1
|
Jankowski JM, Menken LG, Romanelli F, Hong IS, Tang A, Yoon RS, Liporace FA. Outcomes of Antibiotic-Impregnated Calcium Sulfate, Reamer-Irrigator-Aspirator, and Locked Intramedullary Static Spacer in the Treatment of Periprosthetic Joint Infection in the Multiply Revised and Infected Knee: A Single-Center Case Series. Arthroplast Today 2024; 27:101370. [PMID: 38690098 PMCID: PMC11058074 DOI: 10.1016/j.artd.2024.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
Background Periprosthetic joint infection after total knee arthroplasty is commonly treated via 2-stage revision utilizing either articulating or static antibiotic cement spacers. While recent literature exhibits a slight functional advantage in favor of articulating spacers, those patients with a history of recurrent infection/multiple revision procedures are frequently excluded from these studies. The purpose of this study was to report infection eradication rates and efficacy of utilizing antibiotic-loaded locked intramedullary nail for infection for the multiply revised, infected total knee arthroplasty. Methods A retrospective review was performed of all consecutive patients receiving static spacers between 2017 and 2020 at an academic medical center. Surgical techniques for all patients included irrigation and debridement using a reamer-irrigator-aspirator, injection of antibiotic-loaded calcium sulfate into the intramedullary canal, and nail placement. Antibiotic-loaded cement is then used to create a spacer block in the joint space. A Cox proportional hazard regression was run to identify risk factors for reinfection. Results Forty-two knees in 39 patients were identified meeting inclusion criteria. Overall, there was an 68.8% infection eradication rate at an average of 46.9 months following spacer placement. The only risk factors identified on cox regression were increasing number of previous spacers, a surrogate for previous infections (hazards ratio = 14.818, P value = .021), and increasing operative time during spacer placement (hazards ratio = 1.014, P value = .039). Conclusions Use of static spacers, in conjunction with reamer-irrigator-aspirator and antibiotic-loaded calcium sulfate, can be effective in treating chronic, complex periprosthetic joint infections in the setting of bone loss and or soft-tissue compromise and produced similar results to more simple infection scenarios.
Collapse
Affiliation(s)
- Jaclyn M. Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Luke G. Menken
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Filippo Romanelli
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Ian S. Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Alex Tang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S. Yoon
- Corresponding author. Orthopaedic Research, Jersey City Medical Center – RWJBarnabas Health, 377 Jersey Avenue, Suite 550, Jersey City, NJ 07302, USA. Tel.: +1 201 716 5850.
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center – RWJBarnabas Health, Livingston, NJ, USA
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, Jersey City, NJ, USA
| |
Collapse
|
2
|
Mayer MA, Deliso M, Hong IS, Saltzman BM, Longobardi RS, DeLuca PF, Rizio L. Rehabilitation and Return to Play Protocols After Anterior Cruciate Ligament Reconstruction in Soccer Players: A Systematic Review. Am J Sports Med 2024:3635465241233161. [PMID: 38622858 DOI: 10.1177/03635465241233161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Rehabilitation after anterior cruciate ligament ACL reconstruction (ACLR) is crucial for safe return to play (RTP) and reducing the chances of a reinjury. Yet, there is no consensus on the ideal functional tests to assess rehabilitation progress in soccer players after ACLR. PURPOSE The primary objective was to highlight the existing gap in the literature concerning the most effective standardized rehabilitation protocols and testing for facilitating successful RTP among soccer players. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review using PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Inclusion criteria encompassed original studies (level of evidence 1-4) that examined rehabilitation protocols, metrics of knee rehabilitation, and clinical outcomes after ACLR in soccer players. RESULTS This review incorporated 23 studies, predominantly retrospective case series, with a total number of 874 soccer players who underwent ACLR and rehabiliation. 5 (21.7%) studies utilized an accelerated rehabilitation protocol, while 7 (30.4%) of studies utilized a criterion-based rehabilitation. A wide heterogeneity of data was extracted including functional tests of rehabilitation and RTP such as strength test batteries, hop test batteries, and movement quality assessments. Of the 23 selected studies, 2 (8.7%) used all 3 test batteries, 8 (34.8%) used 2 test batteries, 12 (52.2%) used 1 test battery, and 1 (4.3%) used 0 of the test batteries. The mean time between surgery and RTP ranged from 3 to 8 months with only 2 (8.7%) studies reporting complications after ACLR. Lastly, out of the total studies examined, 9 (39.1%) assessed patient-reported outcome measures (PROMs), all of which demonstrated significant improvement from the initial assessment to the final follow up. CONCLUSION Soccer-specific rehabilitation after ACLR lacks standardization. Even though many studies have assessed protocols for optimal RTP and reduced secondary ACL injuries, there is a gap in the literature regarding the most effective protocols and RTP testing. The methodology reported by Kyritsis et al could serve as a foundation for future prospective randomized multicenter studies to establish a standard rehabilitation protocol and enable a successful return to soccer.
Collapse
Affiliation(s)
- McKenzie A Mayer
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Marisa Deliso
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Ian S Hong
- Department of Orthopedic Surgery, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
- Department of Orthopedic Surgery, Jersey City Medical Center, Jersey City, New Jersey, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Raphael S Longobardi
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Peter F DeLuca
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Louis Rizio
- Department of Sports Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| |
Collapse
|
3
|
Lutz AB, Patel DV, Bibbo C, Hong IS, Hameed D, Dubin J, Mont MA. Total Hip Arthroplasty in Human Immunodeficiency Virus Positive Patients: A Systematic Review of Outcomes. J Arthroplasty 2024:S0883-5403(24)00143-8. [PMID: 38452861 DOI: 10.1016/j.arth.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/04/2024] [Accepted: 02/11/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) has become a common intervention for Human Immunodeficiency Virus (HIV)-positive patients who have osteonecrosis of the femoral head. This paper provides a systematic review to assess survivorships, patient-reported outcomes (PROMs), infection rates, other complications, and immune competence for patients who had THAs who did and did not have HIV. METHODS A comprehensive and systematic review of published studies investigating the outcomes of THA in HIV-positive patients (osteonecrosis and non-osteonecrosis patients) was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 10 studies with 9,534 HIV-positive patients fulfilled the inclusion and exclusion criteria. Manuscript quality was assessed on two scales: the Coleman Methodology Score and the level of evidence derived from Centre for Evidence-Based Medicine criteria. Data was extracted from studies in the five key areas of interest: survivorships; PROMs; infection rates; complications; as well as clusters of differention-4 (CD4+) counts and viral loads (VL). RESULTS Implant survivorship was between 95 and 100%. Postoperative Harris Hip Scores were significantly improved from preoperative values in HIV-positive patients. Postoperative PROMs and infections did not appear to be different between HIV-positive and HIV-negative patients. Many of the cohort studies demonstrate comparable complication rates to matched controls. Where described (7 reports), mean CD4+ counts ranged from 425 to 646 cells/mm3, with low VL (3 reports) and variations not found to influence outcomes. CONCLUSION Total hip arthroplasty (THA) is an effective treatment for HIV-positive patients, many of whom suffer from osteonecrosis of the femoral head. The results demonstrate excellent implant survivorship, improved quality of life, and a low risk of infections and complications.
