bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: Systematic Review and Meta-Analysis
Authors: Campbell Ryan C. , Mobbs Ralph J. , Lu Victor M. , Xu Joshua , Rao Prashanth J. , Phan Kevin 
Published: May 2017

Study Design: Systematic review and meta-analysis. Objective: Current surgical management of degenerative spondylolisthesis (DS) involves decompression of the spinal canal followed by fusion with or without interbody. The additional functional and operative benefits derived from interbody inclusion has yet to be thoroughly established with a number of recent studies producing conflicting results. Thus, we aim to compare the functional and operative outcomes after fusion against interbody fusion in the treatment of DS. Methods: This systematic review of the literature comparing posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) outcomes in the treatment of DS was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches of 6 databases yielded 386 articles from database inception to July 2016, which were screening against established criteria for inclusion into this study. Results: A total of 6 studies, satisfied criteria and reported outcomes for 721 patients. Fusion alone was performed in 458 (63.5%) patients and interbody fusion was performed in 263 (36.5%) patients. Functional outcomes Oswestry Disability Index ( P = .29) and visual analog scale ( P = .13) were not statistically different between the 2 approaches. Furthermore, there was no significant inferiority between fusion alone and with interbody in terms of the operative outcomes of blood loss ( P = .38), reoperation rate ( P = .66), hospital stay ( P = .96), complication rate ( P = .78), or fusion rate ( P = .15). Conclusions: There was no statistically significant difference in functional and operative outcomes following fusion alone versus with interbody. Additional subgroup analysis of intrinsic DS features in future large, prospective, randomized controlled trials will improve the validity of these findings.
The Predictive Value of Preoperative Health-Related Quality-of-Life Scores on Postoperative Patient-Reported Outcome Scores in Lumbar Spine Surgery
Authors: Hey Hwee Weng Dennis , Luo Nan , Chin Sze Yung , Lau Eugene Tze Chun , Wang Pei , Kumar Naresh , Lau Leok-Lim , Ruiz John Nathaniel , Thambiah Joseph Shanthakumar , Liu Ka-Po Gabriel , Wong Hee-Kit 
Published: May 2017

Study Design: A single-center, retrospective cohort study. Objective: To predict patient-reported outcomes (PROs) using preoperative health-related quality-of-life (HRQoL) scores by quantifying the correlation between them, so as to aid selection of surgical candidates and preoperative counselling. Methods: All patients who underwent single-level elective lumbar spine surgery over a 2-year period were divided into 3 diagnosis groups: spondylolisthesis, spinal stenosis, and disc herniation. Patient characteristics and health scores (Oswestry Low Back Pain and Disability Index [ODI], EQ-5D, and Short Form-36 version 2 [SF-36v2]) were collected at 6 and 24 months and compared between the 3 diagnosis groups. Multivariate modelling was performed to investigate the predictive value of each parameter, particularly preoperative ODI and EQ-5D, on postoperative ODI and EQ-5D scores for all the patients. Results: ODI and EQ-5D at 6 and 24 months improved significantly for all patients, especially in the disc herniation group, compared to the baseline. The magnitude of improvement in ODI and EQ-5D was predictable using preoperative ODI, EQ-5D, and SF-36v2 Mental Component Score. At 6 months, 1-point baseline ODI predicts for 0.7-point increase in changed ODI, and a 0.01-point increase in baseline EQ-5D predicts for 0.01-point decrease in changed EQ-5D score. At 24 months, 1-point baseline ODI predicts for 1-point increase in changed ODI, and a 0.01-point increase in baseline EQ-5D predicts for 0.009-point decrease in changed EQ-5D. A younger age is shown to be a positive predictor of ODI at 24 months. Conclusions: Poorer baseline health scores predict greater improvement in postoperative PROs at 6 and 24 months after the surgery. HRQoL scores can be used to decide on surgery and in preoperative counselling.
Orthopaedic Resident Preparation and Confidence in Treating On-Field Injuries
Authors: Hodax Jonathan D. , Sobel Andrew D. , DeFroda Steven , Chambers Alison B. , Hulstyn Michael J. 
Published: May 2017

