Percutaneous vertebroplasty for painful long-standing osteoporotic vertebral compression fractures : benefits, risks and optimization

This thesis evaluates the benefit and safety of the treatment of painful long-standing osteoporotic vertebral compression fractures with percutaneous vertebroplasty. In addition, benefit and safety were investigated for specific treatment indications, risk factors for the occurrence of the two most common adverse events were identified and methods for optimization of the timing and execution of the procedure were explored.Nerderlands Orthopaedische Vereniging, J.E. Jurriaanse Stichting, Reumafonds, Anna fonds, Dutch Spine SocietyUBL - phd migration 201

What range of motion is achieved 5 years after external rotationplasty of the shoulder in infants with an obstetric brachial plexus injury?

Background Obstetric brachial plexus injuries result from traction injuries during delivery, and 30% of these children have persisting functional limitations related to an external rotation deficit of the shoulder. Little is known about the long-term effect of soft-tissue procedures of the shoulder in patients with obstetric brachial plexus injuries. Questions/purposes (1) After soft-tissue release for patients with passive external rotation less than 20 degrees and age younger than 2 years and for patients older than 2 years with good external rotation strength, what are the improvements in passive external rotation and abduction arcs at 1 and 5 years? (2) For patients who underwent staged tendon transfer after soft-tissue release, what are the improvements in active external rotation and abduction arcs at 1 and 5 years? (3) For patients with passive external rotation less than 20 degrees and no active external rotation, what are the improvements in active external rotation and abduction arcs at 1 and 5 years? Methods This was a retrospective analysis of a longitudinally maintained institutional database. Between 1996 and 2009, 149 children underwent a soft-tissue procedure of the shoulder for an internal rotation contracture. The inclusion criteria were treatment with an internal contracture release and/or tendon transfer, a maximum age of 18 years at the time of surgery, and a minimum follow-up period of 2 years. Six patients were older than 18 years at the time of surgery and 31 children were seen at our clinic until 1 year postoperatively, but because they had good clinical results and lived far away from our center, these children were discharged to physical therapists in their hometown for annual follow-up. Thus, 112 children (59 boys) were available for analysis. Patients with passive external rotation less than 20 degrees and age younger than 2 years and patients older than 2 years with good external rotation strength received soft-tissue release only (n = 37). Of these patients, 17 children did not have adequate active external rotation, and second-stage tendon transfer surgery was performed. For patients with passive external rotation less than 20 degrees with no active external rotation, single-stage contracture release with tendon transfer was performed (n = 68). When no contracture was present (greater than 20 degrees of external rotation) but the patient had an active deficit (n = 7), tendon transfer alone was performed; this group was not analyzed. A functional assessment of the shoulder was performed preoperatively and postoperatively at 6 weeks, 3 months, and annually thereafter and included abduction, external rotation in adduction and abduction, and the Mallet scale. Results Internal contracture release resulted in an improvement in passive external rotation in adduction and abduction of 29 degrees (95% confidence interval, 21 to 38; p < 0.001) and 17 degrees (95% CI, 10 to 24; p < 0.001) at 1 year of follow-up and 25 degrees (95% CI, 15-35; p < 0.001) and 15 degrees (95% CI, 7 to 24; p = 0.001) at 5 years. Because of insufficient strength of the external rotators after release, 46% of the children (17 of 37) underwent an additional tendon transfer for active external rotation, resulting in an improvement in active external rotation in adduction and abduction at each successive follow-up visit. Patients with staged transfers had improved active function; improvements in active external rotation in adduction and abduction were 49 degrees (95% CI, 28 to 69; p < 0.05) and 45 degrees (95% CI, 11 to 79; p < 0.001) at 1 year of follow-up and 38 degrees (95% CI, 19 to 58; p < 0.05) and 23 degrees (95% CI, -8 to 55; p < 0.001) at 5 years. In patients starting with less than 20 degrees of passive external rotation and no active external rotation, after single-stage contracture release and tendon transfer, active ROM was improved. Active external rotation in adduction and abduction were 75 degrees (95% CI, 66 to 84; p < 0.001) and 50 degrees (95% CI, 43 to 57; p < 0.001) at 1 year of follow-up and 65 degrees (95% CI, 50 to 79; p < 0.001) and 40 degrees (95% CI, 28 to 52; p < 0.001) at 5 years. Conclusion Young children with obstetric brachial plexus injuries who have internal rotation contractures may benefit from soft-tissue release. When active external rotation is lacking, soft-tissue release combined with tendon transfer improved active external rotation in this small series. Future studies on the degree of glenohumeral deformities and functional outcome might give more insight into the level of increase in external rotation.Development and application of statistical models for medical scientific researc

