scholarly journals Fusion Versus Flexible Reconstruction for Patients with Flexible Flatfoot

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0051
Author(s):  
Kathryn Whitelaw ◽  
Shivesh Shah ◽  
Noortje Hagemeijer ◽  
Daniel Guss ◽  
Anne Johnson ◽  
...  
Keyword(s):  
Bivariate Analysis ◽  
Posterior Tibial Tendon ◽  
Complication Rates ◽  
Reconstruction Procedure ◽  
Fusion Procedure ◽  
Patient Demographics ◽  
Significant Difference ◽  
Double Osteotomy ◽  
Calcaneal Lengthening ◽  
Reoperation Rates

Category: Other Introduction/Purpose: When passively correctible, adult acquired flatfoot deformities (AAFD) are often treated with joint-sparing procedures. Questions remain, however, as to the efficacy of such flexible procedures when clinical deformities become more severe. In patients with increasingly severe deformities, a primary fusion may lead to more predictable outcomes, but also risks nonunion. The primary aim of this study was to compare the reoperation rates and complication rates following flexible reconstructions versus fusion procedures in the treatment of flexible AAFD. Methods: All patients, who were diagnosed and treated surgically for a flexible AAFD between January 1, 2001 and January 1, 2016, were identified. Exclusion criteria included incomplete medical records, rigid flatfoot deformities, and prior flatfoot surgery. Procedures defined as flexible reconstructions included medial calcaneal osteotomy (MCO), lateral calcaneal lengthening (LCL), double osteotomy, posterior tibial tendon (PTT) debridement, or PTT augmentation; procedures defined as fusions included subtalar (ST) arthrodesis, talonavicular (TN) arthrodesis, calcaneocuboid (CCJ) arthrodesis (alone or in combination with a LCL), double arthrodesis, or triple arthrodesis. Patient demographics, type of surgical procedure, postoperative complications, and reoperation rates were collected. Bivariate analysis was performed to compare patients who had a flexible reconstruction procedure versus a fusion procedure. Results: Two-hundred-thirty-nine patients (255 feet, mean follow up 62±50 months, range 15-104) were included. Two-hundred-eight (87%) patients underwent a flexible reconstruction, average age 55 (±12.0), while 31 (13%) patients underwent a fusion, average age 58 (±14.4) (p = 0.161). Age, BMI, diabetes and neuropathy rates were similar for both groups. Fifty-four patients (24%) underwent a flexible reconstruction and returned to the OR versus 11 (34%) in the fusion group (p = 0.217). Nonunion occurred more in the fusion group, with 5 (16%) versus 10 (4%) nonunions in the flexible reconstruction (p = 0.027). Symptomatic nonunion rates were similar. Rates of surgical revision for nonunion among patients returning to the OR were similar between flexible (7/54, 3%) and fusion (3/11, 9%) groups (p = 0.117). Conclusion: No significant difference in reoperation rates was found between flexible AAFD patients who were treated with flexible reconstructions versus fusions. As expected, the nonunion rate was significantly higher in the fusion group. Notably, rates of revision surgery for nonunion were similar between groups. Our findings suggest that nonunion should be less of a concern when considering a flexible versus fusion procedure for patients with a severe AAFD, and that other factors such as the degree of deformity should guide decision making.

Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study

2017 ◽  
Vol 102 (9) ◽  
pp. 1248-1253 ◽  
Author(s):  
Mohamad El Wardani ◽  
Ciara Bergin ◽  
Kenza Bradly ◽  
Eamon Sharkawi
Keyword(s):  
Complication Rates ◽  
Failure Rates ◽  
Shunt Surgery ◽  
Patient Demographics ◽  
Aqueous Shunt ◽  
Included Patient ◽  
Significant Difference ◽  
Negative Effect ◽  
Prospective Comparative Study ◽  
Baerveldt Tube

