Pub Date : 2023-08-22DOI: 10.1177/15563316231190603
Sophia Mavrommatis, Aliya G. Feroe, R. Fader, Mahad M. Hassan
Although hip bracing after hip arthroscopy is relatively common, it is not an evidence-based practice; no comparative studies or clinical trials exploring its effectiveness exist. We sought to summarize the rates of and indications for hip bracing after hip arthroscopy, surgeons’ preferences on braces, and the types of braces used. A systematic review was conducted using the PubMed, Embase, and Medline databases to identify studies that examined hip bracing following hip arthroscopy. Two independent reviewers identified relevant studies with final inclusion determined by the senior author. Full-length, original research articles regarding relevant subject matter that were published prior to January 2022 were included in the analysis. Of the 52 articles that underwent full-text review, 14 were included (10 clinical case series, comparative studies, or case-control studies and 4 cross-sectional studies of surgeon-specific postoperative rehabilitation protocols). These studies revealed that the practice of hip bracing after hip arthroscopy is relatively common among orthopedic surgeons, with up to 40% of surgeons using them. Surgical indications for postoperative brace use varied widely. Recommendations on the length of brace use varied, but range of motion restrictions were consistent. Although up to 40% of surgeons use post-hip arthroscopy bracing, there is insufficient evidence to determine whether it improves patient outcomes. Research producing higher levels of evidence regarding the efficacy of bracing following hip arthroscopy is necessary to understand the physical, mental, and economic costs and benefits to patients.
{"title":"Postoperative Brace Use After Hip Arthroscopy: A Systematic Review","authors":"Sophia Mavrommatis, Aliya G. Feroe, R. Fader, Mahad M. Hassan","doi":"10.1177/15563316231190603","DOIUrl":"https://doi.org/10.1177/15563316231190603","url":null,"abstract":"Although hip bracing after hip arthroscopy is relatively common, it is not an evidence-based practice; no comparative studies or clinical trials exploring its effectiveness exist. We sought to summarize the rates of and indications for hip bracing after hip arthroscopy, surgeons’ preferences on braces, and the types of braces used. A systematic review was conducted using the PubMed, Embase, and Medline databases to identify studies that examined hip bracing following hip arthroscopy. Two independent reviewers identified relevant studies with final inclusion determined by the senior author. Full-length, original research articles regarding relevant subject matter that were published prior to January 2022 were included in the analysis. Of the 52 articles that underwent full-text review, 14 were included (10 clinical case series, comparative studies, or case-control studies and 4 cross-sectional studies of surgeon-specific postoperative rehabilitation protocols). These studies revealed that the practice of hip bracing after hip arthroscopy is relatively common among orthopedic surgeons, with up to 40% of surgeons using them. Surgical indications for postoperative brace use varied widely. Recommendations on the length of brace use varied, but range of motion restrictions were consistent. Although up to 40% of surgeons use post-hip arthroscopy bracing, there is insufficient evidence to determine whether it improves patient outcomes. Research producing higher levels of evidence regarding the efficacy of bracing following hip arthroscopy is necessary to understand the physical, mental, and economic costs and benefits to patients.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126561973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-17DOI: 10.1177/15563316231192952
Saad M Alqahtani, Sulaiman A. Elyahia, T. B. Abu-Amara, L. Aloraini, Shayma S. Alsubaie, T. Hegazi, M. Alzahrani
The acromiohumeral center-edge angle (ACEA) is a parameter that can be measured on plain shoulder radiographs and has been found to be associated with increased risk of sustaining a rotator cuff tear. The aim of this study was to investigate this association using plain radiographs and to explore its applicability on shoulder magnetic resonance imaging (MRI) in the same patients. This retrospective study compared 45 patients who underwent rotator cuff repair between September 2021 and April 2022 and 41 patients with normal shoulders. The ACEA was measured by 2 independent observers on anteroposterior radiographs and shoulder MRI. The collected data were analyzed and P values of <.05 were considered statistically significant. The ACEA was found to be higher in patients with rotator cuff tears (23.48° ± 7.11°) when compared with the control group (15.54° ± 4.4°). On shoulder MRI assessment, a higher ACEA was also seen in the rotator cuff tear group (18.93° ± 6.7°) than in the control group (13.79° ± 4.9°). The ACEA measurement on MRI showed strong intrarater reliability (0.965), but weak interrater reliability (0.251). This retrospective study found an association between increased ACEA and risk of rotator cuff tear when measured on plain radiographs. In addition, we found an association between increased ACEA measurement on shoulder MRI and rotator cuff tears, thus suggesting the applicability of ACEA measurement on shoulder MRI.
