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1.
Anna Rienmüller Olivier Borens 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(4):429-434
Background
With improved diagnostic methods and longer prosthesis indwelling time, the frequency of diagnosed Propionibacterium prosthetic joint infections (PJI) is increasing. Data on clinical, microbiological, radiological and surgical treatment are limited, and importance of this organism in PJI is probably underestimated.Materials and methods
We retrospectively analyzed patients with PJI caused by Propionibacterium spp. diagnosed at our institution between 2000 and 2012. Patient data were retrieved through chart review, and the outcome was evaluated at patient follow-up visits.Results
Of 15 included patients (median age 65 years, range 44–87), 8 hip, 4 shoulder, 2 knee and 1 ankle PJI were recorded. The median time from implantation to diagnosis of PJI was 44.2 months (range 2–180 months). Most PJI (8 patients, 53 %) were diagnosed late (>24 months after arthroplasty). Persistent pain was present in 13, local joint symptoms in 8, fever in 4 and sinus tract in 3 patients. Radiological signs of loosening were present in 11 patients (73 %). Organisms were detected in intraoperative biopsy (n = 5), sonication (n = 4) or preoperative joint puncture (n = 4). In three cases coinfection with a coagulase-negative staphylococcus was diagnosed. Revision surgery was performed in all cases. After a mean follow-up of 16 months after revision surgery (range 4–37 months), 14 patients (93 %) showed no signs or symptoms of infection and had a functional prosthesis; one patient experienced a new infection with another organism (Staphylococcus epidermidis).Conclusion
Patients with persistent postoperative pain and/or loosening of implants should be screened for PJI with low-virulent organisms such as Propionibacterium, including.2.
Background
Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation.Methods and material
A total of 145 patients with mean age of 45.21 ± 11.24 years who underwent micro-discectomy in cervical and lumbar regions were enrolled into the study. The samples were excited during the operation and then cultured in the anaerobic incubations. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction.Results
In this study, 145 patients including 25 cases with cervical and 120 cases with lumbar disc herniation were enrolled to the study. There was no significant difference in the age of male and female patients (p = 0.123). P. acnes infection was detected in nine patients (36%) with cervical disc herniation and 46 patients (38.3%) with lumbar disc herniation and no significant differences were reported in P. acnes presence according to the disc regions (p = 0.508.). Moreover, there was a significant difference in the presence of P. acnes infection according to the level of lumbar disc herniation (p = 0.028).Conclusion
According to the results, the presence of P. acnes is equal in patients with cervical and lumbar disc herniation. There was a significant difference in the distribution of P. acnes infection according to level of lumbar disc herniation.Level of Evidence
II3.
Javad?Aghazadeh Firooz?Salehpour Ehsan?Ziaeii Naghme?Javanshir Afshin?Samadi Javid?sadeghi Farhad?Mirzaei
Introduction
Modic changes (MCs) in vertebral bones are induced by two mechanisms of mechanical factors and infection. As Propionibacterium acnes (P. acnes) have been reported to be associated with LBP. The aim of this study is to evaluate the MCs in patients with disc herniation and positive for P. acnes.Methods and material
A total of 120 patients with disc herniation surgery were enrolled into the study. The samples were excised during discectomy and then cultured in both anaerobic and aerobic incubations. Gram staining was employed for investigation of all colonies. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction (PCR). MCs of baseline MRI were evaluated.Results
In this study, 120 subjects (69 male and 51 female) with mean age of 43.15 ± 12.62 years were investigated. Sixty disc samples and eight muscle samples were positive for microorganisms. Moreover, 16S rDNA gene was identified in 46 (38.3%) disc samples. Moreover, 36/46 patients with P. acnes in their sample had MCs.Conclusion
According to the results and presence of 36/46 MCs in patients with lumbar disc herniation, positive for P. acnes suggests that P. acnes can lead to edema on the vertebrae endplates near to infected area.4.
5.
