The Association Between Mental Disorders and Postoperative Outcomes of Scoliosis Surgery: A Systematic Review and Meta-analysis.

Background: Mental disorders may adversely impact postoperative recovery in scoliosis surgery. However, study findings have been inconsistent and a systematic synthesis is lacking. Methods: We searched PubMed, Embase, PsycINFO, and Cochrane Library for studies examining associations between preoperative mental disorders, assessed by various scales, such as the Patient Health Questionnaire (PHQ), the Modified Somatic Perception Questionnaire (MSPQ), and the State-Trait Anxiety Inventory (STAI), and postoperative outcomes, such as pain, disability, quality of life, and satisfaction, in scoliosis surgery. Random-effects meta-analyses pooled standardized mean differences (SMDs) in postoperative outcomes between patients with and without mental disorders. Results: Twelve observational studies were included for the systematic review, and 5 studies were included in the meta-analysis. The meta-analysis demonstrated significantly worse postoperative outcomes in patients with mental disorders compared to those without (SMD -1.96, 95% confidence interval [CI] -3.08 to -0.84, P < 0.001). Significant heterogeneity was present (I2 = 76%). Review of included studies found mental disorders linked to higher preoperative pain/disability and lower quality of life/satisfaction, as well as worse postoperative scores on these outcomes. Moderating factors identified included mental disorder severity, treatment specifics, and patient demographics. Conclusion: Preoperative mental disorders, especially depression and anxiety, are associated with significantly worse postoperative pain, disability, quality of life, and satisfaction in scoliosis surgery. This association may be mediated by psychological factors, such as catastrophizing, self-criticism, and kinesiophobia, and biological factors, such as inflammation, neuroendocrine changes, and central sensitization. Routine psychological screening and interventions for high-risk patients may improve postoperative outcomes but not necessarily surgical effectiveness. Further research is warranted to confirm these findings and elucidate optimal treatment approaches.

Quadriceps tendon pie-crusting release of stiff knees in total knee arthroplasty.

BACKGROUND: Traditional treatments for stiff knees, such as quadriceps snip and V-Y quadricepsplasty, require extensive soft tissue exposure and lead to recurrent poor arc of motion and a permanent extensor lag. In this study, we evaluated the effect of the quadriceps tendon pie-crusting release for treating limited knee flexion in total knee arthroplasty (TKA) and compared the outcomes of two surgical approaches. METHODS: Sixteen knees with severe osteoarthritis were treated with TKA using either a midvastus (eight knees) or parapatellar (eight knees) approach. Quadriceps tendon pie-crusting release was performed after fixation of the knee prosthesis. Maximum knee flexion, Knee Society Score (KSS), and quadriceps strength were recorded and compared between the two surgical approach groups at different time points. RESULTS: The average maximum flexion angle of the knee increased from 40.6 ± 11.8 preoperatively to 63.1 ± 8.4 after fixation of the knee prosthesis in the midvastus group and from 38.8 ± 10.3 to 65.6 ± 9.0 in the parapatellar group. TKA did not lead to adequate correction of extension contracture in these stiff knees. The quadriceps tendon pie-crusting release further improved knee flexion by 35.0 ± 4.6 and 25.6 ± 4.2 in the midvastus and parapatellar groups, respectively (p < 0.001). Patients in the midvastus group had higher mean KSS (88.2 ± 2.4) compared with the parapatellar group (84.1 ± 3.1) at the last follow-up (p = 0.048). CONCLUSIONS: The quadriceps tendon pie-crusting release technique was an effective procedure for improving knee flexion in cases of stiff knee. The midvastus approach maintained the integrity of the extensor mechanism and resulted in better outcomes than the parapatellar approach.

Effect of irrigation fluid temperature on core body temperature and inflammatory response during arthroscopic shoulder surgery.

PURPOSE: This study was designed to evaluate the influence of irrigation fluid on the patients' physiological response to arthroscopic shoulder surgery. METHODS: Patients who were scheduled for arthroscopic shoulder surgery were prospectively included in this study. They were randomly assigned to receive warm arthroscopic irrigation fluid (Group W, n = 33) or room temperature irrigation fluid (Group RT, n = 33) intraoperatively. Core body temperature was measured at regular intervals. The proinflammatory cytokines TNF-α, IL-1, IL-6, and IL-10 were measured in drainage fluid and serum. RESULTS: The changes of core body temperatures in Group RT were similar with those in Group W within 15 min after induction of anesthesia, but the decreases in Group RT were significantly greater after then. The lowest temperature was 35.1 ± 0.4 °C in Group RT and 35.9 ± 0.3 °C in Group W, the difference was statistically different (P < 0.05). Hypothermia occurred in 31 out of 33 subjects in Group RT (31/33; 94 %), but was significantly lower in Group W (9/24; 27 %; P < 0.05). Serum TNF-α changes were undetectable postoperatively. No statistical significant differences in serum IL-1 and serum IL-10 levels were observed between groups. Serum IL-6 levels were significantly lower in Group W (P < 0.05). The levels of the above cytokines in drainage fluid were all significantly lower in Group W after surgery (P < 0.05). CONCLUSION: Hypothermia occurs more often in arthroscopic shoulder surgery by using room temperature irrigation fluid compared with warm irrigation fluid. And local inflammatory response is significantly reduced by using warm irrigation fluid. It seems that warm irrigation fluid is more recommendable for arthroscopic shoulder surgery.

Hamstring tendon autograft versus LARS artificial ligament for arthroscopic posterior cruciate ligament reconstruction in a long-term follow-up.

INTRODUCTION: Surgical reconstruction has been increasingly recommended for the surgical management of posterior cruciate ligament (PCL) ruptures. While the choice of tissue graft still remains controversial. Currently both hamstring tendon autograft (HTG) and ligament advanced reinforcement system (LARS) artificial ligament are widely used but there are seldom reports on the comparisons of their clinical results. Our study was aimed to assess the effectiveness of these two grafts. MATERIALS AND METHODS: Thirty-five patients with unilateral PCL rupture were enrolled in this retrospectively study. Sixteen of them received arthroscopically assisted PCL reconstruction using hamstring tendon autografts (HTG group) and nineteen using LARS ligaments (LARS group). All cases were followed up for 46-57 months with a mean of 51 months. Follow-up examinations included radiographic assessment, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) rating scales and KT-1000 test. RESULTS: All patients improved significantly at the final follow-up compared with the examinational results preoperatively and there were no significant differences between HTG group and LARS group with respect to the results of radiographic assessment, Lysholm score, Tegner score, IKDC rating scales and KT-1000 test. CONCLUSIONS: Similar good clinical results were obtained after PCL reconstruction using hamstring tendon autografts and LARS ligaments. Both LARS ligament and hamstring tendon autograft are ideal grafts for PCL reconstruction.