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Uri O, Alfandari L, Yaron R, Kettanie A, Laufer G, Behrbalk E. Effect of Compressive Shoulder Draping With Adhesive Incise Drape on Soft Tissue Swelling in Shoulder Arthroscopy: A Prospective Randomized Trial. Orthop J Sports Med 2024; 12:23259671241229736. [PMID: 38379580 PMCID: PMC10878228 DOI: 10.1177/23259671241229736] [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: 07/30/2023] [Accepted: 08/17/2023] [Indexed: 02/22/2024] Open
Abstract
Background Soft tissue swelling in shoulder arthroscopy is common and may lead to complications. Measures aimed at reducing this phenomenon are routinely used with limited efficacy. Purpose/Hypothesis The purpose of the study was to assess (1) soft tissue swelling of the shoulder (the operated site) and (2) soft tissue swelling of the neck, chest, and arm (the surrounding tissue) in patients with versus without compressive draping during shoulder arthroscopy. It was hypothesized that compressive draping of the shoulder with adhesive incise drape would reduce soft tissue swelling during shoulder arthroscopy. Study Design Randomized controlled trial; Level of evidence, 1. Methods A total of 50 patients undergoing arthroscopic rotator cuff repair were prospectively randomized to either the study group (in which the shoulder was draped with adhesive incise drape tightened around the shoulder) or the control group (in which a standard shoulder arthroscopy drape was used). The circumferences of the shoulder, arm, chest, and neck were measured preoperatively and postoperatively and compared between the groups. Results The shoulder circumference in the standard draping group increased by 16% during the procedure (from 21.2 ± 1.5 cm preoperatively to 24.5 ± 1.7 cm postoperatively) compared with only 6% in the compressive draping group (from 21.0 ± 1.3 cm preoperatively to 22.3 ± 1.1 cm postoperatively) (P < .01). No serious postoperative complications were observed in either group. Conclusion Compressive shoulder draping with adhesive incise drape was effective in reducing soft tissue swelling around the shoulder in arthroscopic rotator cuff repair compared with standard arthroscopic draping and was not associated with any adverse reactions. Registration NCT03216590 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Ofir Uri
- Department of Orthopedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Liad Alfandari
- Department of Orthopedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ram Yaron
- Department of Orthopedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Amir Kettanie
- Department of Orthopedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Gil Laufer
- Department of Orthopedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Eyal Behrbalk
- Department of Orthopedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
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Uri O, Alfandari L, Folman Y, Keren A, Smith W, Paz I, Behrbalk E. Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques. J Orthop Surg Res 2023; 18:974. [PMID: 38111077 PMCID: PMC10726635 DOI: 10.1186/s13018-023-04457-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Disc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis. METHODS This was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups. RESULTS Postoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003). CONCLUSION The incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.
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Affiliation(s)
- Ofir Uri
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Liad Alfandari
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel.
| | - Yoram Folman
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Amit Keren
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - William Smith
- Department of Neurosurgery, University Medical Center, Las Vegas, NV, USA
| | - Inbar Paz
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
| | - Eyal Behrbalk
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Ha-Shalom, 38100, Hadera, Israel
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Behrbalk E, Uri O, Masarwa R, Alfandari L, Fatal S, Folman Y. Age-related Differences in Clinical Outcomes of Lumbar Discectomy. Geriatr Orthop Surg Rehabil 2022; 12:21514593211066732. [PMID: 34992895 PMCID: PMC8724981 DOI: 10.1177/21514593211066732] [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: 08/24/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Lumbar discectomy is a common and effective treatment for symptomatic disk herniation. It has been suggested that lumbar discectomy in older patients may result in poorer clinical outcomes and lesser satisfaction. The purpose of this study was to assess age-related difference in patient reported outcomes of patients undergoing lumbar discectomy for chronic low back and radicular pain. Materials and methods Patients with chronic lumbar radiculopathy without neurological deficit underwent non-urgent single level lumbar discectomy in our institution between 2014 and 2017. Pain level (using VAS score), Oswestry Disability Index, and SF-12 scores were retrospectively reviewed and compared between younger patients (<60 years, group 1) and older patients (>60 years, group 2). Results Seventy-three patients, aged between 34–76 years participated in this study. VAS, ODI, and SF-12 scores improved significantly after the surgery for each group (P < .01). When comparing between the groups, no significant differences in the outcomes measured were found after the surgery in both early post-operative follow-up and late post-operative follow-up (P > .05). Discussion Elderly patients undergoing lumbar discectomy report a significant reduction in VAS, ODI, and SF-12 scores justifying the procedure. Conclusion Lumbar discectomy improved function and decreased pain level to similar extent in both younger and older patients suffering from radicular symptoms related to lumbar disc herniation.
