scholarly journals Hypermobility, age 40 years or older and BMI >30 kg m−2 increase the risk of complications following peri-acetabular osteotomy

2020 ◽  
Author(s):  
Saif Salih ◽  
Floris Groen ◽  
Fahad Hossein ◽  
Johan Witt
Keyword(s):  
Acetabular Dysplasia ◽  
Major Complication ◽  
Direct Consequence ◽  
High Volume ◽  
Clavien Classification ◽  
Age At Surgery ◽  
Grade Ii ◽  
Symptomatic Acetabular Dysplasia ◽  
Pharmaceutical Interventions

Abstract The peri-acetabular osteotomy (PAO) is a powerful surgical procedure for correcting symptomatic acetabular dysplasia, but it carries the potential for significant surgical complications. This study aims to determine the complication profile of PAO in a series performed by an experienced single surgeon. This was as retrospective review of 223 hips in 200 patients (23 bilateral, 22 males and 201 females). Complication data were collected from notes and radiographic review and graded according to a modified Dindo–Clavien classification. Each hip could be recorded as having more than one complication. Mean age at surgery was 28.8 years (range 13-48), mean weight was 70.9 kg (range 45–115 kg). Diagnosis was dysplasia in 185 hips, retroversion in 25 and a combination in 13. Mean follow-up was 26 months. In all, 61.4% of hips (137) had no complications; 74.0% had no complications or a Grade I complication (one that did not change management); 52 hips (23%) required pharmaceutical interventions (Grade II complications). Six hips (2.7%) suffered a major complication (Grade III or IV) as a direct consequence of the PAO. There were no Grade V complications (death). Hypermobility (Beighton’s score of ≥6, Odds ratio (OR) 2.525 P = 0.041), age 40 years or older (OR 3.126 P = 0.012) and BMI >30 (OR 2.506 P = 0.031), but not Tonnis grade (P = 0.193) increased the risk of more severe complications following a PAO. This single surgeon series from a high volume centre demonstrates that age 40 years or older and BMI >30 kg m−2 and hypermobility increase the risk of more severe of complications.

scholarly journals Periacetabular osteotomy to treat residual dysplasia in adolescents and young adults: indications, complications, results

2018 ◽  
Vol 12 (4) ◽  
pp. 349-357 ◽  
Author(s):  
M. B. Millis ◽  
M. McClincy
Keyword(s):  
Young Adult ◽  
Periacetabular Osteotomy ◽  
High Volume ◽  
Symptomatic Patient ◽  
Adolescent And Young Adult ◽  
Long Term Results ◽  
Symptomatic Acetabular Dysplasia ◽  
Pao Surgery

Purpose Discuss current indications, techniques, complications and results of periacetabular osteotomy (PAO) to treat the adolescent and young adult with symptomatic acetabular dysplasia or the rare minimally symptomatic patient with dysplasia with a guarded prognosis without PAO surgery. Methods Review of clinical experience with PAO at our and other high-volume centres. Results At a mean follow-up of 18 years after PAO, more than 75% of hips are preserved. At 30-year follow-up, longest term reported series notes survival of one-third of hips. Conclusion Both middle- and long-term results suggest efficacy of PAO in improving function and prognosis in most symptomatic adolescent and young adult patients with spherically congruous pre-arthritic dysplastic hips.

scholarly journals What is the pelvic tilt in acetabular dysplasia and does it change following peri-acetabular osteotomy?

2021 ◽  
Author(s):  
Mark A Roussot ◽  
Saif Salih ◽  
George Grammatopoulos ◽  
Johan D Witt
Keyword(s):  
Pelvic Tilt ◽  
Acetabular Dysplasia ◽  
Normal Population ◽  
Pubic Symphysis ◽  
Study Group ◽  
Compensatory Mechanism ◽  
Femoral Head Coverage ◽  
Normal Limits ◽  
Symptomatic Acetabular Dysplasia

Abstract To quantify the pelvic tilt (PT) in patients with symptomatic acetabular dysplasia and determine if it represents a compensatory mechanism to improve femoral head coverage, we studied a cohort of 16 patients undergoing 32 bilateral staged PAOs for acetabular dysplasia and compared this to a matched cohort of 32 patients undergoing PAO for unilateral acetabular dysplasia all with >1 year follow-up. The change in PT was determined with two validated methods, namely, the sacro-femoral-pubic (SFP) angle and the pubic symphysis to sacroiliac index (PS-SI). Despite an improvement in the lateral centre-edge and Tönnis angles to within normal limits following PAO, patients with unilateral and bilateral acetabular dysplasia have similar PT pre-operatively (8° ± 5°) and post-operatively (9° ± 5°). A change of >5° was observed in only six patients (13%) using the SFP angle, and five patients (10%) using the PS-SI, all increased (posterior rotation of the pelvis). No patients were observed to have a change in PT >10°. The observed PT in our study group is equivalent to that found in the normal population and in patient with symptomatic acetabular retroversion. These findings all suggest that PT is morphological rather than a result of a compensatory mechanism, and even if it was compensatory, it does not appear to reverse significantly following PAO. The target for acetabular reorientation, therefore, remains constant.

