Tobacco is a Leading Risk Factor for Liver and Extrahepatic Cancers in Patients With Liver Cirrhosis: A Prospective Cohort Study.

Background & aims: This study aims to assess the incidence and characteristics of all cancers, hepatocellular carcinoma (HCC), and extrahepatic cancers in patients with cirrhosis of various etiologies. Methods: Prospective cohort study in patients with cirrhosis but no cancer, followed every 6-9 months through the HCC early detection program. Cancer incidence was compared with Spanish population data to calculate standardized incidence ratios (SIR), and cumulative incidence was calculated separately for cancer and competing events. Longitudinal outcomes were assessed with multivariate Fine-Gray and Cox regression models. Results: A total of 215 patients (68.4% male, median age 61 years) were included. Cirrhotic etiology was alcohol (38%), hepatitis B or C virus infection (36%), alcohol plus hepatitis B or C virus infection (9%), and other causes (17%). Sixty percent were current or former smokers. Thirty-nine cancers were observed (56% liver cancer), while 3.3 were expected (SIR 11.7; 95% confidence interval [CI] 8.6-16.1). Ten (4.6%) patients were censored for liver transplantation and 34 (15.8%) for death, constituting relevant competing risks. Smoking was significantly associated with overall cancer incidence (smokers: subdistribution hazard ratio [SHR] 3.14, 95% CI 1.33-7.38; former smokers: SHR 2.54, 95% CI 1.08-5.98). In the multivariable regression analysis, viral etiology, Child-Pugh score (B or C versus A), and smoking were associated with liver cancer, and smoking with extrahepatic cancer. Conclusions: Patients with cirrhosis have an 11-fold risk of cancer compared to the general population. Risk is increased in liver and non-liver cancers. Active surveillance of any type of cancer and smoking cessation interventions are needed in these patients.

Complication rates are not higher after outpatient compared to inpatient fast-track total hip arthroplasty: a propensity-matched prospective comparative study.

PURPOSE: Concerns remain with regards to safety of fast-track (FT) and especially outpatient procedures. The purpose of this study was to compare complication rates and clinical outcomes of propensity-matched patients who received FT total hip arthroplasty (THA) in outpatient versus inpatient settings. The hypothesis was that 90-day postoperative complication rates of outpatient FT THA would not be higher than after inpatient FT THA. METHODS: This is a prospective study of consecutive patients who received FT THA at various rates of outpatient and inpatient surgery by 10 senior surgeons (10 centres). The decision between outpatient and inpatient surgery was made on a case-by-case basis depending on the surgeon and patient. All patients were followed until 90 days after surgery. Complications, readmissions and reoperations were collected, and their severity was assessed according to Clavien-Dindo. Patients completed Oxford Hip Score (OHS) at the latest follow-up. RESULTS: Compared to inpatient FT THA, patients scheduled for outpatient FT THA had no significant differences in 90-day postoperative complication rates (10.7% vs. 12.9%, p = 0.129). There were no significant differences between the 2 groups in 90-day readmission rates and reoperation rates, in severity of postoperative complications, and in time of occurrence of postoperative complications. CONCLUSIONS: There were no differences in rates of intraoperative complications, 90-day postoperative complications, readmissions, or reoperations between outpatient and inpatient FT THA. These findings may help hesitant surgeons to move towards outpatient THA pathways as there is no greater risk of early postoperative complications that could be more difficult to manage after discharge.

GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study.

Background: The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0. Methods: Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc). Findings: The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration. Interpretation: GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization. Funding: Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.

No differences in clinical and radiographic outcomes between standard versus high offset collared stems for primary total hip arthroplasty at five years follow-up.