{"title":"The Acromiohumeral Center-Edge Angle and Risk of Rotator Cuff Tear: A Plain Radiograph and MRI Study","authors":"Saad M Alqahtani, Sulaiman A. Elyahia, T. B. Abu-Amara, L. Aloraini, Shayma S. Alsubaie, T. Hegazi, M. Alzahrani","doi":"10.1177/15563316231192952","DOIUrl":"https://doi.org/10.1177/15563316231192952","url":null,"abstract":"The acromiohumeral center-edge angle (ACEA) is a parameter that can be measured on plain shoulder radiographs and has been found to be associated with increased risk of sustaining a rotator cuff tear. The aim of this study was to investigate this association using plain radiographs and to explore its applicability on shoulder magnetic resonance imaging (MRI) in the same patients. This retrospective study compared 45 patients who underwent rotator cuff repair between September 2021 and April 2022 and 41 patients with normal shoulders. The ACEA was measured by 2 independent observers on anteroposterior radiographs and shoulder MRI. The collected data were analyzed and P values of <.05 were considered statistically significant. The ACEA was found to be higher in patients with rotator cuff tears (23.48° ± 7.11°) when compared with the control group (15.54° ± 4.4°). On shoulder MRI assessment, a higher ACEA was also seen in the rotator cuff tear group (18.93° ± 6.7°) than in the control group (13.79° ± 4.9°). The ACEA measurement on MRI showed strong intrarater reliability (0.965), but weak interrater reliability (0.251). This retrospective study found an association between increased ACEA and risk of rotator cuff tear when measured on plain radiographs. In addition, we found an association between increased ACEA measurement on shoulder MRI and rotator cuff tears, thus suggesting the applicability of ACEA measurement on shoulder MRI.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"476 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132093550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-15DOI: 10.1177/15563316231187383
M. Sahr, Ryan E. Breighner, A. Burge, O. Nwawka, G. Konin, D. Helfet, H. Potter
Background: Zero echo time (ZTE) imaging is a relatively new magnetic resonance (MR) pulse sequence that provides bone-soft tissue contrast similar to that of computed tomography (CT). Purpose: We sought to (1) determine the accuracy of ZTE MRI for the diagnosis of common ankle fractures and (2) investigate whether ZTE imaging sequences are equivalent to the gold standard of CT for the characterization of fracture fragments. Methods: We conducted a prospective case series of 54 patients with acute ankle trauma, in whom ZTE MRI was performed, followed by surgical reduction. Fractures on the ZTE sequence were correlated with the operative report as the reference standard. Raw agreement (%) and correlation (κ) were calculated. Selected fracture fragments were measured in 2 dimensions (anterior-posterior and superior-inferior) on corresponding sagittal ZTE and CT images by 3 independent radiologists to determine reliability. Results: The ZTE sequence demonstrated 47 distal fibular, 17 medial malleolar, 24 posterior malleolar, 5 anterior talofibular ligament avulsion, and 4 distal tibial fractures on the 54 cases. Raw agreement with operative findings was 95% (range: 86%-100%) and correlation almost perfect (0.960 [0.926-0.995]). Fragment characterization was accurate and repeatable. Intraobserver and interobserver agreement was excellent. Conclusions: Our case series suggests that the use of the MRI ZTE sequence may provide images with CT-like contrast for characterizing acute ankle fractures.
