Be aware of the "O" sign in the bipolar cup dissociation during closed reduction of bipolar dislocation: A case report.

RATIONALE: Bipolar cup dissociation following hip hemiarthroplasty is a rare complication of which only a few cases have been reported, and it usually requires revision surgery because of difficulties in closed reduction. PATIENT CONCERNS: We report the case of a 57-year-old man who underwent bipolar hemiarthroplasty 2 months ago caused by a left femoral neck fracture. Postoperatively, bipolar dislocation occurred thrice, and the patient showed bipolar cup dissociation during closed reduction maneuver at the recent visit. At the time of this event, no consideration was given to the shape of the prosthesis on the radiograph. DIAGNOSES: The patient was diagnosed with early bipolar cup dissociation. INTERVENTIONS: The patient underwent revision surgery to replace and reassemble the femoral head component. OUTCOMES: No further dislocation occurred following the surgery. LESSONS: To avoid dissociation of the components during closed reduction, it would be helpful to have knowledge of the "O" sign, a concentric circle shape of the prosthesis on the radiograph. LEVEL OF EVIDENCE: Level V, case report.

Technical Feasibility and Early Clinical Outcome of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Larger Cage.

BACKGROUND: Transforaminal lumbar interbody fusion with biportal endoscopic guidance (BE-TLIF) has been previously reported with promising clinical results. However, complications such as delayed union or subsidence occurred as with open surgery. We assumed using larger cages would result in less occurrence of such complications. We aimed to analyze the clinical outcome and technical feasibility of BE-TLIF using larger cages, initially designed for oblique lumbar interbody fusion. METHODS: We enrolled cases that underwent single-level BE-TLIF between January 2021 and January 2022. Polyetheretherketone cages that were larger than the conventional size were used. Diagnoses were degenerative spondylolisthesis or isthmic spondylolisthesis. Visual analog scale scores of the back and leg and Oswestry Disability Index were collected perioperatively. Modified Macnab criteria were used to evaluate the patients at the final follow-up. Radiologic outcome of interbody fusion rate and perioperative complications were analyzed. RESULTS: A total of 35 cases were included in this study. The mean age was 67.5 ± 8.4 and consisted of 13 male patients, and the mean follow-up duration was 18.3 ± 3.7 months. The majority (32/35, 91.3%) of the index level was located within the lower lumbar region, L4-S1. Oswestry Disability Index scores improved from 65.4 ± 5.4 preoperatively to 15.4 ± 6.1 at the final follow-up (P < 0.001). Visual analog scale scores of the leg decreased from 7.9 ± 1.5 to 1.7 ± 1.5 at the final follow-up (P < 0.001). Per the modified Macnab criteria on the final follow-up, 94% of the patients reported good/excellent. Most (94.2%) of the patients showed fusion grade I and II at the 1-year follow-up. No patient showed subsidence or other postoperative complication. CONCLUSIONS: BE-TLIF using a larger cage was safely performed without risk of subsidence during the 1-year follow-up. A cage with a larger footprint may be advantageous in BE-TLIF in the aspect of interbody fusion and subsidence.