PURPOSE: To compare clinical and radiographic outcomes of propensity-matched patients undergoing THA using standard versus high offset stems at five years. METHODS: The authors retrospectively reviewed a consecutive series of primary THAs performed between 01/09/2015-31/12/2017 using a fully-hydroxyapatite coated collared stem, with either a standard (n = 365) or high (n = 110) offset. Outcomes collected included: modified Harris Hip Score (mHHS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and radiographic measurements including limb length discrepancy (LLD), stem subsidence, and stem radiolucencies. RESULTS: Propensity score matching resulted in 80 hips per group. Preoperatively there were no significant differences in patient demographics, surgical data and radiographic measurements, except the standard offset group had significantly smaller femoral (40.0 ± 7.5 vs 48.4 ± 6.2, p < 0.001), acetabular (92. ± 6.3 vs 94.8 ± 7.3, p = 0.011) and global (132.0 ± 10.3 vs 143.2 ± 8.2, p < 0.001) offsets compared to the high offset group. At a minimum five years follow-up, there were no significant differences in mHHS (93.2 ± 11.0 vs 93.1 ± 10.6, p = 0.553), OHS (45.1 ± 4.1 vs 45.3 ± 4.6, p = 0.623), and FJS (85.1 ± 19.3 vs 82.7 ± 23.0, p = 0.910). There were also no differences in radiographic measurements, including LLD (1.5 ± 4.8 vs 1.1 ± 3.5, p = 0.537), stem subsidence (0% vs 0%, p = 1.000), and stem radiolucencies (severe: 6% vs 1%, p = 0.152). CONCLUSION: The present matched-cohort study found no significant differences between standard versus high offset straight fully-hydroxyapatite coated collared stems for primary THA in terms of clinical and radiographic outcomes at five years. These findings may suggest that uncemented collared high offset stems are not associated with an increased risk of radiolucencies and loosening compared to uncemented collared standard offset stems.

No differences in clinical and radiographic outcomes between standard offset and high offset short cementless stems.

PURPOSE: To compare clinical and radiographic outcomes of total hip arthroplasty (THA) using standard offset versus high offset short cementless stems. METHODS: We reviewed a consecutive series of 204 primary THAs performed over 5 years using a short cementless collared stem. At a minimum follow-up of 2 years, 6 patients had deceased, 6 were not evaluated radiographically and, 2 were lost to follow-up. This left a final cohort of 190 hips, of which 72 had received a standard offset stem and 118 had received a high offset stem. Outcomes collected included: Oxford hip score (OHS), forgotten joint score (FJS), canal fill ratio (CFR), canal-bone ratio (CBR), stem subsidence (≥ 3 mm), stem misalignment (> 5°), radiolucent lines (≥ 2 mm), cortical hypertrophy, and calcar modifications. RESULTS: There were no significant differences in postoperative clinical and radiographic outcomes between the standard offset and high offset groups, except for incidence of stems in varus (6% vs 17%; p = 0.001). Multivariable analyses revealed that OHS was significantly worse for patients of greater age (ß = 0.1; p = 0.001), higher BMI (ß = 0.2; p = 0.018), or with inflammatory arthropathy (ß = 4.7; p = 0.005); while FJS was significantly worse for patients with higher BMI (ß = - 0.7; p = 0.003); and cortical hypertrophy was significantly associated with CBR (OR > 100; p = 0.008). CONCLUSIONS: There were little to no differences in clinical or radiographic outcomes of THA performed using standard offset versus high offset short cementless stems. Although high offset stems are more frequently aligned in varus, while cortical hypertrophy occurs in wider intramedullary canals.

Correlation of EUS-guided portal pressure gradient measurements with hepatic venous pressure gradient: a prospective study.

BACKGROUND AND AIMS: Hepatic Venous Portal Gradient (HVPG) measurement remains the gold standard for estimating portal pressure gradient (PPG). AIM: To evaluate the correlation between EUS-guided portal pressure gradient (EUS-PPG) and HVPG in patients with chronic portal hypertension. PATIENTS AND METHODS: Patients with chronic portal hypertension in whom HVPG assessment was clinically indicated were invited to undergo transjugular HVPG and EUS-PPG with a 22G needle in separate sessions for comparison. Intra-class correlation coefficient (ICC), and Bland-Altman method were used to evaluate the agreement between techniques. RESULTS: 33 patients were included. No significant differences in technical success were observed: EUS-PPG (31/33, 93.9%) vs. HVPG (31/33, 93.9%). Thirty patients who underwent successful EUS-PPG and HVPG were analysed. Correlation between the two techniques showed an ICC: 0.82(0.65-0.91). Four patients had major discrepancies (≥ 5 mmHg) between HVPG and EUS-PPG. No significant differences in adverse events were observed. CONCLUSIONS: The correlation between EUS-PPG and HVPG was almost perfect. EUS-PPG could be a safe and reliable method for direct PPG measurement in cirrhotic patients and a valid alternative to HVPG. NCT05689268.