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Affiliation(s)
- Eyal Behrbalk
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofir Uri
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Rawan Masarwa
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Liad Alfandari
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Shifra Fatal
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yoram Folman
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
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Haimovich L, Uri O, Bickels J, Laufer G, Gutman G, Folman Y, Behrbalk E. Bilateral traumatic C6-C7 facet dislocation with C6 spondyloptosis and large disk sequestration in a neurologically intact patient. SAGE Open Med Case Rep 2020; 8:2050313X20929189. [PMID: 32782800 PMCID: PMC7383727 DOI: 10.1177/2050313x20929189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/29/2020] [Indexed: 11/17/2022] Open
Abstract
Traumatic cervical spondyloptosis is an uncommon and severe form of facet joint dislocation that commonly leads to severe neurological damage. Decision making regarding the reduction and fixation technique is challenging, especially when a patient is neurologically intact, since an undiagnosed prolapsed disk at the involved level may lead to severe neurological consequences during reduction. A 24-year-old male was admitted after sustaining a severe direct axial blow to his head. Computed tomographic and magnetic resonance imaging scans revealed an acute C6C7 fracture dislocation with spondyloptosis of C6 vertebra and a large disk fragment posterior to C6 vertebral body. The patient was neurologically intact, apart from mild bilateral numbness over C6 distribution. The patient underwent C6 corpectomy to avoid acute cord compression related to the large sequestered disk behind C6 vertebra. Following C6 corpectomy, we were unable to exert enough axial pull to reduce the facet dislocation through the anterior approach. Therefore, the reduction was performed through a posterior approach with C5T1 posterior fusion, followed by anterior cage placement and C5-7 anterior fusion (front-back-front approach). At postoperative follow-up of 24 months, the patient demonstrated a full and pain-free cervical range-of-motion and remained neurologically intact. Follow-up radiographs of the cervical spine demonstrated good instrumental alignment with solid fusion at 6-month follow-up.
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Affiliation(s)
- Liad Haimovich
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofir Uri
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Jacob Bickels
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Gil Laufer
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Gabriel Gutman
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yoram Folman
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Eyal Behrbalk
- Department of Orthopaedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
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Uri O, Behrbalk E, Folman Y. Local implantation of autologous adipose-derived stem cells increases femoral strength and bone density in osteoporotic rats: A randomized controlled animal study. J Orthop Surg (Hong Kong) 2019; 26:2309499018799534. [PMID: 30235971 DOI: 10.1177/2309499018799534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/23/2022] Open
Abstract
BACKGROUND Deficient osteogenic capacity of bone marrow stem cells plays a critical role in the pathophysiology of osteoporosis. Adipose-derived stem cells (ADSCs) have emerged as a promising source of skeletal progenitor cells. The capacity of ADSCs to undergo osteogenic differentiation and induce mineralized tissue formation may be beneficial in the treatment of osteoporosis. We question whether administration of autologous ADSCs into the proximal femur of osteoporotic rats will induce osteogenesis and enhance bone quality and strength. MATERIALS AND METHODS Thirty ovariectomized female rats were randomly assigned to one of the two treatment groups: (1) percutanous implantation of autogenous ADSCs-seeded scaffold into the proximal femur and (2) percutanous implantation of non-seeded scaffold. The contralateral untreated femur served as control. The effect of treatment on bone characteristics was assessed at 12-week follow-up by micro-computed tomography analysis, mechanical testing, and histological analysis. RESULTS The mean cortical thickness, total bone volume density, and bone load to failure in femora injected with autologous ADSCs-seeded scaffold was significantly higher compared to femora injected with non-seeded scaffold and compared to the untreated control femora ( p < 0.01). Histological examination of the injected specimens revealed complete osseo-integration of the scaffolds with direct conversion of the ADSCs into osteoblasts and no inflammatory response. CONCLUSIONS Autogenous ADSCs implantation into the proximal femur of rats with ovariectomy-related osteoporosis promoted bone regeneration and increased bone strength at short-term follow-up. These findings highlight the potential benefit of autogenous ADSCs in the treatment of osteoporosis. LEVEL OF EVIDENCE Level I, randomized controlled trial, animal study.
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Affiliation(s)
| | | | - Yoram Folman
- Department of Orthopaedics, Hillel Yaffe Medical Center, Hadera, Israel
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Uri O, Behrbalk E, Laufer G, Ron N, Folman Y. [WAITING TIME FOR SURGICAL FIXATION OF FEMORAL NECK FRACTURES: DOES A DIAGNOSIS-RELATED GROUP PAYMENT METHOD MATTER?]. Harefuah 2019; 158:16-20. [PMID: 30663287] [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: 06/09/2023]
Abstract
BACKGROUND Early surgical fixation of femoral neck factures in elderly patients has been suggested to decrease morbidity and mortality and to improve treatment outcome. This study evaluates the effect of the implementation of a diagnosis-related group payment method in our hospital on waiting time for surgery and the short-term outcomes of elderly patients following surgical fixation of hip fractures. METHODS Demographic and clinical characteristics of 75 consecutive patients, who underwent surgery for hip fracture in our hospital, before the implementation of a diagnosis-related group payment method, were compared with those of 75 consecutive patients, who were operated on after the implementation of the payment system. RESULTS Demographic characteristics were similar for both groups. Before the implementation of a diagnosis-related group payment method, 84% of the patients waited longer than 48 hours for surgery, compared to only 24% of patients after the implementation (p<0.001). Medical considerations and operation room availability were the main reasons for delaying surgery in both groups. Mortality and morbidity rates during the hospital stay remained similar, regardless of the implementation of the payment method. CONCLUSIONS The implementation of a diagnosis-related group payment method shortened the waiting time for surgical hip fixation in elderly patients treated in our hospital, with no effect on the mortality and complication rate during the hospital stay.
