SICOT-J最新文献

Objective: To determine the frequency, clinical presentation, and etiological factors of cauda equina syndrome (CES).

Materials and method: This retrospective study was done on 256 participants, and aimed to analyze the frequency and patterns of clinical presentation in suspected cases of CES. The inclusion criteria included participants aged 18 or older with medical records available for review and having red-flagged symptoms for CES. The study collected information on various factors such as age, gender, confirmation of CES on MRI, neurological deficits, etiological factors, duration of symptoms, and more. The data collected was analyzed using descriptive statistics and logistic regression to identify significant variables between MRI-proven CES and suspected CES.

Results: The mean age was 58.05 ± 19.26 years, with 151 females (58.98%) and 105 males (41.02%). The majority (50.78%) had a neurological deficit, while other symptoms included difficulty initiating micturition or impaired sensation of urinary flow (17.58%), loss of sensation of rectal fullness (3.12%), urinary or faecal incontinence (35.16%), bilateral sciatica (21.88%), neurological symptoms in the lower limbs (25.00%), anaesthesia or any leg weakness (24.22%), and bilateral sciatica as the predominant symptom (21.88%). Symptoms were chronic in 47.27% and acute in 21.88%. The odds of MRI-proven CES increase by 3% per year of age. Neurological deficit was strongly associated with MRI-proven CES (OR = 14.97), while loss of sensation of rectal fullness increased the odds by 10-fold (OR = 10.62).

Conclusion: CES can present with various symptoms, including the bilateral neurological deficit, urinary and faecal incontinence, and bilateral sciatica, with age, severe bilateral neurological deficit, and loss of sensation of rectal fullness being associated with MRI-proven CES. Early diagnosis and treatment are crucial for better outcomes.

Introduction: Developmental dysplasia of the hip (DDH) refers to congenital and/or developmental hip instability that can result in hip joint subluxation or dislocation. When detected neonatally, conservative treatment with hip bracing can restore normal hip anatomy. Missed detection of DDH in the neonatal period or late development of DDH often requires surgical intervention to correct the abnormal anatomy. Furthermore, despite surgical intervention, residual sequelae may persist leading to early osteoarthritis of the hip joint requiring joint replacement surgery.

Aim: This study investigates the prevalence of hip dysplasia in patients undergoing total hip arthroplasty (THA) under 50 years of age.

Methods: The hip arthroplasty database at a national referral centre was investigated from January 2014 to December 2020. In patients under 50 years of age, those with an adequate pre-operative anteroposterior pelvic radiograph without previous hip arthroplasty were included, while those with inadequate radiographs were excluded. The following measurements were made on the contralateral non-operated hip: (1) lateral centre-edge angle (LCEA), (2) Tönnis angle, (3) acetabular version, (4) acetabular depth, (5) femoral head lateralisation, (6) femoral head extrusion index, and (7) acetabular depth-to-width ratio.

Results: In total, 451 patients were included in this study. Twenty two percent of the patients had hip dysplasia, based on a LCEA of <25° and 42.6% of patients had hip dysplasia, based on a Tönnis angle of > 10°. The mean LCEA and Tönnis angle were 31.47 ± 9.64 and 9.82 ± 6.79°, respectively.

Conclusion: Hip dysplasia is common in patients undergoing THA under the age of 50 years with over 40% having dysplasia according to the Tönnis angle. Classification of primary and secondary osteoarthritis in the joint registries will benefit our knowledge on the prevalence of DDH in the adult population.

Introduction: The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate.

Material and method: A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated.

Results: The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6 ± 1.7 and 6.0 ± 1.7 mm in proximal fractures and 0.3 ± 2.4 mm and 0.4 ± 2.3 mm in distal fractures, respectively (p < 0.001 and p < 0.001, respectively). The mean time to union was 21.9 ± 2.9 weeks in the proximal fracture group and 16.7 ± 2.4 weeks in the distal fracture group (p < 0.000). The residual fracture gap amount significantly correlated with the level of fracture (r = 0.811, p < 0.001).

Discussion: Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates.

Aim: This study aimed to compare the patient-reported functional outcomes and patient satisfaction after medial Unicompartmental Knee Arthroplasty (UKA) versus Total Knee Arthroplasty (TKA), performed for anteromedial osteoarthritis (AMOA) of the knee in patients from an Indian population, at a minimum 3-year follow-up.