Background: Orthopaedic surgery residents may cover athletic events, although the training provided to prepare residents for this role and oversight from attending physicians during these activities is not well understood. Purpose: To survey orthopaedic residents about the training provided by their residency program for on-field athletic coverage and to understand their levels of preparation for this role and confidence in treating commonly encountered on-field conditions. Study Design: Descriptive epidemiology study. Methods: An anonymous survey was emailed to residents in all American College of Graduate Medical Education–accredited, allopathic, nonmilitary orthopaedic surgery residency programs. This survey queried residents about their demographics, the opportunities their residencies require or allow for athletic coverage, their level of preparation for serving an on-field physician, and their comfort level with treating a number of on-field conditions. Likert-type scales were used to assess resident comfort level for treating 13 orthopaedic and nonorthopaedic conditions as well as their perceived level of preparedness. Results: Of 148 residency programs contacted, 57 programs responded (39%). Of the 57 programs responding, 51 (89.5%) allowed or required residents to cover athletic events, and 27 of 51 (52.9%) reported that training to prepare for this role was provided. Only 6 of 24 programs without training available (25%) had direct attending supervision of residents at all athletic events. Residents who answered that their residency programs mandate training prior to their participation in athletic coverage activities reported a higher level of preparation for this role than those with no training, optional training, or those who were unsure of their training requirement ( P < .0001, P = .035, and P = .013, respectively). In addition, the more senior the resident was, the higher the level of confidence was in treating all orthopaedic and some nonorthopaedic conditions. Residents who had mandatory training displayed a higher comfort level in treating on-field orthopaedic and nonorthopaedic conditions than those without training. Conclusion: Formal training of orthopaedic residents prior to their covering athletic events can improve confidence in treating orthopaedic and nonorthopaedic conditions. Many programs do not ensure that residents are familiar with key and potentially life-saving equipment. An opportunity exists to improve resident education.
Early Results & Accuracy of the MAKO Robtic Unicompartmental Knee Replacement
Authors: GANKO Anthony , DONNELLY William , BRENNAN Stephen , ENGLISH Hugh , HALLIDAY Brett , CRAWFORD Ross 
Published: May 2017

Objectives: To monitor the “learning curve” and assess the accuracy of implantation, safety and early results of a new to Australia, technique for unicompartmental knee replacement Methods: After cadaveric training, the first 50 MAKO unicompartmental replacements, performed by 5 surgeons, were studied. Operative details were recorded including time taken for each step in the surgical procedure. Pre and post operative Knee Society Score (KSS), Oxford knee score (OKS) and WOMAC were recorded. 19 had post-operative CT scans with segmentation using planning software to determine accuracy of implantation compared to plan. Results: In the small number studied there was no evidence of a significant “learning curve” with no significant change in operative times. The procedure proved safe without any failure of technology. At 3 months there was a significant improvement in KSS, WOMAC and OKS. The unicompartmental replacements were inserted with a high degree of accuracy, comparable to other centres and with greater accuracy then reported implantation using “standard” instruments. Conclusion: New robotic technology was able to be introduced safely without a significant learning curve and with satisfactory early results. The technique allowed highly accurate component positioning.
Does Image Derived Instrumentation Alter Revision Rates? An AOANJRR Analysis
Authors: McAuliffe MJ , Beer B , Hatch J , Whitehouse SL , Crawford RW 
Published: May 2017