AimTo examine the efficacy and safety of Baerveldt tube (BT) implantation compared with combined phacoemulsification and Baerveldt tube (PBT) implantation in patients with refractory glaucoma.MethodsSeventy-six eyes of 76 patients were enrolled, 38 pseudophakic eyes underwent BT implantation alone and 38 phakic eyes underwent the BT implantation combined with phacoemulsification. Groups were matched for preoperative intraocular pressure (IOP) and number of glaucoma medications. Preoperative and postoperative measures recorded included patient demographics, visual acuity (VA), IOP, number of antiglaucoma medications and all complications. Patients were followed up for a minimum of 36 months. Failure was defined as: inadequate IOP control (IOP≤5 mm Hg/>21 mm Hg/<20% reduction from baseline, reoperation for glaucoma, loss of light perception vision, or removal of the implant).ResultsThere was a significant difference in failure rates between groups at 36 months (PBT 37% vs BT 15%, P=0.02). There was no significant difference for PBT versus BT in preoperative baseline ocular characteristics. At 36 months: median IOP=14 mm Hg vs 12 mm Hg, P=0.04; mean number of antiglaucomatous medications=1.7 vs 1.3, P=0.61; median VA=0.8 vs 0.7, P=0.44. Postoperative complication rates were similar in both groups (n=5 vs 5; 13% vs 13%).ConclusionsFailure rates were significantly greater in the PBT group at 3 years. Median IOP was also significantly higher in the PBT group. These results suggest that combining phacoemulsification with aqueous shunt surgery may have a negative effect on long-term shunt bleb survival.

scholarly journals Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Wei Wang ◽  
Xiangyao Sun ◽  
Tongtong Zhang ◽  
Siyuan Sun ◽  
Chao Kong ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Reoperation Rates ◽  
Topping Off

The treatment effects of topping-off technique were still controversial. This study compared all available data on postoperative clinical and radiographic outcomes of topping-off technique and posterior lumbar interbody fusion (PLIF). PubMed, EMBASE, and Cochrane were systematically reviewed. Variations included radiographical adjacent segment disease (RASD), clinical adjacent segment disease (CASD), global lumbar lordosis (GLL), visual analogue scale (VAS) of back (VAS-B) and leg (VAS-L), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, duration of surgery, estimated blood loss (EBL), reoperation rates, and complication rates. Sixteen studies, including 1372 cases, were selected for the analysis. Rates of proximal RASD (P=0.0004), distal RASD (P=0.03), postoperative VAS-B (P=0.0001), postoperative VAS-L (P=0.02), EBL (P=0.007), and duration of surgery (P=0.02) were significantly lower in topping-off group than those in PLIF group. Postoperative ODI after 3 years (P=0.04) in the topping-off group was significantly less than that in the PLIF group. There was no significant difference in the rates of CASD (P=0.06), postoperative GLL (P=0.14), postoperative ODI within 3 years (P=0.24), and postoperative JOA (P=0.70) and in reoperation rates (P=0.32) and complication rates (P=0.27) between topping-off group and PLIF. The results confirmed that topping-off technique could effectively prevent ASDs after lumbar internal fixation. However, this effect is effective in preventing RASD. Topping-off technique is more effective in improving the subjective feelings of patients rather than objective motor functions compared with PLIF. With the development of surgical techniques, both topping-off technique and PLIF are safe.

scholarly journals Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis

2018 ◽  
Vol 80 (04) ◽  
pp. 364-370
Author(s):  
David M. Rosenberg ◽  
Brett W. Geever ◽  
Akash S. Patel ◽  
Anisse N. Chaker ◽  
Abhiraj D. Bhimani ◽  
...  
Keyword(s):  
Pineal Gland ◽  
Clinical Decision Making ◽  
Tumor Resection ◽  
Postoperative Outcomes ◽  
Complication Rates ◽  
Database Analysis ◽  
Improvement Program ◽  
Multicenter Studies ◽  
Patient Demographics ◽  
Significant Difference

Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches. Design Retrospective database review. Setting Multi-institutional database. Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach. Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies. Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological. Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.

scholarly journals Role of minimally invasive glaucoma surgery in the management of chronic open-angle glaucoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ojasvi Sharma ◽  
Didar Abdulla ◽  
Anthony King ◽  
Monali Chakrabarti ◽  
Tarun Sharma
Keyword(s):  
Success Rate ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Complication Rates ◽  
Open Angle ◽  
Patient Demographics ◽  
Significant Difference ◽  
Advanced Glaucoma

