To describe and analyze the mid-term functional outcomes of a large series of patients who underwent the Hoffer procedure for brachial plexus birth palsy (BPBP). All patients who underwent the Hoffer procedure with minimum two-year follow-up were retrospectively reviewed. Active shoulder range of movement (ROM), aggregate modified Mallet classification scores, Hospital for Sick Children Active Movement Scale (AMS) scores, and/or Toronto Test Scores were used to assess functional outcomes. Subgroup analysis based on age and level of injury was performed. Risk factors for subsequent humeral derotational osteotomy and other complications were also assessed. A total of 107 patients, average age 3.9 years (1.6 to 13) and 59% female, were included in the study with mean 68 months (24 to 194) follow-up.Aims
Methods
Medial open wedge high tibial osteotomy (HTO) is a generally accepted surgical method for medial unicompartmental osteoarthritis with varus malalignment of the lower extremity. However, several authors have suggested the possibility of unintentional secondary changes during open wedge HTO, which include posterior tibial slope angle (PTS) change, tibial rotation change and medial–lateral slope change of the knee joint line, may influence knee kinematics and produce poor clinical outcomes. We sought to analyze postoperative changes in three-dimensional planes using a virtual wedge osteotomy 3D model. Pre- and post-operative changes in the medial proximal tibial angle (MPTA) in the coronal plane, posterior tibial slope (PTS) in the sagittal plane, and axial tibial rotation were measured as dependent variables. And this study was attempted to determine their mutual relationships and to clarify which independent variables, including hinge axis angle and gap ratio, affect tibial rotation change and PTS change by applying the identified hinge position. A total of 17 patients with 19 knees underwent HTO and were evaluated with 3D-CT before and after surgery. A 3D model was constructed by applying reverse engineering software.Introduction
Method
The pathophysiology of osteonecrosis of femoral head (ONFH) is uncertain for most cases with speculation of vascular impairment and changes in cell biology due to multi-factorial etiologies including corticosteroid, alcohol, smoking, trauma, radiation or caisson disease and genetic. Extracorporeal shockwave therapy (ESWT) began with an incidental observation of osteoblastic response pattern during animal studies in the mid-1980 that generated an interest in the application of ESWT to musculoskeletal disorders. The mechanism of shockwave therapy is not fully understood but several reports showed better clinical outcomes and promoted bone remodelling and regeneration effect of the femoral head after ESWT in ONFH. Therefore, we compared the clinical results of the use of extracorporeal shock wave therapy (ESWT) on the patients with ONFH in radiographic staging. We evaluated 24 patients with 32 hip joints diagnosed ONFH treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and patients were average 47.8 aged. Association Research Circulation Osseous (ARCO) staging system was used to grade radiographic stage before treatment. All the patients were divided to two groups; group 1 (ARCO stage I,II), group 2 (ARCO stage III). Comparative analysis was done between two groups with visual analogue scale (VAS) score and Harris hip score (HHS) at pre-treatment, 3, 6, 12 and 24 months after treatments. The failure was defined when radiographic stage was progressed or arthroplasty surgery was needed due to clinical exacerbation.Introduction
Methods
A large proportion of patients with osteoarthritis of the knee, present with bilateral symptoms at the outpatient department. A simultaneous total knee arthroplasty (TKA) procedure is available for such patients. The first operation in a simultaneous surgery may provide information to the operator to determine component size, soft tissue balancing, and estimate gap size for the second operation, while the second team usually conducts an operation in a confined space on the contralateral side during closure for the first operation, which can disturb cooperation during the second operation and may lead to more intra-operative surgical errors. We hypothesized that the circumstances of the two consecutive operations of a simultaneous bilateral TKA are different, could lead to different outcomes of overlapping bilateral TKAs. We therefore addressed the following research questions to determine whether there would be differences in short-term clinical outcomes, radiographic results, and implanted component size between the two sides A retrospective review of 451 consecutive patients, who underwent simultaneous bilateral TKA between January 2011 and April 2012, was conducted. Bilateral TKAs were performed with the senior surgeon conducting the main procedure (from skin incision to implantation of first prosthesis until prior closure of the first knee) on the right side first and subsequently the left side with a second team. At 1 year after surgery, clinical outcome scores (the Knee Society Knee and Function scores, WOMAC score), radiologic findings were evaluated and clinical results as postoperative blood loss, operation time were compared between bilateral sides.Introduction
Methods
Despite the excellent clinical success of total knee arthroplasty (TAK), controversy remains concerning whether or not to resurface the patella. This has led to a number of randomized controlled trials. Randomized controlled trials constitute the most reliable source of evidence for the evaluation of the efficacy of a potential intervention. But most of these studies include all degree of osteoarthritis of the patellofemoral joint. So we did this prospective study to compare clinical and radiological outcomes after TKA with or without patellar resurfacing in patients with grade IV osteoarthritis on patellofemoral joint. 123 cases (93 patients) with Kellgren-Lawrence grade IV osteoarthritis on patellofemoral joint were enrolled for this study. At the operating room, they were randomly assigned to undergo patella resurfacing (62 cases) or patella retention (61 cases). Among them, 114 cases that could be followed for more than 2 years were included in this study (resurfacing group; 59 cases, retention group; 55 cases). When patellar retention was performed, osteophytes of the patella were removed and marginal electrocauterization was carried out. Preoperative and postoperative clinical outcomes were evaluated and compared regarding the Hospital for Special Surgery Patellar (HSSP) score (total 100 point; anterior knee pain, functional limitation, tenderness, crepitus, Q-strength). We also compared Hospital for Special Surgery (HSS) and WOMAC scores, and range of motion (ROM). We also compared radiological outcomes at the final follow up, with regards to mechanical axis of the lower limb, patella tilt and patella congruence angle between two groups.Background
Materials and Methods
The radiologic and clinical results of High Tibial Osteotomies (HTO) strongly rely on the accuracy of correction, and inadequate intraoperative measurements of the leg axis can lead to over or under- correction. Over the past few years, navigation systems have been proven that navigation systems provide reliable real-time intro-operative information, may increase accuracy, and improves the precision of orthopaedic surgeries. We assessed the radiological and clinical results of navigation- assisted open wedge HTO versus conventional HTO at 24 months after surgery. A total of sixty-five open wedge HTOs were performed using navigation system and compared with forty-six open HTOs that had been performed using the conventional cable technique in terms of intraoperative leg axis assess. The Orthopilot navigation system (HTO version 1.3, B. Braun Aesculap, Tuttligen, Germany) used throughout the procedure of navigated open wedge HTO. The aim of the correction was to achieve of 3°of valgus (2–4°) on both method. For the radiological evaluation, postoperative leg axes were examined using weight bearing full-leg radiography obtained at postoperative two years after surgery. To assess correction accuracies, we compared mechanical tibiofemoral angles and intersections of the mechanical axis of the tibial plateau (%) in both groups. Outliers were defined as under-corrections of < 2° of valgus and as over-corrections of > 5° of valgus. The posterior slope of the proximal tibia was measured using the proximal tibial anatomical axis (PTAA) method. HSS (Hospital for Special Surgery) scores and ROMs (ranges of motion) were evaluated and all complications were recorded and surgical and radiation times were measured. Navigated HTOs corrected mechanical axes to 2.8° valgus (range −3.1∼5.3) with few outliers (9.5%), and maintained posterior slopes (8.5±2.3° preoperatively and 11.0±2.8° postoperatively) (P>0.05). In the conventional group, the mean valgus correction was satisfactory (2.2° valgus), but only 67.4% were within the required range (2∼5° valgus), and 26.1% of cases were under-corrected and 6.5% of cases were over-corrected. Posterior slope increased from 8.0° to 10.6° on average without significant change after surgery. Total fluoroscopic radiation time during navigated HTO was 8.1 seconds (5∼12s) as compared with 46.2 seconds (28∼64 s) during conventional HTO (p<0.05). The surgery time for navigated HTO was 11.2 minutes longer than for conventional HTO (55.5 minutes). No specific complications related to the navigation were encountered. At clinical follow up, mean HSS scores of the navigated HTO and conventional groups improved to 91.8 and 92.5 from preoperative values of 55.3 and 55.9, respectively (p>0.05), and all patients achieved full ROM. Navigation for HTO significantly improved the accuracy of postoperative leg axis, and decreased the variability of correction with fewer outliers, and without any complications. Moreover, it allows multi-plane measurements to be made, in the sagittal and transverse planes as well as the frontal plane intra-operatively in real time, compensates to some extent for preoperative planning shortcomings based on radiography, and significantly reduces radiation time.