Objectives: Image Derived Instrumentation (IDI) has been introduced into regular use in modern day total knee arthroplasty (TKA) with many potential benefits touted. Despite this, much of the research involving IDI has failed to prove any significant benefit in alignment, operative time, blood loss and cost. The purpose of this study, the first of its kind, was to compare IDI with non-IDI TKA with respect to rate of revision. Methods: The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) was queried to analyse the survivorship of primary TKAs using IDI reported to the AOANJRR, between April 2009 to December 2014, compared with those without IDI instrumentation. Subgroup analysis was performed to determine the effect of polyethylene insert thickness upon IDI outcomes. The Kaplan-Meier method and proportional hazards models were used to determine the cumulative rates of revision and which prostheses or circumstances lead to an increased risk of revision. Results: In the period studied, there were 11197 primary TKAs performed utilising IDI. This was 4.8% of all primary TKAs during this period. The overall rate of revision/100 observed years was 1.07 in the PSI group, compared with, 0.82 in the standard group. This was equivalent to a hazard ratio (HR) of 1.15 (1.01,1.31; p=0.041). Posterior stabilised (PS) knees in particular showed an increased risk when compared with minimally stabilised knees when using IDI (HR=1.49; p=0.002) and non-IDI PS knees (HR=1.30; p=0.014). Subgroup analysis of the PSI (Zimmer); Signature (Vanguard) and Visionaire (Smith and Nephew) systems by polyethylene insert thickness found varied alteration in revision rates. Of the specific prosthetic combinations examined the NEXGEN CR FLEX/NEXGEN >11 mm poly (909 pts) HR 1.83 p=0.022 and GII Oxinium PS/GII <11 mm poly (868 pts) HR 1.45 p=0.049 were found to have significantly elevated risk of revision with the use of IDI. Conclusion: Using the AOANJRR we have shown that in primary TKAs, the use of IDI is associated with an increased overall revision rate. This is particularly prevalent in those knees using posterior stabilisation. The effect of polyethylene insert thickness varied dependent on manufacturer. The reasons for this cannot be determined from this analysis but suggest caution should be exercised in relation to this technology. Further study is warranted to better understand the reasons for increased revision rates.
Outcomes of Constrained Prostheses in Primary and Revision TKR
Authors: Parkinson Ben , Lorimer Michelle , Lewis Peter 
Published: May 2017

Introduction: The decision to use varus/valgus constrained or hinge knee prostheses in complex Total Knee Replacement (TKR) cases is difficult. There are few publications that compare survival rates, to aid this decision-making. This study compares the survival rates of unlinked fully constrained and hinge constrained prostheses in the primary and revision settings. Methods: Data from the AOANJRR to 31st of December 2013 was analysed to determine the survival rate of unlinked and hinge constrained TKR in the primary and revision settings (excluding the diagnosis of tumour and infection). Only first-time revisions of a known primary TKR were included in the revision analysis. Kaplan-Meier estimates of survivorship were calculated for the two categories of constraint and were matched for age and diagnosis in both primary and revision TKR situations. Hazard ratios using the Cox proportional-hazards model were used. The survivorship of individual prosthesis models was determined. Results: There were 3237 prostheses implanted during the study period that met the inclusion criteria. Of these, 1896 were for primary TKR and 1341 for revision TKR. There were 1349 unlinked fully constrained and 547 hinge prostheses for primary TKR and 991 unlinked fully constrained and 350 hinge prostheses for revision TKR. In both the primary and revision settings when matched by age, there was no difference in rates of revision for either level of constraint. When matched by indication in the primary setting, there was no difference in the rates of revision for either level of constraint. The rate of revision for both categories of constrained prosthesis was significantly higher in younger patients <55 years of age (p < 0.05). There were no differences in survival rates of individual models of constrained TKR. Conclusions: The survival rates of unlinked constrained and hinge knee prostheses are similar when matched by age or diagnosis. In complex TKR instability cases, surgeons should feel confident in choosing the appropriate prosthesis to gain a stable knee and need not be concerned that a hinge prosthesis may carry a higher revision rate.
The Effect on Long Term Survivorship of Surgeon Preference for Posterior Stabilized or Minimally Stabilized Total Knee Replacement: An Analysis of 63416 Cases from the AOANJRR
Authors: Vertullo Christopher , Lewis Peter , Lorimer Michelle , Graves Stephen 
Published: May 2017

