Does extreme weight loss after bariatric surgery alter spinopelvic parameters and ameliorate back pain? A retrospective case study.

OBJECTIVES: The aim of this study was to evaluate the effect of extreme weight loss on low back pain and spinopelvic parameters. PATIENTS AND METHODS: A total of 45 patients (11 males, 34 females; mean age: 40.2±9.4 years; range, 18 to 57 years) who had bariatric surgery between January 2018 and December 2021 were retrospectively analyzed. Radiological spinopelvic parameters including lumbar lordosis (LL), pelvic incidence (PI), spinopelvic harmony (when PI is within LL±10°), pelvic tilt (PT) and sacral slope (SS) were evaluated pre- and postoperatively. Clinical outcomes were assessed using the Visual Analog Scale-Back Pain (VAS-BP) and Oswestry Disability Index (ODI). RESULTS: The mean BMI loss at the end of the first year after surgery was 28.1±6.7% (range, 21 to 36%). The mean PI was 55.75°±12.47° preoperatively and 53.64°±11.86° at one year and the difference was -3.10°±5.25 (p=0.02), 1.10°±4.95° for PT (p=0.46), -2,70°±3.50° for SS (p<0.001), and 3.1±6.55 for LL (p<0.001). At one year, spinopelvic harmony remained unchanged in 31 patients, nine patients regained harmony, and was lost in five patients who had previously. No significant correlation between alterations in spinopelvic alignment and ODI scores was shown (p<0.05). The mean VAS-BP score was 40±30 mm preoperatively, and 20±3.5 mm postoperatively, indicating a difference of -39±29.5 (p<0.001). The mean ODI was 34.71±20.87 preoperatively, and 16±24 postoperatively, indicating a difference of -15±13 (p<0.001). Subgroup analyses showed that the change in SS was more pronounced with regard to PT change, particularly in young and female patients with >10 kg/m2 reduction in BMI (p<0.001). CONCLUSION: Weight loss after bariatric surgery improves lower back pain leading to changes in PT without affecting SS and altering PI.

Affective temperament does not influence satisfaction after total knee arthroplasty.

BACKGROUND: Inherent temperament of the patient may predict the outcome of the surgical procedure. The purpose of this study was to ascertain whether negative affective temperament affects patient satisfaction and outcome measures. METHODS: This prospective study included 143 patients who underwent total knee arthroplasty for primary arthrosis. Preoperatively, the Memphis, Pisa, Paris and San Diego-Auto questionnaire was used to define the temperament of the patient. Knee Society Score (KSS) and short form-36 (SF-36) outcome measures were used to evaluate the functional outcome. RESULTS: No relationship was determined between temperament and satisfaction (P = .734). Overall, the satisfaction rate of the procedure in our patients was 93%. The KSS improved from a mean of 47.9 to 70.1 (F = 124.275; P < .05) and the SF-36 physical component summary, and SF-36 mental component summary scores improved to a mean of 39.5 and 43.04 points, respectively. CONCLUSION: Temperament was not found to have any effect on patient satisfaction. However, patient satisfaction was directly related to better functional outcomes.

Platelet-rich plasma versus open surgical release in chronic tennis elbow: A retrospective comparative study.

PURPOSE: To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique. METHOD: A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements. RESULTS: VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength. CONCLUSION: The PRP seems to be better for pain relief and functionality in the short and mid-term periods.

Reduced Postoperative Functional Length Ratio Influences Patient Satisfaction in First Metatarsophalangeal Joint Replacement.

