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1.
Kevin A. Reinard Diana M. Cook Hesham M. Zakaria Azam M. Basheer Victor W. Chang Muwaffak M. Abdulhak 《European spine journal》2016,25(7):2068-2077
Purpose
To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery.Methods
A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia.Results
The overall dysphagia rate was 37.7 %. Patients with dysphagia had a longer mean length of stay (p < 0.001), longer mean operative time (p < 0.001), greater intraoperative blood loss (p = 0.002), and fusion above the fourth cervical vertebra, C4, (p = 0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p = 0.554).Conclusion
Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.2.
Jessica J. M. Telleria Rosemary A. Cotter Viviana Bompadre Suzanne E. Steinman 《Journal of children's orthopaedics》2016,10(3):247-254
Background
Reported complications of pediatric septic arthritis range from minor growth abnormalities to potentially life-threatening conditions and death; some children require multiple surgeries for eradication of infection. The purpose of this study is: (1) to determine the failure rate of a single surgical incision and drainage (I&D) in pediatric septic arthritis, (2) to identify risk factors for failure which are detectable at the time of initial presentation, and (3) to trend post-operative C-reactive protein (CRP) values to see if there is a difference between children who fail a single I&D and those who do not.Methods
The medical records for 105 children who underwent operative management of septic arthritis were retrospectively reviewed. Single and multivariate analyses were performed.Results
Eighty-four children required one surgical intervention [mean age 5.18 years (±4.01); 38 females (45 %), 46 males (55 %)], 21 children required revision surgery [mean age 8.16 years (±4.54); 4 females (19 %), 17 males (81 %)], and the overall rate of revision surgery was 20 %. Delayed diagnosis (p = 0.015), elevated CRP at presentation (p = 0.000), positive blood culture (p = 0.000), and age (p = 0.009) were all associated with revision surgery in bivariate analysis. In multivariate analysis, CRP at presentation and positive blood culture were significant risk factors for revision surgery (p = 0.005 and p = 0.025, respectively). Additionally, markedly elevated CRP levels on post-operative days (POD) 1–4 were each independently significant risk factors for requiring multiple surgeries (all p < 0.000). Fever, elevated erythrocyte sedimentation rate, and leukocyte count were not risk factors for multiple surgeries.Conclusions
In this study, a positive blood culture or marked elevation in CRP at presentation or on POD 1–4 were associated with revision surgery. These findings may help improve surgical planning for both the initial surgery in order to avoid revisions, as well as revision surgery, should it be indicated.Level of evidence
III.3.
Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York
Maria S. Altieri Jie Yang Dana A. Telem Ziqi Meng Catherine Frenkel Caitlin Halbert Mark Talamini Aurora D. Pryor 《Surgical endoscopy》2016,30(5):1725-1732
Introduction
We sought to determine the rate of revision and explant of the laparoscopic adjustable gastric banding (LAGB) over a ten-year period in the state of New York.Methods
Following IRB approval, the SPARCS administrative database was used to identify LAGB placement from 2004 to 2010. We tracked patients who underwent band placement with subsequent removal/revision, followed by conversion to either Roux-en-Y gastric bypass (RYBG) or sleeve gastrectomy (SG) between 2004 and 2013. McNemar test and Chi-square test were used to compare complications between primary procedure and subsequent revision and to compare complication rates and mortality rates, respectively. Log-rank test was used to assess patient characteristics and comorbidities. p < 0.05 was considered significant.Results
During a 7-year period, there were 19,221 records of LAGB placements and 6567 records of revisions or removal. We were able to follow up 3158 (16.43 %) who subsequently underwent a band removal or revision over the course of this period. An additional 3606 patients had no records in the state of New York following the procedure, thus making the rate of revision 20.22 %. Initial revision procedures were coded as band removal in 32.77 % (n = 1035), band revision in 30.53 % (n = 964), band removal and replacement in 19.09 % (n = 603), removal and conversion to SG in 5.64 % (n = 178), or removal and conversion to RYGB in 11.97 % (n = 378). From the 3158 patients, 2515 (79.64 %) required only one revision. Six hundred and forty-three patients underwent two or more revisions. Thirty-one out of 3158 (0.0098 %) patients had complications at their initial operation, but 919 (29.1 %) had complications during revision (p < 0.0001).Conclusions
Over a 7-year period, at least 20.22 % of LAGB required removal or revision. Based on all case numbers, total revision rate may be as high as 34.2 %. Although the band is believed to be a reversible procedure, revisional procedures are significantly more morbid than the initial procedure.4.
