Treatment of adolescent idiopathic scoliosis with global (ROD) derotation maneuver using pedicle screws

Introduction: Adolescent idiopathic scoliosis is a three dimensional deformity. For the treatment of deformity, nature of deformity should be well understood and treatment strategy has to be directed to the coronal, sagittal and axial components of deformity. Global Derotation (GD) maneuver is based on simple rod derotation from concave side aiming to correct the deformity on coronal, sagittal and axial profile. In this report we reviewed AIS surgery results treated by global derotation maneuver with all pedicle screw instrumentation.Material& Methods: Between 2003 and 2011, 253 patients had been operated using GD technique.80 of 253 patients was included to our study. The patients routinely evaluated with preoperative-postoperative and last follow up standing ortho-x-rays. Coronal and sagittal profile parameters measured on x-rays with digital software using Cobb method. Rotational component of the deformity was measured according to Nash-Moe method at the apical vertebra.Results: 80 patients (71 female ; 9 male)had been followed up average 19,8 (7-37) months. Patients age average were 15,1(12-21) at operation date. Coronal cobb angle measure in thoracic curves preoperative were 48,9° decreased to mean 3,2° postoperatively. The mean coronal thoracolumbar curve were 45,8° preoperatively and decreased to mean 2°. Apical vertebra rotation measure regressed to mean 0,68 (0-1). Thoracic kyphosis showed downward tendency from mean 37,8° to mean 27,8°.Conclusion: Rod derotation technique enable to correct coronal and axial profile. Coronal Cobb angle improvement seen obviously with correction of axial profile rotation. Sagittal hypokyphotic effect of GD should be kept in mind

Postoperative mechanical alignment analysis of total knee replacement patients operated with 3d printed patient specific instruments: A prospective cohort study

Objective: Total knee replacement (TKR) is a surgical treatment for final stage gonarthrosis. The lifespan of the prosthetic implants used in TKR surgery is a major interest for the orthopaedic research community.Previously, proper implant alignment of the implants has been advocated for longevity of the TKR surgery. Recently, patient-specific (PSI) instruments have been proposed to improve the mechanical alignment of the TKR by permitting better implant positioning over conventional TKR surgery. The aim of this study is to compare the mechanical alignment results of patients operated with PSIs and conventional instruments. Methods: Two groups of 20 patients chosen in a quasi-random manner have been compared in this study. In the first group femoral distal and tibial osteotomies were made by a PSI which was produced by the patients’ computed tomography scans. All osteotomies in the control group were made with the TKR set's routine instruments by conventional means. Patients’ preoperative and postoperative mechanical femorotibal angles (mFTA), femoral coronal angles (FCA), tibial coronal angles (TCA) were measured and the number of outliers which showed more than 3° of malalignment were counted in both groups for comparison. Results: The average postoperative mFTA was found to be 2.09° for the PSI group and in was found to be 284° for the control which was not statistically significant. The comparison of postoperative FCA and TCA also did not show significant difference between the groups. The number of outliers showing more than 3° of malalignment per group were found to be 1 out of 20 (5%) for the PSI group and 7 out of 20 (35%) for the control which was statistically significant. Conclusion: In this study patient-specific instrumentation provided significantly better mechanical alignment compared to conventional TKR for the frequency of outlier cases with malalignment beyond 3°. PSI proved no significant difference when the groups were compared for mFTA, FCA and TCA. Our findings support that PSI may improve TKR alignment by improving the ratio of the outlier patients with marked malalignment. Level of Evidence: Level III, Therapeutic Study

Comparison of spinal sagittal parameters by time of day in a healthy working population with high body-mass index

Object: To determine the change in spinal sagittal parameters which may occur throughout the day in healthy population with high body-mass index (BMI).Methods: Twenty-one healthy hospital employees with high BMI were enrolled in the study. Two standing left lateral ortho-roentgenograms were obtained at 8.00 a.m and at6.00 p.m. Six spinopelvic parameters were measured on the X-rays.Results: Twenty-one subjects with a mean age of 32.72± 7.84 were evaluated. No significant change was found between morning and evening measurements for any of the parameters. As a result of the correlation of daily changes for study parameters for the high BMI cohort showed significant direct relationship between SS and PI, LL and SS, LL and PI and an inverse relationship between LL and PI minus LL, SS and PI minus LL. (p < 0.05).Conclusion: Routine workload in a hospital environment does not cause significant change in the spinopelvic parameters throughout the day