Complications of first metatarsophalangeal joint metallic arthroplasty are well known. However, the resulting shortening of the metatarsals can lead to transverse metatarsalgia or medial column pain at the metatarsophalangeal joints by creating Morton's toe/foot, which increases pressure on the second metatarsal head. The effect of the functional length ratio of the first and second metatarsals on pain and patient satisfaction has not been rigorously evaluated. We evaluated the effect of the first/second metatarsal ratio on patient satisfaction with first metatarsophalangeal joint metallic arthroplasty. From October 2008 to February 2010, 34 patients (median age 66.2, range 55 to 70 years) with hallux rigidus were treated surgically using the Toefit-Plus(™) prosthesis. At a mean follow-up period of 27.5 (range 17 to 35) months, 30 patients (88.24%) underwent re-evaluation. The functional length of the first and second metatarsals and the lucency around the prosthesis were evaluated. Statistically significant (p ≤ .05) improvements were found for the mean modified American Orthopaedic Foot and Ankle Society score (from 44 to 80), pain (from 7 to 3 on a 10-cm visual analog scale), and mean total range of motion (from 42.2° to 59.4°). Also, 20 patients (58.82%) were fully satisfied with the procedure (scores of 8 to 10 on a 3-point Likert scale). Shortening the first metatarsal reduced the functional length ratio (r = 0.95; p < .001) and was associated with lower patient satisfaction (r = 0.66, p = .007). Preoperative consideration of the first/second metatarsal functional length ratio could be useful in preventing medial column pain due to a relatively short first metatarsal to a long second metatarsal axis in the transverse plane.

The fate of lateral femoral cutaneous nerve after surgical reduction of developmental dysplasia of the hip: preliminary results.

This study aimed to determine the fate of the lateral femoral cutaneous nerve (LFCN) after anterior reduction of the hip with or without pelvic or proximal femoral osteotomy for acetabular dysplasia. Using the antidromic technique, recording the response using standard electromyography equipment, evaluation was made of the LFCN in 36 hips of 24 patients (18 female and six male). The response was absent in six patients (25%) and nine patients (37.5%) had a somatosensory evoked potential latency greater than 40 ms. There was no relationship between somatosensory evoked potential latency or absent response with the type of incision or procedure (P=0.229 and 0.794, respectively). LFCN injury after anterior open reduction of the hip has an unexpectedly high incidence in the young paediatric age group. Exposure of the nerve during surgery can negatively affect the nerve nutrition leading to neuropraxia.

Remote ischemic preconditioning enhances fracture healing.

PURPOSE: We hypothesized that RIP accelerates fracture healing. METHODS: Rats (n = 48) were used for the technique of ischemic preconditioning involved applying 35 min of intermittent pneumatic tourniquet for 7 cycles of 5 min each to the fractured hind limb. RESULTS: We observed greater callus maturity in RIP group at first week after fracture when compared to controls (p < 0,0001). The serum MDA levels demonstrated statistically lower values at the RIP group at the first week after fracture; however, there were not significant differences at 3rd and 5th weeks (p = 0.0001, p = 0.725, p = 0.271, respectively). CONCLUSIONS: Greater callus maturity was obtained in RIP group.

Why two-thirds of patients accepted the second session in staged bilateral total knee arthroplasty: a prospective analysis of 111 patients.

PURPOSE: In staged bilateral total knee arthroplasty (TKA), regaining functional recovery and a painless joint with fulfilment of patients' expectations at the first stage is an integral part for a patient to progress to the second stage. As patient expectations drive postoperative satisfaction, the challenge is to match patient and surgeon expectations before surgery. Therefore, this study aimed to evaluate the postoperative patient expectations and clinical outcomes and to evaluate the rate of second stage in bilateral staged TKA. METHODS: The study included 111 patients; 81 females and 30 males with a median age at surgery of 68 years (range 59-85 years) and 46 were older than 70 years. Postoperative functional data included Knee Society Scores (KSS). Expectation data were collected according to the post-visit 'Questionnaire of Patient Expectations of Healthcare'. RESULTS: The overall refusal rate for the second stage was 36.9 % (n = 41). The patients older than 70 years had a higher refusal rate compared to relatively younger patients (< 70 years old) (p = 0.038). Younger age, postoperatively improved KSS, fulfilment of patient expectations of the healthcare process, treatment outcomes and whole expectations were the main determinants for patients accepting the second stage. The most important determinative factors for attendance were 'Process of Healthcare' and subsequently 'Treatment Outcomes' and total questionnaire scores (p < 0.001). CONCLUSION: The postoperative perception of healthcare and the treating surgeon's knowledge and responsivity are the major concerns for patients considering second stage TKA. LEVEL OF EVIDENCE: III.