Collapse
Affiliation(s)
- Alexandra Baker Lutz
- University of Maryland Medical Center, Department of Orthopaedic Surgery, Baltimore, MD, U.S.A
| | - Deepak V Patel
- Seton Hall University School of Graduate Medical Education, South Orange, New Jersey, USA
| | - Christopher Bibbo
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A.; Seton Hall University School of Graduate Medical Education, South Orange, New Jersey, USA.
| | - Ian S Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJ Barnabas Health, 377 Jersey Ave, Suite 550, Jersey City, New Jersey 07302, U.S.A
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, U.S.A
| | - Jeremy Dubin
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, U.S.A
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, U.S.A
| |
Collapse
|
4
|
Gencarelli P, Menken LG, Hong IS, Robbins CJ, Jankowski JM, Yoon RS, Liporace FA. No Difference in Acute Outcomes for Patients Undergoing Fix and Replace Versus Fixation Alone in the Treatment of Geriatric Acetabular Fractures. J Orthop Trauma 2024; 38:88-95. [PMID: 38031287 DOI: 10.1097/bot.0000000000002733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To compare acute outcomes between patients undergoing fix and replace (FaR) versus open-reduction and internal fixation (ORIF) alone in the treatment of geriatric acetabular fractures. METHODS DESIGN Retrospective Cohort Study. SETTING Single Level 2 Trauma Center. PATIENT SELECTION CRITERIA Consecutive acetabular fracture patients ≥ 55 years of age treated by two orthopaedic trauma surgeons at one tertiary care center from January 2017 to April 2022 with FaR versus ORIF were identified. Included were those with complete datasets within the 180-day global period. Excluded were patients with previous ORIF of the acetabulum or femur, or revision total hip arthroplasty. OUTCOME MEASURES AND COMPARISONS The primary outcomes were length of hospital stay (LOS), postoperative weight-bearing status, postoperative disposition, time to postoperative mobilization, and 90-day readmission rates. Secondary outcomes compared included demographic information, injury mechanism, surgical time, complications, revisions, and preoperative and postoperative Hip Disability and Osteoarthritis Outcomes Score for Joint Replacement (HOOS Jr.) scores. These were compared between FaR and ORIF groups. RESULTS Seventeen FaR patients (average age 74.5 ± 9.0 years) and 11 ORIF patients (average age 69.4 ± 9.6 years) met inclusion criteria. Mean follow-up was 26.4 months (range: 6-75.6 months). More FaR group patients were ordered immediate weight-bearing as tolerated or partial weight-bearing compared with ORIF alone (70% vs. 9.0%, P = 0.03). More patients in the FaR group had pre-existing hip osteoarthritis compared with ORIF alone (71% vs. 27%, P = 0.05). Fracture classification ( P = 0.03) and Charlson Comorbidity Index ( P = 0.02) differed between the 2 groups. There were no other differences in demographics, LOS ( P = 0.99), postoperative disposition ( P = 0.54), time to postoperative mobilization ( P = 0.38), 90-day readmission rates ( P = 0.51), operative time ( P = 0.06), radiographic union ( P = 0.35), time to union ( P = 0.63), pre- ( P = 0.32) or postoperative HOOS Jr. scores ( P = 0.80), delta HOOS Jr. scores ( P = 0.28), or reoperation rates between groups ( P = 0.15). CONCLUSIONS FaR and ORIF seem to be sound treatment options in the management of geriatric acetabular fractures. Patients in the FaR group achieved immediate or partial weight-bearing earlier than the ORIF group; however, time to postoperative mobilization did not differ between the two groups. The remainder of acute postoperative outcomes (LOS, postoperative disposition, and 90-day readmission rates) did not differ between the two groups. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Pasquale Gencarelli
- Divison of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center, RWJBarnabas Health, Livingston, Jersey City, NJ
| | | | | | | | | | | | | |
Collapse
|
5
|
Hong IS, Pierpoint LA, Hellwinkel JE, Berk AN, Salandra JM, Meade JD, Piasecki DP, Fleischli JE, Ahmad CS, Trofa DP, Saltzman BM. Clinical Outcomes After ACL Reconstruction in Soccer (Football, Futbol) Players: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:788-804. [PMID: 36988238 PMCID: PMC10606974 DOI: 10.1177/19417381231160167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
CONTEXT The risk factors for anterior cruciate ligament (ACL) tear for athletes participating in pivoting sports includes young age and female sex. A previous meta-analysis has reported a reinjury rate of 15% after ACL reconstruction (ACLR) for athletes across all sports. To the best of the authors' knowledge, this is the first systematic review and meta-analysis of available literature reporting outcomes after ACLR in soccer players. OBJECTIVE To review and aggregate soccer-specific outcomes data after ACLR found in current literature to help guide a more tailored discussion regarding expectations and prognosis for soccer players seeking operative management of ACL injuries. DATA SOURCES A comprehensive search of publications was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and SPORTDiscus databases. STUDY SELECTION Inclusion criteria consisted of original studies, level of evidence 1 to 4, studies reporting clinical and patient-reported outcomes (PROs) after primary ACLR in soccer players at all follow-up length. STUDY DESIGN The primary outcomes of interest were graft failure/reoperation rates, ACL injury in contralateral knee, return to soccer time, and PROs. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Search of literature yielded 32 studies for inclusion that involved 3112 soccer players after ACLR. RESULTS The overall graft failure/reoperation rate ranged between 3.0% and 24.8% (mean follow-up range, 2.3-10 years) and the combined ACL graft failure and contralateral ACL injury rate after initial ACLR was 1.0% to 16.7% (mean follow-up range, 3-10 years); a subgroup analysis for female and male players revealed a secondary ACL injury incidence rate of 27%, 95% CI (22%, 32%) and 10%, 95% CI (6%, 15%), respectively. Soccer players were able to return to play between 6.1 and 11.1 months and the majority of PROs showed favorable scores at medium-term follow-up. CONCLUSION Soccer players experience high ACL injury rates after primary ACLR and demonstrated similar reinjury rates as found in previous literature of athletes who participate in high-demand pivoting sports.