Effect of duration of preoperative pain on outcomes of total temporomandibular joint replacement.

The purpose of the study was to determine whether the duration of preoperative pain affects outcomes of temporomandibular joint replacement (TMJR). Twenty-seven patients who underwent primary TMJR between 1 July 2020 and 31 October 2022 were retrospectively assessed for duration of preoperative pain, level of preoperative and postoperative pain on a visual analogue scale (VAS; 0, none; 10, severe), preoperative and postoperative range of motion (ROM), and net change in quality of life (much better, better, same, worse, much worse), reporting the longest available follow up for each patient. Surgical success was defined as postoperative pain of ≤4 and postoperative ROM of ≥30 mm, or net change (Δ) in ROM of ≥10 mm. Regression analyses evaluated associations between independent variables and postoperative pain and ROM. At a mean follow-up of 17.8 (SD: 6.8, range 3-32) months , pain (5.1, SD: 2.2, p < 0.001) and ROM (9.3 mm, SD: 8.0, p<0.001) significantly improved. Quality of life was much better in 16 patients, better in eight, the same in one, and worse in two. Longer duration of preoperative pain tended to be negatively associated with postoperative ROM (ß = -0.27; 95% CI -0.6 to 0.0; p = 0.078) but was not associated with severity of postoperative pain. Surgical success was achieved in 23/27 patients. The successful group tended to have lower pain on VAS preoperatively (5.9, SD: 1.9) vs 7.5, SD: 1.3) and postoperatively (0.4, SD: 0.8 vs 4.8, SD: 2.6), and greater improvement in quality of life (much better: 14/23 vs 2/4). In conclusion, longer duration of preoperative pain tended to be associated with worse postoperative ROM following TMJR. Higher preoperative pain may be a predictor for unsuccessful surgery.

Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis.

Purpose: to systematically review comparative studies reporting revision rates, clinical outcomes, or radiographic outcomes of total hip arthroplasty (THA) using collared versus collarless conventional-length uncemented hydroxyapatite (HA)-coated stems. Methods: In adherence with PRISMA guidelines, a literature search was performed on Medline, Embase, and Scopus. Comparative clinical studies were eligible if they reported outcomes of collared versus collarless uncemented HA-coated stems for primary THA. Two reviewers screened titles, abstracts, and full-texts to determine eligibility; then performed data extraction; and assessed the quality of studies according to Joanna Briggs Institute (JBI) checklist. Results: The search returned 972 records, 486 were duplicates, and 479 were excluded after title/abstract/full-text screening. Three further studies were included from the references of eligible studies and from discussions with subject matter experts, resulting in 11 included studies. The JBI checklist indicated six studies scored ≥7 points and four studies ≥4 points. Pooled data revealed collared stems had significantly lower revision rates (OR = 0.45; 95% CI = 0.31-0.64) and subsidence (MD = -1 mm; 95% CI = -1.6--0.3), but no significant difference in intraoperative complication rates (OR = 0.94; 95% CI = 0.67-1.32) in the short term to mid-term. Unpooled data indicated that collared stems provide equivalent survival, equivalent or better outcomes, and equivalent or lower complication rates. Conclusion: In comparative studies, collared stems have lower revision rates than collarless stems, as well as equivalent or better clinical and radiographic outcomes. Differences could be due to a protective effect that the collar offers against subsidence, particularly in undersized or misaligned stems. Further studies are warranted to confirm long-term results and better understand differences between registry data and clinical studies.

Epidemiology of Musculoskeletal Injuries in Tennis Players During the French Open Grand Slam Tournament From 2011 to 2022.

