Introducing a Novel Combined Acetabuloplasty and Chondroplasty Technique for the Treatment of Developmental Dysplasia of the Hip.

BACKGROUND: The aim of the treatment of developmental dysplasia of the hip (DDH) is to maintain a concentric reduction. We describe a novel approach to treat DDH that involves improvement of cartilaginous acetabular coverage, involves the preservation of the secondary ossification center of the acetabulum, and is adjunctive to early open reduction. METHODOLOGY: Thirty-nine children (40 hips) aged six to 18 months were included in the study. Open reduction with chondroplasty was performed during the same surgery. Patients were followed up for 15 years with both clinical and radiological assessments. At the final follow-up, all patients were graded as good or excellent according to Severin's classification. RESULTS: The mean age at reduction was 11.9 months (range: 8-16). The mean preoperative acetabular index (AI) was 43.43 (range: 40-48). After the operation, mean AI decreased to 16.97 (P < 0.0001, 95% confidence interval (CI) = 16.24-17.70). AI improved significantly during growth (mean AI changes 13.50, P < 0.0001, 95% CI = 12.65-14.34). The mean lateral center-edge (CE) angle at skeletal maturity was 32.94° (SD = 4.16°). Mild avascular necrosis (AVN) was observed in two hips with involvement of the epiphysis and was of Kalamchi grade 1. CONCLUSION: Chondroplasty in conjunction with open reduction can yield a concentric reduction with improved acetabular coverage that facilitates acetabular remodeling that is sustained until skeletal maturity. Prompt correction through this procedure may help to improve the development of the hip and lead to near normal function as demonstrated by improved mean AI and Severin scores at the last follow-up. With low complication and reoperation rates, this procedure could be considered as a surgical treatment option for DDH in patients between the age of six and 18 months

Effectiveness of titanium plate usage in laminoplasty

Background: Laminoplasty is an established technique for the treatment of cervical stenosis. However, the usage of plates to maintain patency of the laminoplasty door has not been well reported. This study plans to compare the clinical outcomes of laminoplasty with the usage of Sofamor-Danek laminoplasty plates versus techniques without plate usage. Materials and Methods: This study conducted a 2-year medical record review of all patients with multilevel cervical myelopathy who were treated with laminoplasty at UCLA or Cedars-Sinai medical center. Of 46 patients 18 had sufficient documentation to assess clinical outcome, 11 of which had placement of laminoplasty plates. Clinical outcomes were assessed using Odom's scoring criteria. Results: Blood loss and hospital stay are decreased with plate usage during laminoplasty. Average Estimated Blood Loss (EBL) was 160 cc with plate and 380 cc without. Hospital stay was 4.8 days with plate and 5.6 days without. There were no complications during any of the laminoplasty procedures regardless of instrumentation. All patients demonstrated improvement in symptoms after laminoplasty, with 73% of patients in the plate cohort having Odom Scores of “Excellent” versus 44% in the nonplate group. All patients, regardless of technique, showed improvement in symptoms. Conclusions: Laminoplasty with plate utilization is an effective treatment for cervical myelopathy. The similarity in outcomes and complications between these two similar cohorts suggests plate usage in laminoplasty is an attractive alternative to other methods. We hope that future efforts will continue to demonstrate the effectiveness and perhaps superiority of plate utilization in laminoplasty

Non-adherence to medication regimens among older African-American adults

Abstract Background Despite concerns about racial differences on adherence to prescribed medication rigimens among older adults, current information about nonadherence among underserved elderly African Americans with co-morbidities is limited. This study examines the association between adherence to drug regimens and an array of medication-related factors, including polypharmacy, medication regimen complexity, use of Potentially Inappropriate Medications (PIM), and knowledge about the therapeutic purpose and instructions of medication use. Methods Four-hundred African Americans, aged 65 years and older, were recruited from South Los Angeles. Structured, face-to-face interviews and visual inspection of participants’ medications were conducted. From the medication container labels, information including strength of the drug, expiration date, instructions, and special warnings were recorded. The Medication Regimen Complexity Index (MRCI) was measured to quantify multiple features of drug regimen complexity. The Beers Criteria was used to measure the PIM use. Results Participants reported taking an average of 5.7 prescription drugs. Over 56% could not identify the purpose of at least one of their medications. Only two-thirds knew dosage regimen of their medications. Thirty-five percent of participants indicated that they purposely had skipped taking at least one of their medications within last three days. Only 8% of participants admitted that they forgot to take their medications. The results of multivariate analysis showed that co-payment for drugs, memory deficits, MRCI, and medication-related knowledge were all associated with adherence to dosage regimen of medications. Participants with a higher level of knowledge about therapeutic purpose and knowledge about dosage regimen of their medications were seven times (CI: 4.2–10.8) more likely to adhere to frequency and dose of medications. Participants with a low complexity index were two times (CI: 1.1–3.9) more likely to adhere to the dosage regimen of their medications, compared with participants with high drug regimen complexity index. Conclusions While other studies have documented that non-adherence remains an important issue among older adults, our study shows that for underserved elderly African Americans, these issues are particularly striking. A periodic comprehensive assessment of all medications that they use remains a critical initial step to identify medication related issues. Assessment of their disease and medication related knowledge (e.g., therapeutic purposes, side-effects, special instructions, etc.) and their ability to follow complicated medication regimens and modification of their drug regimens requires inter-professional collaboration

Retrospective evaluation of cervical fusion with DTRAX (R) cervical cage

BackgroundCervical radiculopathy is a relatively common problem that often affects individuals in their 5th decade. Most cases resolve with conservative treatment, but when unsuccessful, many opt for surgical intervention. Anterior cervical discectomy and fusion is currently considered the gold standard for the surgical management of cervical radiculopathy. One promising alternative, the DTRAX facet system is minimally invasive and may significantly reduce or eliminate cervical radicular symptoms. This case series and literature review looks to investigate the safety and efficacy of the DTRAX facet system in treating cervical radiculopathy.MethodsThis retrospective analysis was performed by chart review of patients who underwent posterior cervical fusion and received the DTRAX spinal implant at University of California, Los Angeles within the last 8 years. Patient charts were located using the surgical cases report function of Epic electronic medical record, and patients were included in the study if they received a DTRAX implant during the stated time period. Data were compiled and analyzed using Microsoft Excel.ResultsA total of 14 patient charts were reviewed. Of the 14, there were no immediate postoperative complications. One international patient was subsequently lost to follow-up, and of the remaining 13, mean follow-up duration was 273 days, with a range of 15-660 days. All but one reported improvement of symptoms postoperatively, there were no device failures, and no reoperations were required. There were similar outcomes in patients who received single versus multilevel operations.ConclusionThe findings of this retrospective study of 14 patients who received the DTRAX facet system over the last 8 years support the conclusions of previous studies that DTRAX is safe and effective. In addition, this is the first study to look for differences in outcomes between single and multi-level DTRAX operations, of which there were none. Further investigation with larger cohorts should be conducted as DTRAX becomes more widely adopted in order to verify its safety and efficacy in various clinical scenarios