{"title":"Utility of Zero Echo Time MRI for the Diagnosis and Characterization of Ankle Fractures","authors":"M. Sahr, Ryan E. Breighner, A. Burge, O. Nwawka, G. Konin, D. Helfet, H. Potter","doi":"10.1177/15563316231187383","DOIUrl":"https://doi.org/10.1177/15563316231187383","url":null,"abstract":"Background: Zero echo time (ZTE) imaging is a relatively new magnetic resonance (MR) pulse sequence that provides bone-soft tissue contrast similar to that of computed tomography (CT). Purpose: We sought to (1) determine the accuracy of ZTE MRI for the diagnosis of common ankle fractures and (2) investigate whether ZTE imaging sequences are equivalent to the gold standard of CT for the characterization of fracture fragments. Methods: We conducted a prospective case series of 54 patients with acute ankle trauma, in whom ZTE MRI was performed, followed by surgical reduction. Fractures on the ZTE sequence were correlated with the operative report as the reference standard. Raw agreement (%) and correlation (κ) were calculated. Selected fracture fragments were measured in 2 dimensions (anterior-posterior and superior-inferior) on corresponding sagittal ZTE and CT images by 3 independent radiologists to determine reliability. Results: The ZTE sequence demonstrated 47 distal fibular, 17 medial malleolar, 24 posterior malleolar, 5 anterior talofibular ligament avulsion, and 4 distal tibial fractures on the 54 cases. Raw agreement with operative findings was 95% (range: 86%-100%) and correlation almost perfect (0.960 [0.926-0.995]). Fragment characterization was accurate and repeatable. Intraobserver and interobserver agreement was excellent. Conclusions: Our case series suggests that the use of the MRI ZTE sequence may provide images with CT-like contrast for characterizing acute ankle fractures.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123434367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-20DOI: 10.1177/15563316231183380
J. Blum, R. C. Clark, Alexander N. Berk, G. Leach, Riley A. Dean, D. Villavisanis, Frank E. Chiarappa, C. Reid
{"title":"Principles of Photography and Videography: Lessons From Orthoplastic Sarcoma Surgery","authors":"J. Blum, R. C. Clark, Alexander N. Berk, G. Leach, Riley A. Dean, D. Villavisanis, Frank E. Chiarappa, C. Reid","doi":"10.1177/15563316231183380","DOIUrl":"https://doi.org/10.1177/15563316231183380","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126187246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-17DOI: 10.1177/15563316231183093
Mohammed A. Munim, Linsen T Samuel, James Rosneck, A. Kamath
Studies on the feasibility of hip arthroscopy in workers’ compensation (WC) patients have been largely inconsistent or limited by study design, necessitating the need for a systematic review. We sought to systematically compare clinically significant differences between WC patients and their counterparts in relation to (1) functional outcomes, (2) complications, and (3) failure rates after hip arthroscopy. We searched MEDLINE, EMBASE, and PubMed databases for studies published between January 1996 and February 2021. In combination with “AND” or “OR” Boolean operators, the following keywords were implemented: “hip arthroscopy,” “workers’ compensation,” “outcomes,” “complications,” “revision,” and “failure rates.” Two reviewers screened eligible studies, evaluated methodological quality, and abstracted data. In the 13 studies pooled, comprising 1874 patients, 276 (14.7%) patients received WC benefits. Twelve studies utilized functional outcomes, 2 studies assessed pain, and 3 studies evaluated satisfaction. Despite scoring lower in these measures preoperatively, WC patients demonstrated significant improvements after hip arthroscopy. Three studies linked compensation with marginally inferior functional scores, but this association was not significant at longer follow-up. Seven studies examined complication incidence, and 6 studies addressed failure rates, with all reporting no significant differences in rates of complications, secondary arthroscopies, or conversion to total hip arthroplasty. The findings of this systematic review suggest that hip arthroscopy offers clinically significant benefits, regardless of WC status. Postoperative results in WC patients, including functional scores, pain, satisfaction, complications, and failure rates, were favorable, and the degree of improvement was at least comparable with their counterparts. Further studies should consider prospective study designs with larger cohorts and extended follow-up.
{"title":"Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review","authors":"Mohammed A. Munim, Linsen T Samuel, James Rosneck, A. Kamath","doi":"10.1177/15563316231183093","DOIUrl":"https://doi.org/10.1177/15563316231183093","url":null,"abstract":"Studies on the feasibility of hip arthroscopy in workers’ compensation (WC) patients have been largely inconsistent or limited by study design, necessitating the need for a systematic review. We sought to systematically compare clinically significant differences between WC patients and their counterparts in relation to (1) functional outcomes, (2) complications, and (3) failure rates after hip arthroscopy. We searched MEDLINE, EMBASE, and PubMed databases for studies published between January 1996 and February 2021. In combination with “AND” or “OR” Boolean operators, the following keywords were implemented: “hip arthroscopy,” “workers’ compensation,” “outcomes,” “complications,” “revision,” and “failure rates.” Two reviewers screened eligible studies, evaluated methodological quality, and abstracted data. In the 13 studies pooled, comprising 1874 patients, 276 (14.7%) patients received WC benefits. Twelve studies utilized functional outcomes, 2 studies assessed pain, and 3 studies evaluated satisfaction. Despite scoring lower in these measures preoperatively, WC patients demonstrated significant improvements after hip arthroscopy. Three studies linked compensation with marginally inferior functional scores, but this association was not significant at longer follow-up. Seven studies examined complication incidence, and 6 studies addressed failure rates, with all reporting no significant differences in rates of complications, secondary arthroscopies, or conversion to total hip arthroplasty. The findings of this systematic review suggest that hip arthroscopy offers clinically significant benefits, regardless of WC status. Postoperative results in WC patients, including functional scores, pain, satisfaction, complications, and failure rates, were favorable, and the degree of improvement was at least comparable with their counterparts. Further studies should consider prospective study designs with larger cohorts and extended follow-up.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130403455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-06DOI: 10.1177/15563316231183971