Background: The epidemiology of musculoskeletal injuries at the Australian Open, Wimbledon, and US Open tennis tournaments has been investigated in recent studies; however, there is no published literature on the incidence of musculoskeletal injuries at the French Open. Purpose: To describe the incidence, location, and type of musculoskeletal injuries in tennis players during the French Open tournament from 2011 to 2022. Study Design: Descriptive epidemiology study. Methods: A review was performed of all injuries documented by a multidisciplinary medical team during the French Open from 2011 to 2022. All musculoskeletal injuries that occurred during the main draw of the female and male singles or doubles matches were included. Descriptive statistics were used to summarize the data. Injury locations were grouped into regions as well as into upper limb, trunk, and lower limb. Results: In total, there were 750 injuries in 687 tennis players, resulting in a mean of 62.5 injuries per tournament; however, there were no obvious trends in injury incidence over the time frame evaluated. The number of injuries in female and male players was similar (392 vs 358, respectively). The most common injury regions were the thigh/hip/pelvis (n = 156), ankle/foot (n = 114), and spine (n = 103). The most common injury types were muscle-related (n = 244), tendon-related (n = 207), and joint-related (n = 163), and the most affected muscles were the adductors (n = 45), rectus abdominis (n = 38), and lumbar muscles (n = 25). Conclusion: Over the 12-year period from 2011 to 2022 female and male players experienced similar numbers of musculoskeletal injuries, with most injuries occurring in the lower limbs compared with the upper limbs and trunk.

Primary Sclerosing Cholangitis: Gender Effects in Valencia's Low-Prevalence Region.

BACKGROUND AND AIMS: Recent studies point out to epidemiological changes in primary sclerosing cholangitis (PSC). Our aims were to determine in PSC patients followed in several centers in a Mediterranean geographic area: (i) changes in baseline features and (ii) effect of gender on clinical course. METHODS: Retrospective multicenter study of PSC patients treated in 8 hospitals in a Mediterranean area between 2000 and 2021. Charts were reviewed compiling demographic, clinical, radiological, and histological variables. RESULTS: Cohort of 112 PSC patients included, 42% women, 70% diagnosed after 2010. Women were increasingly diagnosed in recent cohorts. The median time from diagnosis to the combined endpoint liver transplantation (Lt) and/or death was 6.9 years. Asthenia at diagnosis (p = 0.009) was associated with lower transplant-free survival, while diagnosis before 2005 was associated with greater LT-free survival (p < 0.001). By Cox regression, LT-free survival was not influenced by age, sex, or cirrhosis at the time of diagnosis. Women were found to have less jaundice at diagnosis (2 vs 14%; p = 0.013), higher prevalence of ANA antibodies (43.9 vs 15.7%; p = 0.003), and lower GGT levels at diagnosis (GGT 123 vs 209U/L; p = 0.014) than men. CONCLUSION: In an area traditionally considered to have low prevalence, the prevalence of affected women surpasses expectations based on existing literature. There appear to be gender-related variations in the presentation of the condition, highlighting the need for confirmation through larger-scale studies.

Consensus document from the Spanish Society for Liver Transplantation: Enhanced recovery after liver transplantation. / Documento de consenso de la Sociedad Española de Trasplante Hepático. Recuperación intensificada en trasplante hepático.

The goal of the Spanish Society for Liver Transplantation (Sociedad Española de Trasplante Hepático) is to promote and create consensus documents about current topics in liver transplantation with a multidisciplinary approach. To this end, in November 2022, the 10th Consensus Document Meeting was held, with the participation of experts from the 26 authorized Spanish liver transplantation programs. This edition discusses enhanced recovery after liver transplantation, dividing needed actions into 3periods: preoperative, intraoperative and postoperative. The evaluated evidence and the consensus conclusions for each of these topics are described.

Consensus document from the Spanish Society for Liver Transplantation: enhanced recovery after liver transplantation.