Collapse
Affiliation(s)
- Ian S. Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | | | - Justin E. Hellwinkel
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Alexander N. Berk
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Jonathan M. Salandra
- Department of Orthopaedic Surgery, Jersey City Medical Center, RWJBarnabas Health, Jersey City, New Jersey
| | - Joshua D. Meade
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - James E. Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| | - Christopher S. Ahmad
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - David P. Trofa
- Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina and Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina
| |
Collapse
|
6
|
Keller DM, Saad BN, Hong IS, Gencarelli P, Tang A, Jankowski JM, Liporace FA, Yoon RS. Comparison of Outcomes After Reverse Total Shoulder Arthroplasty in Patients With Proximal Humerus Fractures Versus Rotator Cuff Arthropathy. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00006. [PMID: 37856701 PMCID: PMC10589608 DOI: 10.5435/jaaosglobal-d-23-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Indications for reverse total shoulder arthroplasty (rTSA) has expanded to encompass complex proximal humerus fractures (PHFs) in recent years. The purpose of this study was to report and assess whether PHF patients treated with rTSA could achieve similar functional outcomes and short-term survivorship to patients who underwent rTSA for rotator cuff arthropathy (RTCA). METHODS All consecutive patients with a preoperative diagnosis of PHF or RTCA, 18 years or older, treated with rTSA at a single academic institution between 2018 and 2020 with a minimum 2-year follow-up were retrospectively reviewed. Primary outcomes were survivorship defined as revision surgery or implant failure analyzed using the Kaplan-Meier survival curve, and functional outcomes, which included Quick Disabilities of the Arm, Shoulder, and Hand, and range of motion (ROM) were compared at multiple follow-up time points up to 2 years. Secondary outcomes were patient demographics, comorbidities, surgical data, length of hospital stay, and discharge disposition. RESULTS A total of 48 patients were included: 21 patients (44%) were diagnosed with PHF and 27 patients (56%) had RTCA. The Kaplan-Meier survival rate estimates at 3 years were 90.5% in the PHF group and 85.2% in the RTCA group. No differences in revision surgery rates between the two groups (P = 0.68) or survivorship (P = 0.63) were found. ROM was significantly lower at subsequent follow-up time points in multiple planes (P < 0.05). A greater proportion of patients in the PHF group received cement for humeral implant fixation compared with the RTCA group (48% versus 7%, P = 0.002). The mean length of hospital stay was longer in PHF patients compared with RTCA patients (2.9 ± 3.8 days versus 1.6 ± 1.8 days, P = 0.13), and a significantly lower proportion of PHF patients were discharged home (67% versus 96%, P = 0.015). CONCLUSION The rTSA implant survivorship at 3 years for both PHF and RTCA patients show comparable results. At the 2-year follow-up, RTCA patients treated with rTSA were found to have better ROM compared with PHF patients.
Collapse
Affiliation(s)
- David M. Keller
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Bishoy N. Saad
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Ian S. Hong
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Pasquale Gencarelli
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Alex Tang
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Jaclyn M. Jankowski
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Frank A. Liporace
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| | - Richard S. Yoon
- From the Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center–RWJBarnabas Health, Livingston, NJ/Jersey City, NJ
| |
Collapse
|
7
|
Wohler AD, Trofa DP, Meade JD, Hong IS, Moorman CT, Piasecki DP, Saltzman BM, Fleischli JE. Adjustable-loop cortical suspension device for posterolateral corner reconstruction in the setting of fibular avulsion fracture: a case series and novel technique description. Arch Orthop Trauma Surg 2023; 143:1981-1987. [PMID: 35305542 DOI: 10.1007/s00402-022-04412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A novel technique using an adjustable-loop cortical suspension toggle device for reduction of a fibular head avulsion fracture (arcuate fracture) in posterolateral corner (PLC) reconstruction is described. Results of clinical follow-up are presented. MATERIALS AND METHODS 9 patients were retrospectively identified who underwent posterolateral corner reconstruction using an adjustable-loop cortical suspension toggle device. Radiographic examination was used to evaluate the successful healing of the avulsed fibular head fragments post-operatively. RESULTS 7 patients reported satisfactory results with their clinical outcome with no feelings of knee instability or objective instability on exam at final follow-up. Post-operative radiographs obtained > 6 months following reconstruction demonstrated well reduced and healed fracture in 5 of 6 patients, with 1 patient demonstrating maintained reduction but incomplete fracture union at 6 months. CONCLUSION This novel surgical technique for PLC reconstruction with an avulsed fibular head fracture is a viable alternative to previously described methods. The majority of patients report subjective satisfaction with a stable knee post-operatively. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Andrew D Wohler
- Department of Orthopaedic Surgery, Atrium Health, Charlotte, NC, USA
| | - David P Trofa
- Columbia University Medical Center, New York, NY, 10032, USA
| | - Joshua D Meade
- OrthoCarolina Sports Medicine Center, 1915 Randolph Rd, Charlotte, NC, 282077, USA
- Atrium Health-Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Ian S Hong
- OrthoCarolina Sports Medicine Center, 1915 Randolph Rd, Charlotte, NC, 282077, USA
- Atrium Health-Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Claude T Moorman
- OrthoCarolina Sports Medicine Center, 1915 Randolph Rd, Charlotte, NC, 282077, USA
- Atrium Health-Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Dana P Piasecki
- OrthoCarolina Sports Medicine Center, 1915 Randolph Rd, Charlotte, NC, 282077, USA
- Atrium Health-Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, 1915 Randolph Rd, Charlotte, NC, 282077, USA.
- Atrium Health-Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA.
