scholarly journals Long term outcomes of computer navigated lateral opening wedge distal femoral osteotomy for lateral compartment knee arthrosis

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0052
Author(s):  
Vikram Kandhari Darshan Angadi ◽  
Darli Myat ◽  
Brett Fritsch ◽  
David Parker ◽  
Myles Coolican
Keyword(s):  
Computer Navigation ◽  
Lateral Compartment ◽  
Femoral Osteotomy ◽  
Long Term Outcomes ◽  
Opening Wedge ◽  
Distal Femoral Osteotomy ◽  
Long Term Follow Up ◽  
Lateral Opening Wedge

Introduction: Osteotomy of the distal femur (DFO) to address symptomatic degeneration in the knee is a well-established procedure with good results reported in the literature . Broadly the osteotomy is based on either an opening or a closing wedge alignment technique. Several patient related parameters including age, gender, body mass index (BMI) and surgical factors such as osteotomy site, gap, and fixation technique amongst others have been demonstrated to influence the outcome of DFO. Preoperative planning based on imaging is vital to assess the type and extent of deformity correction to be undertaken in order to achieve optimal alignment. Computer-assisted surgery (CAS) has been extensively used as dynamic intraoperative alignment aid in knee arthroplasty providing good outcomes. Several investigators in the current literature have utilised computer navigation in proximal tibial osteotomy and reported improved accuracy in realising the planned alignment. However there is paucity of studies reporting the long-term outcomes of distal femur lateral opening-wedge (DFLOWO) using computer navigation. Through our study we aim to report on the long-term outcomes and survivorship of computer navigated DFLOWO. Hypotheses: We hypothesize that use of computer navigation will improve the survivorship of distal femoral osteotomy. Methods: Ethics committee approval was obtained for this study. Due consent was taken for the use of data from all the patients for this study. A retrospective analysis of prospectively collected data for patients with lateral compartment arthritis who underwent navigated lateral opening wedge distal femoral osteotomy from December 2006 to November 2012 was performed. Consecutive patients of lateral compartment knee arthrosis aged less than 55 years who failed to respond to conservative management were included in the study. Patients who had end stage arthritis with fixed flexion deformity of > 15 degrees, < 90 degrees of knee flexion or who did not consent for the procedure were excluded. Included patients were operated by one of the three senior surgeons attached to our research institute. The included patients were followed up with clinical and radiological evaluation at regular intervals (6 weeks / 6 months / 1 year / 5years). The final follow-up for the included patients was done using email questionnaire of the patient reported outcomes measures. Conversion to either UKA or TKA during the follow-up was the end point. Additionally, this information was verified from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) database Results: 19 DFLOWO with mean age of 46.6 ± 6.5 years formed the study cohort. The coronal alignment was corrected from a mean of 7.1º (2-11º) valgus to mean 2.1º (0.5º - 3º) varus. IKDC scores improved from mean of 39 pre-op to 53 at the mean long-term follow-up of 9.1 years. KOOS scores at the long-term follow-up were pain-71, symptoms-56, activities of daily living-82, sports and recreation-59, quality of life-43. Survivorship of DFLOWO was 78.9% at a follow-up of 9.1 years. Presence of ≥ grade 2 ICRS cartilage degeneration in the medial compartment of knee and >7⁰ pre-operative valgus deformity strongly correlated with conversion to TKA at the long-term follow-up (r - 0.66). Conclusion: Computer navigated DFLOWO has satisfactory clinical outcomes and 79% survivorship in long-term follow-up. Presence of more than ICRS ≥ grade 2 degenerative changes in the medial compartment of knee with > 7 degrees pre-operative valgus deformity negatively affects the survivorship of DFLOWO in the long-term follow-up.

Return to Sport following Isolated Lateral Opening Wedge Distal Femoral Osteotomy

Cartilage ◽  
2020 ◽  
pp. 194760352092477
Author(s):  
Avinesh Agarwalla ◽  
Joseph N. Liu ◽  
Grant H. Garcia ◽  
Anirudh K. Gowd ◽  
Richard N. Puzzitiello ◽  
...  
Keyword(s):  
Case Series ◽  
Return To Sport ◽  
Lateral Compartment ◽  
Valgus Deformity ◽  
Femoral Osteotomy ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
Distal Femoral Osteotomy ◽  
Removal Of Hardware ◽  
Lateral Opening Wedge

