Outcome of Anastomotic Urethroplasty: Single-Center Experience

Objective: To determine the short term outcome of anastomotic urethroplasty. Material and Methods: From January 2013 to June 2015, 25 male patients underwent anastomotic urethroplasty at our center and were analyzed prospectively. Mean age was 28.1 years (range 13-50), average stricture length was 2.5 cm (range 1.5-2.5). Patients with post-prostatectomy stricture, stricture more than 2.5 cm in length or patients of stricture with neurogenic bladder and patients with any perineal disease were excluded from the study. Retrograde urethrogram and voiding cysto-urethrogram was done in every patient to assess stricture length and location. Stricture excision and end-to-end anastomosis of urethra with spatulation was performed in every patient. Minimum followup period was 6 months and maximum 30 months. All patients had obliterative stricture. Results: The mean operative time was 105 min (range 90-120). Four patients (16%) developed complications postoperatively. Wound infection occurred in 01 (04%) patient. Stricture recurrence found in 02 (08%) patients and erectile dysfunction in 01 (04%) patients. Twenty one patients (84%) had excellent outcome, Two (08%) needed optical internal urethrotomy and of them one (04%) failed to respond. Conclusion: Anastomotic urethroplasty has a high success rate of 92%. It is technically straightforward with minimal morbidity. Long term follow-up is strongly recommended for ultimate success. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.38-42

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

Background Making decisions in alignment techniques in total knee arthroplasty (TKA) remains controversial. This study aims to identify the potential patients who were suitable for the kinematic (KA) or mechanical alignment (MA). Methods We reviewed 296 consecutive patients (296 TKAs, including 114 KA-TKAs and 182 MA-TKAs) who underwent unilateral TKA using a computer-assisted navigation from 2016 to 2018 in our prospectively maintained database. The minimum followup was one year. Clinical outcomes including the range of motion (ROM) and knee society score (KSS) were compared between KA-TKAs and MA-TKAs. Multiple regression models were used to evaluate the relationship between alignment techniques and KSS at the 1-year followup. Interaction and stratified analyses were conducted according to gender, age, body mass index (BMI), preoperative hip-knee-ankle (HKA) angle, ROM and KSS.Results ROM and KSS at the 1-year followup didn't differ between MA-TKAs and KA-TKAs (all p>0.05). Alignment techniques did not associate with postoperative ROM (Adjusted β=0.4, 95% confidence interval [CI]: -0.3, 1.6; p=0.752) or 1-year KSS (Adjusted β=2.2, 95%CI: -0.7, 5.6; p=0.107). Patients with a BMI more than 30 kg/m^2 achieved better 1-year KSS when using MA than KA (p for interaction<0.05). Additionally, patients with preoperative HKA angle more than 10 degrees varus benefited more from KA than MA (p for interaction<0.05).Conclusions Patients with severe varus deformity may be suitable for the KA technique, whereas MA should be used in obese patients.

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

Background Making decisions in alignment techniques in total knee arthroplasty (TKA) remains controversial. This study aims to identify the potential patients who were suitable for the kinematic (KA) or mechanical alignment (MA). Methods We reviewed 296 consecutive patients (296 TKAs, including 114 KA-TKAs and 182 MA-TKAs) who underwent unilateral TKA using a computer-assisted navigation from 2016 to 2018 in our prospectively maintained database. The minimum followup was one year. Clinical outcomes including the range of motion (ROM) and knee society score (KSS) were compared between KA-TKAs and MA-TKAs. Multiple regression models were used to evaluate the relationship between alignment techniques and KSS at the 1-year followup. Interaction and stratified analyses were conducted according to gender, age, body mass index (BMI), preoperative hip-knee-ankle (HKA) angle, ROM and KSS.Results ROM and KSS at the 1-year followup didn't differ between MA-TKAs and KA-TKAs (all p>0.05). Alignment techniques did not associate with postoperative ROM (Adjusted β=0.4, 95% confidence interval [CI]: -0.3, 1.6; p=0.752) or 1-year KSS (Adjusted β=2.2, 95%CI: -0.7, 5.6; p=0.107). Patients with a BMI more than 30 kg/m^2 achieved better 1-year KSS when using MA than KA (p for interaction<0.05). Additionally, patients with preoperative HKA angle more than 10 degrees varus benefited more from KA than MA (p for interaction<0.05).Conclusions Patients with severe varus deformity may be suitable for the KA technique, whereas MA should be used in obese patients.