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, 1915 Randolph Rd, Charlotte, NC, 282077, USA
- Atrium Health-Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203, USA
| |
Collapse
|
8
|
Attenasio A, Kraeutler MJ, Hong IS, Baskar S, Patel DV, Wright C, Jankowski JM, Liporace FA, Yoon RS. Are complications related to the perineal post on orthopaedic traction tables for surgical fracture fixation more common than we think? A systematic review. Patient Saf Surg 2023; 17:5. [PMID: 36949453 PMCID: PMC10031869 DOI: 10.1186/s13037-023-00355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Traction tables have long been utilized in the management of fractures by orthopaedic surgeons. The purpose of this study was to systematically review the literature to determine the complications inherent to the use of a perineal post when treating femur fractures using a traction table. METHODS A systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) using PubMed, EMBASE, and Cochrane Library. The search phrase used was "fracture" AND "perineal" AND "post" AND ("femur" OR "femoral" OR "intertrochanteric" OR "subtrochanteric"). Inclusion criteria for this review were: level of evidence (LOE) of I - IV, studies reporting on patients surgically treated for femur fractures, studies reporting on patients treated on a fracture table with a perineal post, and studies that reported the presence or absence of perineal post-related complications. The rate and duration of pudendal nerve palsy were analyzed. RESULTS Ten studies (2 prospective and 8 retrospective studies; 2 LOE III and 8 LOE IV) were included consisting of 351 patients of which 293 (83.5%) were femoral shaft fractures and 58 (16.5%) were hip fractures. Complications associated with pudendal nerve palsies were reported in 8 studies and the mean duration of symptoms ranged between 10 and 639 days. Three studies reported a total of 11 patients (3.0%) with perineal soft tissue injury including 8 patients with scrotal necrosis and 3 patients with vulvar necrosis. All patients that developed perineal skin necrosis healed through secondary intention. No permanent complications relating to pudendal neurapraxia or soft tissue injuries were reported at final follow-up timepoints. CONCLUSION The use of a perineal post when treating femur fractures on a fracture table poses risks for pudendal neurapraxia and perineal soft tissue injury. Post padding is mandatory and supplemental padding may also be required. Appropriate perineal skin examination prior to use is also important. Occurring at a higher rate than previously thought, appropriate post-operative examination for any genitoperineal soft tissue complications and sensory disturbances should not be ignored.
Collapse
Affiliation(s)
- Andrea Attenasio
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, 377 Jersey Ave, Suite 550, Livingston, Jersey City, NJ, 07302, USA
| | - Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Ian S Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, 377 Jersey Ave, Suite 550, Livingston, Jersey City, NJ, 07302, USA
| | - Suriya Baskar
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, 377 Jersey Ave, Suite 550, Livingston, Jersey City, NJ, 07302, USA
| | - Deepak V Patel
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Craig Wright
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Jaclyn M Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, 377 Jersey Ave, Suite 550, Livingston, Jersey City, NJ, 07302, USA
| | - Frank A Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, 377 Jersey Ave, Suite 550, Livingston, Jersey City, NJ, 07302, USA
| | - Richard S Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJBarnabas Health, 377 Jersey Ave, Suite 550, Livingston, Jersey City, NJ, 07302, USA.
| |
Collapse
|
9
|
Trofa DP, Hong IS, Lopez CD, Rao AJ, Yu Z, Odum SM, Moorman CT, Piasecki DP, Fleischli JE, Saltzman BM. Isolated Osteochondral Autograft Versus Allograft Transplantation for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:812-824. [PMID: 35139311 DOI: 10.1177/03635465211053594] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Focal cartilage lesions of the knee remain a difficult entity to treat. Current treatment options include arthroscopic debridement, microfracture, autograft or allograft osteochondral transplantation, and cell-based therapies such as autologous chondrocyte transplantation. Osteochondral transplantation techniques restore the normal topography of the condyles and provide mature hyaline cartilage in a single-stage procedure. However, clinical outcomes comparing autograft versus allograft techniques are scarce. PURPOSE To perform a comprehensive systematic review and meta-analysis of high-quality studies to evaluate the results of osteochondral autograft and allograft transplantation for the treatment of symptomatic cartilage defects of the knee. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 2. METHODS A comprehensive search of the literature was conducted using various databases. Inclusion criteria were level 1 or 2 original studies, studies with patients reporting knee cartilage injuries and chondral defects, mean follow-up ≥2 years, and studies focusing on osteochondral transplant techniques. Exclusion criteria were studies with nonknee chondral defects, studies reporting clinical outcomes of osteochondral autograft or allograft combined with other procedures, animal studies, cadaveric studies, non-English language studies, case reports, and reviews or editorials. Primary outcomes included patient-reported outcomes and failure rates associated with both techniques, and factors such as lesion size, age, sex, and the number of plugs transplanted were assessed. Metaregression using a mixed-effects model was utilized for meta-analyses. RESULTS The search resulted in 20 included studies with 364 cases of osteochondral autograft and 272 cases of osteochondral allograft. Mean postoperative survival was 88.2% in the osteochondral autograft cohort as compared with 87.2% in the osteochondral allograft cohort at 5.4 and 5.2 years, respectively (P = .6605). Patient-reported outcomes improved by an average of 65.1% and 81.1% after osteochondral autograft and allograft, respectively (P = .0001). However, meta-analysis revealed no significant difference in patient-reported outcome percentage change between osteochondral autograft and allograft (P = .97) and a coefficient of 0.033 (95% CI, -1.91 to 1.98). Meta-analysis of the relative risk of graft failure after osteochondral autograft versus allograft showed no significant differences (P = .66) and a coefficient of 0.114 (95% CI, -0.46 to 0.69). Furthermore, the regression did not find other predictors (mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location) that may have significantly affected patient-reported outcome percentage change or postoperative failure between osteochondral autograft versus allograft. CONCLUSION Osteochondral autograft and allograft result in favorable patient-reported outcomes and graft survival rates at medium-term follow-up. While predictors for outcomes such as mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location did not affect the comparison of the 2 cohorts, proper patient selection for either procedure remains paramount to the success and potentially long-term viability of the graft.
Collapse
Affiliation(s)
- David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Ian S Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Cesar D Lopez
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Allison J Rao
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
| | - Ziqing Yu
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Susan M Odum
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
| | - Claude T Moorman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Dana P Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| |
Collapse
|
10
|
Hong IS, Sonnenfeld JJ, Sicat CS, Hong RS, Trofa DP, Schiffern SC, Hamid N, Fleischli JE, Saltzman BM. Outcomes After Arthroscopic Revision Bankart Repair: An Updated Systematic Review of Recent Literature. Arthroscopy 2023; 39:438-451. [PMID: 35398484 DOI: 10.1016/j.arthro.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To provide an update of recent literature with a specialized focus on clinical outcomes following arthroscopic revision Bankart repair (ARBR) by performing a systematic review of all available literature published between 2013 and 2020. METHODS A literature search reporting clinical outcomes after ARBR was performed. Criteria for inclusion consisted of original studies; Level of Evidence of I-IV; studies focusing on clinical outcomes after ARBR published between January 1, 2013, and January 4, 2021; studies reporting recurrent dislocation or instability rate after ARBR; reoperation/revision following ARBR, return to sport rates following ARBR; and patient-reported outcomes. The primary outcomes of interest were failure defined as recurrent instability or dislocation, return to sport rates, and patient-reported outcomes at follow-up. RESULTS A large proportion of patients undergoing arthroscopic revision Bankart repair were male, ranging between 67.7% and 93.8%. Failure rate and return to sports rate ranged between 6.1% and 46.8% and 25.9% and 88.3%, respectively, when patients with significant or greater than 20% glenoid bone loss was excluded. Patient-reported outcome scores, which included American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale, saw significant improvement over mean follow-up of ranging 21.64 to 60 months. CONCLUSIONS Both the failure rate and RTS rates after ARBR had a wide range, given the heterogeneity of the studies included, which varied in patient selection criteria pertaining to patients with greater than 20% glenoid bone. Although there have been advancements in arthroscopic techniques and a trend favoring arthroscopic stabilization procedures, there is a lack of consensus in recent literature for careful patient selection criteria that would minimize failure rates and maximize RTS rates after ARBR. LEVEL OF EVIDENCE Level IV, a systematic review of Level III-IV studies.