AbstractTo compare the safety and efficacy of phacoemulsification combined with ab-interno trabeculectomy (Trabectome) and phacoemulsification combined with I-Stent inject in patients with medically uncontrolled primary open-angle glaucoma (POAG). A retrospective comparative case series. 70 eyes of 66 patients completed 2 years follow up after these treatments performed in 2017–2018. 35 eyes of 33 patients underwent combined Phaco-Trabectome (PT); and 35 eyes of 33 patients underwent combined Phaco-I-Stent inject (Pi). Patient demographics and preoperative characteristics are comparable. A 20% drop in IOP was achieved in 27 eyes (77.14%) in PT group and 28 eyes (80%) in Pi group (p = 0.77). Success rate (target IOP achieved and maintained for 2 years) in advance glaucoma was 25% in PT group and 30.7% in Pi group (p = 0.90). In mild to moderate glaucoma, success rate was 85.71% in PT group and 90% in Pi group (p = 0.67). There was no significant difference between two groups with regards to mean reduction in glaucoma medications and complication rates. Trabectome and I-Stent combined with phacoemulsification are equally efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). However, they are not an effective treatment for patients with advanced glaucoma.

scholarly journals The impact of the Covid-19 pandemic on care of women with ectopic pregnancy in a tertiary London hospital

2021 ◽  
Vol 13 (4) ◽  
pp. 395-398
Author(s):  
J.E. Gaughran ◽  
D.M. Geddes-Barton ◽  
T Cliff ◽  
F Bailey ◽  
C Ovadia ◽  
...  
Keyword(s):  
Complication Rates ◽  
Telephone Triage ◽  
Management Options ◽  
Triage System ◽  
Patient Demographics ◽  
Significant Difference ◽  
Diagnosis Rate ◽  
Ectopic Pregnancies ◽  
Operative Findings ◽  
The Impact

Background: In response to the COVID-19 pandemic, a central London tertiary referral hospital’s nurse-led Early Pregnancy & Acute Gynaecology Unit (EPAGU) suspended its walk-in service in favour of a telephone triage system with scheduled appointments. Objective: To assess if the pandemic and this adaptation to clinical services had an impact on the presentation, management and complication rate of ectopic pregnancies. Materials and Methods: A retrospective review was performed of ectopic pregnancies diagnosed in the EPAGU between 5th of March 2020 – 15th of July 2020 (pandemic) and 5th of March 2019 – 15th of July 2019 (pre-pandemic). Main outcome measures: Ultrasound findings, patient demographics, serum hCG concentrations, operative findings and complications. Results: There was a 36% reduction in attendances to the unit during the pandemic. Allowing for this, there was no significant difference in the diagnosis rate between the two periods. There was no significant difference in the gestation at diagnosis, serum hCG concentration or volume of mass at presentation. There was also no significant difference in rate of surgical intervention or complications including rupture of fallopian tube, haemoperitoneum or need for blood transfusion. Conclusion: This study suggests this is a safe means of caring for women with ectopic pregnancies which does not limit management options nor lead to higher complication rates. What is new: Other EPAGUs may choose to adopt a telephone triage system with reassurance of its safety.

A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury

2021 ◽  
pp. 193864002110582
Author(s):  
Eric So ◽  
Jonathan Lee ◽  
Michelle L. Pershing ◽  
Anson K. Chu ◽  
Matthew Wilson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Retrospective Chart Review ◽  
Reoperation Rate ◽  
Complication Rates ◽  
Lisfranc Injury ◽  
Significant Difference ◽  
Lisfranc Injuries ◽  
Reoperation Rates

There is a lack of consensus in the literature regarding optimal treatment methods for Lisfranc injuries, and recent literature has emphasized the need to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA). The purpose of the current study is to compare reoperation and complication rates between ORIF and PA following Lisfranc injury in a private, outpatient, orthopaedic practice. A retrospective chart review was performed on patients undergoing operative intervention for Lisfranc injury between January 2009 and September 2015. A total of 196 patients met the inclusion criteria (130 ORIF, 66 PA), with a mean follow-up of 61.3 and 81.7 weeks, respectively. The ORIF group had a higher reoperation rate than the PA group, due to hardware removal. When hardware removals were excluded, the reoperation rate was similar. Postsurgical complications were compared between the 2 groups with no significant difference. In conclusion, ORIF and PA had similar complication rates. When hardware removals were excluded, the reoperation rates were similar, although hardware removals were more common in the ORIF group compared with the PA group. Levels of Evidence: Level III

Abstract WP14: Higher Aspiration Force Improves Technical Outcomes in ADAPT Thrombectomy for Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Reda M Chalhoub ◽  
Ali M Alawieh ◽  
Clayton Korson ◽  
Mohammad Anadani ◽  
Jonathan Lena ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Lower Number ◽  
Stent Retriever ◽  
Complication Rates ◽  
Procedure Time ◽  
Aspiration Thrombectomy ◽  
Patient Demographics ◽  
Significant Difference ◽  
Catheter Size ◽  
The Impact

