Conventional cementless total hip arthroplasty in patients with dwarfism with height less than 140 cm and minimum 10-year follow up: A clinical study

BackgroundOrthopedic complications can cause issues and severe disability in patients with dwarfism. Thus, these individuals frequently undergo total hip arthroplasty to mitigate decline in daily functioning. Although studies have reported on the difficulties of orthopedic surgery in patients with dwarfism, many do not clearly define dwarfism and have a short follow-up period. We aimed to retrospectively investigate the clinical and radiographic results of total hip arthroplasty for patients with dwarfism.MethodsA total of 68 hips of 49 patients with height <140 cm and at least 10-year follow-up periods were enrolled. All patients had conventional cementless implants. All hips were evaluated using the Japanese Orthopaedic Association hip score.ResultsThe main hip disease etiologies were primary hip osteoarthritis (58%) and secondary osteoarthritis due to developmental dysplasia (31%). Rheumatoid arthritis, rapidly destructive coxarthrosis, spondyloepiphyseal dysplasia, childhood infection, and femoral head aseptic necrosis were also causative pathologies. Hip scores significantly improved from 44 to 82 out of 100. Overall implant-associated survival rate after 10 years was 94.1%. Cup loosening was observed in 2 hips, and subsidence >5 mm was observed in 9 hips. Presence of Crowe IV in hips was a significant risk factor for total hip arthroplasty in patients with dwarfism (p < 0.05); leg lengthening had a weak but significant correlation (r = 0.253, p < 0.05).ConclusionsTotal hip arthroplasty using conventional cementless implants for patients with dwarfism shows good clinical and radiological outcomes and has a relatively low perioperative risk.     

Global Alignment and Proportion (GAP) score in asymptomatic individuals: is it universal?

BACKGROUNDThe global alignment and proportion (GAP) score was established based on American and European subjects, which might limit its applicability to the Chinese population due to ethnicity-related difference of sagittal alignment.PURPOSETo analyze the applicability of GAP score in the Chinese population and to investigate the age- and gender-associated differences of spinopelvic and GAP score parameters.STUDY DESIGNA prospective cross-sectional radiographic study.PATIENTS SAMPLEOf 692 asymptomatic Chinese volunteers aged between 20 and 79 prospectively recruited between January 2017 and June 2019, 490 subjects were eventually included in this study.OUTCOME MEASURESThe pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L1-S1 lordosis, L4-S1 lordosis, sagittal vertical axis (SVA), T1 pelvic angle (TPA) and global tilt (GT) were measured on lateral X-rays. The GAP scores and its parameters including relative pelvic version (RPV), relative lumbar lordosis (RLL), lordosis distribution index (LDI) and relative spinopelvic alignment (RSA) were calculated for each subject.METHODSSubjects were divided into four groups: Group 1M: male subjects <60 years old; Group 1F: female subjects <60 years old; Group 2M: male subjects ≥60 years old and Group 2F: female subjects ≥60 years old. The GAP scores and categories were determined and compared between groups. The results of sagittal alignment were compared with the previous studies evaluating the normative sagittal alignment in other populations. Univariate linear regression analysis was carried out between pelvic incidence (PI) and sacral slope (SS), lumbar lordosis (LL) and global tilt (GT) in each group.RESULTSThe distributions of GAP categories and the updated Roussouly classification were statistically different from other populations. Significantly different distribution of GAP categories was observed between Group 1M and Group 2M, Group 1F and Group 2F, and Group 1M and Group 1F. Radiographic measurements and GAP parameters were significantly different between Group 1M and Group 2M, and Group 1F and Group 2F. Gender-related difference of parameters was more prominent between Group 1M and Group 1F. Linear relationship of PI with SS, LL and GT were different from the regression models of “ideal” sagittal alignment in GAP score.CONCLUSIONSThe GAP score might be inappropriate in Chinese population due to ethnicity-related alignment difference. Worse feasibility of GAP score was observed in female and old subjects.     

Long-term living in unfavorable socioeconomic conditions impairs late-life gait performance.