Rex W. Lutz, Z. Post, Hope S Thalody, Miranda Czymek, D. Ponzio, Christopher E. Kim, A. Ong
Selective genicular artery embolization (GAE) has shown promise as a minimally invasive treatment option for persistent symptomatic recurrent effusions (REs) following total knee arthroplasty (TKA). We sought to investigate the radiographic and clinical success of GAE for RE after TKA. We performed a retrospective review of prospectively collected data on primary and revision TKA patients with RE, both hemorrhagic and non-hemorrhagic, who underwent GAE between 2019 and 2021 with a minimum of 6-month follow-up. All embolization procedures were performed by a single interventional radiologist. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores were collected prior to GAE and at 1, 3, and 6 months post-procedure. Recurrence of effusion following GAE was assessed at 6 months using ultrasound. Seventeen patients, 10 female and 7 male, with 18 TKAs and a mean (SD) age of 63.1 (8.6) years were included. We saw a mean (SD) of 36.1 (24.4) and 3.3 (3.0) point improvement in WOMAC and VAS scores, respectively. In addition, 14 of the 18 TKAs (77.8%) seen at final follow-up had complete resolution of effusion confirmed by ultrasound. Our retrospective review found that a majority of patients showed significant clinical improvement and resolution of effusion following GAE. These findings suggest that GAE may be an effective minimally invasive treatment option for RE following TKA and should be further investigated.
{"title":"Genicular Artery Embolization: A Promising Treatment Option for Recurrent Effusion Following Total Knee Arthroplasty","authors":"Rex W. Lutz, Z. Post, Hope S Thalody, Miranda Czymek, D. Ponzio, Christopher E. Kim, A. Ong","doi":"10.1177/15563316231183971","DOIUrl":"https://doi.org/10.1177/15563316231183971","url":null,"abstract":"Selective genicular artery embolization (GAE) has shown promise as a minimally invasive treatment option for persistent symptomatic recurrent effusions (REs) following total knee arthroplasty (TKA). We sought to investigate the radiographic and clinical success of GAE for RE after TKA. We performed a retrospective review of prospectively collected data on primary and revision TKA patients with RE, both hemorrhagic and non-hemorrhagic, who underwent GAE between 2019 and 2021 with a minimum of 6-month follow-up. All embolization procedures were performed by a single interventional radiologist. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores were collected prior to GAE and at 1, 3, and 6 months post-procedure. Recurrence of effusion following GAE was assessed at 6 months using ultrasound. Seventeen patients, 10 female and 7 male, with 18 TKAs and a mean (SD) age of 63.1 (8.6) years were included. We saw a mean (SD) of 36.1 (24.4) and 3.3 (3.0) point improvement in WOMAC and VAS scores, respectively. In addition, 14 of the 18 TKAs (77.8%) seen at final follow-up had complete resolution of effusion confirmed by ultrasound. Our retrospective review found that a majority of patients showed significant clinical improvement and resolution of effusion following GAE. These findings suggest that GAE may be an effective minimally invasive treatment option for RE following TKA and should be further investigated.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125133014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-06DOI: 10.1177/15563316231183379
Tejas Subramanian, O. Maayan, Pratyush Shahi, Jerry Y. Du, Kasra Araghi, Troy B. Amen, Daniel Shinn, Junho Song, Sidhant S. Dalal, Evan D. Sheha, James Dowdell, S. Iyer, S. Qureshi
Performing lateral lumbar interbody fusion (LLIF) in a single prone position may pose many advantages over the traditional lateral decubitus position, but there are questions concerning its safety profile and outcomes. We sought to study the safety and efficacy of LLIF performed with the patient in the prone position. We conducted a retrospective cohort study including patients who underwent primary LLIF in the prone position for degenerative lumbar conditions. Complications and patient-reported outcome measures (PROMs) (Oswestry Disability Index [ODI], and visual analogue scale [VAS] scores for leg and back pain) were collected. Patients who underwent single-position prone LLIF were then propensity score matched for age, race, comorbidity index, number of levels, body mass index, and smoking status with patients who underwent single-position lateral LLIF. Patient-reported outcome measures and complications were compared between the 2 groups. Two postoperative timepoints were defined: early (<6 months) and late (≥6 months). Twenty single-position prone LLIF patients were included (35% 1-level, 35% 2-level, 15% 3-level, and 15% 4-level). No intraoperative complications were reported. Eleven (55%) patients experienced transient postoperative anterior thigh weakness. Five (25%) patients experienced postoperative complications such as anemia, urinary retention, ileus, and new-onset sensory symptoms. Oswestry Disability Index, VAS leg, and VAS back scores all improved at the >6-month time point compared with preoperative states. There were no significant differences at any postoperative time point for PROMs between prone and lateral LLIF groups. Among the matched cohort, complications were observed in 3 (21%) of patients compared with only 1 (7%) in the lateral group although this difference was not statistically significant. This retrospective study suggests that prone LLIF procedures may be safe and effective. Ergonomic and logistic benefits from the approach may make it a beneficial approach for surgeons to begin implementing.