Introduction: Aspiration thrombectomy using the direct aspiration at first pass technique (ADAPT) has been shown to be non-inferior to stent-retriever thrombectomy in ischemic stroke trials. Favorable outcomes after ADAPT are dependent on successful recanalization and lower number of aspiration attempts. We investigated the impact of aspiration force on technical and clinical outcomes of ADAPT by modulating two underlying determinants, the aspiration catheter size and the reperfusion pump power. Methods: We performed a retrospective analysis of patients undergoing ADAPT thrombectomy between 01/2018 and 02/2019. Patient treated using ADAPT were included irrespective of age, onset to groin or whether thrombolytic therapy was administered. Patient demographics and outcomes were reviewed from patient charts and thrombectomy procedure notes. Patients were dichotomized based on the reperfusion pump used (MAX, 28.5 inHb power vs ENGINE, 29.2 inHg power) and further split into the different reperfusion catheters used. Results: This study included 194 patients who underwent ADAPT thrombectomy during the study period with mean age of 69, and of which 48% were females. Comparing patients treated with two different reperfusion pumps, ENGINE (N=73) and MAX (N=118), similar rates of favorable outcomes measured by 90-day modified Rankin score (mRS) were observed. However, patients in the ENGINE groups had significantly shorter procedure time (20 vs 27 min, p<0.05), lower number of aspiration attempts (1.9 vs 2.2 p<0.05), and low rates of rescue stent retriever therapy (14% vs 33%, p<0.05). The use of ENGINE was an independent predictor of shorter procedure time (p<0.05) and lower rates of symptomatic hemorrhage (p<0.1) compared to MAX pump. There was no significant difference in procedure time and rates of functional outcomes among patients undergoing ADAPT using different sizes of large bore catheters ACE 60, ACE68 and Jet 7. Conclusion: Success of ADAPT thrombectomy is dependent on successful aspiration of the occluding clot, and is dependent on the aspiration force. Higher aspiration forces can be achieved by increasing the power of reperfusion pump leading to better technical outcomes without increased complication rates.

A comparative study of voice outcomes and complication rates in patients undergoing injection laryngoplasty performed under local versus general anaesthesia: an Adelaide voice specialist's experience

2017 ◽  
Vol 131 (S1) ◽  
pp. S41-S46 ◽  
Author(s):  
D Chandran ◽  
C Woods ◽  
S Ullah ◽  
E Ooi ◽  
T Athanasiadis
Keyword(s):  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Voice Handicap Index ◽  
Complication Rates ◽  
Post Injection ◽  
Injection Laryngoplasty ◽  
Patient Demographics ◽  
Management Algorithm ◽  
Significant Difference ◽  
General Anaesthesia Group

AbstractObjective:To compare clinical outcomes and complication rates in patients undergoing injection laryngoplasty performed under local versus general anaesthesia.Methods:A retrospective review was conducted of patients who underwent injection laryngoplasty performed by a single laryngologist in a tertiary Australian laryngology centre, between February 2013 and December 2014. Patient demographics, anaesthetic modality and complications were recorded. Voice Handicap Index 10 and the Grade, Breathiness, Roughness, Asthenia, Strain scale were evaluated.Results:Thirty-four laryngoplasties were performed under general anaesthesia and 41 under local anaesthesia, with mean patient ages of 59.5 and 68.8 years, respectively. Voice Handicap Index 10 scores were significantly improved post-injection (p< 0.001), with no significant difference between general anaesthesia and local anaesthesia (p> 0.05). All aspects of the Grade, Breathiness, Roughness, Asthenia, Strain scale showed significant improvement post-injection, except asthenia. There were seven (9.3 per cent) minor complications (five in the general anaesthesia group, two in the local anaesthesia group), all managed conservatively.Conclusion:Injection laryngoplasties performed under general anaesthesia and local anaesthesia offer similar voice outcomes, with comparable complication rates. Hence, development of a management algorithm for injection laryngoplasties performed under local anaesthesia is recommended.

scholarly journals Comparison of second and third generation total ankle arthroplasty learning curves

