Mental disorders in particular depression and anxiety have been reported to be prevalent among patients with spinal pathologies. Goal of the current study was to analyze the relationship of Zung pre- and post-op score to other PROs and length of stay. Secondary outcomes included revision surgery and post-operative infections. Data from the international multicenter prospective spine degenerative surgery data repository, DegenPRO v1.1 (AO Spine Knowledge Forum Degenerative) were utilized. Patients undergoing cervical or lumbar procedure were included. Patient's demographics, Charlson Comorbidity Index, surgical information, Zung score, NDI, pain related PROs and EQ-5D, and complications at surgery and at various post-op time periods. Except for hospital duration, data were analyzed, using multivariable mixed linear models. A robust linear regression model was used to assess the association between Zung score and hospital duration. All models were adjusted for gender and age. 42 patients had Zung score administered. Among those patients 22 (52%) were within normal range, 18 (43%) were mildly and 2 (5%) severely depressed. 62% of the patients had a lumbar pathology with fusion procedures being the most common. Median EQ-5D (3L) score at surgery was significantly higher (0.7, IQR: 0.4-0.7) for patients within normal range than for those with mild (0.4, IGR: 0.3-0.7) or severe depression (0.3, IQR: 0.3-0.3, p-value: 0.05). Compared to patients within normal Zung range, mixed models, indicated lower EQ-5D (3L) score values and higher values for neck and arm pain at surgery with both PROs and EQ-5D (3L) improving in patients with depression over the follow-up time. No association was found between Zung score and hospital length of stay. The initial analysis showed that 43% of the patients were mildly depressed and mainly male patients. Zung score was correlated with post-operative improvements in EQ-5D and arm and neck pain PROs.
There is a paucity of published Canadian literature comparing lumbar total disc arthroplasty (LDA) to fusion on patient outcomes in degenerative spondylosis. The purpose of this study is to quantify and compare the long-term patient reported outcomes following LDA and matched-fusion procedures. We conducted a matched-cohort study comparing consecutive patients enrolled by CSORN who underwent standalone primary LDA or hybrid techniques for degenerative disk disease between 2015–2019. Fusion patients were included by a primary diagnosis of degenerative disk disease, chief complaint of back pain, who received a primary fusion irrespective of technique. Fusion patients were matched by number of involved levels of surgery to LDA counterparts. Outcome scores and patient satisfaction were assessed preoperatively and 2-years postoperatively. 97 patients (39-female, 58-male) underwent LDA or hybrid construct up to 4 levels. 94 patients (52-female, 42-male) underwent a lumbar fusion were selected based on inclusion criteria. 36 LDA and 57 Fusion patients underwent a 1-level surgery. 39 LDA and 25 Fusion patients underwent 2-level surgery. 18 LDA and 7 Fusion patients underwent 3-level surgery. 4 LDA and 5 Fusion patients underwent a 4-level procedure. Slight differences in average cohort age were found (LDA-43.4yrs, Fusion-49.8yrs, p<0.01). Cohort preoperative-BMI (LDA-27.0kg/m2, Fusion-27.9kg/m2, p=0.29) and total comorbidities (LDA-2.6, Fusion-2.1, p=0.05) demonstrated no clinically significant differences. At 2 year follow-up, no differences were found in ODI improvement (LDA-20.32pts, Fusion-17.02pts, p=0.36), numerical back-pain improvement (LDA-3.5pts, Fusion-3.06pts, p=0.40), numerical leg-pain improvement (LDA-1.67pts, Fusion-1.87pts, p=0.76), and Health Scale improvement (LDA-17.12, Fusion-10.73, p=0.20) between cohorts. Similar positive findings were found in subgroups stratified by number of surgical levels. Satisfaction rate at 2 years was 86.7% and 82.4% for LDA and Fusion patients respectively. There didn't appear to be significant differences in outcomes or satisfaction through 2 years comparing patients who underwent LDA (whether used in isolation or as part of a hybrid construct) for debilitating degenerative disk disease and isolated spinal fusion for back dominant pain.
