Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus

The purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus.

Does performing total joint arthroplasty in the afternoon or evening increase the risk of prosthetic joint infection?

PURPOSE

Does performing total joint arthroplasty in the afternoon or evening increase the rate of early prosthetic joint infection and the likelihood of early prosthetic joint infection?

METHODS

We evaluated patients retrospectively, who underwent primary total hip (THA) or knee arthroplasty (TKA) between January 2016 and December 2019, met the inclusion criteria and had at least 90 days of follow-up. Patients were divided into two groups. Group I consisted of patients whose surgeries had been started and finished before 14:00, and group II included patients whose surgeries started after 14:01. All patients were operated after non-septic cases in specific orthopedic operating rooms. Their demographic data and comorbidities were noted. Primary outcome was to compare the risk of PJI between the groups.

RESULTS

Group I and group II included 2309 and 1881 patients. Total number of patients with the diagnosis of PJI was 58 (1.4%). It was 31 (1.3%) and 27 (1.4%), respectively (p = 0.79). Performing total joint arthroplasty after 14:01 did not increase likelihood of infection (p = 0.83, OR 1.03). Among the parameters, PJI was significantly associated with age (p < 0.01, OR 0.99), smoking status (p < 0.01, OR 0.15) and operating time (p = 0.04, OR 0.99) in TKA and with direct anterior approach (p = 0.02, OR 4.72) in THA. Age (p = 0.06, OR 1.03) was the factor affecting the risk of subsequent PJI after total joint arthroplasty.

CONCLUSION

Performing total joint arthroplasty in the afternoon or in the evening, after aseptic cases does not increase the risk of subsequent of PJI.

Does correction of reverse shoulder arthroplasty angle improve clinical outcomes in cuff tear arthropathy?

OBJECTIVE

The aim of this study was to investigate the impact of correction of the reverse shoulder arthroplasty (RSA) angle on clinical outcomes in patients with cuff tear arthropathy (CTA).

METHODS

This single-center retrospective study was conducted in patients with CTA treated with RSA between 2013 and 2018. A structured questionnaire collecting demographic data, postoperative follow-up time, pre- and postoperative range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Constant functional scores as well as scapular notching according to the Sirveaux Classification and RSA angle were evaluated by independent observers. The association between functional outcomes and RSA angle was analyzed using a curve estimation approach.

RESULTS

Seventy-four patients with a mean age of 69.4 ± 8 years and mean follow-up period of 38.2 ± 10.8 months were included the study. The medialized inlay component was implanted in 35 patients, and the lateralized onlay component was used in 39 patients. The mean preoperative ASES and Constant scores improved from 28.4 ± 5.1 and 31.1 ± 5.9 to 73.4 ± 23.3 and 70.5 ± 16, respectively, at the last follow-up (both P < 0.001). The mean pre- and postoperative RSA angles were measured to be 21.3 ± 9.3° and 5.5 ± 10.1°, respectively, on X-ray. The postoperative RSA angle was 10.4 ± 10.3° in computerized tomography (CT) scans. There was an excellent correlation between X-ray and CT measurements (rs: 0.971, P < 0.001). It was found that patients with good postoperative functional scores tended to have an RSA angle of 0-10° postoperatively. The delta internal rotation of the medialized design group was greater than that of the lateralized design group (P = 0.029).

CONCLUSION

In patients undergoing RSA for CTA, satisfactory clinical outcomes can be obtained by achieving a postoperative RSA angle of 0-10° with an asymmetrical inferior reaming technique.

LEVEL OF EVIDENCE

Level III, Therapeutic Study.

Comparison of tapered-wedge short and standard-length femoral stems in single-stage bilateral direct anterior total hip arthroplasty

PURPOSE

This study was performed to compare short and standard-length tapered-wedge-type femoral stems in single-stage bilateral total hip arthroplasty (THA) through a direct anterior approach (DAA).

