Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China

Displaced acetabular fractures should be treated surgically. Over the past decade, surgical approaches to the acetabulum and the surgical technique for repair of common fracture patterns have advanced. Excellent outcomes after repair of these injuries can be achieved. The aim of this study was to assess the medium-term results of reconstruction of acetabular fractures by using shape-memory alloy designed by the authors. This is a retrospective review conducted at a level 1 trauma centre. From October 1999 to July 2009, 19 patients with acetabular fractures were treated with our patented Ni-Ti shape-memory alloy acetabular tridimensional memory alloy-fixation system (ATMFS). The ATMFS device was cooled with ice before implantation and then warmed to 40–50°C after implantation to produce balanced axial and compression forces that would stabilise the fracture three dimensionally. Our results are as follows; according to the D’Aubigne−Postel scoring system: Fifteen cases out of 19 (79%) achieved excellent or good clinical results. In two patients, late complications included avascular necrosis of the femoral head (ANFH) associated with posterior dislocation of the hip joint two years after the operation. We also observed two cases of grade II or III ectopic ossification, with good hip function, and one case of traumatic arthritis. In conclusion, these results demonstrate the effectiveness of the ATMFS device for the management of acetabular fracture. The device provides continuous compression of the fracture with minimal disruption to the local blood supply.     

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.     

Tunnel enlargement 5 years after anterior cruciate ligament reconstruction: a radiographic and functional evaluation

Purpose

The aetiology and clinical significance of enlargement of bone tunnels following anterior cruciate ligament (ACL) reconstruction remains controversial. This phenomenon has been attributed to biological factors and mechanical factors. We wanted to study the amount of femoral and tibial tunnel enlargement 5 years post-ACL reconstruction. By standardizing the type of femoral fixation, we also wanted to determine whether the type of tibial fixation had any bearing to the amount of tibial tunnel enlargement.

Methods

All patients who underwent arthroscopic hamstring autograft ACL reconstruction between January 2000 and December 2000 were identified. All grafts were fixed with close-looped endobutton proximally. The grafts were fixed on the tibial side with staples or bioabsorbable interference screws. At a minimum of 5 years after surgery, these patients were recalled. They were assessed with Lysholm knee, Tegner activity and the IKDC Subjective and Objective forms and a KT-1000 arthrometer. The diameter of the bone tunnels and tunnel positions in the anterior–posterior and lateral radiographs were measured using digital callipers by a two blinded researchers.

Results

We found that the femoral tunnel enlarged more than the tibial tunnel. At 5 years, the mean tibial tunnel enlargement was 2.46 mm and the mean femoral tunnel enlargement was 3.23 mm. All 54 patients had endobutton femoral fixation. Of them, 34 patients had tibial graft fixation with staples (extracortical fixation) and 20 patients had tibial graft fixation with bioabsorbable interference screws (aperture fixation). The mean enlargement as measured by the two independent observers in the extracortical group was 1.98 mm (24.7 %)* and 1.51 mm (18.2 %)**compared to 3.27 mm (40.4 %)* and 2.92 mm (30.0 %)** in the aperture fixation group. This difference in tibial tunnel enlargement between the groups was significant (p < 0.001, mean difference 1.29 mm). However, this was not correlated with any significant difference in clinical outcome at 5 years.

Conclusion

We, like some authors, have shown that the use of interference screws in tibial fixation despite being aperture fixation actually has a greater amount of tibial enlargement. This lends weight to the biological theory to tunnel enlargement.     

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.     

Isolated acetabular revision after total hip arthroplasty: results at 5–9 years of follow-up

The purpose of the study was to determine whether isolated revision of the acetabular component can be successfully performed without disturbing the femoral stem and to determine the fate of the unrevised femoral stem following revision. Fifty-seven hips in 55 patients underwent isolated acetabular revision without removal of the femoral component. Thirty-three hips with minimal acetabular deficiency required no bone grafting; the remaining 24 hips were treated by morselized or structural allograft in addition to a new acetabular component. Twenty-two of these 24 hips demonstrated incorporation of the bone graft. A mean follow-up of 5.8 (5–9) years, all femoral and acetabular components were judged to be stable and well fixed.

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Résumé Le but de létude est de déterminer si la révision isolé du composant acétabulaire peut être exécutée avec succès sans déranger la tige fémorale et, deuxièmement, de déterminer lavenir de la tige fémorale laissée en place, après cette révision. Cinquante-sept hanches chez cinquante-cinq malades ont subi une révision acétabulaire isolée sans ablation du composant fémoral. Trente-trois hanches avec une déficience acétabulaire minime nont exigé aucune greffe osseuse; les 24 hanches restantes ont été traitées par une allogreffe morcelée ou structurelle associée à un nouveau composant acétabulaire. Vingt-deux de ces 24 hanches ont montré une incorporation de la greffe dos. A un suivi moyen de 5,8 ans (5 à 9 ans) tout les composants fémoraux et acétabulaires ont été jugés stables et bien fixés.

     

Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years

It is not known whether the results of decompressive surgery to treat the mild and moderate forms of spondylotic cervical myelopathy (CSM) are any better than those of a conservative approach. A 10-year prospective randomised study was performed. The objective of the study was to compare conservative and operative treatments of mild and moderate, non-progressive, or slowly progressive, forms of CSM. Sixty-four patients were randomised into two groups of 32. Group A was treated conservatively while group B was treated surgically. The clinical outcome was evaluated by modified JOA score, timed 10-m walk, score of daily activities recorded by video and evaluated by two observers blinded to the type of therapy, and by subjective assessment by the patients themselves. Seventeen patents died of natural, unrelated causes, during the follow-up. A total of 25 patients in the conservatively and 22 in the surgically treated group were used for the final evaluation. There was no statistically significant difference between both groups in mJOA score, in subjective evaluation by the patients themselves and in evaluation of video-recordings of daily living activities by two observers blinded to treatment mode. There was neither any difference found in the percentage of patients losing the ability to walk nor in the time taken to cover the 10-m track from a standing start. Comparison of conservative and surgical treatment in mild and moderate forms of CSM in a 10-year follow-up has not shown, on average, a significant difference in results. In both groups, patients get better and worse. According to the power analysis it is necessary admit that these results possess the low ability to answer definitely the question which treatment is better for the patients with a mild and moderate non-progressive CSM because of the low number of patients for the final evaluation and for clinically negligible differences between two compared arms. These findings can serve as a worthy odds-on hypothesis which needs the confirmation.     

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.

     

Partners agree that the treatment of LUTS reduces patients’ bother and improves their quality of life: prospective 12 years follow-up study

Objectives  

To determine if the partner (partner or spouse) can reliably assess the quality of life (QoL) and bother of the patient suffering from lower urinary tract symptoms (LUTS) before and after treatment thereby assisting in management.     

Closed reduction and percutaneus Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique,complications, clinical and radiological results after 2–10 years

Introduction

To reduce complications, a minimally invasive technique for the treatment of dislocated intraarticular fractures of the calcaneus was used. Therefore previously described closed reduction and internal fixation techniques were combined and modified.

Materials and methods

Sixty-seven out of 92 calcaneal fractures could be retrospectively evaluated with an average follow-up time of 5.7 years (minimum 2–10 years follow-up). For radiographic evaluation, plain radiographs and CT scans were obtained. The Zwipp score was used for clinical evaluation. Sanders type II, III and IV fractures were diagnosed.

Results

Length of surgery averaged 61 min (range 20–175 min). The incidence of subtalar arthritis was correlated to the severity of fracture. Böhler’s angle was restored in 70.1% (47 of 67) of the cases. On the last follow-up evaluation the average Zwipp score was 130 points (range 48–186 points). The majority (77.7%) of patients were content with their treatment result. The rate of significant complications was 6.5%.

Discussion

Compared to open techniques the presented minimally invasive technique showed comparable results with a low rate of serious complications and is a viable alternative for the treatment of intraarticular, dislocated calcaneal fractures.

     

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.     

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.     

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.

     

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.     

Transsphenoidal surgical treatment of pituitary adenomas in patients aged 80 years or older

To know the clinical characteristics of pituitary adenomas in the elderly patients aged 80 years or older who were surgically treated. From 1995 through 2012, 907 patients underwent surgery for the pituitary adenomas at Kagoshima- and Hiroshima University hospitals in Japan. Ten (1.1 %) patients were aged 80 years or older. We retrospectively assessed the clinical characteristics including preoperative comorbidities, manifestations, neuroimaging findings, and endocrinologic features of these ten patients. The subjects included eight males and two females. Their ages ranged from 80 to 86 with mean of 83.1 years. Of these, besides one case of growth hormone-producing adenoma, others were clinically nonfunctioning adenoma. Six patients had modest comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, or chronic kidney dysfunction, and all patients were classified into grade 2–3 on American Society of Anesthesiologists’ Physical Status grading. Transsphenoidal surgery was performed in all due to visual disturbance in eight, diabetes mellitus as an intercurrent illness of acromegaly in one, and for the purpose of preventing visual disturbance in one patient who had an adenoma impinging optic chiasm but still had normal visual field. The surgeries provided sufficient decompression of the optic pathways and improved visual disorder in all. In an acromegalic male, his comorbidities considerably improved. No permanent surgical morbidity ensued. More than three axes of anterior pituitary hormones were preoperatively impaired in all, which were rarely recovered. Transsphenoidal surgery is safe and efficient treatment way for patients aged 80 years or older with pituitary adenomas with chiasmatic symptoms when the patients’ general condition is well preserved and pituitary hormonal deficiency is adequately replaced.     

Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years

Background  

Gastric band erosion is a well-reported complication after laparoscopic adjustable gastric banding (LAGB). The published literature is limited and inconclusive with regard to its management. The authors therefore reviewed all band erosions detected during a 5-year period in a high-volume bariatric practice. Because a significant proportion of the band insertions (65%) were undertaken by an operator beyond his learning curve, the authors hoped to gain a mature, comprehensive understanding of this significant complication.