Collapse
Affiliation(s)
- Ian S Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | | | - Chelsea Sue Sicat
- School of Medicine, New York Medical College, Valhalla, New York, U.S.A
| | - Robin S Hong
- Schulich School of Medicine & Dentistry, Western University, Medical Sciences Building, London, Ontario, Canada
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, U.S.A
| | | | - Nady Hamid
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A..
| |
Collapse
|
11
|
Obana KK, Schallmo MS, Hong IS, Ahmad CS, Moorman CT, Trofa DP, Saltzman BM. Current Trends in Orthobiologics: An 11-Year Review of the Orthopaedic Literature. Am J Sports Med 2022; 50:3121-3129. [PMID: 34528456 DOI: 10.1177/03635465211037343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of "orthobiologics" or regenerative therapies in orthopaedic surgery has grown in recent years. Particular interest has been raised with regard to platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cells. Although studies have analyzed outcomes after orthobiologic treatment, no study has analyzed how the literature as a whole has evolved. PURPOSE To evaluate trends in platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cell publications and to assess how these might inform efforts to establish minimum reporting standards and forecast future use. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A database was compiled systematically using PubMed to identify articles published between 2009 and 2019 within 9 prominent orthopaedic journals and pertaining to the use of platelet-rich plasma, bone marrow aspirate, adipose-derived cells, and amniotic cells in the treatment of musculoskeletal conditions. Included articles were classified as clinical, nonclinical (translational or basic science), or review, and a variety of study parameters were recorded for each. Additional queries were performed to identify articles that utilized minimum reporting standards. RESULTS A total of 474 articles (132 clinical, 271 nonclinical, 71 review) were included, consisting of 244 (51.5%) platelet-rich plasma, 146 (30.8%) bone marrow aspirate, 72 (15.2%) adipose-derived cells, and 12 (2.5%) amniotic cells. The greatest annual increase in publications for each orthobiologic topic was from 2018 to 2019. The American Journal of Sports Medicine demonstrated the highest number of overall (34.2%) and clinical (50.0%) publications, and accounted for 44.3% of all platelet-rich plasma publications. The Journal of Orthopaedic Research accounted for the second highest overall number of publications (24.9%) and highest nonclinical publications (41.0%). Platelet-rich plasma accounted for 91.5% of all level 1 clinical studies, while much greater than half of bone marrow aspirate, adipose-derived cells, and amniotic cell publications were level 3 or lower. Out of the 207 articles that used some form of reporting protocol, 59 (28.5%) used an established algorithm and 125 (60.4%) used their own. CONCLUSION Interest in orthobiologics continues to grow, as evidenced by an increasing trend in publications over an 11-year period. However, current reporting on orthobiologic formulations is largely heterogeneous, emphasizing the need for minimum reporting standards and higher-quality studies.
Collapse
Affiliation(s)
- Kyle K Obana
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i, USA.,Department of Orthopaedics, NewYork-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Michael S Schallmo
- Department of Orthopaedic Surgery, Atrium Health, Charlotte, North Carolina, USA
| | - Ian S Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA.,Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Christopher S Ahmad
- Department of Orthopaedics, NewYork-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Claude T Moorman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA.,Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - David P Trofa
- Department of Orthopaedics, NewYork-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA.,Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| |
Collapse
|
12
|
Hong IS, Meade JD, Young BL, Yu Z, Trofa DP, Fleischli JE, Hamid N, Piasecki D, Saltzman BM. Trends in Repair vs. Biceps Tenodesis for Superior Labrum From Anterior to Posterior (SLAP) Tear: An Epidemiological Study. Cureus 2022; 14:e27096. [PMID: 36017300 PMCID: PMC9393044 DOI: 10.7759/cureus.27096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
|
13
|
Hong IS, Rao AJ, CarlLee TL, Meade JD, Hurwit DJ, Scarola G, Trofa DP, Schiffern SC, Hamid N, Connor PM, Fleischli JE, Saltzman BM. Outcomes after arthroscopic repair of rotator cuff tears in the setting of mild to moderate glenohumeral osteoarthritis. World J Orthop 2022; 13:631-643. [PMID: 36051376 PMCID: PMC9302032 DOI: 10.5312/wjo.v13.i7.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/30/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rotator cuff pathology is a very common source of shoulder pain. Similarly, osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms. Surgical management can be indicated for both pathologies, however, outcomes data is limited when examining rotator cuff repair (RCR) in the setting of glenohumeral arthritis (GHOA). Thus, this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.
AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.
METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017. Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity. Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis. Patients included had a minimum two year follow-up. Rate of conversion to total shoulder arthroplasty, complication rates following initial surgery, and patient-reported outcome measures were collected.
RESULTS A total of 142 patients were included. The number of patients that required total shoulder arthroplasty within two years after index surgery was low. 2/71 (2.8%) patients with GHOA, and 1/71 (1.4%) without GHOA. Following rotator cuff repair, both groups showed favorable patient-reported outcomes.
CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.