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Affiliation(s)
- Ofir Uri
- Division of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Eyal Behrbalk
- Division of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Gil Laufer
- Division of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nimrod Ron
- Division of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yoram Folman
- Division of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
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Chammaa R, Uri O, Lambert S. Primary shoulder arthroplasty using a custom-made hip-inspired implant for the treatment of advanced glenohumeral arthritis in the presence of severe glenoid bone loss. J Shoulder Elbow Surg 2017; 26:101-107. [PMID: 27522339 DOI: 10.1016/j.jse.2016.05.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/18/2016] [Revised: 05/13/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty for end-stage glenohumeral arthritis with severe glenoid bone loss poses a unique challenge for shoulder surgeons. Current surgical solutions are limited and associated with high complication rates. We hypothesized that a custom-made computer-aided design-computer-aided manufacturing (CAD-CAM) total shoulder replacement (TSR; Stanmore Implants Worldwide, Elstree, UK) resembling a total hip prosthesis could offer a reliable alternative for this challenging subset of patients. METHODS Thirty-seven patients with rotator cuff-deficient end-stage glenohumeral arthritis and severe glenoid bone loss (assessed as not amenable to treatment with standard anatomic or reverse total shoulder implants) were treated with the CAD-CAM TSR between 2006 and 2013. Clinical data were collected prospectively and analyzed at a mean follow-up of 5 years. RESULTS Postoperatively, the pain level with activity decreased from 9.2 ± 1.7 to 2.4 ± 2.9 (P < .001). The Oxford Shoulder Score improved from 11 ± 8 points to 27 ± 11 points (P < .001), and the Subjective Shoulder Value (on a 0%-100% scale) improved from 23% ± 14% to 60% ± 24% (P < .001). Active forward elevation improved from 39° ± 23° to 63° ± 38° (P < .001), and external rotation improved from 6° ± 16° to 15° ± 17° (P = .001). Component revision was required in 6 of 37 patients (16%) (glenoid loosening in 1, humeral stem loosening in 3, periprosthetic fracture in 1, and prosthesis dislocation in 1). CONCLUSION The CAD-CAM TSR offers a reliable alternative for the treatment of end-stage glenohumeral arthritis with severe glenoid deficiency not amenable to standard anatomic or reverse total shoulder implants, with maintenance of significant pain relief and clinical-functional improvement at 5-year postoperative follow-up.
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Affiliation(s)
- Ramsey Chammaa
- Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Ofir Uri
- Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
| | - Simon Lambert
- Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Behrbalk E, Uri O, Folman Y, Rickert M, Kaiser R, Boszczyk BM. Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures. Global Spine J 2016; 6:710-720. [PMID: 27781192 PMCID: PMC5077718 DOI: 10.1055/s-0035-1569460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 09/05/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022] Open
Abstract
Study Design Technical report. Objective Multilevel osteoporotic vertebral compression fractures may lead to considerable thoracic deformity and sagittal imbalance, which may necessitate surgical intervention. Correction of advanced thoracic kyphosis in patients with severe osteoporosis remains challenging, with a high rate of failure. This study describes a surgical technique of staged vertebral augmentation with osteotomies for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures. Methods Five patients (average age 62 ± 6 years) with multilevel osteoporotic vertebral compression fractures and severe symptomatic thoracic kyphosis underwent staged vertebral augmentation and surgical correction of their sagittal deformity. Clinical and radiographic outcomes were assessed retrospectively at a mean postoperative follow-up of 34 months. Results Patients' self-reported back pain decreased from 7.2 ± 0.8 to 3.0 ± 0.7 (0 to 10 numerical scale; p < 0.001). Patients' back-related disability decreased from 60 ± 10% to 29 ± 10% (0 to 100% Oswestry Disability Index; p < 0.001). Thoracic kyphosis was corrected from 89 ± 5 degrees to 40 ± 4 degrees (p < 0.001), and the sagittal vertical axis was corrected from 112 ± 83 mm to 38 ± 23 mm (p = 0.058). One patient had cement leakage without subsequent neurologic deficit. Decreased blood pressure was observed in another patient during the cement injection. No correction loss, hardware failure, or neurologic deficiency was seen in the other patients. Conclusion The surgical technique described here, despite its complexity, may offer a safe and effective method for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures.