The goal of the Spanish Society for Liver Transplantation (La Sociedad Española de Trasplante Hepático) is to promote and create consensus documents about current topics in liver transplantation with a multidisciplinary approach. To this end, in November 2022, the 10th Consensus Document Meeting was held, with the participation of experts from the 26 authorized Spanish liver transplantation programs. This edition discusses Enhanced Recovery After Liver Transplantation, dividing needed actions into three periods: preoperative, intraoperative and postoperative. The evaluated evidence and the consensus conclusions for each of these topics are described.

Spontaneously ruptured hepatocellular carcinoma on non-cirrhotic liver: A prospective case series.

BACKGROUND AND AIMS: Spontaneous ruptured hepatocellular carcinoma is an uncommon complication, and there are scarce data about non-cirrhotic patients. Tumor treatment is not standardized and the risk of peritoneal dissemination is unclear. AIM: we analyzed the treatment and survival in patients with rHCC on non-cirrhotic liver. METHODS: One hundred and forty-one non-cirrhotic patients with hepatocellular carcinoma diagnosed by histology were included in a multicenter prospective registry (2018-2022). Seven of them (5%) presented with hemoperitoneum due to spontaneous rupture. RESULTS: Liver disease was associated in three patients (42.9%). A single nodule was detected in three cases (42.9%). One patient had vascular invasion and none extrahepatic spread. Initial hemostatic therapy and sequential treatment was individualized. Patients with single nodule were treated: resection (one case) with recurrence at 4 months treated with TACE and sorafenib. TACE/TAE followed by surgery (two cases) one in remission 43 months later, the other had liver recurrence at 18 months and was transplanted. Patients with multiple lesions were treated: TAE/emergency surgery and subsequent systemic therapy (two cases), one received lenvatinib (1-year survival) and the other sorafenib (5-month survival). TAE and surgery with subsequent systemic therapy (one case). Initial hemostatic surgery, dying on admission (one case). No patient developed intraperitoneal metastasis. All patients with multiple lesions died by tumor. The 3-year survival rate was 42.9%. CONCLUSIONS: Initial hemostasis was achieved in all patients by TAE/TACE or surgery. Subsequent treatment was individualized, based on tumor characteristics, regardless of rupture. Long-time remission could be achieved in single nodule patients.

Trasplante hepático por hemangioendotelioma hepático difuso / Liver transplantation for diffuse epithelioid hemangioendothelioma

RESUMEN El hemangioendotelioma epiteloide hepático (HEH) es un tumor vascular, de etiología no aclarada, extraordinariamente infrecuente. La ausencia de características clínicas, analíticas y radiológicas especificas dificulta su correcto diagnóstico. El tratamiento del HEH depende del tamaño y localización tumoral, la extensión extrahepática y la condición médica del paciente. Entre las posibles opciones se encuentra el trasplante hepático, que obtiene unos buenos resultados clínicos, aunque el riesgo de recidiva no es despreciable. Presentamos un nuevo caso de HEH tratado mediante trasplante hepático.

ABSTRACT Hepatic epithelioid hemangioendothelioma (HEHE) is an extremely rare vascular tumor of unclear etiology. The diagnosis is difficult due to the absence of specific clinical characteristics, laboratory tests results and radiological findings. The management of HEHE depends on tumor size, location, extrahepatic extension, and patients' medical status. Liver transplantation is one of the possible options with good clinical results, although the risk of recurrence is not negligible. We present a new case of HEHE managed with liver transplantation.

A novel device with pedicular anchorage provides better biomechanical properties than balloon kyphoplasty for the treatment of vertebral compression fractures.

