The Longest Known Follow-Up of Vitallium Mold Arthroplasty in China: A Case Report and Literature Review.

BACKGROUND: Before the advent of total hip arthroplasty, Vitallium mold arthroplasty had been widely performed. We present a case with a 42-year follow-up after Vitallium mold arthroplasty. To our knowledge, this case represents the longest known follow-up of Vitallium mold arthroplasty in China. CASE PRESENTATION: This was a 59-year-old male. He underwent Vitallium mold arthroplasty of the left hip 42 years ago because of osteonecrosis of the femoral head. He developed left hip pain 3 months ago and underwent total hip revision surgery. There was some clear synovial fluid in the hip joint. The mold was loosened entirely and taken out effortlessly. Gram-positive cocci could be observed occasionally in the synovial fluid smear, while the synovial fluid culture was negative. The inflammatory markers elevated perioperatively, and prophylactic cefuroxime and vancomycin were utilized successively. All elevated inflammatory markers fell since postoperative day 5, and there was no other sign of infection. The pain and function of the hip joint improved significantly after surgery. CONCLUSIONS: Although Vitallium mold arthroplasty was inferior to total hip arthroplasty in survival rate and functional outcome, it did provide an excellent long-term function of the hip joint.

Fatty infiltration of hip muscles and trochanteric soft tissue thickness are associated with hip fractures in the elderly.

PURPOSE: Apart from bone conditions, muscle and soft tissue parameters might also influence hip fractures. We aimed to evaluate the association between hip muscle and trochanteric soft tissue parameters and hip fractures. METHODS: We retrospectively reviewed 60 patients with hip fractures and 114 controls without hip fractures. Cases and controls were matched for age, sex, and body mass index using propensity score matching. Muscle cross-sectional area (CSA), mean attenuation, and fatty infiltration rate (FIR) (proportion of intramuscular fat content) were measured on CT images for the gluteus maximus, the gluteus medius/minimus, and the anterior and medial compartments of the upper thigh. Trochanteric soft tissue thickness (TSTT) and femoral neck attenuation were also measured. Univariate and multivariate analyses were conducted to identify potential risk factors of hip fractures. RESULTS: Patients with hip fractures had significantly lower femoral neck attenuation, TSTT, and CSA of the gluteus maximus and anterior compartment than controls. FIR of all hip muscle groups were significantly higher in hip fracture patients than controls. Multivariate analysis revealed that every 1% increase in FIR of medial compartment independently increased the odds of hip fractures by 23.7% (OR = 1.237, 95% CI = 1.093-1.401) and every 1 cm longer TSTT independently decreased the odds by 32.8% (OR = 0.672, 95% CI = 0.477-0.946). CONCLUSION: Fatty infiltration of hip muscles can better discriminate hip fractures than muscle area. Increased TSTT is independently associated with low fracture risk.

Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis.

BACKGROUND: The presence of anti-HER2 agents, such as trastuzumab, pertuzumab, and trastuzumab emtansine (T-DM1), significantly improved the prognosis of metastatic HER2-positive (HER2+) breast cancers (BC). However, drug resistance and disease progression are still common. In order to further improve the treatment efficacy, new clinical trials about anti-HER2 agents in combination with chemotherapy are growing rapidly. We conducted the network meta-analysis to synthesize evidences of clinical trials to identify the best therapy for metastatic HER2+ BC. METHODS: A systematic search of randomized controlled trials regarding anti-HER2 agents in combination with chemotherapy for advanced or metastatic breast cancers up to May 2020 was conducted in Embase, PubMed, and the Cochrane Library. The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), objective response rate (ORR), and safety. Bayesian network meta-analysis was conducted to synthesize the results and rank the therapies. RESULTS: Twenty-six studies, including 16 studies for first-line treatments and 10 studies for second- or later-line treatments were included in the network meta-analysis. For first-line studies, the THP (taxanes + trastuzumab + pertuzumab) regimen exhibited the highest probability to be the optimal treatment in all efficacy outcomes and moderate safety. For second- or later-line studies, the T-DM1 and XHTuC (capecitabine + trastuzumab + tucatinib) regimens ranked top two in all efficacy outcomes according to the surface under the cumulative ranking (SUCRA) results. T-DM1 ranked first in PFS and OS whereas XHTuC ranked first in ORR. The safety outcomes of T-DM1 and XHTuC were acceptable. CONCLUSIONS: THP was still the optimal first-line treatment for metastatic HER2+ BC. T-DM1 and XHTuC were recommended for second-line treatments. SYSTEMATIC REVIEW REGISTRATION: INPLASY.com, identifier (INPLASY202090086).