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Affiliation(s)
- Eyal Behrbalk
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel,Address for correspondence Dr. Eyal Behrbalk The Spine Unit, Hillel-Yaffe Medical CenterHa-Shalom Street, Hadera, 38100Israel
| | - Ofir Uri
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Yoram Folman
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Marcus Rickert
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Radek Kaiser
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
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Affiliation(s)
- Arie Bitterman
- Department of Surgery A, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel.
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Uri O, Pritsch M, Oran A, Liebermann DG. Upper limb kinematics after arthroscopic and open shoulder stabilization. J Shoulder Elbow Surg 2015; 24:399-406. [PMID: 25441562 DOI: 10.1016/j.jse.2014.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/08/2014] [Revised: 07/28/2014] [Accepted: 08/13/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder joint stability mediated by proprioception is often quantified by arm repositioning tests (i.e., static end-position accuracy), overlooking ongoing movement quality. This study assessed movement quality by adopting smoothness-related kinematic descriptors. We compared performance of healthy controls with that of patients in arthroscopic shoulder stabilization and open shoulder stabilization groups. We hypothesized that arm kinematics after arthroscopic intervention would more closely resemble healthy movements compared with patients after open shoulder stabilization surgery. METHODS Healthy controls (N = 14) were compared with patients after arthroscopic shoulder stabilization (N = 10) and open shoulder stabilization (N = 12). Right-hand dominant subjects (the affected side in patients) performed 135 unconstrained 3-dimensional pointing movements toward visual targets (seen through pinhole goggles; i.e., no arm vision). Arm kinematic data were recorded and offline analyzed to obtain hand tangential velocity profiles further used to compute the acceleration-to-movement time ratio, peak-to-mean velocity ratio, and number of velocity peaks ("symmetry," "proportion," and "fragmentation" features, respectively). Parametric and nonparametric statistics were used for comparisons (P ≤ .05). RESULTS Control and arthroscopic shoulder stabilization groups presented similar acceleration-to-movement time ratio and peak-to-mean velocity ratio. Both groups differed from the open shoulder stabilization group (P = .001). Distributions of velocity peaks for control and arthroscopic shoulder stabilization groups were similar, whereas open shoulder stabilization and control subjects differed significantly (P = .028). CONCLUSIONS Movement quality mediated by proprioception in arthroscopic shoulder stabilization patients matches that of healthy controls, whereas performance in open shoulder stabilization patients seems inferior compared with that in healthy controls, as assessed by smoothness-related measures (less symmetrical, more fragmented movements).
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Affiliation(s)
- Ofir Uri
- Department of Orthopedic Surgery, Sheba Medical Center, Tel Hashomer, Israel; Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Pritsch
- Department of Orthopedic Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Ariel Oran
- Department of Orthopedic Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Dario G Liebermann
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Behrbalk E, Uri O, Clamp JA, Rickert M, Boszczyk BM. Bilateral reconstructive costoplasty for razorback deformity correction in adolescent idiopathic scoliosis. Eur Spine J 2014; 24:234-41. [PMID: 25377093 DOI: 10.1007/s00586-014-3619-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/05/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Correcting the chest wall deformity is an important goal of scoliosis surgery. A prominent rib hump deformity may not be adequately addressed by scoliosis correction alone. It has been shown that costoplasty in conjugation with scoliosis correction and instrumented spinal fusion is superior to spinal fusion alone in addressing the chest wall deformity. In cases of severe rib hump deformity unilateral convex side costoplasty alone might not adequately restore thoracic cage symmetry necessitating for additional concave side rib cage reconstruction. CASE REPORT A 16-year-old male with adolescent idiopathic scoliosis and a sharp, cosmetically unacceptable, prominent rib hump (razorback deformity) underwent scoliosis correction with posterior spinal fusion and bilateral costoplasty. The convex-sided ribs were resected and used for concave-sided rib reconstruction. The rib hump height was reduced from 70 mm before the procedure to 10 mm after the procedure and the apical trunk rotation was reduced from 36° to 5°, respectively. Solid spinal fusion and ribs union was achieved. The patient remained very satisfied with no loss of correction at 2-year postoperative follow-up. CONCLUSION Bilateral costoplasty in conjugation with scoliosis correction may provide a safe and effective method for the treatment of severe rib cage deformities associated with thoracic scoliosis. It should be considered in the presence of prominent rib hump deformity, where scoliosis correction alone or with unilateral costoplasty is unlikely to provide adequate correction.