Purpose. The aims of this study were to (1) examine the timeline of return to sport (RTS) following isolated lateral opening wedge distal femoral osteotomy (DFO), (2) evaluate the degree of participation on RTS, and (3) identify risk factors for failure to RTS. Methods. Nineteen consecutive patients undergoing isolated lateral opening wedge DFO were reviewed retrospectively at a minimum of 2 years postoperatively. Patients completed a sports questionnaire, visual analogue scale for pain (VAS-Pain), Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Results. Seventeen patents (89.5%; age 32.1 ± 10.1 years; gender 9 males, 52.9%) were contacted at 7.3 ± 4.4 years (range 2.0-13.8 years). Twelve patients (70.6%) resumed playing ≥1 sport at an average time of 9.5 ± 3.3 months (range 3-12 months). Of these 12 patients, 6 returned to a lower level of participation (50.0%). Seven patients (41.2%) had returned to the operating room for further surgery, which included removal of hardware (5.9%) and total knee arthroplasty (5.9%). The average VAS-Pain, SANE, and Marx scores were 3.4 ± 2.6 (range 0-8), 56.2 ± 18.7 (range 20-85), and 5.0 ± 5.3 (range 0-16), respectively. Fourteen patients (82.4%) were at least somewhat satisfied with their procedure. Conclusion. In patients with isolated lateral compartment osteoarthritis and valgus deformity, lateral opening wedge DFO allows 70.6% of patients to RTS by 9.5 ± 3.3 months. However, most patients may be unable to return to their presymptomatic level of function. Patient expectations regarding RTS can be appropriately managed with adequate preoperative patient education. Level of Evidence. IV, case series.

Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload

2019 ◽  
Vol 38 (3) ◽  
pp. 351-359 ◽  
Author(s):  
Carola Pilone ◽  
Federica Rosso ◽  
Umberto Cottino ◽  
Roberto Rossi ◽  
Davide Edoardo Bonasia
Keyword(s):  
Lateral Compartment ◽  
Femoral Osteotomy ◽  
Opening Wedge ◽  
Distal Femoral Osteotomy ◽  
Lateral Opening Wedge

scholarly journals Long-term follow-up results of medial opening wedge high tibia osteotomy with a pre-countered non-locking steel plate

2021 ◽  
Author(s):  
Simo S. A. Miettinen ◽  
Hannu J. A. Miettinen ◽  
Jussi Jalkanen ◽  
Antti Joukainen ◽  
Heikki Kröger
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Mechanical Axis ◽  
Steel Plate ◽  
Cox Regression ◽  
Opening Wedge ◽  
Cumulative Survival ◽  
Long Term Follow Up

Abstract Introduction This retrospective study investigated the long-term follow-up results of medial opening wedge high tibial osteotomy (MOWHTO) with a pre-countered non-locking steel plate implant (Puddu plate = PP) used for medial knee osteoarthrosis (OA) treatment. Materials and methods Consecutive 70 MOWHTOs (66 patients) were performed between 01.01.2004 and 31.12.2008 with the mean follow-up time of 11.4 (SD 4.5; range 1.2–16.1) years. The Kaplan–Meier survival analysis was used to evaluate the cumulative survival of the implant in terms of age (< 50 years old and ≥ 50 years old) and gender. Adverse events were studied and Cox regression analysis was used to evaluate risk factors [age, gender, body mass index (BMI), preoperative mechanical axis, severity of OA, use of bone grafting or substitution and undercorrection of mechanical axis from varus to valgus] for revisions. Results The estimates for the cumulative survival with no need for TKA after MOWHTO were 86% at 5 years, 67% at 10 years and 58% at 16.1 years (SE 0.6, CI 95% 11.1–13.5). A total of 33/70 (47%) adverse events occurred and 38/70 (54%) knees required some revision surgery during the follow-up. Cox regression did not show any statistically significant risk factors for revision. Conclusions The PP has feasible MOWHTO results with a cumulative survival of 67% at 10 years with no need for conversion to TKA. Many adverse events occurred and revision rate due to any reason was high. Age or gender did not have statistically significant differences in terms of survival.