Mechanically aligned total knee arthroplasty(TKA) relies on restoring the hip-knee-ankle angle of the limb to neutral or as close to a straight line as possible. This principle is based on studies that suggest limb and knee alignment is related long term survival and wear. For that cause, there has been recent attention concerning computer-assisted TKA and robot is also one of the most helpful instruments for restoring neutral alignment as known. But many reported data have shown that 20% to 25% of patients with mechanically aligned TKA are dissatisfied. Accordingly, kinematically aligned TKA was implemented as an alternative alignment strategy with the goal of reducing prevalence of unexplained pain, stiffness, and instability and improving the rate of recovery, kinematics, and contact forces. So, we want to report our extremely early experience of robot-assisted TKA planned by kinematic method. This study evaluated the very short term results (6 weeks follow up) after robot-assisted TKA aligned kinematically. 50 knees in 36 patients, who could be followed up more than 6 weeks after surgery from December 2014 to January 2015, were evaluated prospectively. The diagnosis was primary osteoarthritis in all cases. The operation was performed with ROBODOC (ISS Inc., CA, USA) along with the ORTHODOC (ISS Inc., CA, USA) planning computer. The cutting plan was made by single radius femoral component concept, each femoral condyles shape-matched method along the transverse axis using multi-channel CT and MRI to place the implant along the patient's premorbid joint line. Radiographic measurements were made from long bone scanograms. Clinical outcomes and motion were measured preoperatively and 6 weeks postoperatively.Introduction
Materials and Methods
In total knee arthroplasty, the alignment of leg depends on the alignment of the component. In unicompartmental knee arthroplasty, it is determined by the thickness of the implant relative to the bone excised mostly. After initial scepticism, UKA is increasingly accepted as a reliable procedure for unicompartmental knee osteoarthritis with the improvements in implant design, surgical technique and appropriate patient selection. Recently, computer assisted UKA is helpful in accuracy and less invasive procedure. But, fixed bearing or mobile bearing in UKA is still controversy. We compared the early clinical and radiological results of robot-assisted unicompartmental knee arthroplasty using a fixed bearing design versus a mobile type bearing design. A data set of 50 cases of isolated compartmental degenerative disease that underwent robot-assisted UKA using a fixed bearing design were compared to a data set of 50 cases using a mobile bearing type design. The operations were performed by one-senior author with the same robot system. The clinical evaluations included the Knee Society Score (knee score, functional score) and postoperative complications. The radiological evaluations was assessed by 3-foot standing radiographs using the technique of Kennedy and White to determine the mechanical axis and femoro-tibial angle for knee alignment. Operative factors were evaluated including length of skin incision, operation time, blood loss, hospital stay and intraoperative complications.Introduction
Materials and Methods
BHA is popular surgery for femoral neck fractures expecially elderly patients. However, clinical results are variable that factors affecting results are questionable. Therefore we investigated radiologic fators, dysplastic hip whether influences results of BHA. Between 2004 and 2009, 200 patients undergoing bipolar hemiarthroplasty for femoral neck fracture were divided two groups; a lateral center edge (LCE) angle of < 16 degree or > 16 degree on anteroposterior radiographs. All surgical procedures were performed by a single surgeon. Dermogrpahic data, the harris hip score, WOMAC index, Koval activity level, and complication were recorded. The minimum follow up interval was 4 years (mean, 7.8 years).Background
Methods
The purpose of this study was to evaluate the results of modular revision stems, uncemented fluted, tapered to treat periprosthetic femoral (PFF) fracture; we specifically evaluated fracture union, implant stability, patient outcomes, and complications to compare the differences between cemented and cementless primary stem. We retrospectively reviewed 56 cases of unstable periporsthetic femoral fracture (forty B2 and sixteen B3) treated with the uncemented fluted and tapered modular distal fixation stem with or with or without autogenous bone graft. Clinical outcomes were assessed with Harris Hip Score and WOMAC score. Radiologic evaluations were conducted using Beals and Tower's criteria. Any complication during the follow-up period was recorded.Purpose
Materials and Methods