Collapse
Affiliation(s)
- Ian S Hong
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Allison J Rao
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Tyler L CarlLee
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Joshua D Meade
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Daniel J Hurwit
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Gregory Scarola
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York City, NY 10032, United States
| | - Shadley C Schiffern
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Nady Hamid
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC 28207, United States
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - Patrick M Connor
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - James E Fleischli
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - Bryan Michael Saltzman
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| |
Collapse
|
14
|
Rao AJ, Scarola GT, Rowe TM, Yeatts NC, Macknet DM, Ford SE, Hong IS, Gaston RG, Saltzman BM, Hamid N, Connor PM. Distal Biceps Repairs in Females: A Large Single-Center Case Series. HSS J 2022; 18:264-270. [PMID: 35645642 PMCID: PMC9096998 DOI: 10.1177/15563316211009855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distal biceps repair is a commonly reported procedure in male patients, with reliable outcomes and minimal long-term complications. Information on female patients, however, is limited, and variation in presentation and clinical outcomes is unknown. QUESTIONS/PURPOSE We sought to report on the presentation, treatment algorithm, and outcomes of a case series of female patients with distal biceps pathology. METHODS A retrospective evaluation was performed from a large, single specialty orthopedic group from 2005 to 2017. Inclusion criteria were surgical treatment of the distal biceps in female patients, with minimum 3 months of follow-up. The primary outcome variable was the Mayo Elbow Performance Score (MEPS). RESULTS Of 26 patients who met inclusion criteria, 18 (70%) were available for follow-up with patient-reported outcomes. Median age at time of injury was 56.1 years; 46.2% of patients presented with a complete tear of the distal biceps, and the remaining 53.8% presented with a partial tear that failed nonoperative treatment. Six patients had lateral antebrachial cutaneous neuritis in early follow-up, which ultimately resolved. Median MEPS score was 100 (interquartile range: 20). CONCLUSION This study represents the largest case series to date describing the presentation, treatment, and outcomes of female patients with distal biceps repair. Women tend to be older than men, have more insidious onset of pain, present with partial tearing, and may benefit from nonoperative treatment. Ultimately, based on this case series we believe distal biceps repair in female patients is a successful operation with minimal complications and high patient satisfaction.
Collapse
Affiliation(s)
- Allison J. Rao
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA
| | | | | | - Nicholas C. Yeatts
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA,Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA
| | | | - Samuel E. Ford
- Department of Orthopedics, Atrium
Health, Charlotte, NC, USA
| | - Ian S. Hong
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA,Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA
| | - R. Glenn Gaston
- Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA,OrthoCarolina Hand Center, Charlotte,
NC, USA
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA,Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA,Bryan M. Saltzman, MD, OrthoCarolina Sports
Medicine Center, 1915 Randolph Rd, Charlotte, NC 28207, USA.
| | - Nady Hamid
- Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA,OrthoCarolina Shoulder & Elbow
Center, Charlotte, NC, USA
| | - Patrick M. Connor
- OrthoCarolina Sports Medicine Center,
Charlotte, NC, USA,Musculoskeletal Institute, Atrium
Health, Charlotte, NC, USA
| |
Collapse
|
15
|
Bitzer A, Rondinelli S, Hurwit DJ, Sonnenfeld JJ, Hong IS, Connor PM. Conversion of anatomic total shoulder arthroplasty to reverse shoulder arthroplasty using a unique hybrid glenoid component: technique and preliminary results. JSES Rev Rep Tech 2022; 2:155-163. [PMID: 37587957 PMCID: PMC10426665 DOI: 10.1016/j.xrrt.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Degenerative arthritis of the shoulder is a common condition that is successfully treated with anatomic total shoulder arthroplasty (TSA). Rotator cuff disease has evolved as a leading cause of failure of anatomic TSA, requiring revision to reverse shoulder arthroplasty (RSA). This revision procedure can be extremely complex, particularly if removal of a well-fixed glenoid component is necessary. This case series outlines the technique and preliminary clinical results of conversion of anatomic TSA to RSA utilizing both modular humeral and hybrid glenoid components. Methods From July 2017 to December 2019, the senior author (PMC) performed 84 consecutive anatomic TSA procedures utilizing a modular humeral arthroplasty system and a unique hybrid glenoid component. Three cases (3/84, or 3.6%) required conversion from anatomic TSA to RSA because of postoperative traumatic rotator cuff failure. All modular revision cases were performed without humeral stem removal and with utilization of the existing, well-fixed hybrid glenoid central titanium peg as the foundation for glenoid component revision. Preoperative and postoperative American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, forward flexion, and patient satisfaction were analyzed in this modular revision group. In addition, several perioperative variables including operative time, blood loss, and length of stay were compared between this modular revision group and a nonmodular anatomic TSA to RSA revision comparative cohort. Results At an average follow-up of 24 months, average active forward flexion, postoperative American Shoulder and Elbow Surgeons scores, and visual analog scale pain scores improved significantly compared with preoperative scores in the modular revision group. All three patients were satisfied with their outcome. The average total operative time (109 minutes vs. 154 minutes, P = .02), blood loss (183 cc vs. 500 cc, P = .08), and length of hospital stay (26.3 hours vs. 36.6 hours P < .05) were lower in the modular revision group than those in a nonmodular revision cohort. Conclusion Revision of anatomic TSA to RSA utilizing a modular humeral system and a convertible hybrid glenoid component that does not require removal of a well-fixed central titanium peg which serves as the foundation for glenoid component revision was performed efficiently, safely, and successfully in three cases. This technique results in significantly improved clinical outcomes when revision to RSA is needed while potentially decreasing perioperative complications in the revision setting.
Collapse
Affiliation(s)
| | | | | | | | - Ian S. Hong
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Patrick M. Connor
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| |
Collapse
|
16
|
Yeatts NC, Rao AJ, Trofa DP, Hong IS, Moorman CT, Piasecki DP, Fleischli JE, Saltzman BM. Comparable Subjective and Objective Clinical Outcomes After Fibular or Combined Tibial-Fibular-based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00004. [PMID: 34860735 DOI: 10.5435/jaaosglobal-d-21-00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To compare subjective and objective outcomes of fibular and combined tibial-fibular (TF)-based posterolateral corner (PLC) reconstruction. METHODS A systematic review of literature reporting outcomes of posterolateral corner reconstruction was conducted including outcome studies of surgically treated PLC injuries with a minimum 1-year follow-up, postoperative subjective and objective outcomes including the patient-reported outcome scorings of Lysholm score, International Knee Documentation Committee evaluation (subjective and objective), dial test, and varus stress radiographs. RESULTS The 32 studies included comprised 40 cohorts: 12 cohorts (n = 350 knees) used a fibular-based technique, and 28 cohorts (n = 593 knees) used a combined TF-based technique. No statistically significant differences were found in patient-reported outcomes or objective clinical measurements comparing the two techniques using the Lysholm score (P = 0.204, τ2 = 3.46), International Knee Documentation Committee evaluation (subjective P = 0.21 τ2 = 15.57; objective P = 0.398), dial test (P = 0.69), or varus stress radiographs (P = 0.98, τ2 = 0.08). CONCLUSIONS This study found no statistically significant differences in subjective or objective clinical outcome measurements after fibular-based versus combined TF-based PLC reconstruction. Further prospective evaluation comparing long-term clinical outcomes, complications, and surgical time may help to elucidate a preferred reconstructive technique.
