Acta Orthopaedica Belgica
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Comparison between Cubital and Carpal Tunnel Syndrome with Patients’ Reported Outcomes Measures preoperatively - Pilot Study
No full textThe aim of this study was to compare preoperative scores of Patients’ Reported Outcomes Measures of two of the most common upper extremity compression neuropathies: Cubital Tunnel Syndrome (CuTS) or Carpal Tunnel Syndrome (CTS) in a single center. In total, 89 patients at the clinic were examined (CuTS:n=34; CTS:n=55). In the study, both the Michigan Hand Outcomes Questionnaire (MHQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure were used to compare the two analyzed hand disorders. The Mann-Whitney test was used and the results were presented as a median with an interquartile range. These final scores were significantly worse in cases of CTS in comparison to CuTS (MHQ p=0.037; DASH p=0.004). Analysis of each of the 6 MHQ subscales have shown that work and pain domain scores are significantly worse in the CTS group (both p=0.017). The remaining domains of hand function, activities of daily living, appearance, and satisfaction subscales did not show significantly statistical differences. The CTS group has lower outcomes in comparison with CuTS, when assessed by standardized general hand function questionnaires in an outpatient clinic. This study provides information which can be useful in allocation of resources for the two conditions
Forestier’s syndrome: a rare cause of dysphagia.
No full textWe report a 72-year-old male with Forestier's syndrome suffering of dysphagia due to an anterior cervical calcification, unusually great in both volume and extent. Its resection by anterior approach allowed the immediate restoration of a normal swallowing. A bony resection is sufficient in case of Forestier’s syndrome, but it must be associated with fixation in case of degenerative osteophyte with disc instability. Long-term follow-up is necessary because the recurrence of the calcification is slow but frequent
Neurology in Metal-on-Metal Hip Arthroplasty - a Case of Suspected Prosthetic Hip-Associated Cobalt Toxicity
No full textMetal-on-Metal hip arthroplasty was a frequently performed procedure, until concerns raised. Metal ion concentrations raise after the placement of a MoM prosthesis. This might lead to toxic concentrations of cobalt ions which might result in cardiotoxicity, thyroid toxicity and/or neuro-ocular toxicity. It is possible that raised cobalt and chromium concentrations have a role in the development of neurodegenerative diseases like Creutzfeldt-Jakob. We describe a patient with a MoM prosthesis who developed neurological symptoms were we thought of cobalt intoxication but turned out to be Creutzfeldt-Jakob disease
Surgical treatment of partial and full distal biceps tendon ruptures
No full textPurpose: This study presents a series of cases with surgically treated partial distal biceps tendon ruptures. The results of full distal biceps tendon rupture repair are also presented and a comparison is made between the two groups.Methods: Between 2001 and 2015, patients with partial and full ruptures of the distal biceps tendon were surgically repaired. At follow-up, the elbow function of the patients was assessed using the Oxford Elbow Score and maximum flexion and supination forces were measured.Results: Forty-eight elbows in 43 patients returned to the follow-up visit. There was no statistically significant difference between the two groups in terms of function and strength.Conclusions: In this study, there were no statistical differences in outcome between the partial and the full distal biceps tendon groups. Surgical repair seems to be a valuable treatment option for partial distal biceps tendon ruptures
The appropriate management of osteoporotic vertebral compression fractures: a single institute evaluation using the VCF Monitor
No full textOsteoporosis-related vertebral compression fractures (OVCF) are commonly seen in clinical practice. Treatment choice is often challenging due to heterogeneity of the patient population. A European multidisciplinary expert panel developed patient-specific recommendations for treatment choice that were embedded in an online evaluation tool (VCF Monitor).Purpose: To evaluate the appropriateness of treatment choice in patients with OVCF in a German hospital.Patients and methods: Prospective observational study in 190 patients with OCVF (2013-2015). Using the VCF Monitor, treatment choices were compared with the recommendations of the European expert panel.Results: Treatment choices included balloon kyphoplasty (61%), non-surgical management (36%) and other surgical procedures (3%). Compared to the panel recommendations, 70% of treatment choices were appropriate, 24% uncertain, and 3% inappropriate. Less appropriate choices were partly due to patient preferences.Conclusions: The VCF Monitor proved to be a helpful tool for quality assurance in the management of OVCF
Antibiotic Impregnated Cement Coated Ilizarov Rod For The Management Of Infected Non Union Of Long Bones.
No full textThe infected non union of the long bones in the presence of the intramedullary nail is a dreaded complication of fracture management. Around 7% patients may develop this complication in intramedullary nailing. Amongst the various grades of infection, grade three infection is the most difficult to cure and manage as it involves an osteomyelitic bone. Amongst an array of therapeutic modalities, the two stage methods are commonly used with the first stage aimed at controlling the infection and the second stage at inducing union. This increases the number of surgical procedures. We used an Ilizarov threaded rod coated with antibiotic impregnated cement to replace the intramedullary nail with the idea of delivering higher concentration of antibiotic locally as well as provide stability. We achieved a union rate of 91% in a relatively small number of patients with this single procedure. The antibiotic impregnated cement coated Ilizarov rod that we used in our study achieves both infection control and union simultaneously and does not allow cement debonding at removal
Long-term effects of intravenous iloprost therapy in patients with bone marrow oedema of the hip.