The success of total knee arthroplasty depends on many factors, including the preoperative condition of the patient, the design and materials of the components and surgical techniques. It is important to position the femoral and tibial components accurately and to balance the soft tissues. Malpositioning of the component can lead to failures due to aseptic loosening, instability, polyethylene wear and dislocation of the patella. In order to improve post-operative alignment, computer-aid systems have been developed for total knee arthroplasty. Many clinical and experimental studies of these systems have shown that the accuracy of implanted components can be improved in spite of the increase in costs and operating time. This may not, however, improve the outcome in the short-term. Restoration of the normal mechanical axis of the knee and balancing of the surrounding soft tissues have been shown to have an important bearing on the final outcome of knee replacement operations. In severely deformed knees, whether varus or valgus, these goals may be difficult to achieve. We compared the radiologic results of the mechanical axis and implant position of Total Knee Arthroplasty using a robot-assisted method with conventional manually implanted method in severe varus deformed knee. A data set of 50 consecutive cases that were performed from April 2007 to December 2010 using the robot assisted TKA(Group A) were compared with a data set of 50 consecutive cases from the same period that were done using conventional manual TKA(Group B). All cases had a preoperative mechanical varus deformity >15° and one brand of implant was used on all cases. The diagnosis was primary osteoarthritis in all knees. The operations were performed by one-senior author with the same robot system, ROBODOC (ISS Inc., CA, USA) along with the ORTHODOC (ISS Inc., CA, USA) planning computer. (See Figure 1.) The radiological evaluations included mechanical axis, implant position (α,β,γ,δ angle) according to the system of American Knee Society.Introduction
Materials and Methods
Since Smith-Peterson's glass mold arthroplasty in 1939, hip resurfacing arthroplasty was developed and introduced to orthopaedic surgery field but it had many problem like early loosening. Recently it is being popular for some indication as development of new implant design and manufacturing. There are still many suggested advantages of hip resurfacing arthroplasty. These include bone conservation, improved function as a consequence of retention of the femoral head and neck and more precise biomechanical restoration, decreased morbidity at the time of revision arthroplasty, reduced dislocation rates, normal femoral loading and reduced stress-shielding, simpler management of a degenerated hip with a deformity in the proximal femoral metaphysic, an improved outcome in the event of infection, and a reduced prevalence of thromboembolic phenomena as a consequence of not using instruments in the femur. But, there are limited or inconsistent data to support some of these claims regarding the benefits of hip resurfacing including the potential for a more natural feel because of the minimal disturbance of the proximal part of the femur resulting in a better and faster functional outcome. We evaluate the short term results of hip resurfacing arthroplasty using custom patient-specific tooling for prosthesis placement for better standardization. 40 cases, 36 patients(male:20, female:16) those of who were candidates of a Hip Resurfacing procedure, participated in the study. Mean follow up period was 2.5 years (8 months ∼3 years). A CT scan was performed on each patient and a 3D model was generated using the computer tomography dataset. From this model a bone-surface skin was extracted and this data set was used to create a personalized jig. Detailed analysis of the native bone structure was then used to preoperatively plan the appropriate size and position of the implant. A mean 7 degree corrective valgus angle was prescribed on all cases. Postoperative radiological datasets were superimposed onto preoperative plan position and offsets were measured. Operative times were recorded per step during the procedure. Surgeon comfort and ease of use was also noted.Introduction
Materials and Methods
We compared the results of 146 patients who received an anatomic modular knee fixed-bearing total knee replacement (TKR) in one knee and a low contact stress rotating platform mobile-bearing TKR in the other. There were 138 women and eight men with a mean age of 69.8 years (42 to 80). The mean follow-up was 13.2 years (11.0 to 14.5). The patients were assessed clinically and radiologically using the rating systems of the Hospital for Special Surgery and the Knee Society at three months, six months, one year, and annually thereafter. The assessment scores of both rating systems pre-operatively and at the final review did not show any statistically significant differences between the two designs of implant. In the anatomic modular knee group, one knee was revised because of aseptic loosening of the tibial component and one because of infection. In addition, three knees were revised because of wear of the polyethylene tibial bearing. In the low contact stress group, two knees were revised because of instability requiring exchange of the polyethylene insert and one because of infection. The radiological analysis found no statistical difference in the incidence of radiolucent lines at the final review (Student’s We found no evidence of the superiority of one design over the other at long-term follow-up.
Bilateral sequential total knee replacement was carried out under one anaesthetic in 100 patients. One knee was replaced using a CT-free computer-assisted navigation system and the other conventionally without navigation. The two methods were compared for accuracy of orientation and alignment of the components. There were 85 women and 15 men with a mean age of 67.6 years (54 to 83). Radiological and CT imaging was carried out to determine the alignment of the components. The mean follow-up was 2.3 years (2 to 3). The operating and tourniquet times were significantly longer in the navigation group (p <
0.001). There were no significant pre- or post-operative differences between the knee scores of the two groups (p = 0.288 and p = 0.429, respectively). The results of imaging and the number of outliers for all radiological parameters were not statistically different (p = 0.109 to p = 0.920). In this series computer-assisted navigated total knee replacement did not result in more accurate orientation and alignment of the components than that achieved by conventional total knee replacement.
We studied prospectively the long-term results of the Charnley Elite-Plus femoral stem in 184 consecutive young patients (194 hips). There were 130 men and 54 women with a mean age of 49.1 years (21 to 60). The predominant diagnosis was osteonecrosis of the femoral head (63.6%, 117 patients). Clinical and radiological evaluation was undertaken at each follow-up. The mean follow-up was 11.2 years (10 to 12). The mean pre-operative Harris hip score was 43.4 (12 to 49) which improved to 91 (59 to 100) at the final follow-up. The survival of the femoral stem at 12 years was 99% with revision as the end-point. The mean annual linear wear of the polyethylene liner was 0.17 mm (0.13 to 0.22). The prevalence of acetabular osteolysis was 10.8% (21 hips) and osteolysis of the calcar femorale 12.9% (25 hips). A third-generation cementing technique, accurate alignment of the stem and the use of a 22 mm zirconia head were important factors in the prevention of aseptic loosening of the Elite Plus femoral stem in these high-risk young patients.
Our aim in this prospective study was to compare the bone mineral density (BMD) around cementless acetabular and femoral components which were identical in geometry and had the same alumina modular femoral head, but differed in regard to the material of the acetabular liners (alumina ceramic or polyethylene) in 50 patients (100 hips) who had undergone bilateral simultaneous primary total hip replacement. Dual energy X-ray absorptiometry scans of the pelvis and proximal femur were obtained at one week, at one year, and annually thereafter during the five-year period of the study. At the final follow-up, the mean BMD had increased significantly in each group in acetabular zone I of DeLee and Charnley (20% (15% to 26%), p = 0.003), but had decreased in acetabular zone II (24% (18% to 36%) in the alumina group and 25% (17% to 31%) in the polyethylene group, p = 0.001). There was an increase in the mean BMD in zone III of 2% (0.8% to 3.2%) in the alumina group and 1% (0.6% to 2.2%) in the polyethylene group (p = 0.315). There was a decrease in the mean BMD in the calcar region (femoral zone 7) of 15% (8% to 24%) in the alumina group and 14% (6% to 23%) in the polyethylene group (p <
0.001). The mean bone loss in femoral zone 1 of Gruen et al was 2% (1.1% to 3.1%) in the alumina group and 3% (1.3% to 4.3%) in the polyethylene group (p = 0.03), and in femoral zone 6, the mean bone loss was 15% (9% to 27%) in the alumina group and 14% (11% to 29%) in the polyethylene group compared with baseline values. There was an increase in the mean BMD on the final scans in femoral zones 2 (p = 0.04), 3 (p = 0.04), 4 (p = 0.12) and 5 (p = 0.049) in both groups. There was thus no significant difference in the bone remodelling of the acetabulum and femur five years after total hip replacement in those two groups where the only difference was in the acetabular liner.
