Implant survival and functional results of endoprosthetic reconstruction for proximal femoral metastases with pathological fractures

Background: This study aimed to evaluate the patient and implant survival, clinical and functional outcomes, and the rate of complications resulting in reconstruction failure following endoprosthetic reconstruction (EPR) of extensive proximal femoral metastases associated with actual or impending pathological fractures. Methods: A total of 111 patients with actual or impending pathological fractures due to metastatic disease of the proximal femur were treated with EPR between 2003 and 2018. Staged surgery, bilateral EPR, was performed in 3 cases. The patients comprised 51 females and 60 males with a mean age of 52.1 ± 12.3 years. The patient and implant survival were recorded. Clinical and functional outcomes were assessed by using the visual analogue scale (VAS), Musculoskeletal Tumour Society (MSTS) functional scoring, and Karnofsky Performance Scale (KPS). The different types of abductor mechanism repair were evaluated by functional tests and existence of Trendelenburg gait at postoperative follow-ups. The complications resulting in reconstruction failure were investigated. Results: The mean follow-up was 23.1 ± 17.9 months. The overall survival of patients after EPR was 89% at 6 months, 72% at 1 year and 10% at 5 years. The estimated 1- and 5-year overall implant survival was 100% and 97.3% (95% CI, 0.95–0.98), respectively, as the endpoint was defined as complete removal of the prosthesis. Median VAS score before endoprosthetic replacement was 8 and after 3 months 4. Before surgery, the median MSTS score was 40 (30–56.6%) and the median KPS score was 40 (30–50). Postoperative third month, the median MSTS score was 56.6 (53.3–86.6%) and the median KPS score was 60 (40–70). Functional scores were superior in trochanter major split osteotomized group compared to trochanter major removed group. Trendelenburg gait was seen in 20 (17.5%) patients postoperatively. There were 10 (8.7%) complications resulting in reconstruction failure. Conclusion: Endoprosthetic replacement can provide a durable fixation with high implant survival rate and good clinical and functional results in extensive proximal femoral metastases associated with a pathological fracture.

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Functional results of various reconstruction techniques in primary malignant bone tumors

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2020-0004 ◽

2020 ◽

Vol 3 (1) ◽

pp. 15-19

Author(s):

Ioan-Mihai Japie ◽

Dragoş Rădulescu ◽

Adrian Bădilă ◽

Alexandru Papuc ◽

Traian Ciobanu ◽

...

Keyword(s):

Functional Outcomes ◽

Bone Tumors ◽

Distal Tibia ◽

Functional Results ◽

Reconstruction Technique ◽

Malignant Bone Tumors ◽

Msts Score ◽

The Mean ◽

Oncologic Therapy

AbstractIntroduction: The aim of the study was to report the clinical and functional outcomes in patients undergoing limb salvage with various reconstruction techniques in primary malignant bone tumor.Materials and methods: This study was performed between 2011 and 2018 on 52 patients with primary malignant bone tumors admitted to the Department of Orthopaedics and Traumatology of University Emergency Hospital, Bucharest. All the patients underwent surgical treatment (resection-reconstruction technique) followed by oncologic therapy. The mean follow-up was 3 years and 8 months and the minimum follow-up was 12 months.Results: The best results were obtained in patients in whom resection of the tumor followed by reconstruction was possible, without affecting the adjacent joint through arthrodesis or arthroplasty. These patients had an average MSTS score of 75.2%. The patients who underwent reconstruction procedures by endoprosthesis also had good results with an average MSTS score of 72.3%, while patients with arthrodesis obtained rather modest results – the average MSTS score being 67.3%. When taking into consideration the location of tumors, the best MSTS scores were obtained in patients with tumors of the distal radius – 80%, followed by femoral and humeral diaphysis – 75.6%, distal femur – 75.2%, proximal femur – 73.3%, proximal humerus – 72.3%, tibial diaphysis – 72.2%, distal tibia – 70% and proximal tibia 68.7%.Conclusions: The orthopedist must judiciously chose the surgical technique, taking into consideration the anatomical particularities and the needs of the patient. Given the functional results and the emotional acceptability, reconstruction with tumor prosthesis represents the first option.