{"title":"Early Experiences With Single-Position Prone Lateral Lumbar Interbody Fusion: Safety and Outcomes","authors":"Tejas Subramanian, O. Maayan, Pratyush Shahi, Jerry Y. Du, Kasra Araghi, Troy B. Amen, Daniel Shinn, Junho Song, Sidhant S. Dalal, Evan D. Sheha, James Dowdell, S. Iyer, S. Qureshi","doi":"10.1177/15563316231183379","DOIUrl":"https://doi.org/10.1177/15563316231183379","url":null,"abstract":"Performing lateral lumbar interbody fusion (LLIF) in a single prone position may pose many advantages over the traditional lateral decubitus position, but there are questions concerning its safety profile and outcomes. We sought to study the safety and efficacy of LLIF performed with the patient in the prone position. We conducted a retrospective cohort study including patients who underwent primary LLIF in the prone position for degenerative lumbar conditions. Complications and patient-reported outcome measures (PROMs) (Oswestry Disability Index [ODI], and visual analogue scale [VAS] scores for leg and back pain) were collected. Patients who underwent single-position prone LLIF were then propensity score matched for age, race, comorbidity index, number of levels, body mass index, and smoking status with patients who underwent single-position lateral LLIF. Patient-reported outcome measures and complications were compared between the 2 groups. Two postoperative timepoints were defined: early (<6 months) and late (≥6 months). Twenty single-position prone LLIF patients were included (35% 1-level, 35% 2-level, 15% 3-level, and 15% 4-level). No intraoperative complications were reported. Eleven (55%) patients experienced transient postoperative anterior thigh weakness. Five (25%) patients experienced postoperative complications such as anemia, urinary retention, ileus, and new-onset sensory symptoms. Oswestry Disability Index, VAS leg, and VAS back scores all improved at the >6-month time point compared with preoperative states. There were no significant differences at any postoperative time point for PROMs between prone and lateral LLIF groups. Among the matched cohort, complications were observed in 3 (21%) of patients compared with only 1 (7%) in the lateral group although this difference was not statistically significant. This retrospective study suggests that prone LLIF procedures may be safe and effective. Ergonomic and logistic benefits from the approach may make it a beneficial approach for surgeons to begin implementing.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121888745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1177/15563316231183443
Taylor J Reif, Nathan Khabyeh-Hasbani, T. Shin, S. Rozbruch, A. Fragomen
Axial malalignment of the bilateral femurs and tibias, previously known as “miserable” malalignment, now renamed tetratorsional malalignment (TTM), presents with hip and/or knee pain refractory to nonoperative treatment. We sought to investigate whether bilateral rotational osteotomy of the femur and tibia leads to improvement in a deformity-specific patient-reported outcome measure (PROM). A retrospective review of patients who underwent staged rotational correction of the bilateral femur and tibias was performed. Computed tomography (CT) was used to measure the preoperative rotational profile and plan the surgical correction. Stabilization was predominantly with intramedullary nails. The primary outcome measure was the Limb Deformity-modified Scoliosis Research Society (LDSRS) score. Secondary outcomes included change in mechanical limb alignment and complications of the procedure. Sixteen patients (13 female and 3 male) with average age of 23.1 years (range: 15–36 years) underwent 4-segment rotational correction. The averages for femoral and tibial deformity correction were 23.5° (6.2° SD) and 20.9° (5.2° SD), respectively. The total LDSRS score improved from 3.67 (0.3 SD) to 4.39 (0.3 SD) ( P = .001). The LDSRS sub-scores for function, pain, and self-image also significantly improved. In patients not undergoing concurrent coronal deformity correction, the limb mechanical axis was not significantly changed. No additional procedures were performed to obtain bone union. Three patients required peroneal nerve decompression following the index procedure, and all neurologic symptoms resolved. This retrospective review suggests that correction of TTM of the lower extremities may lead to improvements in function, pain, and self-image. There were minimal complications and no iatrogenic deformity among 16 patients reviewed. The new diagnosis, TTM, is descriptive of this debilitating condition without communicating a negative patient image.
