International orthopaedics
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When surgically treated, pelvic-ring deformities due to post-traumatic malunions in adults usually require invasive three-stage (prone/supine/prone or supine/prone/supine) procedures. A standardised two-stage prone/supine procedure was developed by the authors. Technical points and first clinical results are presented. Malunuions related to Tile B and C types of fracture were successfully corrected.
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Randomized Controlled Trial
Total knee arthroplasty without patellar resurfacing.
One hundred and eleven total knee replacements without patellar resurfacing were followed-up for a minimum of 48.8 months (range 48.8-108.2 months; average 78.2 months). Evaluation was performed using the Knee Society Clinical Rating System (KS-CRS). ⋯ There were no significant differences among the knees with mild, moderate, or severe degenerative change to the patella with regard to the preoperative (p=0.83) and postoperative (p=0.39) knee pain score. It seems likely that the postoperative knee pain is not related to the severity of degenerative change to the patella in total knee arthroplasties performed without patellar resurfacing, and none of those patients required patellar resurfacing to achieve knee pain relief.
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Axial pain is one of the major complications after laminoplasty, and preservation of C7 spinous process during the procedure can reduce the axial pain. However, it has not been elucidated whether laminoplasty preserving the C7 spinous process can maintain neurological improvement for a long time. The purpose of our retrospective study was to investigate the long-term neurological outcome after open-door laminoplasty preserving the C7 spinous process for cervical spondylotic myelopathy (CSM). ⋯ No compression of the spinal cord was observed in any MRI at the latest follow-up. Preservation of the C7 spinous process does not influence the long-term outcome of CSM after laminoplasty. Although we did not have a comparative group, the procedure described here should be considered as the solution.
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Minimally invasive total hip arthroplasty using a short skin incision is a subject of much debate in the literature. The present study estimates the possible minimal length of the exposure in an unselected patient cohort and compares the lateral mini-incision technique and traditional total hip arthroplasty (THA). One hundred and two patients were divided into three groups according to the type of surgery and length of incision: mini-incision (less than 10 cm) was performed in 38 patients; midi-incision (10-14 cm) in 43; and standard-incision (longer than 14 cm) in 21 patients. ⋯ The length of incision was shortened and optimized (less than 14 cm) in 82% of patients, and mini-incision was performed in 38 patients of this unselected cohort. Because of the understandable demand of the patients for less invasive intervention, the surgeon should use a smaller but not necessarily mini-incision with minimal soft tissue trauma that still allows him to perform the procedure well, without compromising the type of implants and the otherwise excellent long-term results. Randomized prospective studies are needed to explore the real value of the minimally invasive total hip arthroplasty.
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Randomized Controlled Trial
Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis.
We randomly assigned 17 patients with scaphoid non-union at the proximal pole to three treatment groups: (1) autologous iliac graft (n=6), (2) autologous iliac graft + osteogenic protein-1 (OP-1; n=6), and (3) allogenic iliac graft + OP-1 (n=5). Radiographic, scintigraphic, and clinical assessments were performed throughout the follow-up period of 24 months. ⋯ The addition of OP-1 to allogenic bone implant equalised the clinical outcome with the autologous graft procedure. Consequently the harvesting of autologous graft can be avoided.