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A PROSPECTIVE STUDY TO EVALUATE THE SURGICAL MANAGEMENT OF PROXIMAL HUMERUS FRACTURES BY LOCKING PLATES

10.36106/ijsr/0406283 ◽

2021 ◽

pp. 10-12

Author(s):

Anurag Rathore ◽

Garvita Solanki

Keyword(s):

External Rotation ◽

Functional Results ◽

Average Score ◽

Prospective Clinical Study ◽

Locking Plates ◽

Statistical Parameters ◽

Functional Scores ◽

Minimum Score ◽

Comminuted Fractures ◽

A Prospective Study

BACKGROUND: This prospective clinical study was performed to evaluate the efcacy and functional outcome in proximal humeral fractures following surgery with locking plates. MATERIAL & METHODS: from August 2013 to April 2015, 32 patients were enrolled in this study following exclusion and inclusion criteria. The evaluation parameters included Time taken for fracture union, functional scores, radiographs of the shoulder and ROM (Range of motion- exion, abduction, internal and external rotation etc.). Patients were followed up regularly at 6 weeks, 12 weeks, 24 weeks and 12 months. Functional results were evaluated using Neer's score. All data were collected and analyzed with the help of suitable statistical parameters. RESULTS: The nal results were evaluated by using NEER'S Score. In our study, the minimum score was 65 and maximum was 94. The average score was 83.9 (Mean ± S.D. : 83.875 ± 6.73). We had excellent results in 6(18.75%) patients, 19(59.375%) had satisfactory results, 7(21.875%) patients had unsatisfactory results but none of the case is failure in our study. CONCLUSION: Open reduction and internal xation with Locking Compression Plates, has given good results and it is the implant of choice now-a-days particularly in comminuted fractures and in osteoporotic bones in elderly patients.

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NONOPERATIVE VERSUS OPERATIVE TREATMENT OF PATIENTS WITH DEGENERATIVE SPONDYLOLISTHESIS

Coluna/Columna ◽

10.1590/s1808-185120161501153514 ◽

2016 ◽

Vol 15 (1) ◽

pp. 33-35

Author(s):

Jose Alfredo Corredor ◽

Fernando Flores de Araújo ◽

Rodrigo Góes de Mendonça ◽

Noel Oizerovici Foni ◽

Nelson Astur ◽

...

Keyword(s):

Operative Treatment ◽

Short Form ◽

Degenerative Spondylolisthesis ◽

Functional Results ◽

Good Health ◽

Nonoperative Treatment ◽

Function Score ◽

Cross Sectional ◽

Sf 36 ◽

Functional Scores

ABSTRACT Objective: To evaluate clinical and functional results of patients with lumbar degenerative spondylolisthesis treated with operatively or nonoperatively. Methods: Patients with degenerative spondylolisthesis treated either nonoperatively or operatively from 2004 to 2014 were selected from databases and a cross-sectional evaluation was performed. Outcome measures included back and leg visual analogue scales (VAS), Fischgrund criteria, Short Form-36 (SF-36) function score, and the modified Oswestry Disability Index (ODI). Results: 43 patients were evaluated: 20 with nonoperative treatment and 23 with operative treatment. Baseline characteristics were similar without significant differences between groups. Mean follow-up time was 43 months (range 10 - 72) for the nonoperative group and 36 months (range 6-80) for the operative group. Significant statistical difference in favor of operative group were found in back VAS (mean 4 versus 8, p = 0.000), leg VAS (mean 3 versus 6, p = 0.0015), SF-36 function score (mean 77 versus 35, p = 0.000), and ODI (mean 17 versus 46, p = 0.000). On the basis of the Fischgrund criteria, only 10 % of patients reported excellent or good health post nonoperative treatment versus 83% for those treated operatively (p = 0.000). Conclusion: In this cross-sectional study, we observed that symptomatic patients with degenerative spondylolisthesis who underwent operative treatment have superior clinical and functional scores compared to those that underwent nonoperative treatment.

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Are the Classic and the Congruent Arc Latarjet Procedures Equally Effective for the Treatment of Recurrent Shoulder Instability in Athletes?

The American Journal of Sports Medicine ◽

10.1177/0363546520928343 ◽

2020 ◽

Vol 48 (9) ◽

pp. 2081-2089

Author(s):

Luciano A. Rossi ◽

Ignacio Tanoira ◽

Tomás Gorodischer ◽

Ignacio Pasqualini ◽

Domingo Luis Muscolo ◽

...