Purpose
When the proximal humeral anatomy is altered because of malunion, shoulder arthroplasty is a challenge for the orthopaedic surgeon, and tuberosity osteotomy should be avoided whenever possible. The purpose of this study was to investigate the clinical and radiological outcomes of anatomic stemless shoulder arthroplasty in cases of malunion. We hypothesized that a stemless prosthesis can be implanted without performing tuberosity osteotomy.Methods
We conducted a continuous, single surgeon, retrospective case series study with a minimum follow-up of two years (mean of 44 months, range 24–80). The Constant-Murley score, active range of motion and X-rays were evaluated in 27 patients (mean age of 60 years, range 37–83) with proximal humeral malunion who were treated with a stemless anatomic shoulder prosthesis.Results
In all patients, the prosthesis was implanted without the need for tuberosity osteotomy. The Constant score improved from 27 to 62 (p?≤?0.001), active anterior elevation from 81° to 129° (p?≤?0.001), and external rotation from 5° to 40° (p?≤?0.001). There was no evidence of radiological loosening.Conclusions
Use of a stemless anatomic shoulder prosthesis avoids the need for tuberosity osteotomy and certain surgical difficulties, even in cases of severe tuberosity malunion, and leads to good functional outcomes in the short term.6.
Svetlana Bozhkova Rashid Tikhilov Dmitry Labutin Alexey Denisov Igor Shubnyakov Vadim Razorenov Vasilii Artyukh Anna Rukina 《Journal of orthopaedics and traumatology》2016,17(4):369-376
Background
The unsuccessful treatment of prosthetic joint infection (PJI) with two-stage revision leads to infection recurrence. The objectives of the study were to assess the clinical and demographic characteristics of patients with polymicrobial PJI, and to evaluate the role of the microbial profile involved in PJI in the risk of infection recurrence after the first step of two-stage revision surgery.Materials and methods
A retrospective analysis of 189 cases of culture-positive PJI following total hip replacement over a 5-year period was performed. The demographic characteristics of patients, clinical symptoms, microbiology cultures of intraoperative biopsies, laboratory values of C-reactive protein (CRP), white blood cell count and erythrocyte sedimentation rate were analyzed. Patients were divided into two groups—135 with monomicrobial and 54 with polymicrobial infection.Results
Of all patients, 68.9 % in the monomicrobial and 83.3 % in the polymicrobial group had a body mass index >25 kg/m2 (p = 0.05). The median CRP values were 5.7 mg/L (IQR 4.0–10.0 mg/L) in the monomicrobial compared to 8.8 mg/L (IQR 5.0–27 mg/L) in the polymicrobial group (p = 0.01). The percentage of successful outcomes was 27.8 % in patients with microbial associations (p < 0.0001). Gram-negative pathogens caused polymicrobial PJI in 61.5 % of cases with infection recurrence (OR 4.4; 95 % CI 1.18–16.37; p = 0.03).Conclusions
Overweight and obese patients or those with elevated CRP had a greater risk of polymicrobial PJI. They were predisposed to recurrence of infection after the first step of two-stage revision. An unsuccessful outcome was more likely in cases with polymicrobial infection compared to those with monomicrobial infection. In addition, the presence of multidrug-resistant strains of Gram-negative bacteria substantially increased the risk of PJI treatment being unsuccessful.Level of evidence
Level III, therapeutic study.7.
Florian Dussing Fabian Plachel Teresa Grossauer Thomas Hoffelner Eva Schulz Arvind von Keudell Alexander Auffarth Philipp Moroder 《Obere Extremit?t》2018,13(3):211-217
Background
Recurrence rates after primary traumatic shoulder dislocation are distinctly high. We hypothesized that concomitant isolated fractures of the greater tuberosity are associated with low rates of persistent instability but decreased range of motion.Methods
Between 2007 and 2013, 66 consecutive shoulders in 64 patients were treated for primary shoulder dislocation combined with an isolated fracture of the greater tuberosity with either a nonsurgical (48 shoulders, 72.7%) or surgical (18 shoulders, 27.3%) treatment approach. In all, 55 cases (83.3%) were available for clinical follow-up examination after an average of 59.0?± 20.7 months (range: 25–96 months) and of these, 48 (72.7%) patients consented to radiological evaluation to determine healing and position of the greater tuberosity.Results
The mean range of motion of the affected shoulder was significantly decreased by 9° of elevation (p?=?0.016), 11° of abduction (p?=?0.048), 9° of external rotation in 0° of abduction (p?=?0.005), and 10° of external rotation in 90° of abduction (p?=?0.001), compared with the unaffected shoulder. The mean WOSI score was 373?± 486 points, the mean Constant and Murley score was 75.1?± 19.4 points, and the mean Rowe score was 83?± 20 points. Three cases (5.5%) of re-dislocation were reported among the cohort, all of them were due to a relevant trauma. Radiological evaluation revealed anatomically healed fragments in 31 shoulders (65%), dislocation of the fragment in ten shoulders (21%), impaction into the humeral head in four shoulders (8%), and absorption in three shoulders (6%).Conclusion
A concomitant isolated fracture of the greater tuberosity leads to low recurrence rates along with a significant decrease in range of motion after primary traumatic anterior shoulder dislocation.8.
Purpose
The aim of this study is to report the clinical and radiological results of reverse total shoulder arthroplasty (rTSA) in elderly patients who have been treated for complex humeral fractures.Materials and methods
From January 2005 to December 2014, we have implanted rTSA for proximal humeral fractures in 95 patients (80 womens, 15 mens) about 75 years old on average (range 62–95 years). All rates and results on intraoperative and postoperative complications have been collected in a specific database. In all cases we have used a modular implant prosthesis (Lima Corporate, San Daniele del Friuli, Italy). The prosthesis was implanted cementless in 92 cases. Because of the presence of a high percentage of comorbidities in the elderly patients, we have retrospectively analyzed the necessity of a secondary hospitalization, from a week to a 6-month time after the discharge, due to general health problems and specific postoperative shoulder complications. The mean follow-up was 5 years (range 1–9 years) for 70 of 95 patients, 50 of whom had adequate radiographic controls.Results
None of 95 patients has required a reoperation or a hospitalization for general health problems from 1 week to 6 months postoperative. No early or late infection of prosthesis has been observed. There were seven cases of perioperative complications, three humeral vertical bone fissuring, two glenoid fractures and two cases of deltoid muscle damage. We have had three cases of postoperative hematoma and one case of ulnar nerve neuropathy. The mean constant score was 85.4, and the mean simple shoulder test was 7.4. We have observed a grade 1 scapular notching in 15 cases (30 %). In the remaining 35 reviewed cases, there was no notching. Peri-articular heterotopic ossifications were found in 11 cases (22 %).Conclusion
Reverse shoulder prosthesis in complex humeral fractures in the elderly can be considered as a reliable surgical procedure, which leads to very good clinical and radiological results in case of cementless prosthesis, as well.9.
Eleonora Riccio Massimo Sabbatini Dario Bruzzese Lucia Grumetto Cristina Marchetiello Maria Amicone Michele Andreucci Bruna Guida Davide Passaretti Giacomo Russo Antonio Pisani 《Clinical and experimental nephrology》2018,22(3):529-538
Background
The accumulation of p-cresol, a metabolic product of aromatic amino acids generated by intestinal microbiome, increases the cardiovascular risk in chronic kidney disease (CKD) patients. Therefore, therapeutic strategies to reduce plasma p-cresol levels are highly demanded. It has been reported that the phosphate binder sevelamer (SEV) sequesters p-cresol in vitro, while in vivo studies on dialysis patients showed controversial results. Aim of our study was to evaluate the effect of SEV on p-cresol levels in non-dialysis CKD patients.Methods
This was a single-blind, randomized placebo-controlled trial (Registration number NCT02199444) carried on 69 CKD patients (stage 3–5, not on dialysis), randomly assigned (1:1) to receive either SEV or placebo for 3 months. Total p-cresol serum levels were evaluated at baseline (T0), and 1 (T1) and 3 months (T3) after treatment start. The primary end-point was to evaluate the effect of SEV on p-cresol levels.Results
Compared to baseline (T0, 7.4 ± 2.7 mg/mL), p-cresol mean concentration was significantly reduced in SEV patients after one (? 2.06 mg/mL, 95% CI ? 2.62 to ? 1.50 mg/mL; p < 0.001) and 3 months of treatment (? 3.97 mg/mL, 95% CI ? 4.53 to ? 3.41 mg/mL; p < 0.001); no change of plasma p-cresol concentration was recorded in placebo-treated patients. Moreover, P and LDL values were reduced after 3 months of treatment by SEV but not placebo.Conclusions
In conclusion, our study represents the first evidence that SEV is effective in reducing p-cresol levels in CKD patients in conservative treatment, and confirms its beneficial effects on inflammation and lipid pattern.10.