Activity Level Maintenance at Midterm Follow-up Among Active Patients Undergoing Periacetabular Osteotomy

2019 ◽  
Vol 47 (14) ◽  
pp. 3455-3459
Author(s):  
Ugochi C. Okoroafor ◽  
Cecilia Pascual-Garrido ◽  
Maria T. Schwabe ◽  
Jeffrey J. Nepple ◽  
Perry L. Schoenecker ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Activity Levels ◽  
Center Edge ◽  
Ucla Score ◽  
The Mean ◽  
Symptomatic Acetabular Dysplasia ◽  
Active Patients ◽  
Center Edge Angle

Background: For active patients undergoing periacetabular osteotomy (PAO), returning to and maintaining a high level of activity postoperatively is a priority. Purpose: To evaluate the maintenance of activity levels at midterm follow-up in active patients treated with PAO for symptomatic acetabular dysplasia. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent PAO for symptomatic acetabular dysplasia between June 2006 and August 2013 were identified by a retrospective review of our prospective longitudinal institutional Hip Preservation Database. All patients with a preoperative University of California, Los Angeles (UCLA) score of ≥7 and a potential minimum 5 years of follow-up were included in the study. Functional outcome measures were the UCLA score, modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The maintenance of high activity levels was defined as a UCLA score of ≥7 at final follow-up. Radiographic parameters were measured. Statistical significance was defined as a P value <.05. Results: A total of 66 hips (58 patients) were included. The mean age was 25.3 years (range, 14-47 years), the mean body mass index was 23.9 kg/m2 (range, 19-32 kg/m2), and 72% were female. The mean follow-up was 6.8 years (range, 5-11 years). There were 67% of patients who maintained a UCLA score of ≥7. Patient-reported outcomes improved postoperatively from preoperatively for the mHHS (88 ± 14 vs 67 ± 17, respectively; P < .001) and WOMAC (89 ± 15 vs 73 ± 20, respectively; P < .001). The lateral center-edge angle, anterior center-edge angle, and acetabular inclination were significantly improved at final follow-up ( P < .001). Only 4 patients (7%) cited postoperative activity limitations as being caused by hip pain. There were no conversions to total hip arthroplasty. Conclusion: The majority (67%) of active patients returned to preoperative or higher activity levels after PAO at midterm follow-up.

PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia

2020 ◽  
Vol 48 (2) ◽  
pp. 385-394 ◽  
Author(s):  
Deborah J. Li ◽  
John C. Clohisy ◽  
Maria T. Schwabe ◽  
Elizabeth L. Yanik ◽  
Cecilia Pascual-Garrido
Keyword(s):  
Outcome Measures ◽  
Acetabular Dysplasia ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Ceiling Effects ◽  
The Mean ◽  
Symptomatic Acetabular Dysplasia ◽  
Good Agreement

Background: No previous study has investigated how the Patient-Reported Outcomes Measurement Information System (PROMIS) performs compared with legacy patient-reported outcome measures in patients with symptomatic acetabular dysplasia treated with periacetabular osteotomy (PAO). Purpose: To (1) measure the strength of correlation between the PROMIS and legacy outcome measures and (2) assess floor and ceiling effects of the PROMIS and legacy outcome measures in patients treated with PAO for symptomatic acetabular dysplasia. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This study included 220 patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Outcome measures included the Hip disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS activities of daily living (ADL), modified Harris Hip Score (mHHS), PROMIS pain, and PROMIS physical function subsets, with scores collected preoperatively and/or postoperatively at a minimum 12-month follow-up. The change in mean scores from preoperatively to postoperatively was calculated only in a subgroup of 57 patients with scores at both time points. Distributions of the PROMIS and legacy scores were compared to evaluate floor and ceiling effects, and Pearson correlation coefficients were calculated to evaluate agreement. Results: The mean age at the time of surgery was 27.7 years, and 83.6% were female. The mean follow-up time was 1.5 years. Preoperatively, neither the PROMIS nor the legacy measures showed significant floor or ceiling effects. Postoperatively, all legacy measures showed significant ceiling effects, with 15% of patients with a maximum HOOS pain score of 100, 29% with a HOOS ADL score of 100, and 21% with an mHHS score of 100. The PROMIS and legacy instruments showed good agreement preoperatively and postoperatively. The PROMIS pain had a moderate to strong negative correlation with the HOOS pain ( r = −0.66; P < .0001) and mHHS ( r = −0.60; P < .0001) preoperatively and the HOOS pain ( r = −0.64; P < .0001) and mHHS ( r = −0.64; P < .0001) postoperatively. The PROMIS physical function had a moderate positive correlation with the HOOS ADL ( r = 0.51; P < .0001) and mHHS ( r = 0.49; P < .0001) preoperatively and a stronger correlation postoperatively with the HOOS ADL ( r = 0.56; P < .0001) and mHHS ( r = 0.56; P < .0001). Conclusion: We found good agreement between PROMIS and legacy scores preoperatively and postoperatively. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment.