Keyword(s):

Functional Outcomes ◽

Bone Block ◽

Return To Sports ◽

Glenohumeral Instability ◽

Level Of Evidence ◽

Significant Difference ◽

Functional Scores ◽

The Mean ◽

Anterior Glenohumeral Instability

Background: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. Purpose: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Results: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation ( P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points ( P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up ( P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points ( P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). Conclusion: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

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Lens-sparing vitrectomy for stage 4A retinopathy of prematurity in infants with aggressive-posterior ROP: Anatomic and functional results

European Journal of Ophthalmology ◽

10.1177/1120672120946938 ◽

2020 ◽

pp. 112067212094693

Author(s):

Sara Macor ◽

Silvia Pignatto ◽

Antonio Capone Jr ◽

Stefano Piermarocchi ◽

Paolo Lanzetta

Keyword(s):

Retinal Detachment ◽

Retinopathy Of Prematurity ◽

Functional Outcomes ◽

Vitreous Hemorrhage ◽

Functional Results ◽

Postmenstrual Age ◽

Refractive Correction ◽

Anatomic Success

Aim: To assess long-term anatomic and functional outcomes of early lens-sparing vitrectomy (LSV) for stage 4A retinopathy of prematurity (ROP) in infants with aggressive-posterior ROP (AP-ROP) which progressed to retinal detachment despite laser treatment. Methods: Chart review of infants who underwent early 25-gage LSV for stage 4A ROP. Outcomes were anatomic success, mean visual acuity (VA), development of postoperative complications, and refractive changes. Follow-up examinations were performed at 1, 3, 6, 12, and then every 6 months. Results: Ten eyes of seven preterm infants who underwent LSV were included. Mean follow-up was 36 ± 13.4 months and mean postmenstrual age (PMA) at last follow-up was 37 ± 13.7 months. Mean gestational age (GA) and weight at birth was 26 ± 1.4 weeks and 639 ± 180 g. Two eyes had vitreous hemorrhage 4 and 14 days after surgery, respectively. At last follow-up anatomic success was 100%, mean VA was 20/80 and eight eyes (80%) had high myopic refractive correction (mean spherical equivalent –11.25 D). Conclusion: Early LSV for stage 4A ROP with AP-ROP and progression to retinal detachment is efficacious in terms of anatomic and functional outcomes. Anatomic success is associated with visual improvement despite possible myopic refraction changes during follow-up.

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Plastic lengthening amputation with vascularized bone grafts in children with bone sarcoma: a preliminary report

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02020-5 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Zhiqiang Zhao ◽

Qinglin Jin ◽

Xianbiao Xie ◽

Yongqian Wang ◽

Tiao Lin ◽

...

Keyword(s):

Functional Outcomes ◽

Young Patients ◽

Bone Sarcoma ◽

Postoperative Management ◽

Functional Score ◽

Leg Length ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Functional Scores ◽

Distal Joint

Abstract Background At present, amputation was widely adopted for young patients when limb salvage was deemed risky with several surgical strategy such as rotationplasty. However, leg length discrepancies and unfavorable cosmetic results were indispensable complication of this strategy. The purpose of this study was to propose a novel reconstruction strategy and evaluate the early clinical and functional outcomes of the strategy. Methods Plastic lengthening amputation (PLA) has been developed by lengthening the stump to preserve one additional distal joint for fixing the artificial limb well. The surgical technique and postoperative management were documented, and the functional outcomes were compared with those of traditional amputation (TA). Six pairs of patients matched for age, sex, location, pathological type, and final prosthesis underwent individually designed plastic lengthening amputation with vascularized autografts or traditional amputation between January 2005 and December 2007. All patients were followed, and the locomotor index and the musculoskeletal tumor society score (MSTS) were used to describe and quantitatively grade limb functional outcomes after amputation. The complications and functional outcomes of the patients taken two kinds of procedures were compared. Results Twelve patients with osteosarcoma or Ewing’s sarcoma of either the femur or tibia were included in the study. Six patients underwent plastic lengthening amputations, three of whom also underwent vascular anastomosis. Patients were followed for an average of 48.17 months; bone healing required an average of 3.3 months. No local recurrence was found. The average postoperative locomotor index functional score of the affected limb was 32.67 ± 5.89 in the plastic lengthening amputation group while was 19.50 ± 7.87 in the traditional amputation group. The MSTS functional scores were 22.67 ± 1.33 and 24.17 ± 1.45 at 6 and 12 months for patients in PLA group while 17.00 ± 1.549 and 17.83 ± 1.64 at 6 and 12 months for patients in TA group. Conclusions Plastic lengthening amputations with vascularized autografts could preserve the knee joint to improve the function of the amputated limb in selected bone sarcoma patients.