Purpose
Intra-operative cultures may be obtained in revision spine surgery despite the absence of pre-operative clinical markers of infection. The microbiologic profile of culture positive cases in which there is no clear evidence of infection preoperatively has not been described. The aim of this investigation is to report on the microbiologic profile of unexpected culture positive revision spine surgery cases.Methods
We retrospectively reviewed 595 consecutive revision spine surgeries performed between 2008 and 2013. Five hundred and seventy-eight revision surgeries were performed for diagnoses other than infection and were included in the study.Results
Operative cultures were obtained in 112 cases (19.4 %). Cultures were positive in 45 cases. Pseudarthrosis was not only the most common diagnosis overall (49.1 %) in which intra-operative cultures were obtained, it was also the most common revision surgical diagnosis where cultures were positive (55.6 %). Propionibacterium acnes was cultured in 54.2 % of cases with the primary diagnosis of pseudarthrosis, but only in 40.9 % of cases with other diagnoses (P = 0.554). Overall, staphylococcal species were found most commonly (57.8 % of cases), but P. acnes was at least one of the isolates in 48.9 % of cases and was three times more common than any other organism.Conclusions
Nearly one in five patients with the diagnosis of pseudarthrosis were culture positive. More specifically, pseudarthrosis was the most common culture positive diagnosis and P. acnes species predominated in this patient population. Propionibacterium acnes was overwhelmingly the most common single organism cultured in revision spine surgery. Given this, we recommend all cultures be held for P. acnes, particularly in the setting of pseudarthrosis.11.
Rashid Tikhilov Svetlana Bozhkova Alexey Denisov Dmitry Labutin Igor Shubnyakov Vadim Razorenov Vasilii Artyukh Olga Klitsenko 《International orthopaedics》2016,40(7):1381-1387
Purpose
The purpose of this study was evaluation of the efficacy of the first step of a two-stage procedure for treatment of hip prosthetic joint infection (PJI) using articulating and non-articulating spacers as well as development of a prediction model and prognostic score for infection recurrence.Methods
In a cohort of 217 patients treated for PJI of the hip, demographic characteristics, clinical symptoms, body temperature, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), microbiological cultures and the type of the spacer used were retrospectively analyzed for association with the recurrence of PJI.Results
Patients with infection recurrence had increased levels of ESR and CRP (P?<?0.001) together with higher BMI and shorter infection manifestation period after previous surgery (P?<?0.05). Among these patients, there was no significant difference of clinical characteristics between subjects with articulating and non-articulating spacers. Microbial associations were more often identified in patients with recurrent infection (50 %, P?<?0.01) where Gram-negative bacteria were predominant (61.5 %, P?<?0.01). These patients had higher percentage of Acinetobacter sp. and P. aeruginosa isolates (28.2 %, P?<?0.01).Conclusions
Efficacy of the first step of two-stage revision was 64.1 %. Placement of either articulating or non-articulating spacers did not influence recovery from PJI. Laboratory values of ESR, CRP, BMI and the type of previous surgery were identified as main factors that affect outcomes of the two-stage procedure. A prognostic model with the calculation of a total risk score for PJI recurrence was developed.12.
Giovanni Merolla Giovanni Ciaramella Elisabetta Fabbri Gilles Walch Paolo Paladini Giuseppe Porcellini 《International orthopaedics》2016,40(11):2355-2363
Aim of the study
To assess the clinical and computed tomography (CT) outcomes of shoulder replacement with a novel bone ingrowth all-polyethylene glenoid component (APGC).Methods
Twenty-eight patients (30 shoulders) with osteoarthritis, mean age 62.3 years (range, 45–75), were implanted with the novel component between 2011 and 2013. Patients were evaluated by active range of motion (ROM), Constant-Murley score (CMS), simple shoulder test (SST), X-rays, and multidetector CT at two months and at a mean follow-up of 31 months (range, 24–39). Early and late follow-up CT scans were available for 21/30 shoulders.Results
Median ROM increased from 105 to 160° for anterior elevation, from 100 to 160° for lateral elevation, from 20 to 40° for external rotation, and from 2 to 10 points for internal rotation (all p?<?0.001). CMS rose from 30 to 80.5 points and SST from 2.5 to 11 (both p?<?0.0001). None of the glenoid components migrated. Progressive radiolucency was seen in 28/30 shoulders. There was a strong correlation between greater bone ingrowth (median Arnold score: 7) and lower radiolucency score (median Yian score: 2) at the last follow-up (p?<?0.001). Osteolysis around the central peg was seen in two shoulders. There was no correlation between clinical scores and CT findings (p >0.05).Discussion
The partially cemented glenoid component for TSR assessed in this study resulted in satisfactory shoulder function at an early follow-up. The glenoid prosthesis was stable, with few radiolucent lines and good central peg bone ingrowth.Conclusions
The satisfactory bone ingrowth documented on CT is encouraging and supports the use of the new prosthesis. Long-term follow-up studies can confirm if this device represents a rational alternative to fully cemented polyethylene glenoids.13.