Louise Yeung Brandice Durkan Allison Barrett Cary Kraft Kim Vu Edward Phillips Scott Cunneen Miguel Burch 《Surgical endoscopy》2016,30(6):2244-2250
Background
Laparoscopic adjustable gastric banding (LAGB) is increasingly requiring revisional surgery for complications and failures. Removal of the band and conversion to either laparoscopic Roux-en-y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) is feasible as a single-stage procedure. The objective of this study is to compare the safety and efficacy of single-stage revision from LAGB to either LRYGB or LSG at 6 and 12 months postoperatively.Methods
Retrospective analysis was performed on patients undergoing single-stage revision between 2009 and 2014 at a single academic medical center. Patients were reassessed for weight loss and complications at 6 and 12 months postoperatively.Results
Thirty-two patients underwent single-stage revision to LRYGB, and 72 to LSG. Preoperative BMIs were similar between the two groups (p = 0.27). Median length of stay for LRYGB was 3 days versus 2 for LSG (p = 0.14). Four patients in the LRYGB group required reoperation within 30 days, and two patients in the LSG group required reoperation within 30 days (p = 0.15). There was no difference in ER visits (p = 0.24) or readmission rates (p = 0.80) within 30 days of operation. Six delayed complications were seen in the LSG group with three requiring intervention. At 6 months postoperatively, percent excess weight loss (%EWL) was 50.20 for LRYGB and 30.64 for LSG (p = 0.056). At 12 months, %EWL was 51.19 for LRYGB and 34.89 for LSG (p = 0.31). There was no difference in diabetes or hypertension medication reduction at 12 months between LRYGB and LSG (p > 0.07).Conclusion
Single-stage revision from LAGB to LRYGB or LSG is technically feasible, but not without complications. The complications in the bypass group were more severe. There was no difference in readmission or reoperation rates, weight loss or comorbidity reduction. Revision to LRYGB trended toward higher rate and greater severity of complications with equivalent weight loss and comorbidity reduction.5.
Alexander Kretschmer Alexander Buchner Markus Grabbert Christian G. Stief Micaela Pavlicek Ricarda M. Bauer 《World journal of urology》2016,34(4):595-602
Purpose
To analyze revision rates and risk factors for artificial urinary sphincter failure.Methods
Eighty-four patients underwent implantation of an artificial urinary sphincter in one reference center. Continence rates were defined by daily pad usage. Influence of predefined risk factors for device explantation, revision, differences in preoperative pad usage, and device survival was analyzed using Chi-squared test, Wilcoxon signed-rank test, and Kaplan–Meier analysis. A multivariate analysis was performed using a logistic regression model. A p value below 0.05 was considered statistically significant.Results
After a mean follow-up of 39.7 months, the device was still in situ in 64 patients. In univariate analysis, perioperative need of anticoagulation led to a significant increase in urethral erosion (6 vs. 30 %; p = 0.002) and explantation rate (15 vs. 34 %; p = 0.047). Pelvic irradiation increased postoperative infection rates significantly (0 vs. 10 %; p = 0.018). Penoscrotal approach led to significant increase in urethral erosion rate (0 vs. 21 %; p = 0.015). Implantation of a double cuff led to a significant increase in explantation rate (58 vs. 24 %; p = 0.014), revision rate (75 vs. 38 %; p = 0.017), and infection rate (17 vs. 1 %; p = 0.008). When using cuff size of 3.5 cm, revision rate (20 vs. 50 %; p = 0.026) as well as incontinence rates (40 vs. 82 %; p = 0.014) was significantly lower. In multivariate analysis, only perioperative anticoagulation and double-cuff placement were independent predictors of artificial urinary sphincter failure.Conclusions
Our findings highlight the influence of perioperative anticoagulative therapy. In addition, the current study provides further evidence that double-cuff implantation should be performed only with caution during primary implantation.6.
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.7.
Purpose
To investigate the outcomes of patients with colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated using the liver-first approach in the era of modern chemotherapy in Japan.Methods
We analyzed and compared data retrospectively on patients with asymptomatic resectable colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated either using the liver-first approach (n = 12, LF group) or the primary-first approach (n = 13, PF group).Results
Both groups of patients completed their therapeutic plan and there was no mortality. Postoperative morbidity rates after primary resection and hepatectomy, and post-hepatectomy liver failure rate were comparable between the groups (p = 1.00, p = 0.91, and p = 0.55, respectively). Recurrence rates, median recurrence-free survival since the last operation, and 3-year overall survival rates from diagnosis were also comparable between the LF and PF groups (58.3 vs. 61.5 %, p = 0.87; 10.5 vs. 18.6 months, p = 0.57; and 87.5 vs. 82.5 %, p = 0.46, respectively).Conclusions
The liver-first approach may be an appropriate treatment sequence without adversely affecting perioperative or survival outcomes for selected patients.8.
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.9.
Risk Factors for Early Recurrence of Single Lesion Hepatocellular Carcinoma After Curative Resection
Mitsugi Shimoda Kazuma Tago Takayuki Shiraki Shozo Mori Masato Kato Taku Aoki Keiichi Kubota 《World journal of surgery》2016,40(10):2466-2471
Background and objectives
Hepatic resection is established as the treatment for HCC. However, patients sometimes experience early recurrence of HCC (ER HCC) after curative resection.Methods
A retrospective analysis was conducted for 193 patients with single HCC who underwent curative liver resection in our medical center between April 2000 and March 2013. We divided the cohort into two groups; early recurrence group (ER G) which experienced recurrence within 6 months after resection, and non-early recurrence group (NER G). Risk factors for ER HCC were analyzed.Results
Thirty-nine out of 193 (20.2 %) patients had ER HCC. Univariate analysis showed Glasgow prognostic score (GPS, p = 0.036), neutrophil to lymphocyte ratio (NLR, p = 0.001), level of PIVKA-II (p = 0.0001), level of AFP (p = 0.0001), amounts of blood loss (p = 0.001), operating time (p = 0.002), tumor size (p = 0.0001), stage III and IV (p = 0.0001), and microvascular invasions (portal vein: p = 0.0001 and hepatic vein: p = 0.001) to be associated with ER HCC. By multivariate analysis, there were significant differences in high NLR (p = 0.029) and high AFP (p = 0.0001) in patients with ER HCC.Conclusions
Preoperative high AFP (more than 250 ng/ml) and high NLR (more than 1.829) were independent risk factors for ER HCC.10.
Satoru Kobayashi Yoko Karube Morimichi Nishihira Takashi Inoue Osamu Araki Tetsu Sado Masayuki Chida 《World journal of surgery》2016,40(7):1632-1637
Objectives
There is increasing evidence that Glasgow Prognostic Score (GPS), based on systemic inflammatory response and albumin level, is a useful predictor of overall survival in patients with various types of cancer.Methods
Patients with lung metastasis from colorectal carcinoma who underwent a lung metastasectomy from 2000 to 2015 were retrospectively investigated. Routine laboratory measurements including serum C-reactive protein (CRP), albumin, and the tumor marker carcinoembryonic antigen were performed before the metastasectomy.Results
Ninety-nine patients underwent 132 lung metastasectomy procedures during the study period. Kaplan–Meier analysis revealed that GPS (p = 0.017), number of metastases (p = 0.004), and the presence of liver metastasis (p = 0.010) were associated with overall survival, while univariate analysis selected GPS (p = 0.028), number of metastases (p = 0.005), and liver metastasis (p = 0.014) as predictive factors associated with overall survival. Multivariate analysis also indicated GPS (p = 0.004), number of metastases (p = 0.004), and liver metastasis (p = 0.013) as predictive factors associated with overall survival.Conclusion
In addition to number of metastases and liver metastasis, GPS is an important predictor of overall survival in colorectal cancer patients who undergo a lung metastasectomy.11.
Venkat Boddapati Michael C. Fu William W. Schairer Lawrence V. Gulotta David M. Dines Joshua S. Dines 《HSS journal》2018,14(1):23-28
Background
With an increasing volume of primary total shoulder arthroplasties (TSA), the number of revision TSA cases is expected to increase as well. However, the postoperative medical morbidity of revision TSA has not been clearly described.Questions/Purposes
The purpose of this study was to determine the rate of postoperative complications following revision TSA, relative to primary TSA. In addition, we sought to identify independent predictors of complications, as well as to compare operative time and postoperative length of stay between primary and revision TSA.Methods
Patients who underwent primary/revision TSA between 2005 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Differences in complications, readmission rates, operative time, length of stay, and predictors of complications were evaluated using bivariate and multivariate analyses.Results
A total of 10,371 primary TSA (95.4%) and 496 revision TSA cases (4.6%) were identified. The overall complication rate was 6.5% in primary and 10.7% in revision TSA patients (p < 0.001). Multivariate analysis identified an increased risk of any complication (odds ratio 1.73, p < 0.001), major complication (2.08, p = 0.001), and wound infection (3.45, p = 0.001) in revision TSA patients, relative to primary cases. Operative time was increased in revision cases (mean ± standard deviation, 125 ± 62.5), relative to primary (115 ± 47.7, p < 0.001). Age > 75, female sex, history of diabetes or chronic obstructive pulmonary disease, and American Society of Anesthesiologists classification ≥ 3 were associated with increased risk of any complication. Smoking history was the only significant predictor of wound infection.Conclusion
Revision TSA, in comparison to primary, poses an increased risk of postoperative complications, particularly wound infections. A history of smoking was an independent predictor of wound infections.12.
Introduction
According to the Tokyo Guidelines, severity of acute cholecystitis is divided into three grades based on the degree of inflammation and the presence of organ dysfunction. These guidelines recommend grade I (mild) acute cholecystitis to be treated with early laparoscopic cholecystectomy and grade II (moderate) acute cholecystitis with delayed cholecystectomy. Yet, several studies have shown that, for acute cholecystitis in general, early cholecystectomy is superior to delayed cholecystectomy in terms of complication rate, duration of hospital stay and costs. The aim of this study was to determine the clinical outcomes of emergency cholecystectomy in patients with grade II acute cholecystitis. Based on our findings, we propose a revision of the Tokyo Guidelines.Methods
We performed a retrospective observational cohort study of 589 consecutive patients undergoing emergency cholecystectomy for acute calculous cholecystitis in a large teaching hospital between January 2002 and January 2015. Patients were classified according to the severity assessment criteria of the Tokyo Guidelines. Patients with grade I and grade II acute cholecystitis were compared for perioperative outcomes.Results
Emergency cholecystectomy was performed in 270 patients with grade I acute cholecystitis and 187 patients with grade II acute cholecystitis. There was no difference in conversion rate (6 vs. 6%, p = 0.985) and operating time (60 min [25–255] vs. 70 min [30–255], p = 0.421). Also the perioperative complication rate (7 vs. 9%, p = 0.517), 30-day mortality (1 vs. 1%, p = 0.648) and length of hospital stay (4 days [1–42] vs. 4 days [1–62], p = 0.327) were similar between grade I and grade II acute cholecystitis.Conclusion
The clinical outcomes of emergency cholecystectomy did not differ between patients with grade I and grade II acute cholecystitis. The findings support a revision of the Tokyo Guidelines with respect to the recommendation of performing emergency cholecystectomy in both grade I and grade II acute cholecystitis.13.
Pooria?Hosseini Jeff?B.?Pawelek Stacie?Nguyen George?H.?Thompson Suken?A.?Shah John?M.?Flynn John?P.?Dormans Behrooz?A.?Akbarnia
Purpose
Is there any relationship between lengthening intervals and rod fracture in traditional growing rod (TGR) surgery?Methods
A multicenter EOS database was queried for patients who had: (1) dual growing rods for EOS; (2) minimum 2-year follow-up; (3) a minimum of 2 lengthenings; and (4) revision surgery due to rod fracture. Of 138 patients who met the criteria: 56 patients experienced at least one-rod fracture (RF group) and 82 patients had no rod fractures (NRF group). In addition to each patient’s lengthening intervals, demographics, construct details, and radiographic parameters were compared.Results
RF and NRF patients had a mean pre-op age of 5.7 years (range 1.3–10.7) and 7.3 years (range 1.6–12.8), respectively (p < 0.001). There was no significant association between etiologies and rod fracture or between BMI and rod fracture (p = 0.979). There was no significant difference between lengthening intervals between the RF and NRF groups (p > 0.05). RF and NRF patients had statistically similar mean pre-op major curve size and max kyphosis (p = 0.279; p = 0.619, respectively). Stainless steel rods fractured more frequently compared with Titanium rods (SS 49.2 % vs. Ti 38 %; p = 0.004). Rod fracture occurred more in rods smaller than 4 mm (p = 0.011).Conclusions
Lengthening intervals were not statistically different in RF and NRF groups and there was no association between lengthening interval and rod fracture in TGR cases. It was shown that patients who had rod fracture were younger and were more likely to have SS rods with smaller than 4 mm diameter.14.