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Outcomes following treatment of the infected Achilles tendon

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00168 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0016

Author(s):

Mark Bowers ◽

Norman Turner ◽

Daniel Ryssman

Keyword(s):

Achilles Tendon ◽

Functional Outcomes ◽

Functional Results ◽

Therapy Program ◽

Tendon Surgery ◽

Extensive Debridement ◽

Eradication Of Infection ◽

Secondary Closure ◽

Ability Measure

Category: Sports Introduction/Purpose: Infection following Achilles tendon surgery is a devastating complication and can be difficult to treat. Our purpose was to evaluate clinical and functional outcomes of patients who have undergone treatment for an infected Achilles tendon. Methods: We retrospectively reviewed the medical records of 20 patients who had undergone surgical treatment for an infected Achilles tendon between 2000 and 2016. The mean follow-up time was 21 months (range 2-68 months). All patients underwent extensive debridement of the tendon with removal of all infected tissue and foreign material. Soft tissue wound coverage was utilized for large wounds that were not amenable to primary or secondary closure. All patients received culture specific intravenous antibiotics for three to six weeks. Postoperatively, the extremity was immobilized in a splint followed by a cast until the wound was healed. The cast was then replaced with a walking boot and the patients were provided a physical therapy program. Functional outcomes were measured using the Foot and Ankle Ability Measure (FAAM) Activity of Daily Living (ADL) scale. Results: All wounds had healed at the time of last follow-up. Three patients (15%) required an unplanned return to the operating room for repeat debridement. All patients were able to walk without the use of a gait aid. Five patients (25%) required continued use of a boot or brace during ambulation. The average FAAM score was 87 (range, 71.4-100). At last follow-up, most patients reported their overall function as “normal” or “nearly normal”. Conclusion: Eradication of infection and satisfactory functional results can be attained after radical debridement, wound closure, and administration of culture specific IV antibiotics.

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The Functional Outcomes of Coloanal and Low Colorectal Anastomoses with Reservoirs after Low Rectal Cancer Resections

The American Surgeon ◽

10.1177/000313481408001224 ◽

2014 ◽

Vol 80 (12) ◽

pp. 1222-1229 ◽

Cited By ~ 7

Author(s):

FranÇ Ois Rubin ◽

Richard Douard ◽

Philippe Wind

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Functional Outcomes ◽

Functional Results ◽

Functional Impairments ◽

Level Of Evidence ◽

Anastomotic Complications ◽

Colorectal Anastomoses ◽

Anterior Rectal Resection ◽

Colonic Reservoir

Nearly half of patients undergoing low anterior rectal cancer resection have a functional sequelae after straight coloanal or low colorectal anastomoses (SA), including low anterior rectal resection syndrome, which combines stool fragmentation, urge incontinence, and incontinence. SA are responsible for anastomotic leakage rates of 0 to 29.2 per cent. Adding a colonic reservoir improves the functional results while reducing anastomotic complications. These colonic reservoir techniques include the colonic J pouch (CJP), transverse coloplasty (TC), and side-to-end anastomosis (STEA) procedures. The aim of this literature review was to compare the functional outcomes of these three techniques from a high level of evidence. CJP with a 4- to 6-cm reservoir is a good surgical option because it reduces functional impairments during the first year, and probably up to 5 years, but is not always feasible. TC appears to perform as well as CJP, is achievable in over 95 per cent of patients, but still with some doubts about a higher anastomotic leakage rate and worse functional outcomes. STEA appears equivalent to CJP in terms of morbidity and even better functional outcomes. STEA, with a terminal side segment size of 3 cm, is feasible in the majority of nonobese patients, combines good functional results, has low anastomotic leakage rates, and is easy to complete.