Meniscal allograft transplantation in the Netherlands: long-term survival, patient-reported outcomes, and their association with preoperative complaints and interventions

Purpose Evaluation of survival of meniscal allograft transplantation (MAT) and postoperative patient-reported outcome (PRO), and their association with prior interventions of the knee. Methods A prospective consecutive study of 109 consecutive patients who had an arthroscopic meniscal allograft transplantation (MAT) between 1999 and 2017 by a single surgeon. Patients were assessed with KOOS scores, preoperative and after a minimal follow-up of 2 years. Furthermore, two anchor questions (whether expectations were met and overall satisfaction, on a five-point Likert scale) were asked. Additionally, prior interventions to MAT were evaluated. Results Prior to MAT, patients had undergone an average of 2.8 (range 1-14) of surgical procedures of the knee. Overall, mean allograft survival was 16.1 years (95% CI 14.8-17.5 years). Higher age at surgery was associated with lower MAT survival: hazard ratio for MAT failure was 1.19 per year increase (95% CI 1.04 to 1.36,p = 0.009). At 4.5 years (IQR, 2-9) of follow-up, all KOOS score were still improved compared to baseline. Age below 35 years, simultaneous anterior cruciate ligament reconstruction and number of knee surgeries before MAT were associated with lower KOOS scores. Overall patient expectations and overall satisfaction after MAT were not associated with preoperative patient characteristics nor with the number or kind of preoperative interventions. Conclusion Meniscal allograft transplantation has a good overall survival with a clinically relevant improvement. Both meniscal allograft survival and PRO were associated with age. PRO was lower in patients younger than 35 years at time of MAT and meniscal allograft survival was worse in patients older than 50 years. PRO was associated with preoperative patient characteristics and number of surgical procedures prior to MAT. All patients reported improved postoperative satisfaction and met expectations after MAT, both independent of the preoperative history of knee interventions.Orthopaedics, Trauma Surgery and Rehabilitatio

Elevated risk of infection with SARS-CoV-2 Beta, Gamma, and Delta variants compared with Alpha variant in vaccinated individuals

The extent to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) break through infection- or vaccine-induced immunity is not well understood. We analyzed 28,578 sequenced SARS-CoV-2 samples from individuals with known immune status obtained through national community testing in the Netherlands from March to August 2021. We found evidence of an increased risk of infection by the Beta (B.1.351), Gamma (P.1), or Delta (B.1.617.2) variants compared with the Alpha (B.1.1.7) variant after vaccination. No clear differences were found between vaccines. However, the effect was larger in the first 14 to 59 days after complete vaccination compared with ≥60 days. In contrast to vaccine-induced immunity, there was no increased risk for reinfection with Beta, Gamma, or Delta variants relative to the Alpha variant in individuals with infection-induced immunity.</p

CORR Insights (R): The Pattern of Acetabular Cartilage Wear Is Hip Morphology-dependent and Patient Demographic-dependent

Orthopaedics, Trauma Surgery and Rehabilitatio

Re: Nieuwenhuijse MJ, Bollen L, van Erkel AR, et al. Optimal Intravertebral Cement Volume in Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures. Spine 2012;37:1747-55. Response

Optimising joint reconstruction management in arthritis and bone tumour patient

Re: Nieuwenhuijse MJ, Bollen L, van Erkel AR, Dijkstra PD. Optimal Intravertebral Cement Volume in Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures. Spine 2012;37:1747-55 Response

Optimising joint reconstruction management in arthritis and bone tumour patient

5-year clinical and radiostereometric analysis (RSA) follow-up of 39 CUT femoral neck total hip prostheses in young osteoarthritis patients

Optimising joint reconstruction management in arthritis and bone tumour patient

Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors

Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas