Synovial sarcoma in patients under 20 years of age: a multicenter study with a minimum follow-up of 10 years

Purpose  

Synovial sarcoma (SS) is an aggressive soft-tissue tumor noted for late local recurrence and metastasis. This study investigates the long-term outcome of SS in patients of pediatric age and evaluates potential prognostic factors for SS.     

A long-term follow-up of 60 Lord total hip arthroplasties in rheumatic disease: a mean follow-up of 14 years

The aim of the study was to analyse the survivorship of 60 total hip arthroplasties using the cementless Lord prosthesis in 51 patients with inflammatory joint disease. Patients were operated on between the years 1985 and 1988. The mean follow-up time was 13.8 (4.0–18.6) years. During the follow-up, one deep infection was encountered, and seven patients died of causes unrelated to the hip replacement. Revision surgery or death of the patient was used as an end point. The overall survival was 88.1% [95% confidence interval (CI) 76.6–94.1] for the stem, and 64.3% (95% CI 50.6–75.1) for the cup at 15 years. Causes for revision surgery were loosening of the cup in 17 hips, loosening of both components in five hips, and one deep infection.

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Résumé Le but de cette étude est d’analyser la courbe de survie de 60 prothèses totales de hanche chez 51 patients présentant une pathologie inflammatoire, les malades ayant été prothèsés avec une prothèse sans ciment de type Lord. Les patients ont été opérés entre 1985 et 1988. La moyenne de suivi a été de 13,8 ans (4 à 18,6 ans). Durant cette période une seule infection profonde a été rencontrée et 7 patients sont décédés sans relation avec leurs prothèses. La révision de la prothèse où la mort du patient a été utilisée comme terme pour l’utilisation de la courbe de survie, le taux de survie a été de 88,1% (95% d’intervalle de confiance 76,6 à 94,1) pour la pièce fémorale et 64,3% (95% d’intervalle de confiance 50,6 à 75,1) pour la cupule à 15 ans. Les causes de révision ont été le descellement de la cupule dans 17 hanches et le descellement des deux composants dans 5 hanches avec une seule infection profonde.

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This study was conducted at the Rheumatism Foundation Hospital.     

Natural history of renal cell carcinoma: a case with 18 years follow-up

A 53-year-old woman presented to our hospital with a non-metastatic 4 cm renal mass in the right kidney. The patient rejected treatment, but consented to follow-up observation of her condition. The patient underwent a series of computed tomography scans to monitor the progression of the disease. We were able to observe not only an increase in renal mass size, but also involvement of para-aortic lymph nodes, inferior vena cava, and metastasis to the lung. Eighteen years after diagnosis, the subject was hospitalized and died as a result of complications of the disease. Autopsy showed the pathologic diagnosis of the renal mass to be a grade 2 clear cell carcinoma. The literature contains several papers that describe the natural history of renal masses and carcinomas over short periods; however, prior to our case, no reports existed that detailed long-term progression of renal cell carcinoma (RCC) from initial diagnosis to death. It is necessary to clarify the course that RCC takes due to its unpredictable, indolent nature. This will provide clinicians with better insight into how to manage the disease, decide on treatment options, and improve overall survival.     

Complications and reoperations after laparoscopic sacrocolpopexy with a mean follow-up of 4 years

Introduction and hypothesis

There is a lack of knowledge concerning long-term reoperation and complications after laparoscopic sacrocolpopexy (LSCP). We analyzed the rates and indications and potential risk factors for reoperation after LSCP in a large series of consecutive patients.

Methods

This was a single-center, retrospective study including all patients who underwent LSCP between 2003 and 2013. Data regarding pelvic organ prolapse (POP), surgical modalities and perioperative complications were collected. Patients were then contacted by telephone or postal letter in 2014. The main outcome criteria were grade III Dindo classification complications: reoperation for POP recurrence, mesh complications, and urinary incontinence (UI).

Results

Between January 2003 and December 2013, a total of 464 consecutive patients (mean age, 59 years) underwent LSCP. Almost all (99.1 %) patients presented with POP ≥ grade 3 (POP-Q classification). Long-term evaluations were completed for 391 (84.1 %) patients. The median follow-up was 53.5?±?28.2 months. The global reoperation rate was 12.5 %. The main reoperation indications were UI-related surgery in 21 patients (5.5 %), POP recurrence surgery in 20 patients (5.1 %), and mesh-related surgery in 11 patients (2.8 %). Multivariate analysis showed that older age at the time of initial surgery and concomitant subtotal hysterectomy were significant protective factors against global reoperation (HR?=?0.606, CI 95 % [0.451–0.815] and 0.367, CI 95 % [0.193–0.698] respectively) and reduced the risk of POP recurrence surgery.