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Changes in occlusal plane through orthognathic surgery

Dental Press Journal of Orthodontics ◽

10.1590/s2176-94512012000400028 ◽

2012 ◽

Vol 17 (4) ◽

pp. 160-173 ◽

Cited By ~ 3

Author(s):

Lucas Senhorinho Esteves ◽

Carolina Ávila ◽

Paulo José Medeiros

Keyword(s):

Surgical Treatment ◽

Functional Outcomes ◽

Orthognathic Surgery ◽

Functional Results ◽

Clinical Results ◽

Occlusal Plane ◽

Functional Disorders ◽

Dentofacial Deformities ◽

Treatment Objective ◽

Surgical Manipulation

INTRODUCTION: A conventional ortho-surgical treatment, although with good clinical results, does not often achieve the desired functional outcomes. Patients with dentofacial deformities, especially those with increased occlusal planes (OP), are also affected by muscle, joint and breathing functional disorders, as well as facial esthetic involvement. The surgical manipulation of the OP in orthognathic surgery is an alternative to overcome the limitations of conventional treatment. OBJECTIVE: To report the importance of assessing the occlusal plane during diagnosis, planning and ortho-surgical treatment of patients with facial skeletal deformities and its main advantages. CONCLUSION: Although both philosophies of ortho-surgical treatment (conventional and by surgical manipulation of the OP) have presented good results, the selective correction of the OP allows a full treatment of these patients, providing better esthetic and functional results.

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Influence of Graft Bending Angle on Graft Maturation, the Femoral Tunnel, and Functional Outcomes by 12 Months After Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119882663 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711988266

Author(s):

Hong Li ◽

Shaohua Liu ◽

Yaying Sun ◽

Hongyun Li ◽

Shiyi Chen ◽

...

Keyword(s):

Functional Outcomes ◽

Ligament Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Bone Tunnel ◽

Bending Angle ◽

Cruciate Ligament Reconstruction ◽

Functional Scores ◽

Tunnel Diameter ◽

Anterior Cruciate

Background: The graft bending angle (GBA), the angle between the femoral bone tunnel and the line connecting the femoral and tibial tunnel apertures, has been proven to influence stress within the graft and could be an important factor in graft healing within the joint and bone tunnel. However, the influence of the GBA on functional outcomes, particularly on return to sports (RTS), is rarely reported. Purpose/Hypothesis: The purpose of this study was to investigate the influence of the GBA on graft maturation, the femoral tunnel, and functional outcomes at 12 months after anterior cruciate ligament reconstruction (ACLR). We hypothesized that a greater GBA might be related to bone tunnel widening, poor graft healing, and inferior functional outcomes after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 43 consecutive patients who underwent unilateral ACLR with hamstring tendon autografts participated in this study. Their knees were evaluated using functional scores (International Knee Documentation Committee [IKDC] score, Lysholm knee activity score, Tegner activity scale, RTS) and the anterior tibial translation side-to-side difference (ATTD), as measured using a KT-1000 arthrometer and 3.0-T magnetic resonance imaging (MRI), at 12 months after surgery. Based on MRI, the signal/noise quotient (SNQ) of the graft, the GBA, and the femoral tunnel diameter were measured. Results: The mean GBA was 56° (range, 41°-69°). The GBA had a significant positive correlation with the SNQ (rho, 0.45; P = .003) and bone tunnel diameter (rho, 0.35; P = .02), but it had no significant correlation with any functional scores. Patients were divided into 3 groups based on GBA values: low GBA (LGBA; 40° < GBA ≤ 50°), middle GBA (MGBA; 50° < GBA ≤ 60°), and high GBA (HGBA; 60° < GBA ≤ 70°). The HGBA group had a significantly higher mean SNQ than both the LGBA ( P = .01) and MGBA groups ( P = .02). It also had a greater mean tunnel diameter than the LGBA group ( P = .04). There was no significant difference in IKDC scores, Lysholm scores, ATTD, Tegner scores, or rates of RTS among groups. Conclusion: The GBA did not affect functional outcomes at 12 months after ACLR, although it affected the SNQ of the graft and the femoral tunnel diameter.

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