The Effect of Paraspinal Muscle Degeneration on Distal Pedicle Screw Loosening Following Corrective Surgery for Degenerative Lumbar Scoliosis.

MINI: A total of 137 degenerative lumbar scoliosis patients were divided into two groups. In group A (six or more fused levels), mean rFCSA of erector spinae <0.71 was an independent risk factor of LIV screw loosening. In Group B (four or five fused levels), paraspinal muscle degeneration had no influence on LIV screw loosening. STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to evaluate the effect of degeneration of paraspinal muscles, including psoas muscles, erector spinae muscles, and multifidus muscles on pedicle screw loosening at lower instrumented vertebra (LIV) following corrective surgery for degenerative lumbar scoliosis (DLS). SUMMARY OF BACKGROUND DATA: The relation between paraspinal muscles and pedicle screw loosening in DLS patients has not been reported. METHODS: A total of 137 DLS patients underwent corrective surgery with at least 1-year follow-up were included. The patients were divided into two groups: Group A (68 patients) had six or more fused levels and Group B (69 patients) had four or five fused levels. Muscular parameters, including relative cross-sectional area (rCSA) and muscle-fat index (MFI), were measured on preoperative magnetic resonance imaging. rCSA and MFI were measured for both gross muscle (G) and functional muscle (F) as rGCSA, rFCSA, GMFI, and FMFI. Muscle ratio was calculated as rFCSA/rGCSA. Pedicle screw loosening was assessed on spine radiographs or CT at final follow-up. Clinical and radiological screw loosening were classified according to clinical significance. RESULTS: LIV screw loosening occurred in 77 patients at final follow-up. In Group A, patients with LIV screw loosening had significantly higher FMFI of psoas muscles and lower rFCSA and rGCSA of erector spinae. Logistic regression revealed that mean rFCSA of erector spinae <0.71 (odds ratio = 5.0, 95% confidence interval = 1.5-16.4) was an independent risk factor of LIV screw loosening. Mean muscle ratio of erector spinae was significantly lower in patients with clinical screw loosening compared with radiological screw loosening in univariate analysis. In Group B, all muscular parameters showed no significant difference. CONCLUSION: Degeneration of paraspinal muscles, especially psoas muscles and erector spinae, affected LIV screw loosening in six or more level fusion in corrective surgery for DLS, whereas the four- or five-level fusion had no this influence. LEVEL OF EVIDENCE: 3.

A retrospective study. The aim of this study was to evaluate the effect of degeneration of paraspinal muscles, including psoas muscles, erector spinae muscles, and multifidus muscles on pedicle screw loosening at lower instrumented vertebra (LIV) following corrective surgery for degenerative lumbar scoliosis (DLS). The relation between paraspinal muscles and pedicle screw loosening in DLS patients has not been reported. A total of 137 DLS patients underwent corrective surgery with at least 1-year follow-up were included. The patients were divided into two groups: Group A (68 patients) had six or more fused levels and Group B (69 patients) had four or five fused levels. Muscular parameters, including relative cross-sectional area (rCSA) and muscle-fat index (MFI), were measured on preoperative magnetic resonance imaging. rCSA and MFI were measured for both gross muscle (G) and functional muscle (F) as rGCSA, rFCSA, GMFI, and FMFI. Muscle ratio was calculated as rFCSA/rGCSA. Pedicle screw loosening was assessed on spine radiographs or CT at final follow-up. Clinical and radiological screw loosening were classified according to clinical significance. LIV screw loosening occurred in 77 patients at final follow-up. In Group A, patients with LIV screw loosening had significantly higher FMFI of psoas muscles and lower rFCSA and rGCSA of erector spinae. Logistic regression revealed that mean rFCSA of erector spinae <0.71 (odds ratio = 5.0, 95% confidence interval = 1.5­16.4) was an independent risk factor of LIV screw loosening. Mean muscle ratio of erector spinae was significantly lower in patients with clinical screw loosening compared with radiological screw loosening in univariate analysis. In Group B, all muscular parameters showed no significant difference. Degeneration of paraspinal muscles, especially psoas muscles and erector spinae, affected LIV screw loosening in six or more level fusion in corrective surgery for DLS, whereas the four- or five-level fusion had no this influence. Level of Evidence: 3.