{"title":"Correction of Tetratorsional Malalignment of the Lower Extremities Improves Patient-Reported Outcomes","authors":"Taylor J Reif, Nathan Khabyeh-Hasbani, T. Shin, S. Rozbruch, A. Fragomen","doi":"10.1177/15563316231183443","DOIUrl":"https://doi.org/10.1177/15563316231183443","url":null,"abstract":"Axial malalignment of the bilateral femurs and tibias, previously known as “miserable” malalignment, now renamed tetratorsional malalignment (TTM), presents with hip and/or knee pain refractory to nonoperative treatment. We sought to investigate whether bilateral rotational osteotomy of the femur and tibia leads to improvement in a deformity-specific patient-reported outcome measure (PROM). A retrospective review of patients who underwent staged rotational correction of the bilateral femur and tibias was performed. Computed tomography (CT) was used to measure the preoperative rotational profile and plan the surgical correction. Stabilization was predominantly with intramedullary nails. The primary outcome measure was the Limb Deformity-modified Scoliosis Research Society (LDSRS) score. Secondary outcomes included change in mechanical limb alignment and complications of the procedure. Sixteen patients (13 female and 3 male) with average age of 23.1 years (range: 15–36 years) underwent 4-segment rotational correction. The averages for femoral and tibial deformity correction were 23.5° (6.2° SD) and 20.9° (5.2° SD), respectively. The total LDSRS score improved from 3.67 (0.3 SD) to 4.39 (0.3 SD) ( P = .001). The LDSRS sub-scores for function, pain, and self-image also significantly improved. In patients not undergoing concurrent coronal deformity correction, the limb mechanical axis was not significantly changed. No additional procedures were performed to obtain bone union. Three patients required peroneal nerve decompression following the index procedure, and all neurologic symptoms resolved. This retrospective review suggests that correction of TTM of the lower extremities may lead to improvements in function, pain, and self-image. There were minimal complications and no iatrogenic deformity among 16 patients reviewed. The new diagnosis, TTM, is descriptive of this debilitating condition without communicating a negative patient image.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"206 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131977531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-26DOI: 10.1177/15563316231179472
C. Mancuso, L. Robbins
Physicians understand that certain personal attributes are essential in medical leaders, but they often do not know what actions are expected of them as leaders or what they should do to be more effective leaders. We sought to compile, through interviews with senior leaders at an academic institution, real leadership scenarios for a series of case-based examples to be used during group mentoring sessions for aspiring medical leaders. We conducted one-to-one interviews using open-ended questions with 11 current and emeritus chairpersons or chiefs of major departments or divisions at our academic medical center. Questions were designed to elicit anecdotes and examples of actions that demonstrate effective and ineffective leadership. Responses were analyzed with qualitative techniques to generate topics of leadership behaviors, which then were compiled into a collection of illustrative examples. The leaders interviewed discussed challenges they encountered in daily routines and described how they addressed certain dilemmas. Topics included making decisions without complete information, winning over reluctant administrators, building alliances with peers, involving subordinates in initiatives, and using knowledge to defend one’s position. Actions requiring interpersonal skills also were discussed, including varying modes of communication, avoiding adversity, displaying gratitude toward subordinates, and safeguarding one’s professional image. The leaders’ insights and recommendations were compiled into a themed collection of topics to be used during group mentoring sessions to enhance leadership skills. This qualitative study suggests that the wisdom and experience of senior leaders may be gleaned for a collection of case-based topics that could complement other formal training programs for aspiring medical leaders.
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Pub Date : 2023-06-26DOI: 10.1177/15563316231183346
Emily Pilc, S. Washburn, H. R. Tuten
{"title":"Volar Radiocarpal Dislocation in a Child With Trisomy 21: A Case Report","authors":"Emily Pilc, S. Washburn, H. R. Tuten","doi":"10.1177/15563316231183346","DOIUrl":"https://doi.org/10.1177/15563316231183346","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125180540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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