Conclusion

Prolapse recurrence and mesh-related surgery occurred in 5.1 and 2.8 % of patients respectively, 4 years after laparoscopic sacrocolpopexy. Age and concomitant subtotal hysterectomy could play a role in the incidence of long-term reoperation.

     

Results of a cemented titanium alloy straight femoral shaft prosthesis after 10 years of follow-up

Two-hundred fifty implantations of a cemented femoral stem made of titanium alloy in 239 patients were followed for 9.7 years (range 8.7-10.3 years). Eighty-nine patients with 93 hips have died and two could not be located. Five hips have been revised, two for infection, one for aseptic loosening and two during revision of the cup. Three stems showed radiological loosening but have not been revised. The average hip score was 85. The results are encouraging and comparable to other cemented femoral stems.     

High tibial osteotomy for medial osteoarthritis of the knee: 15 years follow-up

We reviewed 192 patients (224 knees) to assess the results of HTO in medial gonarthrosis during the period 1982–2008. Median follow-up was about 15 years for 134 females and 58 males. Among the knees, 118 had an average opening wedge for varus angle of 13° and 106 had closing wedges of 11°. Knee Society scoring before osteotomies was 68/200 for opening wedge and 81/200 for closing wedge. Modified Ahlback classification showed preoperative grades I (n = 44), II (78), III (83) and IV (19). Healing delay was 55 days for closing and 70 for opening osteotomy. Twenty-nine knees were still painful. Twenty-eight patients were revised and 19 others had complications. After opening wedge osteotomy, scoring was 101/200 and valgus angle was 2°. After closing wedge osteotomy, scoring was 94/200 and valgus angle was 4°. Global results were as follows: very good, 12%; good, 30%; fair, 31%; and poor, 27%. HTO decreases stresses on medial compartments and widens joint space. The average of 5° mechanical valgus at the time of osteotomy seems to be quite effective at the follow-up for at least ten years. Our indications are opening wedge for grades 1–3 and wide varus angle, until the age of between 65–70. Closing wedge is indicated for medium varus in younger patients.     

Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up

Background

Up to 41 % of patients report pain after cholecystectomy and in most studies follow-up for these symptoms did not exceed 5 years. The episodic nature of abdominal pain associated with symptomatic cholelithiasis warrants long-term follow-up studies. We assessed which patient and surgical factors were associated with absence of pain and patient-reported success of surgery after ≥5 years of follow-up.

Methods

Patients of ≥18 years of age with symptomatic cholelithiasis, classified as ASA I or II, who had previously returned a preoperative questionnaire were sent a questionnaire consisting of the gastrointestinal quality of life index (GIQLI) and patient ratings of current versus presurgical abdominal symptoms and of surgery result. Logistic regression analysis was performed to determine associations.

Results

Questionnaires were sent to 197 patients and returned by 126 (64.0 %) patients (73.8 % female, mean age at surgery 47.5 ± 12.2 years) at a mean of 10.0 ± 1.0 years after cholecystectomy. Absence of abdominal pain was reported by 60.3 % of the patients. Patients classified as ASA II as opposed to ASA I were less likely to report absence of pain (OR 0.41, 95 % CI 0.17–0.99). A positive rating of long-term postsurgical versus presurgical abdominal symptoms was given by 89.7 % of the patients and 90.5 % considered the cholecystectomy result to be good. No variables were significantly associated with these latter two outcome measures.

Conclusions

We found a high patient-reported surgery success rate after >5 years of follow-up after cholecystectomy despite residual abdominal pain in some of these patients. None of the patient and surgery-related characteristics were consistently associated with all three outcome measures. This discrepancy between patient’ outcomes highlights the need for realistic expectations prior to cholecystectomy.     

Progression of untreated mild thoracic Scheuermann's kyphosis – Radiographic and functional assessment after mean follow-up of 46 years

Background

There is no data available on the radiographic development of the Scheuermann's deformity. Our purpose was to investigate radiographic deformity progression and the relation between kyphosis progression and clinical outcome in patients with untreated Scheuermann's kyphosis.

Surgical management of chronic proximal hamstring tendinopathy in athletes: a 2 to 11 years of follow-up

Background

Proximal hamstring tendinopathy typically afflicts athletes. The poor knowledge of this pathology can lead to late diagnosis and late treatment, which in chronic cases could be challenging. Surgical treatment could resolve the symptoms and could permit the return to full sport activity also in chronic cases.