Introduction & Aims: Controversy still exists as to the optimum management of the PCL in TKR, with registry data suggesting Posterior Stabilised TKR have a higher Cumulative Percent Revision (CPR) compared to Minimally Stabilised TKR. Proponents of PS TKR suggest this difference is due to selection bias as result of preferential use of PS TKR in complex or more severe cases. To remove this selection bias, we aimed to compare CPR based on surgeon TKR stability preference to treat with PS or MS TKR rather than actual prosthesis type received. Method: Observational series. An analysis of AOANJRR data from 1999 – 2014 was utilized to identify two cohorts of high volume surgeons who preferred to use routinely either MS or PS TKR. Only fixed tibial inserts and patellar resurfacing TKR were included. A MS preferring surgeon used MS TKR at least 90% of the time and a PS preferring surgeon used PS TKR at least 90% of the time. Consequently, each patient cohort included both PS and MS TKR in differing proportions. Results: Procedures undertaken by PS preferring surgeons had a significantly higher risk of revision (CPR (Hazard Ratio = 1.45 (95% CI 1.30, 1.63), p< 0.001). There was a higher rate of revision for loosening and infection in the PS group. Of the 39 941 TKR with cemented fixation of both femur and tibia, the PS preferring surgeons had a higher CPR than the MS preferring cohort (HR = 1.55 (1.33, 1.80), p< 0.001). Regardless of whether the polyethylene was crosslinked or non-crosslinked, the MS preferring surgeons had a lower CPR compared to the PS preferring surgeons. Conclusions: In this analysis, procedures undertaken by surgeons who mainly preferred to use PS TKR had a higher rate of revision than those that mainly used MS TKR. This finding was irrespective of patient age and was also evident when fixation and the type of polyethylene used was taken into account.
One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome
Authors: Kejriwal Ritwik , Buelow Jens 
Published: May 2017

Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.
Variable outcomes of medial meniscectomy in middle aged and older patients after 2 to 8 years
Authors: Paterson Roger , Balasubramaniam Pradeep 
Published: May 2017

Objectives: To review midterm results of arthroscopic medial meniscectomy in patients over the age of 40. Methods: Retrospective observational series. All 354 patients over 40 years of age (after exclusion criteria) who underwent medial meniscectomy by a single surgeon for clinical and MRI correlated medial meniscal tears, having failed conservative treatment, between 2009 and 2014 were sent a questionnaire. Completed questionnaires from 179 patients at an average follow up of 52 ± 15 months (range, 20-79) were analysed. Results: The average time to maximum recovery was longer than expected at 5.6 ± 6 months (range 0.5-36). 74% (133) felt they were largely or completely relieved of symptoms, but, as predicted from past experience, 5% (8) were worse post-operatively. Symptoms became worse in the follow-up period in another 26% (47). 11% (20) had further surgery (15 to TKR). 9% (17) preferred to have left the knee alone in retrospect. Final WOMET and Tegner-Lysholm scores showed overall fair results (36% excellent, 17% good, 22% fair, 25% poor.) Conclusion: Medial meniscectomy in the middle aged and elderly remains controversial, with some claiming that it is no better than placebo, and possibly harmful. This data should provide guidance in counselling patients regarding the risks, and likelihood of benefit, from such surgery, and has led to the authors using more rigorous selection criteria. Prospective studies are needed.
A Prospective Outcome, MRI and Biospy Study of MACI Cartilage Transplantation
Authors: Clatworthy Mark 
Published: May 2017