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Ryan Callahan ◽  
Michael Aynardi ◽  
Kempland Walley ◽  
Kaitlin Saloky ◽  
Paul Juliano
Keyword(s):  
Learning Curve ◽  
Learning Curves ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
2Nd Generation ◽  
Significant Difference ◽  
Surgeon Experience ◽  
Reoperation Rates

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has evolved over the past decades with later generation implants being associated with improved instrumentation and hardware. There have been multiple reports of the “learning curve” associated with total ankle arthroplasty. These report higher complication rates during the initial procedures performed by an inexperienced surgeon. To our knowledge, there is no comparison of the 2nd generation and 3 rd generation implant learning curves. Methods: The clinical outcomes of the first 15 cases (8/2002-4/2005) of a 2nd generation fixed bearing prosthesis (Agility Total Ankle System) and the first 15 cases (6/2007-3/2009) of a 3 rd generation fixed bearing prosthesis (Salto Talaris® TotalAnkle Prosthesis) performed by a single surgeon were retrospectively reviewed to determine complication incidence. The initial cases with each system were also independently reviewed to determine if there was a significant learning curve in regards to complications. Reoperation, infection, gutter impingement, fracture, persistent pain, and periprosthetic cyst formation were included for comparison of complication rates. Results: The overall complication rates for the Agility were 54.9% (28/51) and 35.7% (25/70) for Salto Talaris. There was no significant difference in reoperation rates when comparing the first 15 Agility cases (8/15, 53%) to the remainder of Agility cases (11/36, 30.6%) p=0.2. The initial 15 Salto Talaris cases also demonstrated no significant difference in reoperation rates (1/15, 8%) when compared to the remaining Salto Talaris replacements (7/55, 12.7%) p=1. Reoperation rates were higher in the initial 15 Agility cases (8/15, 53%) compared to the initial 15 Salto cases (1/15, 8%) p=0.01. There was no significant difference in infection, hardware failure, and medial malleolus fracture rates for any of the groups. Conclusion: While this series demonstrated no significant learning curve for each individual total ankle system, there was a significantly higher reoperation rate in the initial cases for the 2nd generation TAA when compared to the initial cases of the 3 rd generation implants. This could be attributed to improved instrumentation and hardware and/or surgeon experience.

Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot

2020 ◽  
pp. 193864002095055
Author(s):  
Kathryn Whitelaw ◽  
Shivesh Shah ◽  
Noortje C. Hagemeijer ◽  
Daniel Guss ◽  
Anne H. Johnson ◽  
...  
Keyword(s):  
Case Series ◽  
Bivariate Analysis ◽  
Complication Rates ◽  
Retrospective Case ◽  
Patient Demographics ◽  
First Metatarsal ◽  
Surgery Patient ◽  
Radiographic Measurements ◽  
Flexible Flatfoot ◽  
Anteroposterior View

Aims Passively correctible, adult-acquired flatfoot deformities (AAFD) are treated with joint-sparing procedures. Questions remain as to the efficacy of such procedures when clinical deformities are severe. In severe deformities, a primary fusion may lead to predictable outcomes, but risks nonunion. We evaluated pre- and postsurgical flexible AAFD patients undergoing joint-sparing or fusion procedures, comparing reoperation and complication rates. Methods We identified patients with flexible AAFD between January 1, 2001 and 2016. Exclusion criteria were incomplete medical record, rigid AAFD, and prior flatfoot surgery. Patient demographics, pre- and postsurgical radiographic measurements, surgery performed, and postoperative complications were evaluated by bivariate analysis, comparing joint-sparing versus fusion procedures. Results Of 239 patients (255 feet) (mean follow-up 62 ± 50 months), 209 (87%) underwent joint-sparing reconstructions, 30 (12.6%) underwent fusions. Fifty-four (24.1%) feet underwent joint-sparing reconstruction with reoperation versus 11 (35.5%) in fusion patients ( P = .17). Radiographic improvement in talonavicular angle, talar first-metatarsal (anteroposterior view), and Meary’s angle was higher in fusion patients ( P < .001, P < .001, and P = .003, respectively). Discussion More nonunion reoperations among fusion patients were offset by reoperations in joint-sparing patients. Fusion uniquely corrected Meary’s angle. Nonunion is of less concern for joint-sparing versus fusion for patients with severe flexible AAFD. Degree of deformity versus advantage of joint motion should improve decision making. Levels of Evidence: Level IV: Retrospective case series

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