PURPOSE: To compare the biomechanical behavior of vertebrae with vertebral compression fractures (VCF) treated by a novel system with pedicular anchorage (dowelplasty) versus balloon kyphoplasty. METHODS: Four cadaveric spines (T12-L5) were harvested, cleaned from soft tissues, and separated into vertebrae. Axial compressive loads were applied to each vertebra until a VCF was generated. Half of the vertebrae (n = 11) were instrumented using the "dowelplasty" system, consisting of a hollow titanium dowel anchored into the pedicle, through which a cannulated titanium nail is inserted and locked and through which cement is injected. The other half (n = 11) were instrumented using balloon kyphoplasty. Axial compressive loads were re-applied to each vertebra until fracture. Fracture load and fracture energy were calculated from load-displacement data for the pre- and post-treatment states. RESULTS: Compared to balloon kyphoplasty, dowelplasty granted greater net change in fracture load (373N; 95%CI,-331-1076N) and fracture energy (755Nmm; 95%CI,-563-2072Nmm). A sensitivity analysis was performed without L4 and L5 vertebrae from the dowelplasty group, since the length of the cannulated nails was too short for these vertebrae: compared to balloon kyphoplasty, dowelplasty granted an even greater net change in fracture load (680N; 95%CI,-96-1457N) and fracture energy (1274Nmm; 95%CI,-233-2781Nmm). CONCLUSION: Treating VCFs with dowelplasty grants increased fracture load and fracture energy compared to the pre-treatment state. Furthermore, dowelplasty grants greater improvement in fracture load and fracture energy compared to balloon kyphoplasty, which suggests that dowelplasty may be a good alternative for the treatment of VCF. LEVEL OF EVIDENCE: level IV.

Sacroiliac joint MRI for diagnosis of ax-SpA: algorithm to improve the specificity of the current ASAS MRI criteria.

OBJECTIVE: To compare sacroiliac joint (SIJ) lesions on MRI in women with versus without axial spondyloarthritis (ax-SpA) and establish an algorithm to determine whether such lesions are due to ax-SpA. METHODS: This retrospective comparative study assessed bone marrow edema (BME), sclerosis, erosions, osteophytes, and ankylosis at the SIJ in two groups of women, one with and another without ax-SpA. Sensitivity and specificity were calculated for combinations/characteristics of lesions, using rheumatologists' assessment with assessment of spondyloarthritis international society (ASAS) criteria as the gold standard for diagnosis of ax-SpA. RESULTS: Compared to women without ax-SpA, women with ax-SpA had more BME (61% vs 17%, p < 0.001), sclerosis (40% vs 22%, p < 0.001), erosions (35% vs 5%, p < 0.001), and ankylosis (2% vs 0%, p = 0.007), but less osteophytes (5% vs 33%, p < 0.001). The ASAS MRI criteria yielded 59% sensitivity and 88% specificity, while a new algorithm achieved 56% sensitivity and 95% specificity using the following criteria: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. CONCLUSIONS: We recommend the following pragmatic algorithm for MRI diagnosis of ax-SpA in women: no osteophytes at the SIJ and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. The false positive rate when using the new algorithm (3.3%) is less than half than when using the ASAS MRI criteria (7.7%); thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA. CLINICAL RELEVANCE STATEMENT: The developed algorithm has a false-positive rate that is less than half than when using the ASAS MRI criteria (3.3% vs 7.7%), thus its application in clinical practice could reduce overdiagnosis and prevent overtreatment of axial spondyloarthritis. KEY POINTS: • Compared to women without axial spondyloarthritis (ax-SpA), women with ax-SpA had a significantly higher prevalence of bone marrow edema (BME), sclerosis, erosions, and ankylosis, but a significantly lower prevalence of osteophytes. • A new algorithm for positive ax-SpA based on sacroiliac joint MRI was developed: no osteophytes at the sacroiliac joint (SIJ) and either (i) BME at the SIJ with at least one dimension ≥ 8 mm or (ii) at least one erosion at the SIJ. • We recommend this new algorithm for diagnosis of ax-SpA in women, as it has a significantly better specificity than the assessment of spondyloarthritis international society (ASAS) MRI criteria and less than half the false positive rate; thus, its application in clinical practice could reduce overdiagnosis and prevent overtreatment of ax-SpA.

Outcomes of arthroscopic versus open reduction and internal fixation for the treatment of acute traumatic lunate fractures: a systematic review.