MATERIALS AND METHODS

The patients were divided into two groups according to their femoral stem types as short tapered-wedge stem and standard-length tapered-wedge stem groups. Outcome parameters were the surgical time, estimated blood loss (EBL), length of stay (LOS), thigh pain, Harris Hip Score (HHS), and visual analog scale (VAS) score clinically, and canal fill ratio (CFR), coronal plan alignment of the stems, subsidence, and postoperative leg length difference (LLD), radiologically.

RESULTS

The short-stem group and standard-length-stem group consisted of 20 patients (40 hips, mean age 52.0 ± 14.1) and 22 patients (44 hips, mean age 49.4 ± 11.9), respectively. There were no significant differences between the groups in terms of mean surgical times (p = 0.6), EBL (p = 0.2), LOS (p = 0.2), the rate of thigh pain (p = 0.4), improvements in HHS (p = 0.4) and VAS scores (p = 0.6), LLD (p = 0.3), amount of subsidence (p = 0.9), and varus or valgus misalignment (p = 0.7). The CFR at the level of the lesser trochanter was significantly higher in the short-stem group (0.79 ± 0.1) than the standard-length-stem group (0.73 ± 0.1) (p < 0.01).

CONCLUSION

In single-stage bilateral THA through DAA, short, tapered-wedge femoral stems provide similar radiographic and functional results to standard stems at short-term follow-up.

Local Prophylactic Teicoplanin Effect on Spinal Fusion Surgery: A Comparative Retrospective Study

BACKGROUND

 Surgical site infection (SSI) is one of the most severe complications of spinal fusion surgery that lead to increased morbidity and mortality rates. Prophylactic antibiotic usage is one of the methods that reduce the possibility of SSI in this procedure. The aim of this study was to determine the effect of local subfascial teicoplanin usage on radiologic and functional outcomes and compare it to the effect of vancomycin on surgical outcomes in patients who underwent decompression with posterior instrumentation (DPI) for lumbar spinal stenosis (LSS).

METHODS

 Medical charts of patients with LSS who received DPI and met the study criteria were divided into three groups: the teicoplanin group included patients who underwent DPI with local teicoplanin before closure, the vancomycin group included patients who underwent DPI with local vancomycin, and the control group included patients who underwent DPI without any local prophylactic antibiotics.

RESULTS

 A total of 101 patients were included in the study. No significant differences were found among groups regarding demographics, follow-up, and clinical and functional outcomes. No significant differences were observed among groups regarding postoperative improvements in SF-36-MCS, SF-36-PCS, Oswestry Disability Index, and Visual Analog Scale (VAS; p > 0.05). In the teicoplanin and vancomycin groups, the SSI rate was lower than that in the control group (2/35, 1/34, and 5/32, respectively, p = 0.136) without statistical significance; however, the postoperative fusion volume was significantly higher in the teicoplanin group when compared to the other groups (3.35 ± 1.08, 2.68 ± 1.17, and 2.65 ± 1.28 cm3, respectively, p = 0.007).

CONCLUSIONS

 Although its cost is relatively higher, teicoplanin was a good alternative to vancomycin in preventing SSIs with a higher fusion rate, but no superiority was observed regarding other outcomes.

The effect of eccentric glenoid reaming in reverse shoulder artrhoplasty for glenohumeral osteoarthritis

Background

The objective of this study was to evaluate the abilitiy of eccentric reaming in reverse total shoulder arthroplasty (RSA), in patients with glenohumeral osteoarthritis (GHOA), to correct preoperative glenoid retroversion and to compare with cuff tear arthopaty (CTA) cases.

Methods

Fifty-nine patients who underwent RSA with GHOA or CTA diagnosis between 2013 and 2022 and who had pre- and postoperative computed tomography scans were included in the study. Preoperative glenoid version and postoperative glenoid component versions of 17 patients with GHOA and 40 patients with CTA were measured by Friedman method.

Results

The median preoperative glenoid versions in GHOA and CTA groups were measured as 16° and 4° retroverted respectively (p < 0.01). The median postoperative glenoid component versions in GHOA and CTA groups were 5° and 3° retroverted respectively (p = 0.09). The version change differences between the two groups varied significantly (p < 0.01).