Michael D. Bell Faysal A. Yafi Fadi Brimo Jordan Steinberg Armen G. Aprikian Simon Tanguay Wassim Kassouf 《World journal of urology》2016,34(10):1405-1409
Purpose
Urinary cytology (C) and cystoscopy remain the gold standard for the detection and screening of bladder cancer (BC). In this prospective study, we analyzed whether baseline C, ImmunoCyt (I), BTA Stat (B), hemoglobin dipstick (H), and NMP22 BladderChek (N) can predict recurrence and progression.Methods
Urinary samples from 91 patients with BC were prospectively collected over an 18-month period. Baseline characteristics of the population included patient demographics, various clinicopathological variables and use of intravesical therapy. Progression and recurrence were then assessed after a median follow-up of 48 months (IQR 23.7–59.5). Univariate and multivariate analyses were performed using COX proportional hazards models.Results
On univariate analysis, C (HR 1.36; p = 0.26), I (HR 0.89; p = 0.66), B (HR 0.80; p = 0.42), H (HR 0.75; p = 0.30), and N (HR 0.82; p = 0.48) were not associated with recurrence-free survival (RFS). With regard to progression-free survival (PFS), C was significantly prognostic (HR 2.67; p = 0.017), whereas I, B, H, and N were not. On multivariable analysis, NMP22 was the only marker to be independently associated with RFS (HR 0.41, p < 0.01) and PFS (HR 0.32, p = 0.02).Conclusion
Based on the results of this study, baseline C, B, I, and H were not independently prognostic. Prognostic impact of NMP22 requires further validation in a multicenter larger study.15.
Woohyung Lee Ji-Ho Park Ju-Yeon Kim Seung-Jin Kwag Taejin Park Sang-Ho Jeong Young-Tae Ju Eun-Jung Jung Young-Joon Lee Soon-Chan Hong Sang-Kyung Choi Chi-Young Jeong 《Surgical endoscopy》2016,30(11):4835-4840
Background
Laparoscopic liver resection (LLR) has become an essential method for treating malignant liver tumors. Although the perioperative and oncologic outcomes of LLR in patients with hepatocellular carcinoma have been reported, there are few reports of LLR for intrahepatic cholangiocarcinoma (IHCC).Methods
Patients who underwent liver resection for T1 or T2 IHCC between March 2010 and March 2015 in Gyeongsang National University Hospital were enrolled. They were divided into open (n = 23) and laparoscopic (n = 14) approaches, and the perioperative and oncologic outcomes were compared.Results
The Pringle maneuver was less frequently used (p = 0.015) and estimated blood loss was lesser (p = 0.006) in the laparoscopic group. There were no significant differences in complication rate (p = 1.000), hospital stay (p = 0.371), tumor size (p = 0.159), lymph node metastasis (p = 0.127), and the number of retrieved lymph nodes (p = 0.553). The patients were followed up for a median of 21 months. The 3-year overall survival (OS) and recurrence-free survival (RFS) rates were 74.7 and 55.2 %, respectively. No differences were observed in the 3-year OS (75.7 vs 84.6 %, p = 0.672) and RFS (56.7 vs 76.9 %, p = 0.456) rates between the open and laparoscopic groups, even after the groups were divided into patients that received liver resection with or without lymph node dissection.Conclusion
LLR for IHCC is a treatment modality that should be considered as an option alongside open liver resection in selected patients.16.
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.17.