scholarly journals Balloon-assisted coiling of cerebral aneurysms with the dual-lumen Scepter XC balloon catheter: Experience at two high-volume centers

2019 ◽  
Vol 25 (4) ◽  
pp. 414-418 ◽  
Author(s):  
Adam N Wallace ◽  
Edgar Samaniego ◽  
Yasha Kayan ◽  
Colin P Derdeyn ◽  
Josser E Delgado Almandoz ◽  
...  
Keyword(s):  
Balloon Catheter ◽  
Cerebral Aneurysms ◽  
Major Complication ◽  
High Volume ◽  
Aneurysm Rupture ◽  
Complication Rates ◽  
Patient Demographics ◽  
Major Procedure ◽  
Aneurysm Occlusion

Background The Scepter XC is a dual-lumen balloon catheter that accommodates a 0.014-inch microwire and can be used for balloon-assisted coiling of cerebral aneurysms. We describe our experience with the use of this device. Methods Two high-volume institution neurointerventional databases were retrospectively reviewed for cerebral aneurysms treated with balloon-assisted coiling using the Scepter XC balloon catheter. Patient demographics, aneurysm characteristics, and procedural details were recorded. Major procedure-related neurologic complications were defined as events that caused an increase in modified Rankin Scale that persisted for more than 1 week after the procedure. Follow-up aneurysm occlusion was assessed using the Raymond-Roy classification. Results During the study period, 231 aneurysms were treated in 219 patients (152 women, 67 men) with a mean age of 58.4 ± 12.2 years. Mean aneurysm size was 6.1 ± 3.1 mm, with a mean neck diameter of 3.1 ± 1.3 mm. In total, 77.5% of aneurysms were wide necked, and 39.8% were treated in the setting of subarachnoid hemorrhage. The major complication rate was 0.9% (2/231) per treated aneurysm, including one stroke and one death related to intraoperative aneurysm rupture. Excluding patients who died, angiographic follow up was available for 85.3% (191/224) of aneurysms. During a mean follow up of 17.4 ± 13.0 months (range, 1.7–66.5 months), Raymond-Roy 1 and 2 occlusion rates were 56.5% (108/191) and 35.6% (68/191), respectively. The retreatment rate was 12.6% (24/191). Conclusion Our experience using the coaxial dual-lumen Scepter XC for balloon-assisted coiling demonstrates acceptable aneurysm occlusion and complication rates.

Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia

2017 ◽  
Vol 45 (11) ◽  
pp. 2460-2467 ◽  
Author(s):  
Benjamin F. Ricciardi ◽  
Kara G. Fields ◽  
Catherine Wentzel ◽  
Bryan T. Kelly ◽  
Ernest L. Sink
Keyword(s):  
Cohort Study ◽  
Functional Outcomes ◽  
Hip Dysplasia ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Group Versus ◽  
Outcome Scores ◽  
Symptomatic Acetabular Dysplasia