Conclusions

GHOA is related with higher preoperative glenoid retroversion compared to CTA. However; with eccentric glenoid reaming, adequate version correction and similar postoperative glenoid version can be achieved in GHOA compared to CTA when performing a RSA.

Level of evidence

Level III. Retrospective study. Treatment study.

Surgical Management and Outcomes of Patients with Idiopathic Peroneal Spastic Flatfoot: A Retrospective Case Series

BACKGROUND

Although tarsal coalition represents the most common cause of peroneal spastic flatfoot, its existence cannot be verified in several cases. In some patients with rigid flatfoot, no cause can be detected after clinical, laboratory, and radiologic examination, and the condition is called idiopathic peroneal spastic flatfoot (IPSF). This study aimed to present our experience with surgical management and outcomes in patients with IPSF.

METHODS

Seven patients with IPSF, who were operated on between 2016 and 2019, and followed for at least 12 months were included, whereas those with known causes, such as tarsal coalition or other causes (eg, traumatic) were excluded. All patients were followed up for 3 months with botulinum toxin injection and cast immobilization as a routine protocol, and clinical improvement was not achieved. The Evans procedure and grafting with tricortical iliac crest bone graft in five patients and subtalar arthrodesis in two patients were performed. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores and Foot and Ankle Disability Index scores were obtained preoperatively and postoperatively from all patients.

RESULTS

On physical examination, all feet manifested rigid pes planus with varying degrees of hindfoot valgus and limited subtalar motion. Overall, the mean American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores significantly increased from 42 (range, 20-76) and 45 (range, 19-68) preoperatively (P = .018) to 85 (range, 67-97) and 84 (range, 67-99) (P = .043) at the final follow-up, respectively. No major intraoperative or postoperative complications were observed in any of the patients. All computed tomographic and magnetic resonance imaging scans revealed no evidence of tarsal coalitions in any of the feet. All radiologic workups failed to demonstrate secondary signs of fibrous or cartilaginous coalitions.

CONCLUSIONS

Operative treatment seems to be a good option in the treatment of patients with IPSF who do not benefit from conservative treatment. In the future, it is recommended to investigate the ideal treatment options for this group of patients.

Comparison of the Functional and Radiological Outcomes of Single- and Two-Stage Bilateral Open Wedge High Tibial Osteotomy

PURPOSE

This study compared the functional and radiological outcomes and complications of single- (SS) and two-stage (TS) bilateral high tibial osteotomy (HTO).

METHODS

From 2014 to 2018, 48 patients underwent bilateral HTO surgery for osteoarthritis. The outcomes of SS in 28 knees and TS in 32 knees were compared using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) as functional outcomes, and the medial proximal tibial (MPTA), hip-knee-ankle (HKA), tibial slope (TSA) angles, and mechanical axis deviation (MAD) as radiological outcomes. We also evaluated the estimated blood loss (EBL).

RESULTS

No significant differences in the pre- and postoperative mean OKS and KOOS were found between the groups. There was a significant difference between the groups in the last postoperative HKA angle (- 0.9 ± 3.9 and 1.8 ± 4.3°, respectively). In SS and TS, the respective total mean surgical time was 108 ± 28 and 143 ± 36 min (p < 0.001). The mean calculated EBL was 612 ± 267 and 544 ± 357 mL, respectively, (p = 0.5), and the mean length of stay (LOS) was 2.2 ± 0.83 and 3.5 ± 1.0 days, respectively, (p = 0.01).

CONCLUSION

SS bilateral HTO is a safe reasonable option for certain patients with bilateral knee osteoarthritis because it involves a single hospitalization, one-time exposure to anesthesia risks, accelerated rehabilitation, earlier return to expected life status, reduced total hospital stay, and a likely decrease in total cost.

Are the functional outcomes really inferior following unicondylar knee arthroplasty in patients with partial-thickness cartilage loss?

OBJECTIVE

The main indication for medial Unicondylar Knee Arthroplasty (UKA) is Full-Thickness Cartilage Loss (FTCL) in the isolated medial compartment of the knee. However, controversial outcomes were reported in patients with Partial-Thickness Cartilage Loss (PTCL). The aim of this study is to compare PTCL and FTCL based on intraoperative findings in medial UKA in terms of functional outcomes and complication rates requiring reoperation and revision.