Cho WH Song WS Jeon DG Kong CB Kim JI Lee SY 《Archives of orthopaedic and trauma surgery》2012,132(2):163-169
Introduction
The underlying cause of proximal tibial prosthetic failure by infection is unclear. We asked: (1) Is resection amount related to prosthetic infection? (2) What other risk factors are related with infection? (3) What are the survivorship and functional outcomes of proximal tibial endoprosthetic reconstruction?Methods
Sixty-two patients who underwent modular proximal tibial megaprosthesis reconstruction were analyzed. Follow-up duration averaged 98 months (range 26–240 months). Associations between prognostic variables and prosthesis survival were assessed.Results
The 10-year prosthetic survival of the 62 implants was 73.9 ± 11.7%. Prostheses were removed in 16 (25.8%) patients for infection and 3 of the 16 underwent amputation. Resection of >37% (P = 0.016) of the tibia was found to be related to infection. Application of chemotherapy (P = 0.912) and use of synthetic material to fix the patella tendon (P = 0.2) were not found to influence prosthetic survival. Functional outcomes (determined by the MSTS system) of the 52 patients that maintained a mobile joint averaged 24.2 (81%) (range 18–28).Conclusions
Our study suggests that the amount of bone resection is related with prosthetic failure by infection, however, the contribution of other risk factors should not be underestimated.14.
C. Iorio R. M. Lanzetti D. Lupariello A. Vadalà M. Fabbri A. Ciompi A. Ferretti A. De Carli 《Musculoskeletal surgery》2018,102(3):283-288
Purpose
Some authors consider preservation of the subscapularis tendon as one of the most important elements for a successful long-term outcome in patients operated on with open capsulorrhaphy for recurrent anterior shoulder dislocation. The purpose of this study was to evaluate whether vertical tenotomy of the subscapularis tendon might affect internal rotation strength recovery in patients operated on with open capsulorrhaphy for recurrent anterior shoulder dislocation.Methods
Ninety-six patients were retrospectively followed up at a mean of 72.5 months. They underwent clinical evaluation, Rowe and Walch–Duplay scoring scales, the Visual Analog Scale (VAS), and dynamometric measurements (side-to-side) of internal and external rotation, forward elevation, and abduction. All patients were athletes: 25% were practising risk-free sports, 44% contact sports, 14.5% sports with cocking of the arm, and 14.5% high-risk sports activities.Results
Five (5.2%) recurrences were registered, and all patients returned to pre-operative sports activity. The Rowe score was 98.12, the Walch–Duplay score 92.25, and the VAS score 0.1. Dynamometric assessment showed no significant differences (side-to-side) in internal rotation (p = 0.34), external rotation (p = 0.9), flexion (p = 0.7), and abduction (p = 0.7). Dominant arms showed better results than non-dominant arms (p < 0.01).Conclusion
Complete tenotomy of the subscapularis tendon does not seem to negatively affect internal rotation strength recovery or external rotation movement in athletes.15.
Jean Sébastien Beranger Shahnaz Klouche Thomas Bauer Thomas Demoures Philippe Hardy 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(3):277-282
Purpose
The aim of this study was to assess return-to-sport outcomes following the Latarjet–Bristow procedure.Methods
This retrospective study included all athletes <50 years old, who underwent a Latarjet–Bristow procedure for anterior shoulder instability in 2009–2012. Main criteria assessments were the number of athletes returning to any sport and the number returning to the same sport at their preinjury level. The main follow-up was 46.8 ± 9.7 months.Results
Forty-seven patients were analyzed, 46 men/1 women, mean age 27.9 ± 7.9 years. Eighteen patients practiced competitive sports and 29 recreational sports. None of them were professional athletes. One hundred percent returned to sports after a mean 6.3 ± 4.3 months. Thirty/47 (63.8 %) patients returned to the same sport at the same level at least and 10/47 (21.3 %) patients changed sport because of their shoulder. Compared to patients who returned to the same sport at the same level, patients who changed sports or returned to a lower level had practiced overhead or forced overhead sports [OR = 4.7 (1.3–16.9), p = 0.02] before surgery, experienced avoidance behavior at the final follow-up (p = 0.002), apprehension (p = 0.00001) and had a worse Western Ontario Shoulder Instability Index score and sub-items (p = 0.003) except for daily activities (p = 0.21). At the final follow-up, 45/47 (95.7 %) patients were still practicing a sport.Conclusion
All the patients returned to sports, most to their preinjury sport at the same level. Patients who practiced an overhead sport were more likely to play at a lower level or to change sport postoperatively.Level of evidence
IV, retrospective study—Case series with no comparison group.16.