Nondrainage decreases blood transfusion need and infection rate in bilateral total knee arthroplasty.

This retrospective study enrolled 526 patients undergoing bilateral total knee arthroplasties at our institution. In nondrainage group (Group 1) of 255 patients (510 knees), a disposable elastic sterile exsanguination tourniquet (HemaClear), wound closure in layers and Jones Bandage, without pre-tourniquet removal hemostasis or Hemovac drain were used. In drainage group (Group 2) of 227 patients (454 knees), pneumatic tourniquet, post-deflation hemostasis, a Hemovac drain and Jones bandage were used. The maximal drop in hemoglobin was significantly greater in Group 2 than Group 1 (P < 0.001). Also infection rate was significantly lower in Group 1 (P = 0.017). The use of sterile tourniquet removed after wound closure without Hemovac drain decreases blood transfusion need, infection rate, tourniquet related pain and postoperative complications.

One-stage treatment of congenital severely dislocated hips in older children through various acetabuloplasty techniques: 22 children followed for 1-5 years.

BACKGROUND: There is no consensus regarding the best treatment for children with late diagnosis of congenital hip dislocation. PATIENTS AND METHODS: This retrospective study involved 29 hips in 22 children (19 girls) with an age range of 3-14 years, who had been operated with various techniques for congenital hip dislocation between 1998 and 2002. 6 patients had right, 9 patients had left, and 7 patients had bilateral congenital hip dislocation. The mean length of follow-up was 3 (1-5) years. RESULTS: While the mean acetabular index was 53 degrees (35-65) preoperatively, at the last follow-up it was 30 degrees (15-50). 27 hips were type 4 and 2 hips were type 3 by Tönnis criteria. Satisfactory reduction (Severin Class I) had been achieved in 19 hips at the follow-up radiography, and they developed no osteonecrosis. The outcome was successful in children under 7 years of age, but problems encountered in those over 7 increased unless sufficient reduction had been achieved. INTERPRETATION: Age at treatment of late-diagnosed congenital hip dislocation appears to be important for outcome.

The impact of proximal fibula fractures in the prognosis of tibial plateau fractures: a novel classification.

Fifty-five patients who presented with the complaint of tibia plateau fractures between January 1998 and November 2001 were retrospectively evaluated. The evaluation was based on their treatment modality. Twenty-five conservatively-treated patients (group 1) and 30 surgically-treated patients (group 2) were evaluated. In group 1, seven patients with proximal fibula fractures had lateral hamstring tightness. Five out of these seven patients had concomitant lateral knee pain. Similarly, nine patients with proximal fibula fractures in group 2 had lateral hamstring tightness, and seven patients in the same group suffered from lateral knee pain. The patients with no fibula proximal fracture in both groups had no hamstring tightness or lateral knee pain. The proximal fibula in the knee joint and its anatomical structures are of utmost importance for the anatomical integrity of the knee and its normal functions. The fibula has rich anatomical relations, some of which are important structures of the knee. These anatomical structures and the fibula provide stability of the knee joint and its functions as well as being an important mechanical support to the knee joint. Therefore, the knee joint will receive the negative effects from the pathologies of the bone or soft tissue that may occur in fibula fractures.

Isolated medial cuneiform tuberculosis: a case report.

Skeletal involvement in extrapulmonary tuberculosis is extremely rare, and foot involvement accounts for less than 10% of osteoarticular tuberculosis. Tuberculosis osteomyelitis of the foot can also mimic a wide range of pathology. As a result, this condition is often misdiagnosed, or the true nature of the lesion is identified late in the diagnostic process. This article reports a case of tuberculosis in the medial cuneiform of a 3-year-old girl. Initially misdiagnosed as osteochondrosis, the patient returned 2 years later with a draining sinus on the medial aspect of the left midfoot. New radiographs showed a cystic lesion in the substance of the medial cuneiform. A diagnosis of tuberculosis was established after biopsy and histopathological examination of operative specimen. Antituberculosis treatment was implemented and continued for 16 months. At that time, clinical signs of infection had ceased.