the future, larger sample sizes should be considered and more variables could be restricted to explore the issue.

Ligament Suspensionplasty With Suture Tape Augmentation​ for Basal Thumb Arthritis.

Thumb carpometacarpal arthritis is common with aging, more common in women than men, and usually occurs after age 40. If a patient fails conservative treatments such as splinting, medications, and corticosteroid injections, then surgical intervention may be appropriate. Currently, there is no consensus on the best surgical treatment. By limiting metacarpal subsidence, ligament suspensionplasty with suture tape augmentation offers great pain relief, excellent functional outcomes, and limited postoperative immobilization. With this technique, trapeziectomy is first performed. A portion of the abductor pollicis longus tendon is resected and loaded onto the SwiveLock anchor using 4-0 FiberLoop, in addition to suture tape. The prepared graft and tape construct is anchored into the lateral first metacarpal (MC) base and index metacarpal base. After surgery, patients are put in a short arm thumb spica splint, interphalangeal (IP) joints free. Active motion is initiated at the first postoperative visit, usually within 1 week. All patients who had thumb arthritis treated with carpometacarpal suspensionplasty and suture tape augmentation between 2015 and 2022 by a single hand surgeon at our institution were queried. A total of 110 patients were invited to take part in this study, and 61 patients consented and were included in this study. Mean last in-office follow up was at 7.5±4.0 months, which showed significant improvements in pinch strength ( P =0.011). A survey taken at a mean 2.8±1.3 years (range: 0.5 to 5.2y) after surgery reports a postoperative DASH score of 7.3±7.7 (range: 0 to 23.3), and VAS pain score of 0.7±1.1 (range: 0 to 5).

Tympanic membrane repair using improved endoscopic ear canal flap dissection method

Objective:To investigate the clinical value of tympanic membrane repairment with modified ear canal flap under endoscope. Methods:A retrospective analysis was conducted on the clinical data of 62 patients who underwent simple tympanic membrane perforation repair surgery in our hospital from August 2019 to January 2023. All patients were divided into two groups: 37 cases in the otoscopy group and 25 cases in the microscope group. The surgical duration, postoperative pain response, and postoperative tympanic membrane healing and hearing recovery were compared between the two groups. Results:Compared with the microscope group, the total surgical duration of the otoscopy group was significantly shortened[（70.4±13.2） min vs. （102.8±17.5） min, P<0.001], and there was a statistically significant difference in postoperative VAS pain score[（3.1±1.2） vs. （6.5±1.4）, P<0.001]. The two groups achieved tympanic membrane healing and no infection occurred after operation. There was no significant difference in postoperative hearing recovery between the two groups（P>0.05）. Conclusion:Modified tympanic membrane repairment through otoscope can greatly shorten the operation time and reduce the hospitalization cost, which is more suitable for the application of primary hospitals.

Clinical observation on warming needle moxibustion combined with rehabilitation techniques in the treatment of anterior disc displacement without reduction.

To observe the effect of warming needle moxibustion combined with rehabilitation techniques on clinical symptoms and quality of life of patients with anterior disc displacement without reduction (ADDwoR). This randomized controlled trial included 66patients, with ADDwoR, attending the Hangzhou Hospital of Traditional Chinese Medicine. Patients were assigned to the Experimental (12 sessions of warming needle moxibustion combined with rehabilitation manipulation therapy) and Control (rehabilitation therapy only) group (n = 33, each). Duration of treatment was 4 weeks, with 3 times a week. Outcomes included VAS pain score, maximum mouth opening (MMO), mandibular function impairment score (MFIQ), oral health impact scale (OHIP-14 scale), and mandibular dysfunction index (Fricton score). Safety assessments during treatment included incidence of fainting, broken needle, bleeding, hematoma and scalding. After treatment, the VAS scores, mandibular function impairment scores, oral health impact degree scale, and the scores of Dysfunction index (DI), palpation index (PI) and craniomandibular index (CMI) in the two groups were significantly decreased compared with before. While the maximum mouth opening was increased in both groups, the clinical efficacy evaluation showed the total significant rate of the control group was 59%, and the total significant rate of the experimental group was 83%, demonstrating a significant clinical efficacy difference between the two groups. Compared to targeted rehabilitation exercises only, warming needle moxibustion combined with rehabilitation manipulation can not only improve the pain and maximum mouth opening, but also mandibular function impairment, mandibular joint disorder and oral health of patients with ADDwoR. http://www.chictr.org.cn/index.aspx , identififier: ChiCTR2200059039.