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Affiliation(s)
- Eyal Behrbalk
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals, Queen's Medical Centre Campus, Nottingham, UK,
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Behrbalk E, Uri O, Maxwell-Armstrong C, Quraishi NA. Diagnosis and treatment of a rectal-cutaneous fistula: a rare complication of coccygectomy. Eur Spine J 2014; 25:1920-2. [PMID: 25366229 DOI: 10.1007/s00586-014-3579-1] [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] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 08/31/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Coccygectomy may be indicated for the treatment of debilitating coccygodynia unresponsive to non-operative treatment. Perineal contamination and postoperative wound infection following coccygectomy remains a major concern. We present a rare post-coccygectomy complication of rectal-cutaneous fistula. To our knowledge no such case has been previously described. CASE PRESENTATION A 24-year-old woman presented with recurrent wound infections 1 year after coccygectomy at another institution, which persisted despite two surgical debridements and antibiotic treatment. Wound cultures showed non-specific poly-microbial bacterial growth. MRI scan of the spine and pelvis revealed a sinus track and soft tissue edema with no evidence of abscess or osteomyelitis. Methylene blue injection to the sinus tract confirmed the presence of a rectal-cutaneous fistula. The patient underwent further debridement, fistulectomy and synchronous defunctioning colostomy and resection of the involved colon segment. The wound healed by secondary intention with complete resolution of the infection. Re-anastomosis and closure of the colostomy was performed 6 months later. At 2-year follow-up, the patient had no signs of infection and her initial coccygeal symptoms had improved. CONCLUSION Postoperative infection following coccygectomy remains a major concern. A discharging sinus at the surgical site may suggest the presence of a rectal-cutaneous fistula, which requires a combined approach of spinal and colorectal surgeons. Methylene blue injection to the sinus tract may facilitate the diagnosis of a rectal-cutaneous fistula.
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Affiliation(s)
- Eyal Behrbalk
- Centre for Spinal Studies and Surgery, Queens Medical Centre Campus of Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - Ofir Uri
- Centre for Spinal Studies and Surgery, Queens Medical Centre Campus of Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - Charles Maxwell-Armstrong
- Department of General Surgery, Queens Medical Centre Campus of Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - Nasir A Quraishi
- Centre for Spinal Studies and Surgery, Queens Medical Centre Campus of Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
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Middleton C, Uri O, Phillips S, Barmpagiannis K, Higgs D, Falworth M, Bayley I, Lambert S. A reverse shoulder arthroplasty with increased offset for the treatment of cuff-deficient shoulders with glenohumeral arthritis. Bone Joint J 2014; 96-B:936-42. [DOI: 10.1302/0301-620x.96b7.32946] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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] [Indexed: 01/30/2023]
Abstract
Inherent disadvantages of reverse shoulder arthroplasty designs based on the Grammont concept have raised a renewed interest in less-medialised designs and techniques. The aim of this study was to evaluate the outcome of reverse shoulder arthroplasty (RSA) with the fully-constrained, less-medialised, Bayley–Walker prosthesis performed for the treatment of rotator-cuff-deficient shoulders with glenohumeral arthritis. A total of 97 arthroplasties in 92 patients (53 women and 44 men, mean age 67 years (standard deviation (sd) 10, (49 to 85)) were retrospectively reviewed at a mean follow-up of 50 months ((sd 25) (24 to 96)). The mean Oxford shoulder score and subjective shoulder value improved from 47 (sd 9) and 24 points (sd 18) respectively before surgery to 28 (sd 11) and 61 (sd 24) points after surgery (p < 0.001). The mean pain at rest decreased from 5.3 (sd 2.8) to 1.5 (sd 2.3) (p < 0.001). The mean active forward elevation and external rotation increased from 42°(sd 30) and 9° (sd 15) respectively pre-operatively to 78° (sd 39) and 24° (sd 17) post-operatively (p < 0.001). A total of 20 patients required further surgery for complications; 13 required revision of components. No patient developed scapular notching. The Bayley–Walker prosthesis provides reliable pain relief and reasonable functional improvement for patients with symptomatic cuff-deficient shoulders. Compared with other designs of RSA, it offers a modest improvement in forward elevation, but restores external rotation to some extent and prevents scapular notching. A longer follow-up is required to assess the survival of the prosthesis and the clinical performance over time. Cite this article: Bone Joint J 2014;96-B:936–42.