Background: Persistent acetabular dysplasia is a common reason for the failure of hip arthroscopic surgery; however, the effect of prior hip arthroscopic surgery on functional outcomes after subsequent periacetabular osteotomy (PAO) is unknown. Hypothesis/Purpose: The purpose of this study was to (1) compare demographic and radiological findings in patients who had and had not undergone previous hip arthroscopic surgery before PAO for symptomatic acetabular dysplasia and (2) compare the short-term, hip-specific patient-reported outcomes in these same patient populations. It was hypothesized that prior hip arthroscopic surgery is associated with worse early functional outcomes in PAO. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study design was utilized. Patients undergoing PAO were enrolled from a single-center, prospective hip preservation registry from March 2011 to April 2015. Patients with a minimum of 1-year clinical follow-up with preoperative and postoperative outcome scores undergoing PAO were eligible for inclusion (n = 93 patients; mean clinical follow-up, 24 months [range, 11-58 months]). The study group consisted of patients undergoing PAO for symptomatic hip dysplasia after prior hip arthroscopic surgery (PREVSCOPE group; 22 patients, 25 hips). Patients undergoing PAO without prior hip arthroscopic surgery (PAOALONE group; 71 patients, 85 hips) were included as a comparison group. Demographic and radiological variables were recorded. Postoperative functional outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS], and International Hip Outcome Tool [iHOT-33]) were recorded at 6 months and annually postoperatively. Results: There were no demographic differences between the 2 groups at baseline. Acetabular version, femoral version, Tönnis grade, preoperative lateral center edge angle, and intraoperative procedures were not different between the 2 groups. At 1-year follow-up from the last hip surgical procedure, the mean (±SD) mHHS (73 ± 14 vs 86 ± 14, respectively; P < .001), HOS–Activities of Daily Living (84 ± 12 vs 93 ± 11, respectively; P = .007), HOS-Sport (62 ± 25 vs 85 ± 18, respectively; P < .001), and iHOT-33 (62 ± 21 vs 79 ± 20, respectively; P = .004) were decreased in the PREVSCOPE group versus the PAOALONE group. At last follow-up (mean, 18 months from the last hip surgical procedure), the mHHS and HOS-Sport were lower in the PREVSCOPE group versus the PAOALONE group. There was no difference in complication or reoperation rates between the 2 groups. Conclusion: Failed hip arthroscopic surgery before PAO for symptomatic hip dysplasia is associated with lower hip-specific functional outcomes within the first 1 year of follow-up despite similar baseline demographic and radiological characteristics. These differences persisted in certain outcome scores (mHHS, HOS-Sport) at last follow-up but were less pronounced than at 1 year.

Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?

2017 ◽  
Vol 45 (11) ◽  
pp. 2468-2475 ◽  
Author(s):  
Daisuke Hara ◽  
Satoshi Hamai ◽  
Jun-ichi Fukushi ◽  
Ken-ichi Kawaguchi ◽  
Goro Motomura ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Time Of Surgery ◽  
Center Edge ◽  
Number Of Patients ◽  
Ucla Score ◽  
The Mean ◽  
Grade 3 ◽  
Symptomatic Acetabular Dysplasia

Background: Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear. Purpose: To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d’Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO. Results: The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4. Conclusion: Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.

scholarly journals COVID-19 Lockdown Effect on Not Institutionalized Patients with Dementia and Caregivers

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 893
Author(s):  
Rita Moretti ◽  
Paola Caruso ◽  
Mauro Giuffré ◽  
Claudio Tiribelli
Keyword(s):  
Medical Condition ◽  
Direct Consequence ◽  
Anxiety And Depression ◽  
Behavioral Reactions ◽  
Old Patients ◽  
Subcortical Vascular Dementia ◽  
Behavior Disturbances ◽  
Institutionalized Patients ◽  
Severity Degree

SARS-COV-2 is a severe medical condition. Old patients are very vulnerable, but they have been studied only as institutionalized patients. During the lock-down, little attention is dedicated to old, demented patients who lived at home. This study wants to examine their behavioral reactions by video-phone follow-up. We conducted a longitudinal study in subcortical vascular dementia (sVAD) patients. We enrolled 221 sVAD, not institutionalized patients. We divided sVAD patients into low-medium grade sVAD (A) and severe sVAD (B), based on neuroimaging severity degree and executive alterations. At baseline, at the end of lock-down, and two months later, global behavioral symptoms were recorded for each patient. We found significantly higher scores of general behavioral deterioration, anxiety, delusions, hallucinations and apathy after controlling for sVAD severity. The direct consequence was a drastic increment of psychotropic drugs prescribed and employed during the lock-down. Moreover, caregivers’ stress has been evaluated, together with their anxiety and depression levels. During the lock-down, their scores increased and reflected a severe worsening of their behavior. Our data demonstrate that social isolation induces a severe perception of loneliness and abandonment; these fears can exacerbate behavior disturbances in old-aged frail persons. Thus, these can be considered as indirect victims of SARS-COV-2.

scholarly journals Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oriel Spierer ◽  
Abraham Spierer
Keyword(s):  
Young Children ◽  
Success Rate ◽  
Lateral Rectus ◽  
Intermittent Exotropia ◽  
Age At Surgery ◽  
Surgical Methods ◽  
Before And After ◽  
The Mean ◽  
Consecutive Esotropia

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

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