Management of Canine Y-T Humeral Fractures Using Titanium Polyaxial Locking Plates in 17 Dogs

2022 ◽  
Vol 58 (1) ◽  
pp. 7-16
Author(s):  
Claudio Motta ◽  
Philip Witte ◽  
Andrew Craig
Keyword(s):  
Functional Impairment ◽  
Complication Rates ◽  
Load Testing ◽  
Inclusion Criteria ◽  
Long Term Outcomes ◽  
Long Term Follow Up ◽  
Mild Impairment ◽  
Condylar Fractures

ABSTRACT The objective of this study was to document the short- and medium-to-long-term outcomes and complication rates of Y-T humeral condylar fractures fixed using titanium polyaxial locking plate (T-PLP). A retrospective review was performed of the medical records and radiographs of dogs with a Y-T humeral condylar fracture treated with T-PLP at a single veterinary referral center (2012–2018). Seventeen cases met the inclusion criteria. Medium- to long-term follow-up (.6 mo) information was derived using the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Recorded complications were catastrophic (1/17) and minor (2/17). Gait at 10–12 wk following surgery was subjectively assessed as good or excellent for 13 cases. Radiographic bone union was achieved in 7/12 cases at 4–6 wk. LOAD scores obtained a mean of 15 mo (range 6–29 mo) following surgery and indicated no or mild impairment in 15/16 and moderate functional impairment in 1. The application of T-PLP for the treatment of Y-T humeral condylar fractures resulted in adequate stabilization allowing successful fracture healing and medium- to long-term outcomes comparable to previous reports. According to results of LOAD testing, the medium- to long-term follow-up suggests that clients were aware of mild to moderate functional impairment in all cases.

scholarly journals Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

2021 ◽  
Vol 8 ◽  
Author(s):  
Congcong Luo ◽  
Ruidong Qi ◽  
Yongliang Zhong ◽  
Suwei Chen ◽  
Hao Liu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Aortic Dissection ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Long Term Outcomes ◽  
Chronic Type ◽  
Elephant Trunk ◽  
Long Term Follow Up

Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection.Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions.Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047).Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.

scholarly journals Long-term outcomes of coil embolization of unruptured intracranial aneurysms

2018 ◽  
Vol 129 (6) ◽  
pp. 1492-1498 ◽  
Author(s):  
Masaomi Koyanagi ◽  
Akira Ishii ◽  
Hirotoshi Imamura ◽  
Tetsu Satow ◽  
Kazumichi Yoshida ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Additional Treatment ◽  
Long Term Outcomes ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
Long Term Follow Up ◽  
Multiple Stroke

OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

scholarly journals Case of nivolumab-induced sclerosing cholangitis: lessons from long-term follow-up

2020 ◽  
Vol 7 (1) ◽  
pp. e000487
Author(s):  
Tess McClure ◽  
Wanyuan Cui ◽  
Khashayar Asadi ◽  
Thomas John ◽  
Adam Testro
Keyword(s):  
Sclerosing Cholangitis ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Solid Organ ◽  
Long Term Outcomes ◽  
Durable Response ◽  
Long Term Follow Up ◽  
Proven Case

Nivolumab is an immune checkpoint inhibitor used to treat multiple solid-organ malignancies. While many of its immune-related adverse events are well established, nivolumab-induced sclerosing cholangitis remains poorly characterised, with no defined diagnostic criteria. Moreover, data regarding long-term outcomes are particularly lacking. We present a biopsy-proven case of nivolumab-induced sclerosing cholangitis, which uniquely captures 18 months of follow-up post-treatment. Our case highlights key features of intrahepatic subtype sclerosing cholangitis and suggests durable response to corticosteroid therapy.

scholarly journals ACLR GRAFT STRAND NUMBER: LONG-TERM FOLLOW-UP ON 400 PATIENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0017
Author(s):  
Julien T Aoyama ◽  
Joshua T Bram ◽  
John Todd R. Lawrence ◽  
Theodore J Ganley
Keyword(s):  
Multivariate Regression ◽  
Normal Weight ◽  
Obese Patients ◽  
Long Term Outcomes ◽  
Post Surgery ◽  
Graft Rupture ◽  
Long Term Follow Up ◽  
Graft Diameter