METHODS

Two hundred and fifteen knees of 174 patients who underwent mobile-bearing UKA between October 2014 and February 2018 for the diagnosis of symptomatic anteromedial osteoarthritis were evaluated retrospectively. A single senior surgeon evaluated the type of cartilage loss in the medial compartment intraoperatively according to the International Cartilage Repair Society classification system. Clinical outcomes were evaluated using Oxford Knee Score (OKS) and International Knee Documentation Committee (IKDC) score pre- and post-operatively at the last follow-up. Patients with PTCL and FTCL were compared in terms of their pre- and post-operative OKS and IKDC scores, and their improvements, as well as complication rates requiring reoperation and revision.

RESULTS

The mean follow-up time was 33.1 ± 5.3 months. The PTCL (n = 80) and FTCL (n = 135) groups were statistically similar in terms of age (P = 0.41), gender (P = 0.921), body mass index (P = 0.165), bilaterality (P = 0.111), American Society of Anesthesiologists physical status (P = 0.218), Charlson Comorbidity Index (P = 0.74), and post-operative follow-up (P = 0.167). The mean pre-operative OKS and IKDC scores were improved from 24.5 ± 4.1 and 39.9 ± 5 to 40.3 ± 3.6 and 73.9 ± 7.7 at the last follow-up, respectively (P < 0.001). Pre-operative OKS and IKDC scores were superior in favor of the PTCL group. However, no significant difference was found between the groups in terms of post-operative OKS (P = 0.53) and IKDC (P = 0.975) scores, and their improvements (OKS, P = 0.953; IKDC, P = 0.536). The complication rates requiring reoperation was 5% (n = 11) in all patients. Of these, 9% (n = 7) from the PTCL group and 3% (n = 4) from the FTCL group were reoperated. Nevertheless, no significant difference was found between the groups (P = 0.105).

CONCLUSION

In PTCL, medial UKA is a reliable surgery in terms of functional outcomes, the same as in FTCL; however, its complication rates requiring reoperation is higher without statistical significance.

LEVEL OF EVIDENCE

Level III, Therapeutic Study.

Sagittal Patellar Offset Ratio Can Be a Predictor of Anterior Knee Pain after Primary Total Knee Arthroplasty without Patella Resurfacing

BACKGROUND

Anterior knee pain (AKP) is an issue that persists even after successful total knee arthroplasty (TKA). In some patients, reasons for AKP occurrence are known, but it is unexplained in some others despite the patellofemoral joint being thought to be the main focus of pain. We investigated the relationship between unexplained AKP and the patellofemoral joint in the sagittal plane after primary TKA.

METHODS

We evaluated 372 knees of 317 patients retrospectively, who had completed a minimum 24-month follow-up. We divided them into two groups according to the presence of AKP. Sagittal patellar offset ratio (SPOR), anterior femoral offset ratio (AFOR), and Insall-Salvati ratio (ISR) were measured on lateral X-rays. Clinical outcomes were evaluated using the Oxford knee score (OKS) and WOMAC pre-and postoperatively, and AKP was evaluated using a visual analog scale (VAS) postoperatively.

RESULTS

Between non-AKP and AKP groups, SPOR (p < 0.001) and AFOR (p = 0.03) were significantly different but not ISR (p = 0.89). SPOR and AFOR were found to be two independent risk factors that may predict the likelihood of AKP. Receiver operating characteristic (ROC) analysis revealed that AFOR is a poor value, whereas SPOR is a reasonable predictive value. No correlation between SPOR and postoperative OKS (p = 0.92) and WOMAC (p = 0.25) and no correlation between AFOR and postoperative OKS (p = 0.44) and WOMAC (p = 0.58) were found.

CONCLUSION

We found that SPOR is a good predictive tool with a cutoff value of 46.4% and 91.5% sensitivity for AKP and its increased ratio increases the probability of AKP following TKA. Considering that the patellar offset will not change, especially in patients without patella resurfacing, care should be taken not to increase the anterior femoral offset.