Materials and methods

We retrospectively evaluated 17 high-level athletes surgically treated for proximal hamstring tendinopathy. Symptoms lasted for an average of 23 months and were resistive to conservative treatment.

Results

The follow-up period averaged 71 months. Return to run without pain occurred at a mean of 2.4 months (range 1–4) after surgery. All patients returned to sports at their pre-symptom level at a mean of 4.4 months after surgery. Results were excellent in 15 patients (88 %) and good in two patients (12 %). No results were fair or poor.

Conclusions

Surgical treatment to manage chronic proximal hamstring tendinopathy in high-level athletes showed excellent results in terms of relief from symptoms and return to previous sport level.     

Satisfied patients after shoulder arthrodesis for brachial plexus lesions even after 20 years of follow-up

Purpose

Patients with an upper brachial plexus lesion can suffer from dysfunction, joint deformities and instability of the shoulder. The goal of this study was to determine pain, shoulder function, patient satisfaction and muscle strength in shoulder arthrodesis in patients with an upper brachial plexus lesion more than 15 years after surgery.

Methods

We retrospectively studied 12 patients with a brachial plexus lesion of mean age 46 years (27–61). At a mean of 19.8 years (15.4–30.3) after shoulder arthrodesis, patient-reported outcome measures (PROMs), range of motion (e.g., active and passive), patient satisfaction, strength of the affected and non-affected side (e.g., maximum isometric strength in Newton in forward and retroflexion, ab- and adduction, internal and external rotation) and position of fusion were obtained. PROMS consisted of the Visual Analogue Scale (VAS; 0–100, 0 being painless) for pain and the Disabilities of the Arm, Shoulder and Hand Score (DASH; 0–100, 0 being the best score) for function.

Results

At latest follow-up, the median VAS pain score was 49 (0–96) and 0 for, respectively, the affected and unaffected side. The DASH was 15 (8–46), meaning a reasonable to good function of the upper extremity. Active and passive retroflexion was significantly different (p = 0.028). All subjects stated that in the same situation they would undergo a shoulder arthrodesis again. The unaffected side was significantly stronger in every direction. Arthrodesis showed position of fusion of 31° (12–70) abduction, 20° (10–50) forward flexion and 22° (? 14 to 58) internal rotation. The unaffected side was significantly (p ≤ 0.05) stronger in every movement direction.

Conclusion

At a mean of 20 years after shoulder arthrodesis, patients with an upper brachial plexus lesion are still satisfied with a good to moderate functional improvement.

Level of evidence III

A retrospective cohort study.

     

Preperitoneal gridiron hernia repair for inguinal hernia: Single-center experience with 2 years of follow-up

The optimal operation technique for groin hernia repair has not been established. This study evaluates the long-term recurrence rate and perioperative complications after posterior inguinal mesh hernia repair using a gridiron incision described by Frans Ugahary. A retrospective analysis was performed of the medical records of 366 patients who underwent Ugahary hernia repair. Operative results and perioperative morbidity were evaluated retrospectively. Follow-up was done by clinical examination. The main outcome measure was recurrence rate at a mean follow-up of 2 years. Of the 386 groin hernia repairs, 263 hernia repairs were examinated in the outpatient clinic. The overall recurrence rate was 6.5% with a mean follow-up of 2 years, and 10.1% of the patients had minor complications. This retrospective study demonstrates that the repair according to Ugahary is a safe technique for operating on groin hernia. However, the procedure is difficult to reproduce in nonexpert hands. This technique must be compared to other inguinal hernia operation techniques in the near future.     

The use of structural periacetabular allografts in acetabular revision surgery: 2.5–5 years follow-up

Introduction  “Acetabular bone loss” presents a major reconstructive challenge in total hip arthroplasty. Loss of acetabular bone stock is a consequence of removal of bone during the original procedure, subsequent prosthetic failure and osteolysis resulting from wear particles of cement and polyethylene. In case of severe bone loss treatment options are rather limited, as fixation requires either biological (cancellous allograft with cage or structural allograft) or non-biological (trabecular metal, triflange implant, etc.) scaffolds. Materials and methods  Fourteen acetabular revisions with a cemented cup, supported by a deep frozen structural periacetabular allograft without using a reinforcement ring or an antiprotrusio cage were performed. Clinical assessment was done using a Harris hip score. Graft resorption was radiographically quantified using a digital measurement program. Results  Kaplan–Meier survivorship was 67.1% at 42 months. After a mean follow-up of 3.6 years, 9 out of 14 patients had good clinical results. Mean resorption of 17.1% in six out of ten patients was observed. No sound evidence for union was found in nine out of ten patients. In the four re-revised patients, no bone stock restoration was found. Conclusion  The bicortical allograft without protective device seems to function as a passive biocompatible dead scaffold, which has a less intrinsic strength at intermediate term follow-up, compared to the by ring or cage protected structural allografts.     