Background: Studies on pediatric anterior cruciate ligament reconstructions (ACLRs) often focus on graft choice, as rates of these injuries have risen in recent years. Large multicenter studies have found younger age and smaller graft size to be risk factors for graft failure and contralateral tears, but despite large sample sizes these studies have not looked specifically at graft strand number. Therefore the purpose of this study was to use a large sample size to ask whether ACLR graft strand number affects long-term outcomes. Hypothesis/Purpose: Examine long-term effects of ACLR graft strand number using a large cohort. Methods: This was a retrospective comparison study of all patients presenting between 1/1/2008 and 12/31/16 for a first-time ACLR at a single pediatric hospital. After querying medical records for all ACLRs using CPT codes, graft strand number, graft diameter, and other variables were abstracted. Long-term outcomes on graft rupture, contralateral ACL tear, and subsequent meniscus injury were collected via phone calls and REDCap emails. Patient groups were compared for differences in graft strand number and diameter using bivariate analyses, and differences in long-term outcomes were analyzed using multivariate regression. Results: 436 patients met the inclusion criteria also completed the long-term follow-up on outcomes. Long-term follow-up ranged from 18 months post surgery to 10 years post surgery. Patients with larger graft diameter were significantly less likely to suffer a complication (graft rupture, contralateral ACL tear, or subsequent meniscus injury) in multivariate regression (p=0.03), while strand number, sex, weight, and age showed no significant difference. Transphyseal reconstructions had larger graft diameters (8.8mm) than partial hybrid (8.6mm) and all-epiphyseal reconstructions (8.3mm) (p<0.001), but had no differences in graft strand number. Males had larger graft diameters (8.9mm) than females (8.6mm) (p=0.03), but also had no differences in graft strand number. Obese patients had larger graft diameters (9.1mm) than overweight (8.9mm) and normal weight patients (8.6mm) (p=0.002). Obese patients also had more graft strands (6.9) than overweight (6.2) or normal weight patients (6.1), but this difference was not significant (p=0.051). Conclusion: This data supports the existing literature that pediatric ACLR patients with larger graft diameters are less likely to suffer long-term complications. Using both a large patient cohort and long-term follow-up, this data also showed that graft strand number was not significantly correlated with outcomes. This suggests that strand number is not important when constructing ACLR grafts, as long as sufficient graft diameter can be achieved.

scholarly journals P183 The prevalence of incidental terminal ileitis in persons undergoing non-diagnostic colonoscopy: a meta-analysis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S230-S230
Author(s):  
M Agrawal ◽  
M Bento-Miranda ◽  
S Walsh ◽  
J F Colombel ◽  
R Ungaro
Keyword(s):  
Meta Analysis ◽  
Scientific Meeting ◽  
Long Term Outcomes ◽  
Diagnostic Colonoscopy ◽  
Terminal Ileitis ◽  
Prevalence Studies ◽  
Therapeutic Implications ◽  
Long Term Follow Up

Abstract Background Incidentally diagnosed terminal ileitis has been reported among asymptomatic persons undergoing non-diagnostic colonoscopy. The purpose of our study was to determine the prevalence and long-term outcomes of asymptomatic terminal ileitis. Methods We developed and executed a systematic search strategy in three biomedical databases (Medline, Embase and Web of Science) and relevant scientific meeting abstracts, from inception to May 1, 2019, to identify observational studies that reported the prevalence of asymptomatic terminal ileitis in adults undergoing screening or polyp surveillance colonoscopy, and/or the long-term outcomes of such lesions. A random-effects meta-analysis was conducted to determine the pooled prevalence rate, confidence interval (CI), and report the heterogeneity score I2. Risk factors for progression to overt CD were abstracted. Results Of 2388 eligible studies, 1784 were screened after excluding duplicates, 84 were reviewed in full text and 14 studies were eligible for inclusion. Eight studies reported the prevalence of asymptomatic terminal ileitis in 46,460 persons undergoing non-diagnostic colonoscopy, and eight (two of eight reporting prevalence) studies reported follow-up data. The pooled rate of asymptomatic terminal ileitis was 1.5% (CI 1.0%, 16.3%), with I2 of 0 (Figure). The use of non-steroidal anti-inflammatory drugs varied between 0% and 37%. Of 147 persons with asymptomatic terminal ileitis with follow-up data (range 13–63.6 months in three studies), five had progression to CD, three were treated for CD with steroids, 5-amino salicylates, azathioprine and vedolizumab, and lesions resolved in four. Three studies reported the absence of symptoms as a predictor of lack of progression. Conclusion Asymptomatic terminal ileitis can be found incidentally in 1.5% of non-diagnostic colonoscopies. Based on limited data, the rate of its progression to overt CD seems low, and watchful waiting could likely be a reasonable strategy. More long-term follow-up studies are needed to inform the natural history of incidental terminal ileitis, factors that predict progression to CD and therapeutic implications.

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