Hss Journal最新文献

Background: Bioactive glass (BG) is a promising alternative to conventional autogenous and allogeneic bone grafts with osteoconductive, osteoinductive, and antimicrobial properties. The effects of its use in comparison to allograft in the context of benign bone lesions remain less explored.

Purpose: We sought to compare the efficacy of 45S5 BG granules to allograft in treating benign bone lesions.

Methods: This retrospective study compared the outcomes of 45S5 BG granules and allograft bone in 42 patients undergoing curettage for benign bone lesions. Patients were divided into 2 groups based on the graft material used (n = 21 in each group). Radiological evaluation using the modified Neer classification and functional assessment using the Musculoskeletal Tumor Society (MSTS) score were performed. Complications and time to return to previous activity levels were also recorded.

Results: No significant differences were found between the BG and allograft groups in terms of postoperative Neer scores, postoperative MSTS scores, complication rates, or time to return to previous activity levels. Both groups showed significant improvement in MSTS scores over time, although improvement in MSTS scores for both groups did not reach the minimal clinically important difference, suggesting that the observed changes may not be clinically significant.

Conclusion: This retrospective study found that BG demonstrated comparable efficacy to allograft cancellous bone in the treatment of benign bone lesions, suggesting that it may serve as a suitable alternative. Further study should focus on longer-term follow-up and larger sample sizes to further elucidate the role of BG in the management of these lesions.

Background: It is unclear what influence patient sex and body mass index (BMI) have on perioperative outcomes following total hip arthroplasty (THA), especially regarding anterior versus posterolateral approaches. Purpose/Study Questions: We sought to compare perioperative outcomes of primary THA via direct anterior (DAA) versus posterolateral (PLA) approaches, stratified by patient sex and BMI. Methods: A retrospective review at a single institution identified 8258 patients 18 to 80 years old who underwent primary THA via DAA or PLA for osteoarthritis between February 2019 and April 2022. Patients were stratified by sex and BMI (<30 or 30-40). We compared operative times, lengths of stay (LOS), opioid consumption and prescribing patterns, and achievement of Hip Injury and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) across the cohorts. Results: Median operative time was 6 to 11 minutes longer for DAA than for PLA. Median LOS was shorter for DAA, with the largest difference observed in women with BMI <30 (19-hour difference) and BMI 30 to 40 (20-hour difference). In-hospital milligram morphine equivalents consumed were lower for DAA in men with BMI <30 (45 vs 53), women with BMI <30 (45 vs 53), and women with BMI 30-40 (60 vs 75). There was no difference observed in HOOS JR MCID, SCB, or PASS achievement scores at 1 year for any cohort. Conclusion: This retrospective study found longer operative times for DAA than PLA and shorter LOS in women undergoing DAA than those undergoing PLA. There were minimal clinical differences in in-hospital opioid consumption, 90-day opioid prescription patterns, and patient-reported outcome measures. These findings suggest that patient sex and BMI may have implications on case scheduling and discharge planning for primary THA. Further study is warranted.

Background: Pedicle screw placement during spine fusion is physically and mentally demanding for surgeons. Consequently, spine surgeons can become fatigued, which has implications for both patient safety and surgeon well-being.

Purpose: We sought to assess the cognitive workload of surgeons placing pedicle screws using robotic-assisted navigation compared with fluoroscopic and computed tomography (CT)-assisted placement.

Methods: We performed a nonrandomized prospective controlled trial to compare the cognitive workload of 3 surgeons performing single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using robotic, CT, or fluoroscopic navigation on 25 patients (15 in the robotic navigation group and 10 in the nonrobotic group). Immediately after each procedure, surgeons submitted the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), which has 6 subscales: mental demands, physical demands, temporal demands, performance, effort, and frustration. Four tasks associated with pedicle screw placement were assessed independently: (1) screw planning, (2) calibrating robot/obtaining imaging/registration, (3) pedicle cannulation, and (4) screw placement. Patient demographics and surgical characteristics were obtained and reviewed.

Results: Surgeons' self-reported cognitive workload was significantly reduced when using robotic-assisted navigation versus CT/fluoroscopic navigation. Workload was reduced for screw planning, pedicle cannulation, and screw placement. In addition, there were significant reductions in each subdomain for these 3 tasks, encompassing mental demand, physical demand, temporal demand, effort, and frustration with improved task performance.

Conclusions: This study found significant reductions in mental workload with improved perceived performance for robotic-assisted pedicle screw placement compared with fluoroscopic and CT-navigation techniques. Lowering the cognitive burden associated with screw placement may allow surgeons to address the remainder of the operative case with less decision fatigue, prevent complications, and increase surgeon wellness.

Background: Correct localization and characterization of nerve abnormality is of critical importance to appropriate intervention. Ultrasound (US) is known to be accurate in the diagnosis of peripheral neuropathy and in preoperative localization of nerve abnormalities and skin marking.

Purpose: We sought to investigate the utility of US-guided preoperative skin marking for the localization of peripheral nerve abnormality and to compare the US findings to electrodiagnostic (EDx) reports.

Methods: Using the radiology information system at a single institution, we identified US examinations performed for preoperative localization of peripheral nerve abnormality from July 2016 to March 2023. Data collected included US characterization, surgical description, and EDx report of neuropathy.