Methods: This is a prospective matched cohort study (1:2 ratio). One hundred and one UKA cases were matched to 206 TKA cases by propensity score matching for age, body mass index (BMI), gender distribution, and the Charlson Comorbidity Index (CCI). The primary outcome (Oxford knee score, OKS) was assessed at a 3-year follow-up, along with secondary outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] Score, Forgotten Joint Score (FJS), Anterior Knee Pain (Kujala) score, patient satisfaction, and revision rate at the final follow-up).

Results: The UKA group was superior to the TKA group in patient-reported functional outcomes based on the OKS (p = 0.004). Using the FJS score, UKA was more likely to be a forgotten joint compared to TKA (p < 0.001). However, differences in the OKS and FJS did not meet the reported minimal clinically important difference (MCID) thresholds. Quality of life (EuroQol-5D VAS scale) was found to be significantly higher in the UKA group (p < 0.001). Patients in the UKA group were more likely to be very satisfied (75.2%) versus the TKA group (62.1%, p = 0.023).

Conclusion: For AMOA, UKA was associated with improved patient satisfaction compared to TKA. Although patient-reported outcome measures were statistically in favour of UKA over TKA, the differences were not clinically significant. Multicenter and randomized studies comparing the two procedures are warranted.

Evidence: Level-II Therapeutic.

Background: Reverse oblique fractures (AO/OTA 31-A3) account for 5-23% of all intertrochanteric fractures and are challenging to manage. The Gamma 3-Proximal Femoral Nail (GPFN) and the Trochanteric Fixation Nail Advanced (TFNA) are two common cephalomedullary systems used to treat this fracture. No study has reported on outcomes with the TFN-A for reverse oblique fractures. This study aimed to compare outcomes and complication rates in patients with reverse oblique fractures, treated with either TFNA or GPFN.

Patients and methods: A total of 203 patients with reverse oblique fractures (137 in the GPFN group and 66 in the TFNA group), were treated in our institution between June 2010 and May 2019. Data was collected on postoperative radiological variables including screw or blade location, and tip-apex distance (TAD). Data were also collected for non-orthopaedic complication rates and orthopaedic complications. A sub-group analysis was additionally performed for different nail lengths.

Results: We found no significant difference in the overall rate of complications and revisions between the two groups. Patients treated with the 235 mm TFN-A nail sustained lower rates of cutout, compared to 180 mm GPFN (GPFN: 6% TFN-A: 0%, p = 0.043). The frequency of revision surgeries and malunions/non-unions did not differ significantly between the two groups and additionally showed no difference in the subgroup analysis.

Conclusion: The 235 mm TFN-A was associated with lower rates of cut-out compared to the short GPFN for reverse oblique intertrochanteric fractures. Future well-designed prospective studies are warranted to investigate the role of the TFN-A in improving outcomes for such fractures.

Background: Excellent midterm results for total hip arthroplasties (THA) with cementless, tapered porous Taperloc^® femoral stems have been reported. Reports regarding such cemented stems, however, are lacking.

Objectives: To evaluate the long-term outcomes of both cemented and cementless THAs with the Taperloc femoral component.

Methods: The medical records of 71 patients (76 hips), operated on between January 1991 and December 2003, who had a minimum follow-up of 10 years were available for analysis. Functional analysis was performed with the Harris hip score (HHS) questionnaire and the numerical analogue scale (NAS). Radiographic analysis was performed for subsidence, radiolucent lines and osteolysis.

Results: The cohort was comprised of 47 female and 24 male patients, with a mean age of 59.7 ± 12.4 years. The mean follow-up was 17.8 ± 4.4 years. 52.6% of THAs analyzed were cementless and 47.4% were cemented. Post-operative radiographs were available for 57 surgeries. Subsidence, hypertrophic ossification, radiolucent lines and osteolysis were noted in 4 (7%), 2 (2.6%), 14 (18.4%) and 11 (14.5%) hips respectively. The average HHS score at a mean follow-up of 20.1 ± 3.9 years was 62.1 (±27.7) and the NAS score was 4.6 (±3.6). During the study period, five revision surgeries were performed due to stem-related problems, one of which was for aseptic loosening.

Conclusions: Our long-term experience with the Taperloc stem, both cemented and cementless, demonstrates good outcomes, with low rates of failure. This makes this prosthesis an attractive option for THAs.

Level of evidence: IV.