Objectives: MACI has been performed by one surgeon. in New Zealand in patients who have failed a microfracture procedure A prospective study with outcome scores, serial MRI’s and biopsies has been performed Method: Fifteen patients have had a MACI since July 2004. All patients have a five year follow up, four a ten year follow up. No patients have been lost to follow up. The mean age is 34 (range 25-45). The mean defect size is 3.76 cm2 (range 2.2 – 6.0 cm2). VAS pain, KOOS score, IKDC subjective score, WOMAC score, SF 36 & Tegner Activity score were collected by a research assistant preoperatively and at 6 months, 1, 2, 3 5 and 10 years. An MRI scan was performed at all time intervals. Biopsies were taken at 3 – 5 years in all patients. Results: All outcome scores and VAS pain scores show a significant improvement post MACI up to two years, a plateau to five years the deteroriation at ten years. There are two failure to date thus survival is 87% at a mean of 8 years. MRI showed restoration of repair tissue with a mean fill of 90% at 2years, 72% at 5 years and 49% at ten years and all patients at ten years had a full thickness defect 86% of patients had bone oedema at 5 years, 100% at 10 years 28% had bone cysts at 5 years, 100% at 10 years All patients have had MACI biopsies. Eleven biopsies show fibrocartilage and four show hyaline like cartilage. Eleven have a normal ICRS arthroscopic score, three a nearly normal score and one abnormal score however 80% have a softer MACI graft than surrounding articular cartilage. Conclusion: Outcome scores are reasonable but are deterioating at 10 years Serial MRI’s show significant graft deterioration, increasing bone oedema and bone cyst formation At rearthroscopy 80% of grafts are soft and 73% of biopsies show fibrocartilage. MACI post microfracture is not the long term solution for isolated chondral defects.
Treatment of Symptomatic Bipartite Patella by Fragment Excision, Capsular Repair and Novel ITB Release
Authors: Caldwell Bruce , O’Reilly-Harbridge Sarah 
Published: May 2017

Objectives: The aim of this paper is to present the mid-term results of a novel technique used to treat symptomatic bipartite patella. Methods: Diagnosis of symptomatic bipartite patella was made by history, examination, Xray, MRI and/or bone scan. Patients with typical localised pain, pain on manually stressing the fragment, a positive ITB tightness test, a typical Xray and either, a hot bone scan or bone oedema on MRI were considered for treatment. All patients had a pre-op Kujala and Lysholm score recorded. Surgical Technique: Under GA and tourniquet a 4 part procedure was performed: Routine arthroscopy to assess patella tracking and fragment stability A 2 cm incision was made on the distal thigh 10-12 cm above the joint line over the ITB. A zig-zag incision was made across the ITB/IPB from anteriorly to the corner of the intermuscular septum. A 4 cm incision was made over the edge of the lateral patella. A longitudinal capsular incision was made at the edge of the patella. The capsule was reflected off the dorsal patella by sharp dissection and the bipartite fragment was excised through the synchondrosis. A watertight repair of the lateral capsule was performed with absorbable suture. Routine closures were performed. Comment: The author considers the ITB/IPB to be an important factor in the development and progression of the disorder. The addition of the novel release allows a tension-free capsular repair, reducing lateral facet loads, improving patella tracking without affecting patella stability Results: Over an 11 year period twenty patients underwent the procedure. 15 were available with a minimum 2 year and mean 6.35 year follow-up. Pre-op and post-op Kujala and Lysholm scores were compared. Patients were predominantly male (14:1) between ages 10-54 years. A clear history of trauma was present in 6 patients while in 9 symptoms were related to overuse. The pre-op Kujala score ranged from 28-90 with an average of 59. Post-op scores improved markedly with range 70-100 with 12 patients (80%) scoring >90 and an average improvement of 32 pts. Lysholm scores similarly improved significantly, with an average 32 pts improvement (range 1-66). Complications were minimal. Conclusion: Fragment excision, capsular repair and novel ITB release resulted in significant reproducible improvements in both objective and subjective outcome measures. Resolution of symptoms occurred in all patients suggesting the technique is a useful option in the treatment of symptomatic bipartite patella.