Collapse
Affiliation(s)
- Nicholas C Yeatts
- From the OrthoCarolina-Sports Medicine Center (Dr. Yeatts, Dr. Rao, Mr. Hong, Dr. Moorman, Dr. Piasecki, Dr. Fleischli and Dr. Saltzman), Atrium Health-Musculoskeletal Institute, Charlotte, NC (Dr. Yeatts, Hong, Dr. Moorman, Dr. Piasecki, Dr. Fleischli, and Dr. Saltzman), and the Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY (Dr. Trofa)
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Hong IS, Moontasri NJ, Ratliff DF. Epinephrine-Containing Digital Nerve Block: A Case of Digital Tip Necrosis Leading to Amputation in a Patient With No Known Vascular, Rheumatologic, or Smoking History. Journal of Hand Surgery Global Online 2021; 3:215-217. [PMID: 35415561 PMCID: PMC8991753 DOI: 10.1016/j.jhsg.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ian S. Hong
- New York Medical College, School of Medicine, Valhalla, NY
| | - Nancy J. Moontasri
- Department of Orthopedics, St. Joseph’s Regional Medical Center, Paterson, NJ
| | - David F. Ratliff
- Department of Orthopedics, St. Joseph’s Regional Medical Center, Paterson, NJ
- Corresponding author: David F. Ratliff, MD, Modern Orthopaedics of New Jersey, 2025 Hamburg Turnpike, Suite C, Wayne, NJ 07405.
| |
Collapse
|
18
|
Hong IS, Kim Y, Kim HJ, Choi BH, Jeon D, Bahng JB, Kim ES. Preliminary physical and electromagnetic design for the injector of the heavy ion superconducting linac. Rev Sci Instrum 2014; 85:02A709. [PMID: 24593443 DOI: 10.1063/1.4826606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Rare Isotope Science Project in Korea has developed a high current heavy ion accelerator using superconducting linacs. A normal conducting injector system was proposed to supply heavy ions to the superconducting driver linac. A beam physics and engineering design study was performed, and the beam dynamics of the injector was simulated. Optimized beam transmission and emittance were obtained from the beam dynamics simulation. Various normal conducting bunchers, such as multi-harmonic buncher, velocity equalizer, radiofrequency quadrupole, and re-bunchers, will be used and have been electromagnetically calculated.
Collapse
Affiliation(s)
- I S Hong
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - Y Kim
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - H J Kim
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - B H Choi
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - D Jeon
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - J B Bahng
- Department of Physics, Kyungbook National University, Daegu 702-701, South Korea
| | - E S Kim
- Department of Physics, Kyungbook National University, Daegu 702-701, South Korea
| |
Collapse
|
19
|
Choi S, Kim Y, Hong IS, Jeon D. Superconducting magnets for the RAON electron cyclotron resonance ion source. Rev Sci Instrum 2014; 85:02A906. [PMID: 24593485 DOI: 10.1063/1.4825384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The RAON linear accelerator of Rare Isotope Science Project has been developed since 2011, and the superconducting magnet for ECRIS was designed. The RAON ECR ion source was considered as a 3rd generation source. The fully superconducting magnet has been designed for operating using 28 GHz radio frequency. The RAON ECRIS operates in a minimum B field configuration which means that a magnetic sextupole field for radial confinement is superimposed with a magnetic mirror field for axial confinement. The highest field strength reaches 3.5 T on axis and 2 T at the plasma chamber wall for operating frequency up to 28 GHz. In this paper, the design results are presented of optimized superconducting magnet consisting of four solenoids and sextupole. The prototype magnet for ECRIS was fabricated and tested to verify the feasibility of the design. On the basis of test results, a fully superconducting magnet will be fabricated and tested.
Collapse
Affiliation(s)
- S Choi
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - Y Kim
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - I S Hong
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - D Jeon
- Rare Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| |
Collapse
|
20
|
Kim Y, Choi S, Hong IS. Design of the plasma chamber and beam extraction system for SC ECRIS of RAON accelerator. Rev Sci Instrum 2014; 85:02A907. [PMID: 24593486 DOI: 10.1063/1.4825385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The RAON accelerator is the heavy ion accelerator being built in Korea. It contains a 3rd generation SC ECRIS which uses 28 GHz/18 GHz microwave power to extract 12 puA uranium ion beams. A plasma chamber for that ECRIS is made of aluminum machined from bulk Al. That chamber contains cooling channels to remove dumped power and another access port for microwave introduction and plasma diagnostics. Beam extraction electrodes were designed considering the engineering issues and preliminary beam extraction analysis was done. That plasma chamber will be assembled with a cryostat, and beam extraction experiment will be done.
Collapse
Affiliation(s)
- Y Kim
- The Rair Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - S Choi
- The Rair Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| | - I S Hong
- The Rair Isotope Science Project, Institute for Basic Science, Daejeon 305-811, South Korea
| |
Collapse
|
21
|
Hong IS, Park BS, Jang JH, Kwon HJ, Cho YS, Hwang YS. Design and construction of a compact microwave proton source for a proton linac. Rev Sci Instrum 2010; 81:02A314. [PMID: 20192335 DOI: 10.1063/1.3271170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 100 MeV, 20 mA proton linear accelerator is being developed by the Proton Engineering Frontier Project at the Korea Atomic Energy Research Institute. 20 MeV acceleration system using radio frequency quadrupole and drift tube linac was already developed and has been tested. To operate this acceleration system with a long time, more reliable proton source is needed. A compact microwave proton source was proposed and has been designed and constructed as a prototype ion source for the 100 MeV proton linear accelerator. The design of microwave power injection system is based on the microwave proton injector at LANL and CEA. The wave power from a 2.45 GHz, 2 kW magnetron source is introduced into a compact plasma chamber with 7 cm diameter and 5 cm length through a standard tapered, double-ridged waveguide (WRD250) and a quartz window. The microwave power supply is installed on high voltage platform. Axial magnetic fields up to 1 kG can be provided with a water-cooled solenoid coil. A single-hole three electrode extraction system is designed for an extraction current up to 30 mA at a 50 kV extraction voltage. The design and initial operations of the proton source are presented.
Collapse
Affiliation(s)
- I S Hong
- Proton Engineering Frontier Project, Korea Atomic Energy Research Institute, Daejeon 305-353, Republic of Korea.
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
To evaluate the usefulness of MR cisternography fourteen patients that had hemifacial spasm and 20 control patients underwent MR cisternography. All the patients with hemifacial spasm had a confirmed vascular compression after surgery. MR cisternography was performed using a 1.5-tesla superconducting MR magnet in which a 3D (dimensional) heavily T2-weighted turbo spin-echo sequence was used. In 34 randomly selected individuals, we retrospectively determined whether MR cisternography images could be used to evaluate symptoms, and what the benefits of obtaining this image was. The results were correlated with the surgical findings. The sensitivity was 100% and the specificity was 94% in all patients having a hemifacial spasm. The offending vessels were the anterior inferior cerebellar artery (AICA) in six patients cases, the posterior inferior cerebellar artery (PICA) in six, both the vertebral artery and PICA in one, and the vertebral artery in one. All the images showed good resolution and contrast, and also showed the exact correlation between the facial nerve and intracranial vessels in the multiplaner image. The findings of neurovascular compression were well correlated with the surgical findings. We believe that high-resolution 3D MR cisternography is a very useful method for evaluating the neurovascular compression in patients that have hemifacial spasm.