No full textBone marrow oedema (BMO) is a multifactorial condition. Various conservative treatment options include analgesic therapy, immobilisation of the affected joint and/or systemic intravenous iloprost or bisphosphonate therapy. Many studies confirm the positive effect of iloprost therapy in larger joints, e.g. the hip and knee joint, after short-term follow up. The objective of this study was to show that treatment with iloprost leads to positive long-term functional and radiological outcomes for BMO of the hip joint. Nineteen patients with BMO of the hip joint, ARCO stage 1-2, were included in this study. The Harris Hip Score, the SF-36, the WOMAC score and a visual analogue pain scale (VAS) were evaluated before and after Ilomedin therapy. All patients underwent MRI for radiological follow-up monitoring three months after treatment. Significant improvements were found in the WOMAC Index and the VAS. In 79% of patients, follow-up MRI after three months showed complete regression of the oedema.Based on the positive results of our study, we support treatment with iloprost for BMO of the hip joint at ARCO stage 1-2
Percutaneous cementoplasty with lateral approach under regional anesthesia for acetabulum in patients with bone metastasis
No full textThe purpose of this study is to demonstrate the surgical technique and to show the results of percutaneous cementoplasty (PC) for acetabular metastases using lateral approach under regional anesthesia. Forty-two cases underwent PC for acetabular metastases. The PC was performed using spinal anesthesia, lateral approach and fluoroscopic guidance. We assessed visual analogue scale (VAS) and revised musculoskeletal tumor society (MSTS) rating system and maximum standardized uptake value (SUVmax) of the acetabular lesion using F-18-FDG PET/CT before and after the PC. The mean injected volume of polymethylmethacrylamide to the pelvis was 21±11.8 ml. The mean of regional VAS (6.2±1.1 vs. 3.1±2.7, p<0.001), MSTS (10.3±3.9 vs. 18.3±3.2, p<0.001) and local SUVmax (8.6±5.2 vs. 5.7±3.6 , p=0.012) on PET/CT showed significant reductions after surgery. Twenty-three patients (55%) died of disease at mean 11.8±4.8 months after surgery. PC using lateral approach and regional anesthesia could be a simple and safe surgical method for relieving pain and maintaining skeletal stability against acetabular metastasis
Bilateral early knee osteoarthritis treated with unilateral proximal tibial osteotomy and contralateral non-surgical technique
No full textNon-surgical decrease of knee mechanical loads by some techniques may be effective in treating early primary knee osteoarthritis. Thirty-six consecutive patients with bilateral early primary knee osteoarthritis and genu varum were treated with unilateral proximal tibial osteotomy in the more degenerative knee. After the osteotomized bone healed, ambulation with protected weight bearing using a cane in the contralateral hand was advised continuously for at least three months until knee pain subsided bilaterally. Thirty-one patients were followed for an average of 4.6 years (range, 2.1-7.8 years). All osteotomized bones healed. Twenty patients (64.5%) had satisfactory knee function bilaterally. Eight patients (25.8%) only had satisfactory knee function in the operated knee. Thus, 28 patients (90.3%) improved operated knee function (p< 0.001). Non-operated knees improved to satisfactory function from 38.7% initially to 71.0% at the latest follow-up (p= 0.01). Bilateral early primary knee osteoarthritis may be successfully treated with unilateral proximal tibial osteotomy.
Custom-made triflanged acetabular components in the treatment of major acetabular defects. Short-term results and clinical experience
No full textWe report on the Belgian experience with the aMace® custom-made triflange acetabular component in revision total hip arthroplasty between September 2009 and November 2014. We focused on (1) the complexity of the preoperative planning and reimbursement procedure; (2) the surgical problems and operative experience; and (3) the early outcome. We collected 20 patients’ reviews and 22 surgeons’ reviews, with a mean follow-up of 25 months. The preoperative planning and reimbursement procedures were rated as time-consuming and cumbersome. In 6/22 cases, the operation was difficult or very difficult. Technical problems occurred in 8/22 cases, including problematic fitting in four. However, all aMace® components could be implanted successfully. The mean postoperative Harris Hip Score (HHS) was 68/100; patients’ satisfaction was high and most patients experienced no or mild pain. Complications occurred in 8/22 cases, half of them dislocations. The aMace® implant can provide a solution for complex acetabular revisions. As dislocations were common, the use of dual-mobility cups should be considered. Because of the high cost and the lack of bone stock restoration, we suggest using custom-made triflange acetabular implants only in cases with large cavitational and segmental defects, which would be difficult to reconstruct with alternative methods