The purpose of the study was to compare outcomes of fully-arthroscopic reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) to treat acute traumatic lunate fractures. A literature search was conducted using Medline and Embase. Demographic data and outcomes were extracted for included studies. The search identified 2146 references: 17 articles were included, reporting on 20 cases (4 ARIF and 16 ORIF). No differences between ARIF and ORIF were found in rates of union (100% vs 93%, P = 1.000), grip strengths (mean difference, 8%; 95%CI, -16 to 31; P = 0.592), rates of return to work (100% vs 100%, P = 1.000), or ranges of motion (mean difference, 28°; 95%CI, -25 to 80; P = 0.426). Lunate fractures were not identified in 6 of the 19 radiographs, but were identified in all CT scans. There were no differences in outcomes between ARIF and ORIF for the treatment of fresh lunate fractures. The authors recommend surgeons to perform CT scans when diagnosing high-energy wrist trauma so as not to overlook lunate fractures. LEVEL OF EVIDENCE: Level IV.

Excellent Clinical Outcomes and Return to Dance of 6 Active, Professional Ballet Dancers Aged Younger Than 40 Years at Total Hip Arthroplasty Through Direct Anterior Approach With a Custom Stem: A Case Report.

OBJECTIVE: To report clinical outcomes and return to dance after total hip arthroplasty (THA) by direct anterior approach (DAA) using custom stems in young, active, professional ballet dancers. DESIGN: Case report. SETTING: Tertiary. PATIENTS: Six active, professional ballet dancers younger than 40 years who intended to resume ballet after THA. INTERVENTIONS: Primary THA by muscle-sparing DAA using custom stems. MAIN OUTCOME MEASURES: Return to dance, Oxford hip score (OHS), forgotten joint score (FJS), and satisfaction with surgery and pain using numeric rating scale (NRS). CTs were acquired 2 days after surgery to assess implant position. Descriptive statistics were used. RESULTS: The cohort comprised 4 women and 2 men aged 15 to 39 years. At 2.5 to 5.1 years of follow-up, all patients returned to professional ballet dance. Time to return to dance was 3 to 4 months for 3 patients and 12 to 14 months for 3 patients. Clinical scores were excellent, except for FJS in 1 patient who had considerable pain at her spine and ipsilateral foot. All patients were satisfied with surgery (NRS = 10). There were no complications, reoperations, or revisions. CTs confirmed that stems and cups were correctly positioned. CONCLUSIONS: All 6 young, active, professional ballet dancers who underwent THA by muscle-sparing DAA using custom stems returned to professional ballet dance and were completely satisfied with surgery. At >2 years of follow-up, 5 patients had excellent clinical outcomes and reported their dancing level to be as expected or better, whereas 1 patient had a lower FJS and was unable to return to her expected dance level.

Comparison of Cobb angle measurements for scoliosis assessment using different imaging modalities: a systematic review.

Purpose: To report accuracy, repeatability, and agreement of Cobb angle measurements on radiographs and/or stereo-radiographs (EOS) compared against one another or against other imaging modalities. Methods: This review follows Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A literature search was conducted on 21 July 2021 using Medline, Embase, and Cochrane. Two researchers independently performed title/abstract/full-text screening and data extraction. Studies were eligible if they reported Cobb angles, and/or their repeatability and agreement, measured on radiographs and/or EOS compared against one another or against other imaging modalities. Results: Of the 2993 records identified, 845 were duplicates and 2212 were excluded during title/abstract/full-text screening. Two more relevant studies were identified from references of eligible studies, leaving 14 studies for inclusion. Two studies compared Cobb angles from EOS vs CT, while 12 compared radiographs vs other imaging modalities: EOS, CT, MRI, digital fluoroscopy, or dual-energy x-ray absorptiometry. Angles from standing radiographs tended to be higher than those from supine MRI and CT, and angles from standing EOS tended to be higher than those from supine or prone CT. Correlations across modalities were strong (R = 0.78-0.97). Inter-observer agreement was excellent for all studies (ICC = 0.77-1.00), except one (ICC = 0.13 radiographs and ICC = 0.68 for MRI). Conclusion: Differences of up to 11º were found when comparing Cobb angles across combinations of imaging modalities and patient positions. It is not possible, however, to determine whether the differences observed are due to the change of modality, position, or both. Therefore, clinicians should be careful when utilizing the thresholds for standing radiographs across other modalities and positions for diagnosis and assessment of scoliosis.