When to Combine Acetabular Osteotomy in Patients With Proximal Femoral Deformity Causing Residual Hip Dysplasia/Subluxation After Reduction of Developmental Dysplasia of the Hip

BACKGROUND

After the successful reduction of developmental dysplasia of the hip, residual hip dysplasia may persist and lead to early osteoarthritis. Femoral and/or acetabular osteotomy has been used to address this problem. The purpose of this study is to determine the indication of femoral versus combined femoral-acetabular osteotomy in the management of residual hip dysplasia.

METHODS

Fifty-five patients with unilateral dislocated-type dysplasia of the hip, who had residual hip dysplasia after reduction, underwent femoral osteotomy with or without acetabular osteotomy before 8 years of age, and were followed for more than 2 years and over 8 years of age, were the subjects of this retrospective study. Twenty-eight patients underwent femoral osteotomy only at a median age of 34 months (group F), and 27 underwent combined femoral-Dega osteotomy at a median age of 49 months (group C). Seventeen patients in group F and 4 in group C had an additional osteotomy due to persistent hip dysplasia. Acetabular index (AI), lateral center-edge angle, and center-head distance difference were measured on serial radiographs. The z-value of AI (Z AI ) was calculated. At the latest follow-up, patients in group F with Severin I/II who did not have an additional osteotomy were considered satisfactory, and patients with Severin III/IV or those who had an additional osteotomy were considered unsatisfactory. Preoperative variables were tested for the difference between satisfactory and unsatisfactory cases. Receiver operating characteristic analysis was performed to delineate a cutoff value of a significant parameter dividing the outcome.

RESULTS

AI and Z AI before index osteotomy were significant parameters predicting a satisfactory outcome in group F. Receiver operating characteristic analysis returned a cutoff value of Z AI 2.6 (Area Under the Curve=0.86, P =0.001). Eight of 12 cases (66.7%) with Z AI <2.6 in group F achieved a satisfactory outcome, whereas only 2 of 14 cases with Z AI ≥2.6 in group F did ( P =0.02).

CONCLUSION

Z AI 2.6 may serve as a threshold to combine acetabular osteotomy with femoral osteotomy in the management of residual hip dysplasia before 8 years of age.

LEVEL OF EVIDENCE

Therapeutic III.

Prevalence and Clinical Impact of Acromial Cupping after Arthroscopic Rotator Cuff Repair: Does Acromioplasty Matter?

Background

Although the effectiveness of acromioplasty is controversial, it is commonly performed during rotator cuff repair to reduce external impingement. During follow-up, osteolysis under the acromion (acromial cupping) could be observed. However, this phenomenon has been rarely addressed in the literature. The purpose of this study was to compare the prevalence and severity of acromial cupping after rotator cuff repair depending on the concomitant performance of acromioplasty and evaluate the influence of acromial cupping on clinical and radiological outcome.

Methods

This is a retrospective study involving patients who underwent arthroscopic rotator cuff repair for small-to-large full-thickness rotator cuff tears from October 2015 to March 2019 and clinical follow-up and magnetic resonance imaging at least 1 year postoperatively. A total of 110 patients were enrolled and divided into two groups depending on whether acromioplasty had been performed (group A) or not (group N). The prevalence of acromial cupping was evaluated in each group. In addition, we stratified patients according to the severity of acromial cupping to investigate its influence on healing and functional scores (visual analog scale [VAS], American Shoulder and Elbow Surgeons [ASES] score, simple shoulder test [SST], and Constant-Murley score).

Results

There were 85 patients in group A and 25 patients in group N. The prevalence of acromial cupping and acromial cysts was as follows: 36.4% (40 patients) and 6.4% (7 patients), respectively, in the total subjects; 43.5% (37/85) and 5.9% (5/85), respectively, in group A; and 12.0% (3/25) and 8.0% (2/25), respectively, in group N. The prevalence of acromial cupping was significantly different between the two groups (p = 0.012). However, functional outcomes were not significantly different between groups stratified by the severity of acromial cupping (VAS, p = 0.464; ASES score, p = 0.902; SST, p = 0.816; and Constant-Murley score, p = 0.117). The difference in healing rate was statistically insignificant between groups (p = 0.726).

Conclusions

The incidence and severity of acromial cupping were significantly greater in patients who underwent rotator cuff repair with acromioplasty. It was a relatively common phenomenon, especially after acromioplasty. However, neither the existence nor the severity of acromial cupping affected functional outcomes or healing.

Can Indirect Decompression Reduce Adjacent Segment Degeneration and the Associated Reoperation Rate After Lumbar Interbody Fusion? A Systemic Review and Meta-analysis

OBJECTIVE

We sought to assess and compare the rate of adjacent segment degeneration (ASDeg), adjacent segment disease, and related reoperations between patients who underwent lumbar interbody fusion surgery using indirect or direct decompression.

METHODS

On the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review and meta-analysis was performed to identify and analyze studies that compared the rate of ASDeg, adjacent segment disease, and related reoperations between indirect and direct decompression techniques. Indirect decompression included anterior lumbar interbody fusion, lateral lumbar interbody fusion, and oblique lateral interbody fusion, whereas direct decompression included posterior or transforaminal lumbar interbody fusion.

RESULTS

Seven studies including a total of 576 patients (indirect: 314; direct: 262) were identified. The pooled rates of ASDeg were 19.4% (45/232) and 34.9% (66/189) for indirect and direct decompression, respectively. A fixed-effects model showed 0.34 times lower odds of developing ASDeg in the indirect decompression group (odds ratio = 0.34, 95% confidence interval [CI] = 0.20, 0.57). The pooled incidence of reoperation was 2.5% (8/314) and 6.1% (16/262) for indirect and direct decompression, respectively. A fixed-effects model showed 0.40 times lower odds of reoperation from ASDeg in the indirect decompression group (odds ratio = 0.40, 95% CI = 0.18, 0.89). The pooled mean difference for the segmental lordosis angle was 1.80 degrees (95% CI = 0.74, 2.86) and 7.11 degrees (95% CI = 4.47, 9.74) for total lumbar lordosis angle, favoring indirect decompression.

CONCLUSIONS

Indirect decompression showed lower odds of developing ASDeg and undergoing reoperation for ASDeg after lumbar interbody fusion surgery in this meta-analysis. However, the limited number and quality of the included studies should be considered when interpreting the results.

Bibliometric Analysis of Orthopedic Literature on Total Knee Arthroplasty in Asian Countries: A 10-year Analysis

Purpose

We aimed to determine the quantity and quality of research output of selected Asian countries in the field of total knee arthroplasty (TKA) in the last 10 years.

Materials and Methods

Top 15 Asian countries were selected according to their gross domestic product. The Science Citation Index Expanded database was used to search for the literature published between 2004 and 2013 using "Total Knee Arthroplasty". The numbers of articles, journals and citations and the contribution of each country were analyzed. The articles were classified according to the type of study and the relative proportion of each type was analyzed.

Results

Asian surgeons have increasingly contributed to orthopedic literature on TKA for the past 10 years, but the dominant contribution came from only a few countries. The total number of articles published by Asian countries increased by 261%, with Japan producing most of the studies and China showing the maximum growth rate. The majority of studies were published in low impact factor journals. Korea published the highest proportion of articles in high impact factor journals. Clinical papers were most frequent.

Conclusions

Our identification of research productivity pertaining to TKA among Asian countries gives a unique insight into the level of academic research in the field of TKA in these countries. There is a need to improve the quality of research to enhance the publishing power in high impact journals as well as the need for more basic research and epidemiological studies considering the unique differences among Asian patients undergoing TKA.