Results: Search parameters identified 67 nerves in 55 patients treated surgically after US-guided localization of the nerve with skin marking. The EDx characterization was performed in 36 (54%) of these cases. The US diagnoses included neuroma, transection, perineural scarring, hardware impingement, and intraneural fascicular constriction. There was 100% accuracy of US findings as confirmed by operative notes. Skin marking by US guidance correlated to the sites of the nerve documented in operative reports of all 67 cases.

Conclusion: In this single-institution retrospective review, US-guided preoperative skin marking of nerve abnormality was used to correctly localize peripheral nerve abnormality, and US diagnoses were corroborated by intraoperative findings. Further higher-level study is needed to support these findings suggesting the efficacy of US in mapping the course of peripheral nerves.

Background: Clinical practice guidelines (CPGs) are developed to synthesize evidence into recommendations for clinical practice. Minimal evidence exists on the evaluation practice of physical therapists in the treatment of patients with neck pain. Purpose: We sought to describe (1) the extent to which clinicians perform the Neck Pain CPG-recommended examination measures and (2) the percentage of patients properly classified. Methods: We retrospectively analyzed the electronic health records of 397 patients with neck pain at an ambulatory care setting in an academic medical center. The frequency of physical therapists' evaluation measures, subjective findings, positive examination results, and the percentage of patients properly classified into impairment-based categories (IBCs) were recorded. Descriptive statistics and χ² tests were used to assess patient demographics and compare classification accuracy across IBCs. Results: Of the 397 patients, 56% were classified into an IBC. The most common IBC was neck pain with mobility deficits (24%), followed by neck pain with radiating pain (17%), neck pain with movement coordination impairments (NPMCIs) (8%), and neck pain with headache (6%). Neck pain with movement coordination impairment had the lowest percentage of proper classifications. Classification accuracy was highest when subjective and objective findings were combined and varied between IBCs. Conclusion: Our findings suggest that physical therapists evaluating patients with neck pain may have increased classification accuracy when subjective and objective findings are considered. Decreased classification accuracy was demonstrated in the NPMCI category, highlighting opportunities for further education and research.

Background: Restoring leg length during total hip arthroplasty (THA) for femoral neck fracture is challenging due to the lack of an intact femoral neck on the fractured side. Thus, templating methods typically use size of the intact contralateral hip to estimate length. Common reference points include the distance from the lesser trochanter to the center of the femoral head (LTC) and femoral head diameter (FHD). Objectives: We sought to (1) investigate the LTC:FHD ratio as a preoperative templating method and (2) compare this method with calibrated LTC measurements. Methods: We performed a retrospective review of patients undergoing primary THA between 2021 and 2022 with recorded intraoperative measurements of LTC and FHD at a single academic orthopedic specialty hospital. Preoperative hip X-rays were used to determine the "predicted LTC length" with 2 separate methods: the LTC:FHD ratio yielding the "Ratio Predicted LTC" and the calibrated measurements method yielding the "Calibrated Predicted LTC." These measurements were compared with intraoperative measurements of the LTC length to determine accuracy. Results: Sixty-two hips in 59 patients were studied. The ratio predicted LTC and contralateral ratio predicted LTC length showed no significant difference from the intraoperative LTC length with a strong correlation between the 2 measurements (correlation coefficient = 0.77 and 0.80). The calibrated predicted LTC lengths were significantly different from the intraoperative LTC lengths (mean difference, 3.0 mm; 95% confidence interval [CI] = [2.2, 3.8]). Conclusions: This retrospective review suggests the LTC:FHD ratio multiplied by intraoperative FHD may be an accurate method for restoring anatomic femoral head height in THA (LTC_a = [LTC_r/FHD_r] × FHD_a). This method may be useful in hip fracture populations with distorted proximal femoral anatomy.

Background: Three-dimensional (3D) printer technology has seen a surge in use in medicine, particularly in orthopedics. A recent area of research is its use in peripheral nerve repair, which often requires a graft or conduit to bridge segmental defects. Currently, nerve gaps are bridged using autografts, allografts, or synthetic conduits. Purpose: We sought to improve upon the current design of simple hollow, cylindrical conduits that often result in poor nerve regeneration. Previous attempts were made at reducing axonal dispersion with the use of multichanneled conduits. To our knowledge, none has attempted to mimic and test the anatomical topography of the nerve. Methods: Using serial histology sections, 3D reconstruction software, and computer-aided design, a scaffold was created based on the fascicular topography of a rat sciatic nerve. A 3D printer produced both cylindrical conduits and topography-based scaffolds. These were implanted in 12 Lewis rats: 6 rats with the topographical scaffold and 6 rats with the cylindrical conduit. Each rodent's uninjured contralateral limb was used as a control for comparison of functional and histologic outcomes. Walking track analysis was performed, and the Sciatic Functional Index (SFI) was calculated with the Image J software. After 6 weeks, rats were sacrificed and analyses performed on the regenerated nerve tissue. Primary outcomes measured included nerve (fiber) density, nerve fiber width, total number of nerve fibers, G-ratio (ratio of axon width to total fiber width), and percent debris. Secondary outcomes measured included electrophysiology studies of electromyography (EMG) latency and EMG amplitude and isometric force output by the gastrocnemius and tibialis anterior. Results: There were no differences observed between the cylindrical conduit and topographical scaffold in terms of histological outcomes, muscle force, EMG, or SFI. Conclusion: This study of regeneration of the sciatic nerve in a rat model suggests the feasibility of 3D-printed topographical scaffolds. More research is required to quantify the functional outcomes of this technology for peripheral nerve regeneration.