Brian E. Schwartz Hristo I. Piponov Cory W. Helder William F. Mayers Mark H. Gonzalez 《International orthopaedics》2016,40(9):1793-1802
Purpose
With the increasing number of primary total hip arthroplasties (THA) being performed, the frequency of revision surgery is also expected to increase. We analysed the immediate in-hospital complications and epidemiologic data of 3,469 revision and 18,186 primary THA cases.Methods
The National Hospital Discharge Survey (NHDS) was evaluated between 2001 and 2010 for patients who underwent revision and primary THA. Patients were identified and included in our retrospective study based on ICD-9 procedure codes.Results
The number of primary and revision THAs increased steadily from 2001 to 2010. The revision burden decreased for the same studied period (r?=?–0.92) to reach 13.9 % in 2010. The South region had higher revision burden of 17.4 % (p?<?0.001). The primary THA group was more likely to be obese, morbidly obese, and have hypertension (p?<?0.001). The revision THA group had an increased rate of blood transfusions (p?<?0.001), deep venous thrombosis (p?=?0.008), post-operative sepsis (p?<?0.001), and wound complications (p?<?0.001). The in-hospital mortality rate was also higher for the revision THA group (0.6 % versus 0.2 %, p?<?0.001).Conclusions
The revision burden has undergone a steady decrease over the ten years studied and the reason for this is likely multifactorial. The South region had a significantly higher revision burden when compared to the rest of the United States. Larger hospitals tend to perform relatively more revisions. Revision THA patients are associated with longer hospital stay, higher complications rate, and higher in-hospital mortality rate.18.
Purpose
The purpose of this study was to evaluate the role of medial opening wedge high tibial osteotomy (HTO) in medial unicompartmental osteoarthritis (MCOA) of knee and to compare between the two methods of osteotomy using either dynamic axial fixator (DAF) or locking compression plate (LCP).Methods
A total of 20 patients with medial osteoarthritis of knee were enrolled in this prospective study who were divided into two groups of 10 each. First group comprising of two males and eight females were treated by HTO using DAF. Second group comprising of five males and five females were treated by HTO using LCP. We assessed various radiological parameters including hip knee ankle angle (HKA), tibiofemoral angle (TFA), weight-bearing line on tibia, Insall Salvati index and tibial slope. Functional outcome of knee at final follow-up was assessed by Oxford knee score (OKS) and visual analogue scale.Results
In first group, mean HKA angle changed from 187° to 178.30° (p = 0.006), mean TFA from 182.40° to 172° (p = 0.003), average position of weight-bearing line from 11.24 to 59.54 % (p = 0.004), and mean OKS 43.3–16.9 (p = 0.004). In second group, mean HKA angle changed from 186° to 178.80° (p = 0.004), mean TFA from 180.90° to 173.60° (p = 0.004), average position of weight-bearing line from 14 to 61.3 % (p = 0.004), and mean OKS 43.2–16.5 (p = 0.002).Conclusion
HTO is an established treatment for patients with symptomatic MCOA knee with significant improvement in the clinical and radiographic parameters. There is no significant difference between the two methods; however, external fixator has the complication of pin tract infections.Level of evidence
II.19.
Purpose
Although several studies have compared the clinical efficacy of an adductor canal block (ACB) to that of a femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA), disputes mainly exist in the recovery of quadriceps strength and mobilization ability between the two methods. The aim of the present study was to compare, in a systematic review and meta-analysis, the clinical efficacy of ACB with that of FNB.Methods
We systematically searched randomized controlled trials comparing FNB with ACB for analgesia after TKA in Pubmed and the Cochrane Library from inception to April 30th 2015. There was no limitation of publication language. Trial quality was assessed using the modified Jadad scale, and eligible data were pooled for meta-analysis.Results
Five studies of 348 patients were included. Outcomes showed that patients who received ACB had similar or better recovery of quadriceps strength and mobilization ability than those that underwent FNB. Similar efficacy was found between the two strategies regarding adductor strength, pain scores [at rest (p = 0.86), at or after knee flexion (p = 0.31)], opioid consumption (p = 0.99), opioid-associated adverse effects (p = 0.60), length of hospital stay (p = 0.42), patient satisfaction (p = 0.57), and success rate of blockade (p = 0.20).Conclusions
The present study suggests that TKA patients who receive ACB can achieve similar or even better recovery of quadriceps strength and mobilization ability than those treated with FNB. Taken as a whole, ACB may be a better analgesia strategy after TKA at present.20.
Burkhard?Ubrig Alexander?Roosen Christian?Wagner Guenter?Trabs Frank?Schiefelbein Jorn?H.?Witt Georg?Schoen Nina?Natascha?Harke