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Affiliation(s)
- C. Middleton
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - O. Uri
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - S. Phillips
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - K. Barmpagiannis
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - D. Higgs
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - M. Falworth
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - I. Bayley
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
| | - S. Lambert
- Royal National Orthopaedic Hospital, The
Shoulder and Elbow Service, Brockley Hill, Stanmore, Middlesex, HA7
4LP, UK
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Uri O, Bayley I, Lambert S. Hip-inspired implant for revision of failed reverse shoulder arthroplasty with severe glenoid bone loss. Improved clinical outcome in 11 patients at 3-year follow-up. Acta Orthop 2014; 85:171-6. [PMID: 24650026 PMCID: PMC3967260 DOI: 10.3109/17453674.2014.899850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Glenoid reconstruction and inverted glenoid re-implantation is strongly advocated in revisions of failed reverse shoulder arthroplasty (RSA). Nevertheless, severe glenoid deficiency may preclude glenoid reconstruction and may dictate less favorable solutions, such as conversion to hemiarthropasty or resection arthropasty. The CAD/CAM shoulder (Stanmore Implants, Elstree, UK), a hip arthroplasty-inspired implant, may facilitate glenoid component fixation in these challenging revisions where glenoid reconstruction is not feasible. We questioned (1) whether revision arthroplasty with the CAD/CAM shoulder would alleviate pain and improve shoulder function in patients with failed RSA, not amenable to glenoid reconstruction, (2) whether the CAD/CAM hip-inspired glenoid shell would enable secure and durable glenoid component fixation in these challenging revisions. PATIENTS AND METHODS 11 patients with failed RSAs and unreconstructable glenoids underwent revision with the CAD/CAM shoulder and were followed-up for mean 35 (28-42) months. Clinical outcomes included the Oxford shoulder score, subjective shoulder value, pain rating, physical examination, and shoulder radiographs. RESULTS The average Oxford shoulder score and subjective shoulder value improved statistically significantly after the revision from 50 to 33 points and from 17% to 48% respectively. Pain rating at rest and during activity improved significantly from 5.3 to 2.3 and from 8.1 to 3.8 respectively. Active forward flexion increased from 25 to 54 degrees and external rotation increased from 9 to 21 degrees. 4 patients required reoperation for postoperative complications. No cases of glenoid loosening occurred. INTERPRETATION The CAD/CAM shoulder offers an alternative solution for the treatment of failed RSA that is not amenable to glenoid reconstruction.
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Affiliation(s)
- Ofir Uri
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
| | - Ian Bayley
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
| | - Simon Lambert
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
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Uri O, Barmpagiannis K, Higgs D, Falworth M, Alexander S, Lambert SM. Clinical outcome after reconstruction for sternoclavicular joint instability using a sternocleidomastoid tendon graft. J Bone Joint Surg Am 2014; 96:417-22. [PMID: 24599204 DOI: 10.2106/jbjs.m.00681] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior instability of the sternoclavicular joint is uncommon and usually follows a benign course, although symptomatic patients may require surgical intervention. The optimal treatment for symptomatic instability of the sternoclavicular joint remains unclear. The aim of this study was to evaluate the clinical outcome after reconstruction of the sternoclavicular joint with use of a sternocleidomastoid tendon graft to treat chronic debilitating anterior instability of the sternoclavicular joint. METHODS Thirty-two patients underwent surgical reconstruction of the sternoclavicular joint for chronic debilitating anterior instability using the tendon of the sternal head of the ipsilateral sternocleidomastoid muscle and were followed for a mean of forty-four months. The etiology of instability was posttraumatic in fourteen patients, generalized hyperlaxity in seven patients, and degenerative instability in eleven patients. Outcome measures included the Oxford instability shoulder score, subjective shoulder value, pain rating, and postoperative grading of sternoclavicular joint stability. RESULTS Clinical scores and pain rating were similar for the three groups before surgery and improved significantly in all of the groups to the same extent after the surgery. At the time of the latest follow-up, eleven of fourteen patients in the posttraumatic group, six of seven patients in the generalized hyperlaxity group, and eight of eleven patients in the degenerative group reported the sternoclavicular joint as stable with no functional limitation. Two patients reported that the joint remained unstable. No other complications occurred. CONCLUSIONS Sternoclavicular joint reconstruction using a sternocleidomastoid tendon graft is safe and offers reliable pain relief and functional improvement for patients with chronic debilitating anterior instability of the sternoclavicular joint.
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Affiliation(s)
- Ofir Uri
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Konstantinos Barmpagiannis
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Deborah Higgs
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Mark Falworth
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Susan Alexander
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
| | - Simon M Lambert
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:
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Uri O, Beckles V, Higgs D, Falworth M, Middleton C, Lambert S. Increased-offset reverse shoulder arthroplasty for the treatment of failed post-traumatic humeral head replacement. J Shoulder Elbow Surg 2014; 23:401-8. [PMID: 24090978 DOI: 10.1016/j.jse.2013.07.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 03/18/2013] [Revised: 07/09/2013] [Accepted: 07/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Late complications after humeral head replacement (HHR) for comminuted proximal humeral fractures are common and may necessitate revision surgery. This study evaluated the outcome of revision surgery of failed post-traumatic HHR with a less medialized reverse shoulder prosthesis. METHODS Thirty-three patients with failed post-traumatic HHR due to rotator-cuff insufficiency and glenoid erosion, but with sufficient preservation of the glenoid bone stock to permit primary stability of an inverted glenoid implant, underwent revision using the Bayley-Walker reverse shoulder prosthesis (Stanmore Implants, Elstree, UK) and were monitored up for a mean of 31 months. Outcome measures included the Oxford Shoulder Score, subjective shoulder value, pain rating, active range of motion, and shoulder radiographs. RESULTS The average postrevision Oxford Shoulder Score and subjective shoulder value improved from 50 ± 6 to 29 ± 11 and from 23 ± 19 to 51 ± 23, respectively (P < .001). Pain level decreased from 6.2 ± 2.1 to 1.4 ± 2.0 (P < .001). Active forward flexion increased from 34° ± 22° to 63° ± 30° and external rotation from 11° ± 14° to 20° ± 16°(P < .01). More patients were able to use their affected arm to reach a functional triangle consisting the mouth, opposite armpit, and ipsilateral buttock after revision (24% vs 73%; P < .001). Seven patients (21%) had postrevision complications. No glenoid loosening or scapular notching occurred. CONCLUSION Revision of failed post-traumatic HHR with the Bayley-Walker shoulder offers reliable pain relief and improvement in shoulder function with a complication rate similar to other reverse prostheses. Nevertheless, revision shoulder arthroplasty remains challenging with a high rate of complications.