M. Tyrrell Burrus Jourdan M. Cancienne Jeffrey D. Boatright Scott Yang Stephen F. Brockmeier Brian C. Werner 《HSS journal》2018,14(1):2-8
Background
Humeral head avascular necrosis (AVN) of differing etiologies may lead to shoulder arthroplasty due to subchondral bone collapse and deformity of the articular surface. There have been no large studies evaluating the complications for these patients after they undergo total shoulder arthroplasty (TSA).Questions/Purposes
The first objective of this study is to evaluate the complication rate after TSA in patients with humeral head AVN. The secondary objective is to compare the complication rates among the different etiologies of the AVN.Methods
Patients who underwent TSA were identified in the PearlDiver database using ICD-9 codes. Patients who underwent shoulder arthroplasty for humeral head AVN were identified using ICD-9 codes and were subclassified according to AVN etiology (posttraumatic, alcohol use, chronic steroid use, and idiopathic). Complications evaluated included postoperative infection within 6 months, dislocation within 1 year, revision shoulder arthroplasty up to 8 years postoperatively, shoulder stiffness within 1 year, and periprosthetic fracture within 1 year and systemic complications within 3 months. Postoperative complication rates were compared to controls.Results
The study cohorts included 4129 TSA patients with AVN with 141,778 control TSA patients. Patients with posttraumatic AVN were significantly more likely to have a postoperative infection (OR 2.47, P < 0.001), dislocation (OR 1.45, P = 0.029), revision surgery (OR 1.53, P = 0.001), stiffness (OR 1.24, P = 0.042), and systemic complication (OR 1.49, P < 0.001). Steroid-associated AVN was associated with a significantly increased risk for a postoperative infection (OR 1.72, P = 0.004), revision surgery (OR 1.33, P = 0.040), fracture (OR 2.76, P = 0.002), and systemic complication (OR 1.59, P < 0.001). Idiopathic and alcohol-associated AVN were not significantly associated with any of the postoperative evaluated complications.Conclusions
TSA in patients with humeral head AVN is associated with significantly increased rates of numerous postoperative complications compared to patients without a diagnosis of AVN, including infection, dislocation, revision arthroplasty, stiffness, periprosthetic fracture, and medical complications. Specifically, AVN due to steroid use or from a posttraumatic cause appears to be associated with the statistically highest rates of postoperative TSA complications. Given these findings, orthopedic surgeons should be increasingly aware of this association, which should influence the shared decision-making process of undergoing TSA in patients with humeral head AVN.17.
Kerem Bilsel Hasan Hüseyin Ceylan Fatih Yıldız Tunay Erden Ali Toprak Ibrahim Tuncay 《International orthopaedics》2016,40(5):885-889
Purpose
Some patients with shoulder laxity complain of coxalgia without a history of trauma. We hypothesised that patients who have recurrent shoulder instability accompanied with generalised joint hyperlaxity tend to have acetabular dysplasia.Methods
Pelvic radiographs of 26 young patients with hyperlaxity who had shoulder instability complaints without any history of hip joint trauma were evaluated by measuring their centre-edge angle (CEA) and acetabular angle (AA). In addition, Beighton generalised joint laxity tests were performed. All of the patients had shoulder pain and instability accompanied with hyperlaxity. We performed magnetic resonance imaging examination to show SLAP-Bankart lesions and pelvis anteroposterior X-rays to detect acetabular dysplasia.Results
The average age of the study group was 26?±?8.03 years (13-39). Six patients were female and 20 were male. When CEA (<22.6 degrees) was used as a criterion for acetabular dysplasia, the dysplasia rate of our patient group was 3.84 % for the right hip, 3.84 % for the left hip and 3.84 % overall. When AA (>42.2 degrees) was used as the dysplasia criterion, the dysplasia rate of patient group was 30.76 % for the right hip, 57.69 % for the left hip and 57.69 % overall.Conclusions
CEA values were significantly lower (p?=?0.009) and AA values were significantly higher (p?<?0.001) in our study group than the previously-reported average values of the Turkish population. We think that acetabular dysplasia is more frequent in patients with hyperlaxity; further studies are needed to test this idea.18.