Arthrodesis of the distal interphalangeal joint: description of a new technique and clinical follow-up at 2 years

INTRODUCTION: Arthrodesis of the distal interphalangeal joint (DIPJ) is an accepted operative procedure to treat osteoarthritis, instability and joint deformity. There is a wide spectrum of recommended operative techniques including cerclage wires, headless screws, bio-resorbable pins and lag screws. Lag screw fixation remains one of the most accepted methods of fixation; however, problems can occur in particular subsidence of the screw head leading to loss of compression and prominence of the screw head in the finger tip necessitating removal. We describe here a new technique of DIPJ arthrodesis that avoids these problems. METHODS AND PATIENTS: The technique is described here in detail, and clinical results are given for 18 joints (17 patients) followed-up at a mean 24 months (range 6-44). RESULTS: Mean post-operative DASH score was 15. There were no cases of non-union; only four complications were seen, one case of nail growth disturbance and one of early screw breakage necessitating revision. Two infections necessitated early hardware removal although both arthodesis were united. CONCLUSION: The technique is simple and reliable giving consistent clinical results.     

Volumetric measurement of periprosthetic bone remodeling: prospective 5 years follow-up after cemented total hip arthroplasty

Introduction Periprosthetic bone remodeling after total hip arthroplasty (THA) is a well recognized phenomenon. Many authors have published osteodensitometric data with DEXA analysis. This study based on computerized tomography (CT). Materials and methods The objective of the current project is to collect prospective volumetric bone density data with a clinical CT study in six patients after cemented THA (titanium alloy stem). The follow-up time is 5 years. A data set of about 100,000 bone voxels for each femur was collected. Bone density was observed by dint of an osteodensitometric computer program. The median results were shown in seven regions of interest (ROI) around the prosthesis stem, according to Gruen. Results The statistical analysis of the six cases after 60 months with respect to the postoperative control demonstrated a significantly lower density in ROI 2 (−125.5HU, P = 0.014), ROI 3 (−116.7HU, P = 0.023), ROI 4 (−54.5HU, P = 0.023), ROI 5 (−90.9HU, P = 0.014) and ROI 6 (−104.9HU, P = 0.014). Maximum density decrease was observed in ROI 2 and 3. The statistical analysis of the six cases after 60 months with respect to the 24 months control demonstrated a significantly lower density in ROI 2 (−62.6HU, P = 0.014), ROI 5 (−62.9HU, P = 0.023). There was a density decrease in ROI 3, 4, 6, 7 which was not significant and a slight increase in ROI 1. Conclusion To our knowledge, this is the first collection of fully prospective 5 years 3D periprosthetic density data. The CT method used in the study presented here measures three-dimensionally, while the frequently used DEXA (dual X-ray absorptiometry) method measures two-dimensionally. The data are also unique as they are suitable for direct patient-specific 3D finite element meshing and biomechanical calculation. They can be graphically post-processed in order to obtain cross-sectional or 3D displays of density patterns.     

Long-term outcomes of the revision open lumbar discectomy by fenestration: A follow-up study of more than 10 years

A total of 51 patients who underwent the second open discectomy by fenestration from January 1988 through December 1994, were followed for an average of 146.8 months. The long-term follow-up results were evaluated through direct examinations and questionnaires. At the final follow-up, according to the Macnab classification an excellent and good outcome was achieved in 70.6% of the cases, and 78.4% were satisfied with their results. The failure rate was 15.7% (8 patients). Excluding those 8 failed cases who needed another reoperation, the average improvement calculated by Japanese Orthopaedic Association (JOA) scores was 64.6%. Factors that were associated with a fair and bad outcome included smoking, isolated trauma or injury, fibrosis and the duration of the remaining or recurrent primary postoperative symptoms. We noted that psychosociological signs were probably negative predictors of lumbar disc surgery outcome. Because the revision operation is typically associated with a higher complexity, selection of suitable surgical candidates and determination of valid indications for operative treatment are very important.