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Affiliation(s)
- Ofir Uri
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
| | - Verona Beckles
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Deborah Higgs
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Mark Falworth
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Claire Middleton
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Simon Lambert
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Uri O, Beckles V, Falworth M, Higgs D, Lambert S. Revision arthroplasty with a hip-inspired computer-assisted design/computer-assisted manufacturing implant for glenoid-deficient shoulders. J Shoulder Elbow Surg 2014; 23:205-13. [PMID: 23849676 DOI: 10.1016/j.jse.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 03/18/2013] [Revised: 04/25/2013] [Accepted: 05/02/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Revision arthroplasty for failed post-traumatic humeral head replacement associated with rotator cuff and glenoid deficiency is challenging. Current surgical solutions are fraught with complications, and no best-practice strategy has been established. We hypothesized that the computer-assisted design/computer-assisted manufacturing (CAD/CAM) shoulder (Stanmore Implants, Elstree, UK), a total shoulder design resembling a total hip prosthesis, can offer a reliable alternative in this surgically challenging subset of patients with rotator cuff deficiency and advanced glenoid bone loss. METHODS Twenty-one patients with failed post-traumatic humeral head replacement associated with rotator cuff and glenoid deficiency underwent revision with CAD/CAM shoulders between 2005 and 2010. Clinical data were collected prospectively and analyzed at a mean follow-up of 3 years. RESULTS After revision, the pain rating at rest (on a 0-10 numerical scale) decreased from 5.6 ± 1.3 to 1.1 ± 1.3 (P < .001) and pain during activity decreased from 7.4 ± 1.2 to 2.1 ± 1.8 (P < .001). The Oxford shoulder score improved from 47 ± 6 to 31 ± 9 (P < .001), and the subjective shoulder value (on a 0%-100% scale) improved from 22% ± 14% to 45% ± 18% (P < .001). Active shoulder range of motion was similar before and after revision. Postoperative complications occurred in 9 patients and included 1 infection, 2 periprosthetic fractures, 2 prosthetic dislocations, and 4 fixation screw fractures. No case of glenoid loosening occurred. CONCLUSION The CAD/CAM shoulder offers a reliable method of securing a glenoid component in shoulders with advanced glenoid deficiency and should be considered as an alternative to other surgical methods in these challenging cases. At 3 years' follow-up, pain and clinical scores improved significantly and no case of glenoid loosening occurred.
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Affiliation(s)
- Ofir Uri
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
| | - Verona Beckles
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Mark Falworth
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Deborah Higgs
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Simon Lambert
- The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Uri O, Elias S, Behrbalk E, Halpern P. No gender-related bias in acute musculoskeletal pain management in the emergency department. Emerg Med J 2013; 32:149-52. [DOI: 10.1136/emermed-2013-202716] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Behrbalk E, Uri O, Parks RM, Musson R, Soh RCC, Boszczyk BM. Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2. Eur Spine J 2013; 22:2869-75. [PMID: 23955421 DOI: 10.1007/s00586-013-2948-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/22/2013] [Accepted: 08/03/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Anterior lumbar interbody fusion (ALIF) is an established treatment for structural instability associated with symptomatic disk degeneration (SDD). Stand-alone ALIF offers many advantages, however, it may increase the risk of non-union. Recombinant human bone morphogenetic protein-2 (BMP-2) may enhance fusion rate but is associated with postoperative complication. The optimal dose of BMP-2 remains unclear. This study assessed the fusion and subsidence rates of stand-alone ALIF using the SynFix-LR interbody cage with 6 ml/level of BMP-2. METHODS Thirty-two ALIF procedures were performed by a single surgeon in 25 patients. Twenty-five procedures were performed for SDD without spondylolisthesis (SDD group) and seven procedures were performed for SDD with grade-I olisthesis (SDD-olisthesis group). Patients were followed-up for a mean of 17 ± 6 months. RESULTS Solid fusion was achieved in 29 cases (90.6 %) within 6 months postoperatively. Five cases of implant subsidence were observed (16 %). Four of these occurred in the SDD-olisthesis group and one occurred in the SDD group (57 % vs. 4 % respectively; p = 0.004). Three cases of subsidence failed to fuse and required revision. The body mass index of patients with olisthesis who developed subsidence was higher than those who did not develop subsidence (29 ± 2.6 vs. 22 ± 6.5 respectively; p = 0.04). No BMP-2 related complications occurred. CONCLUSION The overall fusion rate of stand-alone ALIF using the SynFix-LR system with BMP-2 was 90.6 %, comparable with other published series. No BMP-2 related complication occurred at a dose of 6 mg/level. Degenerative spondylolisthesis and obesity seemed to increase the rate of implant subsidence, and thus we believe that adding posterior fusion for these cases should be considered.