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

Background Making decision in alignment techniques in total knee arthroplasty (TKA) remains controversial. This study aims to identify the potential patients who were suitable for the kinematic (KA) or mechanical alignment (MA). Methods We reviewed 296 patients (296 TKAs, including 114 KA-TKAs and 182 MA-TKAs) who underwent unilateral TKA using a portable navigation system from 2016 to 2018 in our prospectively maintained database. The minimum followup was 1 year. Clinical outcomes including range of motion (ROM) and knee society score (KSS) were compared between KA-TKAs and MA-TKAs. Multiple regression models were used to evaluate the relationship between alignment techniques and KSS at the 1-year followup. Interaction and stratified analyses were conducted according to gender, age, body mass index (BMI), preoperative hip-knee-ankle (HKA) angle, ROM and KSS. Results ROM and KSS at the 1-year followup didn’t differ between MA-TKAs and KA-TKAs (all p>0.05). Alignment techniques did not associate with postoperative ROM (Adjusted β=0.4, 95% confidence interval [CI]: -0.3, 1.6; p=0.752) or 1-year KSS (Adjusted β=2.2, 95%CI: -0.7, 5.6; p=0.107). Patients with BMI more than 30 kg/m^2 achieved better 1-year KSS when using MA than KA (p for interaction<0.05), Additionally, patients with preoperative HKA angle more than 10 degrees varus benefited more from KA than MA (p for interaction<0.05). Conclusions Patients with severe varus deformity may be suitable for the KA technique, whereas MA should be used in obese patients.

Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

Introduction The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum followup of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occured. Conclusions Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity. Sometimes it can work with the aid of augment or cup-cage construct. When both the superior and inferior portions of the pelvis achieve osteointegration into the porous metal cup, a long-term durability can be expected.

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

Background Making decision in alignment techniques in total knee arthroplasty (TKA) remains controversial. This study aims to identify the potential patients who were suitable for the kinematic (KA) or mechanical alignment (MA).Methods We reviewed 296 patients (296 TKAs, including 114 KA-TKAs and 182 MA-TKAs) who underwent unilateral TKA using a portable navigation system from 2016 to 2018 in our prospectively maintained database. The minimum followup was 1 year. Clinical outcomes including range of motion (ROM) and knee society score (KSS) were compared between KA-TKAs and MA-TKAs. Multiple regression models were used to evaluate the relationship between alignment techniques and KSS at the 1-year followup. Interaction and stratified analyses were conducted according to gender, age, body mass index (BMI), preoperative hip-knee-ankle (HKA) angle, ROM and KSS. Results ROM and KSS at the 1-year followup didn’t differ between MA-TKAs and KA-TKAs (all p>0.05). Alignment techniques did not associate with postoperative ROM (Adjusted β=0.4, 95% confidence interval [CI]: -0.3, 1.6; p=0.752) or 1-year KSS (Adjusted β=2.2, 95%CI: -0.7, 5.6; p=0.107). Patients with BMI more than 30 kg/m^2 achieved better 1-year KSS when using MA than KA (p for interaction<0.05), Additionally, patients with preoperative HKA angle more than 10 degrees varus benefited more from KA than MA (p for interaction<0.05). Conclusions Patients with severe varus deformity may be suitable for the KA technique, whereas MA should be used in obese patients.

Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

Introduction The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum followup of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occured. Conclusions Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity. Sometimes it can work with the aid of augment or cup-cage construct. When both the superior and inferior portions of the pelvis achieve osteointegration into the porous metal cup, a long-term durability can be expected.

A study of outcome of surgical management of ruptured intracranial aneurysms

Background: The present study is a retrospective analysis of collected data of consecutive cases with ruptured intracranial aneurysms treated at two centres. The clinical outcome and associated complications were graded using the modified Rankins scale.Methods: A total of 48 patients of ruptured intracranial aneurysms were managed between January 2014 and August 2017. All forty eight patients underwent clipping. All the 48 patients who were consequently treated with surgery for intracranial aneurysm were analysed.Results: Of the total of 48 patients, Six patients died in the post-operative period while the remaining 42 patients were available for a minimum followup of 6 months duration. the post operatives outcomes matched the presenting Hunt and Hess grade in 80% patients.Conclusions: Surgical outcome of ICA Aneurysm is generally good. Poor results are mainly related to poor aneurysm grade, atherosclerotic intracranial carotid artery, and severe vasospasm. ACOM aneurysm in spite of being very common the outcome of patients with ACOM aneurysms remains not so good. In patients with MCA aneurysm the post-operative outcome is significantly better if surgery is undertaken earlier.

Aequalis Humeral Head Resurfacing in Glenohumeral Arthritis at a Minimum Followup of 2 Years

Aim. To evaluate results of Aequalis humeral head resurfacing in patients with end-stage glenohumeral arthritis at a minimum followup of two years. Patients and Methods. Twenty-one consecutive patients underwent humeral head resurfacing hemiarthroplasty between 2007 and 2009. Three patients did not fulfill the inclusion criteria. 18 patients with mean age of 75.1 years (range 58–91 years) and a mean duration of preoperative symptoms of 33.6 months (range 6–120 months) were analyzed. Patients’ self-reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome. Results. The mean initial OSS was 15 (range 3–29). The score improved by an average of 19.5 points at a mean followup of 36.3 months (range 24–54 months) to reach a mean final OSS of 34.5 (range 6–47). The improvement of OSS was highly significant with a two-tailed P value less than 0.0001. The overall patient satisfaction was 94%. Conclusion. This study demonstrates Aequalis shoulder resurfacing hemiarthroplasty as a reliable procedure, away from its originating center, for improvement of shoulder function as shown by the patients’ self-reported outcome score (OSS) in end-stage glenohumeral arthritis at a minimum followup of 2 years.