Collapse
Affiliation(s)
- M S Lee
- Department of Radiology, Yonsei University, Wonju College of Medicine, Wonju, Kangwon-do 220-701, Korea
| | | | | | | | | |
Collapse
|
23
|
Brunson J, Press HC, Hong IS. Granulomatous orchitis. J Natl Med Assoc 2000; 92:458-9. [PMID: 11052461 PMCID: PMC2608522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- J Brunson
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | | | | |
Collapse
|
24
|
Kim YJ, Sung KJ, Kim MS, Hong IS. CT manifestations of cervical tuberculous lymphadenitis. J Otolaryngol 1993; 22:321-5. [PMID: 8230386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cervical tuberculous lymphadenitis is a commonly encountered disease, especially in Korea. Differentiation from other metastatic lymphadenopathies and benign conditions such as cystic neck masses is important. CT findings of tuberculous lymphadenopathy in the abdomen and thorax are frequently reported in the literature, though there are only a few articles concerning cervical tuberculous lymphadenopathy. The authors retrospectively analyzed CT findings of 42 cases with cervical tuberculous lymphadenitis regarding distribution, contour, enhancing pattern, changes in the adjacent fascial plane, and dermal and subcutaneous manifestations. We concluded that the following are suggestive of tuberculous lymphadenitis: the presence of conglomerated nodal masses with central lucency, thick irregular rim of contrast enhancement and inner nodularity, varying degree of homogenous enhancement in smaller nodes, dermal and subcutaneous manifestations of inflammation such as thickening of the overlying skin, engorgement of the lymphatics and thickening of the adjacent muscles, and a diffusely effaced fascial plane. There were only a few cases of central low densities with calcifications on CT scan. However, common CT patterns of tuberculous adenitis may also be seen in other diseases, such as lymphoma and metastatic lymphadenopathy, and a thorough clinical examination and detection of primary lesions may be more helpful in differentiating these lymphadenopathies.
Collapse
Affiliation(s)
- Y J Kim
- Department of Diagnostic Radiology, Yonsei University, Wonju College of Medicine, Republic of Korea
| | | | | | | |
Collapse
|
25
|
Hong IS, Mezghebe HM, Gaiter TE, Lofton J. Actinomycosis of the neck: diagnosis by fine-needle aspiration biopsy. J Natl Med Assoc 1993; 85:145-6. [PMID: 8441189 PMCID: PMC2571855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A patient with actinomyces infection of the posterior neck was diagnosed by fine-needle aspiration biopsy. The lesion presented as a recurrent, firm, and indurated mass that was clinically diagnosed as adenitis and cellulitis and was thought to be a lymphoma 6 months after the onset of his illness. Smears and cell block sections of the aspirate showed characteristic colonies ("sulfur granules") of actinomyces. Subsequent regional lymph node biopsy revealed reactive lymphoid hyperplasia.
Collapse
Affiliation(s)
- I S Hong
- Department of Pathology, Howard University Hospital, Washington, DC
| | | | | | | |
Collapse
|
26
|
Fridie IL, Hong IS, Green WR. Multicentric gastrointestinal and extraintestinal leiomyosarcomatosis: a case report. J Natl Med Assoc 1992; 84:629-31. [PMID: 1629928 PMCID: PMC2571693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article presents a case of synchronous polypoid primary adenocarcinoma of the transverse colon without lymph node or distance metastasis. During the postmortem examination, polypoid smooth muscle tumors in the patient's gastrointestinal tract and extensive extraintestinal smooth muscle tumors in the patient's liver, lungs, and visceral organs, including the diaphragm, parathyroid gland, bone marrow of the vertebrae, and subcutaneous tissue of the left wrist, were reviewed to determine their origin. Histomorphologically, all of the tumors were classified as leiomyosarcomas.
Collapse
Affiliation(s)
- I L Fridie
- Department of Pathology, Howard University Medical Center, Howard University College of Medicine, Washington, DC 20059
| | | | | |
Collapse
|
27
|
Rapp NS, Chung Y, Shin SH, Hong IS, Jang JY, Seel DJ. Mutagenic and anti-mutagenic properties of meju and other Korean food products from fermented soybeans. Yonsei Med J 1988; 29:117-23. [PMID: 3218254 DOI: 10.3349/ymj.1988.29.2.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/1987] [Accepted: 02/26/1988] [Indexed: 01/04/2023] Open
|
28
|
|
29
|
Hong IS, Johnson G, Kovi J. Cutaneous T cell lymphoma (mycosis fungoides) in blacks. J Natl Med Assoc 1981; 73:859-62. [PMID: 7277519 PMCID: PMC2552730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Between 1954 and 1980, 11 patients with cutaneous T cell lymphoma (mycosis fungoides) were diagnosed at the Howard University Hospital. There were five males and six females, all of whom were black. In association with the cutaneous T cell lymphoma, six cases of poikiloderma atrophicans vasculare were demonstrated.
Collapse
|
30
|
Hong IS. The exfoliative cytology of endometrial stromal sarcoma in peritoneal fluid. Acta Cytol 1981; 25:277-81. [PMID: 6942619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
31
|
Hong IS. Cytologic findings in a case of malignant fibrous histiocytoma. Acta Cytol 1978; 22:519-22. [PMID: 216203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Morphologic changes in malignant cells obtained by needle aspiration of a recurrent malignant fibrous histiocytoma of the left axilla in a 61 year old male are reported. Basically, two types of cells are described: pleomorphic malignant histiocytic cells with marked phagocytic activity and sarcomatous spindle cells. Intermediate forms with features of both types are identified.
Collapse
|
32
|
Hong IS, Chung EB. Thyroglossal cyst in black patients. J Natl Med Assoc 1977; 69:35-8. [PMID: 833895 PMCID: PMC2536844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the 16-year period, July 1, 1959 to June 30, 1975, inclusively, there were only 20 patients with thyroglossal cyst found at the Howard University Hospital (0.03 percent of routine surgicals). There were 12 males and eight females, all of whom were black. Anatomic and histopathologic variations of thyroglossal cysts will be emphasized, and the pitfalls in diagnosis discussed. A brief review of the literature will be presented.
Collapse
|