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Affiliation(s)
- Eyal Behrbalk
- The Spine Unit, Queen's Medical Centre, Nottingham, UK,
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Uri O, Behrbalk E, Haim A, Kaufman E, Halpern P. Procedural sedation with propofol for painful orthopaedic manipulation in the emergency department expedites patient management compared with a midazolam/ketamine regimen: a randomized prospective study. J Bone Joint Surg Am 2011; 93:2255-62. [PMID: 22258771 DOI: 10.2106/jbjs.j.01307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of procedural sedation and analgesia to allow painful orthopaedic manipulations in the emergency department has become a standard practice over the last decade. Both propofol and midazolam/ketamine are attractive sedative regimens for routine use in the emergency department. We hypothesized that sedation with propofol as compared with midazolam/ketamine will save time in the emergency department. The purpose of the present study was to compare the recovery time, the total sedation time, and the adverse events of procedural sedation and analgesia induced with propofol as compared with midazolam/ketamine. METHODS This prospective randomized study was conducted in the emergency department of a tertiary care, university-affiliated medical center. All sedations and orthopaedic manipulations were performed by trained and approved orthopaedic residents assisted by a registered nurse according to the same protocol. Sedation time and adverse events were recorded in real time. RESULTS Sixty adults (thirty-five men and twenty-five women) with a mean age (and standard deviation) of 45 ± 17 years were randomly enrolled in the study, with thirty patients being managed with each regimen. The average recovery time was 7.8 ± 3.7 minutes following sedation with propofol, compared with 30.7 ± 10.1 minutes following sedation with midazolam/ketamine (p < 0.001). The average total sedation time was 16.2 ± 3.8 minutes for the propofol group, compared with 41.6 ± 10.7 minutes for the midazolam/ketamine group (p < 0.001). The overall rate of respiratory and hemodynamic adverse events was 20% for the propofol group and 10% for the midazolam/ketamine group. CONCLUSIONS The use of propofol for an orthopaedic procedure requiring sedation in the emergency department expedites patient management and saves time in comparison with the use of midazolam/ketamine.
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Affiliation(s)
- Ofir Uri
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Uri O, Yosefov L, Haim A, Behrbalk E, Halpern P. Lidocaine gel as an anesthetic protocol for nasogastric tube insertion in the ED. Am J Emerg Med 2011; 29:386-90. [DOI: 10.1016/j.ajem.2009.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 10/21/2009] [Accepted: 10/24/2009] [Indexed: 10/19/2022] Open
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Uri O, Behrbalk E. [Tissue necrosis following intramuscular administration of various drugs (Nicolau syndrome): clinical presentation, pathophysiology and treatment]. Harefuah 2009; 148:186-209. [PMID: 19485279] [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: 05/27/2023]
Abstract
Skin and soft tissue necrosis is a rare but serious complication following intramuscular administration of various drugs (Nicolau syndrome). It typically presents with pain and pallor at the injection site, followed by erythema and livedoid reticular patch that progresses to necrosis. The pathogenesis is not completely understood, although vascular origin (i.e. damage to an end artery at the injection site) seems to be the most realistic hypothesis. This review aims to provide an overview of the currently available Literature.
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Affiliation(s)
- Ofir Uri
- Department of Orthopedics A, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel.
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Uri O, Haim A. [Ankle joint arthritis--etiology, diagnosis and treatment]. Harefuah 2008; 147:897-939. [PMID: 19264011] [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: 05/27/2023]
Abstract
Ankle joint arthritis causes functional limitation and affects the quality of life many patients. It follows traumatic injuries, inflammatory joint arthritis, primary osteoarthritis, hemochromatosis and infections. Understanding the unique anatomy and biomechanics of the ankle is important for diagnosis and treatment of ankle joint pathology. The treatment of ankle joint arthritis has advanced considerably in recent years and it is still a surgical challenge. Total ankle replacement seems to be a promising form of treatment, even though current data does not demonstrate advantages over ankle joint arthrodesis.
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Affiliation(s)
- Ofir Uri
- Department of Orthopedics A, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, University of Tel Aviv.
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Uri O. [Enuresis nocturna treated with an alarm apparatus]. Tidsskr Nor Laegeforen 1977; 97:304-5. [PMID: 847679] [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: 12/24/2022] Open
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Schjetne OB, Uri O. [Nocturnal enuresis. Treatment with an antidepressive (Tofranil) controlled by a placebo in a double-blind trial on 28 children]. Tidsskr Nor Laegeforen 1970; 90:873-6. [PMID: 5450027] [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: 01/15/2023] Open
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