Hiroaki Kanazawa Yuichiro Maruyama Katsuo Shitoto Minoru Yokoyama Kazuo Kaneko 《Journal of orthopaedics and traumatology》2017,18(1):23-30
Background
The optimum treatment for isolated patellofemoral joint osteoarthritis (PFJ-OA) remains controversial. The aim of this study was to assess the mid-term clinical results of a modified crosse de hockey procedure for the treatment of isolated PFJ-OA.Materials and methods
We assessed 37 knees in 31 patients treated by a modified crosse de hockey procedure. The mean age was 57.6 years (range, 46–75 years) and mean follow-up was 90.1 months (range, 24–216 months). We evaluated clinical and radiographic outcomes, as well as complication rates at the mid-term follow-up.Results
The Kujala score (mean improvement of 46.7, P < 0.001) and the Fulkerson score (mean improvement of 19, P = 0.001) were significantly higher compared to preoperative values. Overall clinical results rated excellent in 24.3 %, very good in 21.6 %, good in 35.1 %, fair in 13.5 %, and poor in 5.4 % of knees. Patellar tilting (P = 0.015) and congruence angle (P = 0.018) significantly improved postoperatively. On the other hand, the Insall-Salvati index decreased at the time of follow-up, although it remained in the physiologic range. Postoperatively, consecutive disease progression in the tibiofemoral joint and patellofemoral joint osteoarthritis were 18.9 and 5.4 %, respectively. The operative complication rate was 5.4 % in this case series. These percentages were lower than those of alternative tibial tuberosity osteotomy techniques.Conclusion
In most patients with chronic isolated PFJ-OA, tibial tuberosity osteotomy by modified crosse de hockey is a reliable procedure that provides good/excellent mid-term clinical results.Level of evidence
Level IV.19.
Purpose
To investigate whether an optimal upper instrumented vertebra (UIV) tilt angle would prevent ‘lateral’ shoulder imbalance or neck tilt (with ‘medial’ shoulder imbalance) post-operatively.Methods
The mean follow-up for 60 AIS (Lenke 1 and Lenke 2) patients was 49.3 ± 8.4 months. Optimal UIV tilt angle was calculated from the cervical supine side bending radiographs. Lateral shoulder imbalance was graded using the clinical shoulder grading. The clinical neck tilt grading was as follows: Grade 0: no neck tilt, Grade 1: actively correctable neck tilt, Grade 2: neck tilt that cannot be corrected by active contraction and Grade 3: severe neck tilt with trapezial asymmetry >1 cm. T1 tilt, clavicle angle and cervical axis were measured. UIVDiff (difference between post-operative UIV tilt and pre-operative Optimal UIV tilt) and the reserve motion of the UIV were correlated with the outcome measures. Patients were assessed at 6 weeks and at final follow-up with a minimum follow-up duration of 24 months.Results
Among patients with grade 0 neck tilt, 88.2 % of patients had the UIV tilt angle within the reserve motion range. This percentage dropped to 75.0 % in patients with grade 1 neck tilt whereas in patients with grade 2 and grade 3 neck tilt, the percentage dropped further to 22.2 and 20.0 % (p = 0.000). The occurrence of grade 2 and 3 neck tilt when UIVDiff was <5°, 5–10° and >10° was 9.5, 50.0 and 100.0 %, respectively (p = 0.005). UIVDiff and T1 tilt had a positive and strong correlation (r 2 = 0.618). However, UIVDiff had poor correlation with clavicle angle and the lateral shoulder imbalance.Conclusion
An optimal UIV tilt might prevent neck tilt with ‘medial’ shoulder imbalance due to trapezial prominence and but not ‘lateral’ shoulder imbalance.20.
Yaiza Lopiz Javier García-Coiradas Laura Serrano-Mateo Carlos García-Fernández Fernando Marco 《International orthopaedics》2016,40(4):771-781