A comparative study of modified Bassini's repair and lichtenstein repair for indirect inguinal hernia in young age population

Background: Inguinal hernia surgery has significant world-wide diversity in management. European Hernia Society guidelines 2020, for management of groin hernias recommends the use of open non-mesh repair in specific patients or types (e.g. young males with lateral hernia)as an acceptable alternative to a Lichtenstein technique. The present study deals with the comparison of intra operative, postoperative course and clinical outcome of modified bassinis repair (non mesh) and Lichtenstein repair [mesh repair] for indirect inguinal hernia in young age population. Methods: Observational analytical prospective cohort study, conducted in General Surgery, Peoples hospital, Bhopal from November 2022 to February 2024. Patient of indirect inguinal hernia in the age (16-35 years) group and operated by either Modified Bassinis (Group A, n=34) or lichtenstein hernia repair (Group B, n=48). The above study arms group were studied and compared. Results: Mean duration of surgery among Group A patients was 62.65 minutes and 57.19 minutes in Group B. Seropurulent discharge among 2.9% patients in Group A and 4.2% in Group B and superficial SSI among 2.9% patients in Group A and 4.2% in Group B was reported. Chronic post-operative pain VAS score was assessed at end of 2nd week, end of 1 month and end of 3 months with statistically no significant among two groups. Conclusions: Our study did not demonstrate any significant difference of one repair method over the other. However, an Individualized approach for cases with a customized strategy is recommended for surgical management of hernia.

Sports Activity with Ankle Osteoarthritis and Total Ankle Arthroplasty.

Background/Objectives: The interest in performing total ankle arthroplasty (TAA) to address end-stage ankle osteoarthritis (OA) is continuously growing. Sports activity plays an important role in our world. The literature is sparse regarding return-to-sports activity following TAA. The levels and types of sports in TAA are rarely reported. The purpose of this prospective case series study is to investigate sports activity in ankle osteoarthritis (OA) and TAA in terms of rate, frequency, type, and clinical outcomes with a minimum 2 years of follow-up after surgery. Methods: A total of 103 patients (105 implants, 52 female, and 51 male), mean age 60.5 years (range, 23-84 years) with end-stage ankle OA were treated using a three-component, uncemented, mobile-bearing VANTAGE Total Ankle System. The mean follow-up was 2.9 years (range, 2-5 years). Visual Analogic Scale Pain Score (VAS, 0-10 points), Ankle Dorsiflexion/Plantarflexion (DF/PF) range of motion (ROM; degrees), functional American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0-100 points), Subjective Patients' Satisfaction Score (0-10 points), Sports Activity Rate, Sports Frequency Score, and sports type were assessed. Results: The mean preoperative VAS Pain Score was 6.7 points (range, 3-10 points) and 0.2 points for postoperative (range, 0-3 points) (p < 0.001). The mean DF/PF ROM was 24.9° preoperative (range, 0-60°) and 52.9° postoperative (range, 15-85°) (p < 0.001). The mean preoperative functional AOFAS Ankle/Hindfoot Score was 39.5 points (range, 4-57 points) and 97.8 points for postoperative (range, 75-100 points) (p < 0.001). The mean postoperative Subjective Patients' Satisfaction Score was 9.7 points (range, 7-10 points). The preoperative Sports Activity Rate was 31.1%, with 85.4% for postoperative (p < 0.001). All the groups exhibited substantial Sports Frequency Score increases (p < 0.001). The most practised sports were hiking, biking, fitness, and swimming. Conclusions: total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle OA. TAA facilitates a noteworthy increase in sports activity. This research offers important sports insights to patients with ankle OA and TAA.

The role of cannabis on total hip and knee surgeries outcomes: a systematic review and meta-analysis.

Cannabis refers to medications derived from the Cannabis plant. Cannabis has long been used to treat a wide range of conditions. The widespread legalization of cannabis has increased its use. This meta-analysis evaluates the effects of preoperative cannabis usage on TKA and THA outcomes and complications. This review follows CRD Guidance for Undertaking Reviews in Healthcare and PRISMA 2020 guidelines. On October 12, 2023, we extensively searched MEDLINE (PubMed), Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. There were no time, place, or language restrictions. We also examined the references and citations in the included publications to find relevant research. We found 208 references in PubMed/Medline, Scopus, Web of Science, and other databases. After reviewing all publications, we identified 18 references that match the requirements for further assessment. The odds ratios (ORs) for reoperation and readmission are 1.35 (95% CI: 0.69, 2.66, and p-value = 0.38), and 0.89 (95% CI: 0.41, 1.92, and p-value = 0.76). Inpatient morphine milligram equivalent (MME) and length of stay (LOS) have a mean difference (MD) of -1.71 (95% CI: -13.46, 10.05, and p-value = 0.78), and - 0.13 (95% CI: -0.33, 0.08, and p-value = 0.23). The MD of the VAS pain score 24-72h after surgery is 0.40 (95% CI: -0.07, 0.87, and p-value = 0.10). The odds ratio for PTE and DVT is 1.54 (95% CI: 0.1, 23.24, and p-value = 0.75), and 1.38 (95% CI: 1.08, 1.77, and p-value = 0.01), respectively. Cannabis users experienced significantly higher rates of DVT following THA and TKA. Our subgroup analysis found that cannabis users who underwent TKA had considerably higher rates of reoperation (p-value = 0.10) and readmission (p-value ≤ 0.01), while those who underwent THA had significantly lower rates of PTE. These findings highlight the need to include cannabis use as a risk factor in surgical planning and patient care protocols, and further studies are warranted. This study design and protocol were performed in accordance with the PRISMA Statement. The protocol was registered previously on PROSPERO CRD42024551078.

Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients.

Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs. The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR. After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores. Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications. UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes. Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.