BackgroundLow socioeconomic status has been associated with individual health-related problems; however, no study has specifically investigated the impact of socioeconomic disparities on gait performance using an index that considers the population aggregation, as the Human Development Index (HDI). Thus, the aim of the present study was to assess gait parameters of older people living in cities with differences in socioeconomic conditions, identified by HDI.MethodsCross-sectional design study conducted with a sample of 233 older people from two Brazilians regions: Coari, state of Amazonas, Brazil (n= 124, low-HDI-Bra) and Ribeirão Preto, state of São Paulo, Brazil (n= 109, very high-HDI-Bra). The gait performance was assessed by an electronic walkway, and the interest variables were gait speed, cadence, stride time, step length and stride width.ResultsLow-HDI-Bra group presented worse gait performance as identified by slower gait speed (p = < .001), slower cadence (p = < .001), higher stride time (p = < .001), shorter step length (p = < .001), compared with the very high-HDI-Bra group. There was a positive association between HDI, and gait spend, cadence and step length, and there was a negative association between HDI and stride time and stride width.ConclusionsLong-term exposure to socioeconomic inequalities found in low HDI cities may impair gait performance in late life. Such information may be relevant to create public politics that use the gait parameter based on the region where the people live.     

An atypical case of calf pain: Plantaris tendon axial instability

Plantaris tendon (PT) might induce calf or Achilles pain. In this case report, a 59-year-old woman presented with axial instability of plantaris tendon; post Achilles tendon lengthening. She beneficiated from a needle tenotomy of the PT and had a prompt symptom alleviation. The patient was fully satisfied and had a SANE score of 95% at 12 months follow up and was able to return to moderate sports activities without limitations (hiking, Nordic walking). The instability of the PT might be considered for the differential diagnosis of medial calf pain for which needle tenotomy may be considered a valuable option.     

Perception of gender discrimination among spine surgeons across Latin America: a web-based survey

BACKGROUND CONTEXTFemale physicians rarely choose spine surgery as their specialty. Although the specialty's nature and its associated lifestyle are potential barriers, gender-related issues may play an important part.PURPOSETo evaluate the gender discrimination among spine surgeons across Latin America.STUDY DESIGNCross-sectional survey.PATIENT SAMPLEThe participants in this study were 223 AO Spine Latin America (AOSLA) registered members who answered the web-based survey.OUTCOME MEASURESPersonal and professional demographics; gender-related objective and subjective experiences regarding career and personal life.METHODSA survey link containing a 24-item questionnaire was sent to the members’ e-mails in September 2019. The survey was designed to evaluate the perception of gender discrimination by spine surgeons during their academic and professional lives.RESULTSOut of 223 members who answered the survey, 196 (87.96%) were male and 27 (12.11%) female. Most were orthopedic surgeons (64.13%), ≥40 years of age (55.16%), and had <20 years of experience (69.95%). Gender discrimination was more frequent among women than among men (66.67% vs. 1.02%), as did discouragement from becoming a spine surgeon, orthopedic surgeon, or neurosurgeon (81.48% vs. 0.51%). Females reported higher rates of sexual harassment (44.44% vs. 7.65%) and more often felt disadvantaged because of gender (55.56% vs. 2.55%). Working harder than men to achieve the same prestige and lack of female mentorship were the most common obstacles reported by women (55.56%). Residency/fellowship influenced the decision to postpone/avoid having children for 66.67% of women but only 37.75% of men. Creation of a Women's Committee in AO Spine was supported by 74.07% of women and 38.78% of men.CONCLUSIONSGender-based discrimination affects women more frequently than men in spine surgery. These experiences likely contribute to the low prevalence of female spine surgeons. Efforts to mitigate bias and support the professional development of women in neurosurgery, orthopedics and spine communities are encouraged.     

Preoperative functional status as a predictor of short-term outcome in adult spinal deformity surgery

Adult spinal deformity (ASD) may cause severe disability and difficulty with daily activities. The purpose of this study was to investigate the impact of preoperative functional status on 30-day major complication occurrence in ASD surgery. A review of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database was performed for the years 2007–2013. Inclusion criteria were adult patients (over 21 years of age) who underwent spinal fusion for ASD. Functional status was defined as “independent” or “dependent” (requiring assistance from another person) for activities of daily living such as bathing, dressing, feeding, toileting, or mobility. The association between functional status and complications (overall and major) was investigated via multivariate analysis. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). A total of 1247 patients met inclusion criteria (94.4% independent and 5.6% dependent patients). The overall 30-day complication rate was 16.0% (15.6% for independent patients and 22.9% for dependent patients, p = 0.10); major complications occurred in 9.2% of independent patients and 17.1% for dependent patients (p = 0.02). After controlling for patient age, smoking status, preoperative hematocrit, revision status, use of osteotomy, number of levels fused, and operative time, being dependent on another person for activities of daily living was found to be a significant predictor of major complication development (OR 2.09; 95% CI, 1.04–4.20; p = 0.03). Depending on others for activities of daily living before undergoing ASD surgery may predict the development of major perioperative complications, increasing the risk by 2-fold compared to independent patients.